Public Consulting Group

Adult Care Facility Complaint Investigator (RN or LPN)- Long Island

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Compact / Multi-State

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in six Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

Ability to work both independently and as a part of a team Ability to think critically, incorporating multiple factors into larger concepts. Ability to work with and relate to others with customer relation techniques, professionalism, and respect for other cultures Ability to effectively use active listening and interviewing skills Superior organizational and interpersonal skills Ability to consistently interact with individuals, family members, guardians, provider staff, and others appropriately, professionally, and respectfully. The ability to function as a part of a diverse work team Exceptional strength in strategic thinking, analysis, problem-solving, organizational leadership, and collaboration Demonstrated ability to establish and execute defined goals and objectives to ensure compliance with performance measures Strong verbal and written communication skills Compassionate and people-oriented Proficient with MS Office: Word, Excel, Outlook, PowerPoint Must have a reliable internet connection Must have a valid driver's license and reliable transportation to travel to on-site facility locations and regional office locations Qualifications: Registered Professional Nurse (RN) licensed and registered in the State of New York with: One (1) year of survey or investigation experience, or; Three (3) years of professional nursing experience in a post-licensure professional nursing experience, with at least two (2) years of which must have been professional clinical nursing experience in a licensed healthcare facility. A bachelor’s or master’s degree in nursing can be substituted for one year of the required general nursing experience. Licensed Practical Nurse (LPN) licensed and registered in the State of New York with two (2) years of survey or investigation experience Surveyor Minimum Qualifications Test Certification, preferred Work Statement: Travel for this position will primarily be regional within New York State, though occasional statewide travel may be required to conduct facility investigations. Additionally, travel to the regional office or other locations within the state may be required for training, team meetings, or client engagements. We are accepting applications on an ongoing basis until filled. #LI-Remote #LI-MB1

PCG is seeking Registered Nurses or Licensed Practical Nurses to conduct on-site investigations in Adult Care Facilities across the State of New York. The Designated Complaint Investigator will: Conduct on-site and offsite complaint, incident, death, and questionable operations investigations at facilities as assigned Follow all NYSDOH-established protocols pertaining to the assigned investigation, including but not limited to: Interviewing residents, staff, and witnesses Conducting records reviews Site inspection Investigation closure process Document all investigation activities in the appropriate data system(s) following all documentation timeline criteria Participate in closures and emergency events as assigned Attend and complete all training, both in person and remotely, as required Obtain Surveyor Minimum Qualifications Test Certification within one year of employment Professionally represent PCG and the NYSDOH

Pyramid Consulting, Inc

Health Coach – RN (Care Management)

Posted on:

March 4, 2026

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Pyramid Consulting, a global leader in workforce and technology solutions, empowers individuals and organizations to transform and thrive in the most challenging and competitive markets. Pyramid Consulting’s award-winning family of brands – Pyramid Talent, Celsior, and GenSpark– operate together to deliver seamless and integrated solutions which benefit our clients and the consultants who serve them. Through the ‘intentionally inclusive’ recruitment of uniquely qualified candidates and teams; the training and upskilling of recent college graduates and organizational talent; and the customized development and management of innovative technology solutions and teams, Pyramid Consulting proves its lasting commitment to the sustainable growth and success of its consultants and clients. Founded in 1996 and headquartered in Atlanta, Pyramid Consulting serves over 125 Fortune 500 companies across most industries with more than 6500 consultants in 25 countries.

Immediate need for a talented Health Coach – RN (Care Management). This is a 03 months Contract opportunity with long-term potential and is located in Tristate PA, DE, NJ(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 26-06688 Pay Range: $40 - $45 /hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Current, active, unrestricted Pennsylvania RN license (multistate/compact license acceptable if it includes PA). Minimum 3 years of combined experience in clinical nursing, case management, disease management, or chronic/complex condition management.

Serve as the primary nurse for members requiring lifestyle guidance, acute symptom support, chronic care management, complex condition management, or end-of-life navigation. Conduct telephonic outreach, coaching, and case management to help members develop self-management skills and improve adherence to evidence-based care. Perform initial and ongoing assessments to identify member needs, risks, barriers, and opportunities for intervention. Develop individualized care plans with measurable goals and provide follow-up to evaluate progress and adjust interventions. Provide clinical coaching to members calling with acute symptoms, chronic condition questions, or general health inquiries. Coordinate with physicians and healthcare teams to facilitate communication and ensure appropriate, timely care. Identify member barriers to treatment adherence and support behavior change and lifestyle improvements. Connect members with community, online, and telephonic resources; assist with accessing covered benefits and services. Monitor service quality based on member feedback and report safety or quality issues as needed. Maintain accurate and timely documentation consistent with regulatory, accreditation, and organizational standards. Participate in ongoing training and educational programs to maintain licensure and enhance Health Coach competency. Provide exceptional customer service with a supportive, member-centered approach. Perform other duties as assigned.

NPHire

Work-From-Home Nurse Practitioner | Flexible Primary & Women's Health

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Minnesota

PHire connects top NP talent with leading healthcare employers and staffing agencies. We're the only job-matching platform built exclusively for Nurse Practitioners, simplifying both the job search and the hiring process so the best match rises to the top every time.

A rapidly growing virtual women’s health clinic is hiring full-time Nurse Practitioners to deliver evidence-based care for women navigating perimenopause, menopause, and midlife health needs. This is a fully remote role with structured hours, strong operational support, and a clinical culture built around quality visits, education, and continuity. If you want meaningful specialty work without the administrative overload, this is a strong fit. You will have time to listen, educate, and create personalized plans, with onboarding and user-friendly technology designed to keep your day efficient. Ongoing weekly clinical education is built into the model so you can deepen your expertise in women’s midlife health while working within a collaborative team.

Qualifications: Active, unrestricted Minnesota NP license (we have multiple remote openings in other states at NPHire.com) Board certification aligned to primary care or women’s health (FNP, WHNP, or similar) Prescriptive authority Recent NP experience in primary care, women’s health, or gynecology (employer states 3+ years) Comfortable with telehealth platforms, EMRs, and technology-forward workflows

Provide telehealth visits focused on midlife women’s health and primary care needs Assess symptoms, develop treatment plans, and support longitudinal follow-up Educate patients on options, adherence, and lifestyle strategies Prescribe and manage medications within state regulations Document efficiently in the EMR and collaborate with the clinical team

StationMD

On-call RN

Posted on:

March 4, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

New York

StationMD is a telehealth company dedicated to serving individuals with intellectual and/or developmental disabilities (I/DD). All StationMD clinicians are board-certified and specially trained to treat individuals with I/DD. Clinicians are available 24/7 via telemedicine for urgent and non-urgent medical matters. StationMD also offers scheduled behavioral health telemedicine to individuals with I/DD. In providing this suite of services, StationMD enables individuals with I/DD faster access to high-quality care and substantially reduces unnecessary medical costs.

Job Title:On-Call RN Reports to: VP of Nursing Employment: Part-time, Non-exempt Schedule: Nights, Weekends This position works weekend shifts. We are looking for qualified Registered Nurses to join StationMD to provide remote on-call nursing triage services. The RN on-call service line will receive incoming calls from our clients and individuals with I/DD and or their caregivers in need of medical attention, questions, medication clarification, and guidance. The RN will provide telephonic assessment, guidance, and disposition to the appropriate level of care. The StationMD team of RNs and clinicians work closely as a team to determine the right care at the correct time and place, which may be care instructions, a telemedicine visit with a StationMD clinician, Urgent Care, ER or 911.

Qualifications: Must have an unrestricted New York RN License Must be willing to obtain and maintain state licenses as required by StationMD Must be willing and able to complete and maintain all continuing education requirements and any additional training courses as required by state licensing boards or StationMD Must not have any restrictions in participating in CMS programs Must work from the United States (cannot be International) Must have a minimum of 3 years experience as an RN in a hospital, ER, Med/surge I/DD nursing experience is preferred Knowledge of OPWDD regulations recommended, not required Current CPR/BLS required Must be proficient with computer technology and in using multiple applications at one time Must be detail oriented and able to multitask Must have proven time management skills Must have the ability to manage multiple priorities (or tasks), deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required Must have the ability to work in a production focused environment Education Bachelor’s degree in nursing recommended but not required Physical/Mental Requirements: Must have a home office working area set up in a private setting, free from non-StationMD activities Must be able to speak and write fluent English to effectively communicate with leadership (internal and external), clients, and staff Must be able to read and understand complex information and ideas StationMD will provide: Expenses for licensing cost Access paid expenses to CE courses Computer

Receiving incoming calls from contracted clients who serve patients with an I/DD diagnosis Assessing patients’ current health status and recommending appropriate levels of care based on clinical judgment, evidenced based guidelines, and clinical protocols Demonstrating knowledge of medications Demonstrating telephone communication skills with appropriate phone etiquette Making critical independent decisions and prioritizing appropriately Documenting all calls and actions taken into StationMDs proprietary Electronic Health Record system, StationConnect Utilizing technology as appropriate to meet the requirements of the job functions Communicating to the health care team members the outcome of the assessment/reassessment to ensure appropriate follow up occurs based on the needs of the patient care through a dedicated workflow involving both human touch and technology Displaying an exemplary level of patience, courtesy, and flexibility Interacting with patients, family members, unlicensed staff and physicians, in a manner conducive to maintain positive relationships and to meet the goals and objectives of StationMD Adhering to ethical, legal/regulatory, and accreditation standards Consulting with supervisor for issues or requested services outside scope of practice or those which require assistance in performing Performing other duties as assigned This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts, or working conditions associated with the position. While this description is intended to be an accurate reflection of the current position, management reserves the right to revise the job or require that other or different tasks be performed when circumstances change (e.g., emergencies, change in personnel, workload, rush jobs, or technological developments).

Suki

Commercial Nursing Specialist

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

California

Suki is a leading technology company that provides AI voice solutions for healthcare. Its mission is to reimagine the healthcare technology stack, making it invisible and assistive to lift the administrative burden from clinicians. Its flagship product is Suki Assistant, an AI assistant that uses generative AI to automatically create clinical documentation by ambiently listening to patient-clinician conversations. Suki helps clinicians complete notes 72% faster on average, assists with other tasks including coding and answering questions, and generates incremental revenue for organizations, delivering a 9X ROI in year 1. Suki also offers its proprietary AI and speech platform, Suki Platform, to partners who want to create best-in-class ambient and voice experiences for their solutions. Clinicians that use Suki already spend over 70% less time on administrative tasks, and we’re striving to do even better. Come and join us! We are a user-driven company and are committed to making sure every pixel of our product is in service of the doctors. We’re a team of technologists, clinicians, and industry experts working together to push the limits on technology used in medicine. We’re confident enough to move fast and talented enough not to break things. Check out this short video to learn more about our mission and our culture.

You will partner with Suki’s Commercial organization to support nursing-focused sales opportunities, serving as the nursing subject matter expert during pre-sales engagements, demonstrations, and strategic conversations. This is a customer-facing, clinically grounded role, ideal for a nurse who enjoys storytelling, education, and influencing adoption..

Active or prior RN license with strong hospital-based clinical experience. Experience in clinical sales support, pre-sales, solutions consulting, or healthcare technology. Exceptional communication and presentation skills, including comfort delivering live demos. Strong ability to explain nursing workflows, documentation practices, and clinical concepts clearly and confidently. Experience partnering with Sales, Product, and Marketing teams. Background in nursing informatics or clinical informatics. Experience supporting enterprise healthcare sales cycles. Familiarity with EHR environments (Epic, Cerner, Meditech) and nursing documentation workflows We don’t expect a candidate to have done everything listed above — but you should be able to make a credible case that you’ve done most of it and are excited to grow into the rest. Why you’ll love working at Suki Impact: You’ll influence how nursing is represented in a category-defining AI product from day one. People: Work alongside technologists, clinicians, and industry leaders who deeply respect nursing. Momentum: Named by Fast Company as one of the most innovative companies and Google’s Partner of the Year for AI/ML. Scale: Backed by top-tier investors with $165M raised and a massive market opportunity ahead.

Nursing-Focused Sales Support & Demonstrations: Partner with the Sales and Customer Success teams to support new and existing sales opportunities involving nursing stakeholders. Serve as the nursing subject matter expert in pre-sales conversations with nurse leaders, educators, informatics teams, and frontline nurses. Lead or co-lead nursing-focused product demonstrations and workflow walkthroughs, grounded in real-world bedside practice. Address nursing-specific questions, objections, and workflow considerations during live sales engagements. 2. Sales Enablement & Clinical Translation Provide nursing workflow context and clinical perspective to Sales and Customer Success teams to strengthen positioning and credibility. Help translate nursing pain points (documentation burden, interruptions, compliance, handoffs) into clear value narratives (ROI/Clinical impact). Share recurring themes, objections, and insights from sales conversations with Nursing leadership, Product, and Engineering teams. 3. Product Feedback & Clinical Validation Contribute clinical input to product refinement and model validation by flagging workflow gaps, edge cases, and adoption risks. Participate in reviews of nursing-facing features, workflows, and outputs as requested. Help ensure nursing documentation outputs reflect how nurses actually think, speak, and chart. 4. Cross-Functional Collaboration & External Representation In collaboration with Marketing and Nursing leadership: Support development and refinement of nursing-facing collateral, including demo materials, sales decks, and talking points. Reinforce consistency in nursing messaging across Sales, Marketing, and Clinical communications. Represent Suki’s nursing perspective at select conferences, panels, webinars, or customer events as needed. Communication cadence with our India product counterpart to strategize on market and product feedback What makes you a great fit: core traits we value Clinical credibility: You bring real nursing experience and can speak confidently with frontline nurses and executive leaders alike. Executive presence: You listen well, communicate clearly, and can adapt your message to different audiences. Consultative mindset: You seek to understand before you explain and help customers connect problems to solutions. Comfort with ambiguity: You thrive in fast-moving environments where products evolve quickly. Collaboration-first: You enjoy working cross-functionally and contributing to shared success.

Mercor

Healthcare Specialist - Fully Remote

Posted on:

March 4, 2026

Job Type:

Contract

Role Type:

License:

NP/APP

State License:

California

Mercor is at the intersection of labor markets and AI research. We connect human expertise with leading AI labs and enterprises to train frontier models.

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey. Position: Nurse Practitioner Type: Contract Compensation: $80–$100/hour Location: Remote Duration: 3–4 weeks Commitment: 30–40 hours/week Start Date: Immediate; applications reviewed on a rolling basis.

Must-Have: 4+ years professional experience in nursing. Excellent written communication with strong grammar and spelling skills.

Develop deliverables addressing common requests in the nursing domain. Review peer-developed deliverables to enhance AI research. Collaborate with AI research teams to improve training data quality. Work independently and asynchronously to meet deadlines and improve AI model performance. Shape the future of AI systems by solving real-world issues in nursing.

Residex®

Registered Nurse Sales Executive

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Colorado

Residex® delivers Intelligent Care through a secure, all-in-one assisted living software platform that empowers caregivers with data-driven tools for smarter, safer, and more efficient care. With expert nursing support and proactive insights, Residex helps prioritize well-being and drive better outcomes. Designed specifically for assisted living, memory care, and residential care communities, Residex offers 16 integrated modules that streamline operations, simplify compliance, and support caregivers every step of the way. Thea®, our AI Scheduling Assistant, automates weekly schedules and manages callouts with ease. Alongside enhanced employee management tools workforce management is more efficient and predictable than ever.

At Residex, we’ve reimagined senior care management from the ground up. We are seeking a dynamic Sales Executive in Colorado to drive growth for Residex with our comprehensive EHR/eMAR/Staff Scheduling software platform that serves the senior care industry. You must be an RN and have at least 5 years of experience in a clinical setting. Must be located in Colorado.

Required Qualifications: BSN in Nursing required 5+ years of clinical experience, preferably in Assisted Living, In-Home / Private Care, Group Homes and Memory Care Comfortable with healthcare terminology and the challenges with technology adoption. Dope verbal & written communication with ability to simplify complex technical concepts Consultative selling approach with active listening skills and strong needs-analysis. Self-motivated with proven ability to manage time effectively + setting & completing tasks. Detail-oriented with strong organizational and follow-up and follow-through discipline. Collaborative mindset with willingness to support team goals and work across the org. Technical Skills: Proficiency with CRM platforms like HubSpot or Salesforce. Advanced knowledge of Microsoft suite (Teams, PowerPoint, Excel, Word). Comfortable demonstrating healthcare software applications. What Success Looks Like: Consistent achievement of monthly and quarterly sales objectives. Accurate and timely CRM data maintenance. Positive contribution to product roadmap through actionable feedback. Professional representation of Residex brand at industry events. High customer satisfaction scores and retention rates. Ability to position our software as a solution rather than just a product requires active listening & ability to demonstrate value/business impact

Lead Management: Self generate and qualify/work inbound leads from multiple channels including trade shows, website inquiries, client referrals and direct outreach. Solution Evangelist: Conduct discovery and compelling virtual and in-person presentations/demos that align our software capabilities with prospect pain points & regulatory requirements. Sales Cycle Management: Own the full sales cycle from initial contact through contract execution, maintaining accurate pipeline data in our CRM. Strategic Partnerships: Identify complimentary industry partners to work with building brand awareness and generating additional qualified opportunities for the sales team. Account Growth: Identify upsell and cross-sell opportunities by promoting additional modules and features to existing customers based on evolving needs. Product & Marketing Collaboration Content Development: Partner with marketing to create sales enablement materials including case studies, comparison sheets, webinar content and event ideas that can help drive leads and meaningful interactions. Product Feedback Loop: Serve as a customer voice by documenting feature requests, usability concerns, and competitive insights for the product development team. Market Intelligence: Monitor industry trends, conference intel, regulatory changes, and competitor positioning to inform and revise sales strategy.

ClinNEXUS

Licensed Vocational Nurse

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

At ClinNEXUS - we are changing lives through our mission of "Navigating Complexity, Empowering Lives" and growing fast! We're pioneering a transformation in the American healthcare system through proactive community engagement at the grassroots level. Our goal is to forge social connections, enhance clinical outcomes, and lower healthcare expenses for our patients. How we do this is by being proactive via individualized patient assessments, which ensures we are fully equipped to address every patient and their unique needs.

In partnership with health plans and clinical providers, the ClinNEXUS Enhanced Care Management (ECM) Licensed Vocational Nurse works to build trusting relationships with individuals experiencing homelessness and/or managing multiple chronic health conditions. The ECM Licensed Vocational Nurse will be responsible for review of member care plans, addressing the member's medical and behavioral health needs, with such review focused on identifying appropriate clinical services to be provided to individuals by third-party providers. The ECM Licensed Vocational Nurse will not be responsible for providing clinical services directly to an individual. In addition, the ECM Licensed Vocational Nurse provides advocacy, and assists with connection to health services, housing, and other social services. The ECM Licensed Vocational Nurse employs techniques to foster patient engagement, patient education, coaching, and access to and care navigation of systems to improve health outcomes. The ECM Licensed Vocational Nurse will primarily interact with individuals via remote teleconferencing technologies, and may also interact in-person. The ECM Licensed Vocational Nurse demonstrates deep cultural competency, leans into patients' diverse beliefs, values, and social norms, and ensures care is provided in a culturally and linguistically appropriate manner to meet the needs of all patients served. Compensation Hourly Pay Rate: The good faith pay range for this position is $32.00 to $44.00 per hour. The specific pay rate within this range will be based on the candidate's qualifications, including experience, skills and geographic location.

Valid Licensed Vocational Nurse (LVN) license in California. CPR certification (American Heart Association or Red Cross). Knowledge of medical terminology and medications. Ability to work independently with minimal supervision. Excellent verbal and written communication (in English), negotiation, and relationship-building skills. Self-driven, motivated and highly empathetic. Resilience to deal with various situations. High level of empathy and ability to engage with people with various backgrounds. A technical aptitude with strong analytical, critical thinking, and reporting abilities. Ability to effectively interact and build collaborative relationships with community agencies, members, and clinical personnel. Valid California driver's license, reliable personal transportation, proof of insurance, and a driving record in good standing. Proficiency in utilizing electronic health records and related software, as well as computer, technology platforms including documentation systems, data reporting tools, and virtual communication platforms (e.g., Google Workplace Suite, HealthCloud for SalesForce, Smartsheet) to conduct administrative duties, keep track of health records, research, and professional networking. Meet and maintain credentialing requirements with contracted healthcare partners, including background screening, drug testing, FACIS (Fraud and Abuse Control Information System) checks, ID or licensure verification, and ability to produce applicable vaccination or immunization records or declinations, in order to access partner systems or facilities. Working Conditions/Physical Requirements: Ability to work remotely, with reliable internet access. Frequent use of computers, phones, video conference tools and related office equipment. Requires high manual dexterity and prolonged, extensive standing, sitting, walking, and lifting. Adequate hearing and clear speech for in-person or telephone communication. Speak clearly to communicate information to members and staff. Vision suitable for reading various documents, including memos, screens, and forms. Ability to reach above the shoulder level to work. Ability to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn, etc. Regular independent travel for home visits and community-based meetings. Occasionally subjected to irregular hours. May be exposed to infections and contagious diseases Nice to haves: Knowledge of the local community where providing service and residency in the service-area. Experience working in care management. Strong verbal and written ability in English and Spanish, Hmong or Punjabi preferred.

Showcase exemplary communication, and organizational prowess to cultivate a vibrant and positive work atmosphere. Assist the Enhanced Care Management (ECM) team regarding members' physical and medical needs. Participate in the review of and support of member-centered care plans for enrollees. Assist in identifying health care resources that focus on general health conditions, treatments, and interventions specific to each individual's health needs and consistent with standards of care. Monitor individualized care plans and support members to comprehend care plans and instructions, motivating them to actively engage in their health journey. Diligently monitor services to ensure adherence to care plan goals. Actively consult with Care Managers to review medical visit summaries, discharge papers, prepare for upcoming appointments, or review appointment outcomes to help ensure enrollees are being positioned to receive appropriate clinical and social services from third-parties with whom ClinNEXUS works. Assist Care Managers to implement health and preventive care education for acute health conditions, chronic disease management, and medication monitoring techniques. Engage vulnerable populations as part of a multidisciplinary outreach team, including home visits, accompaniment to appointments, outreach to hospitals, homeless shelters and other settings, as needed. Help address Social Determinants of Health and enhance connections to community-based organizations. Work with the ECM team to be aware of and understand hospital admission/discharge plans with the behavioral health clinician, PCP, pertinent specialists, and other organizations with the goal of preventing readmissions, if possible. Coordinate medication review and reconciliation following transitions in care. Assist the ECM team to implement prevention and engagement activities. Engage in quality improvement efforts for ECM team operations. Assess the needs of patients with the ECM team, identifying social determinants of health and recommending appropriate follow-up and community connections. Coordinate identification of needed member care activities by third parties, through implementation of home visits and offering culturally sensitive support for effective medical care and behavioral change within the team. Assist members in accessing resources, including appointment scheduling and navigating program applications. Foster positive relationships with team members, patients, providers, and community representatives to enhance teamwork and service excellence. Provide exceptional service to all stakeholders, ensuring culturally and appropriate care, attending meetings as necessary, and upholding established policies and procedures. Other duties and projects as assigned.

Lifespark

Skilled Nursing Facility Admissions Nurse - Remote Minnesota

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Minnesota

Lifespark is a complete senior health company. We help people stay healthy at home, navigate their health options with confidence, and live fuller, more independent lives. We provide a single point of contact for each client’s everyday health needs. We also provide options for expert senior medical care on their own terms, when, where, and how they need it. With Lifespark COMPLETE, our approach is powered by a single comprehensive life record that gives us a complete picture of each client as a person. We believe nothing should stop people from doing the things they love, being with the ones they cherish, or living the way they want. We’re here to help people Age Magnificently.

The Admissions Nurse is responsible for the overall direction and coordination of activities related to admission of residents to the facility while providing superior customer service. Position: Skilled Nursing Facility Admissions Nurse - Remote Minnesota Wage RN $39.00-$44.00 LPN $32.00-$37.50 Service Area: Remote, Minneapolis Area (our Corporate Office is in St. Louis Park, MN 55416; occasional travel to sites) Schedule: 1.0 FTE, Full - Time / Monday – Friday with rotating weekends, or every weekend

Experience and Education: An unencumbered nursing license in Minnesota, LPN or RN. Must have, as a minimum, three (3) years of experience with demonstrated success in a nursing position in a healthcare setting. Knowledgeable of nursing and medical practices and procedures, as well as laws, regulations and guidelines pertaining to long-term care. Knowledge, Skills, And Abilities: Exceptional telephone and communication skills and the desire to work closely with senior adults is essential. Must be able to relate professionally, positively, and cooperatively with residents, resident’s families, and employees. Must possess proficient computer skills, including email use. Must be capable of maintaining regular attendance. Must meet all local health regulations and pass post-employment physical exam if required. This requirement also includes drug screening, criminal background investigation, and reference inquiry. Must be capable of performing the Essential Job Functions of this job, with or without reasonable accommodation. In accordance with the Americans with Disabilities Act, all essential job functions are required. Management reserves the right to change job responsibilities, duties, and hours as needs change. This document is for management communication only and is not intended to imply a written or implied contract of employment. Physical Demands: The following physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Walking/mobility, reaching, bending, lifting or repositioning residents, grasping, pushing medication carts, pulling, fine hand coordination, ability to hear and respond to pages, ability to understand and follow written and oral instructions and directions, ability to read and write and do mathematical percentile, ability to communicate with the residents and others, ability to distinguish smells, tastes, and temperatures, and ability to remain calm in emergency situations and when handling multiple tasks.

Participates in an open and collaborative relationship between the business office and the admissions office, both working toward shared facility goals for occupancy and collections. Perform duties daily in the admissions office as assigned by the Admissions Director to facilitate the conversion of referrals to admission status. Always knows, the status of each referral. Communicate with external team members regarding referral status and any additional information needed to assist with the admission decision. Reviews referrals for medical approval and communicates findings to the Admissions Director for decision. Consults with the Director of Nursing regarding facility capabilities as needed based on the most recent Facility Assessment. Reviews medications on referrals and performs an analysis regarding availability of medications and clinical capabilities of nursing staff based on the most recent Facility Assessment. Consult the Director of Nursing to assist with the admission decision as needed. Transcribes physician’s orders and queries the physician as needed to ensure accuracy of resident medical information prior to admitting the resident. Reviews and evaluates resident diagnoses and overall condition related to Medicare part A criteria for skilled coverage as well as related to Medicaid medical eligibility criteria for long term care placement prior to admitting the resident. Maintains working knowledge of Medicare Part A skilled coverage guidelines and Medicaid medical eligibility criteria for long term care residents. Assists with processing referrals timely daily as assigned by the Admissions Director. Identifies and documents primary and other diagnoses codes for all admissions and readmissions in the medical record based on a review of the available medical information. Maintains working knowledge of the ICD-10 CM coding process and is competent in the use of the ICD-10 CM coding manual. Maintains a working knowledge of the Patient Driven Payment Model related to primary diagnosis and the clinical mapping for payment categorization. Is cross trained in all functions performed by the Admissions Coordinator and performs duties as needed or assigned by the Admissions Director. Knows, always, which payment entities require prior authorization for payment and secures prior authorization when required. Maintains working knowledge of facility practices related to all pay status types such as other insurances, Medicare A, Medicaid, Private, Veteran’s Administration contracts, and hospital contracts, etc. May at times be required to complete mental health screenings as required by federal and state regulations prior to admission. Maintains working knowledge of facility practices related to all pay status types such as other insurances, Medicare A, Medicaid, Private, Veteran’s Administration contracts, and hospital contracts, etc. Behaves in a manner aligned with facility goals for occupancy and customer service. Informs the Admissions Director of obstacles or barriers to admitting residents and recommends solutions to such obstacles and barriers. Communicates with interdisciplinary team members timely regarding clinical needs such as equipment, medications, etc. for pending admissions. Demonstrates interpersonal relationship skills by developing and maintaining trust with coworkers. Speak effectively with physicians when necessary to clarify medical information Participates in facility assessment activities as needed, such as carrying out duties assigned as part of a performance improvement committee. Collaborates with members of the interdisciplinary team, physicians, consultants, and community agencies to identify and resolve issues that improve the admissions process. Promote teamwork, mutual respect, and effective communication. Participates in the facility’s plan of correction response to an inspection survey and implements any follow-up as designated by the Administrator or Director of Nursing. Promotes safe work practices, safety rules, and accident prevention procedures to prevent employee injury and illness. Must be adaptable, flexible to changes, and able to prioritize and organize work efficiently to accomplish workload within time allotted. Understands, complies with, and promotes all rules regarding resident’s rights. Abides by the facility’s policies, procedures and practices. Attend meetings and mandatory in-services. All other duties as needed.

Providence Health & Services

Utilization Review RN - Remote

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Oregon

At Providence, our strength begins with understanding. We take time to see, hear and value everyone who walks through our doors—patient or caregiver, family support person or volunteer. Working with us means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. Providence Health & Services and our family of organizations are gradually coming together under a unified Providence brand over the next two years. Together, our 120,000 caregivers (all employees) serve in 52 hospitals, 1,085 clinics and a comprehensive range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

Utilization Review RN - Remote Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. This position offers 100% remote work for candidates residing in Oregon .

Required Qualifications Upon hire: Oregon Registered Nurse License 5 years clinical nursing experience. Experience working with physicians in collaboration and management of patient care. Preferred Qualifications: Bachelor’s Degree in Nursing or health care. Utilization review, discharge planning and/or managed care experience.

The RN Care Coord-Qual Med Mgmt will provide administration of medical management programs for prior authorization. These programs are developed to manage medical expense, determine medically appropriate services and define clinical criteria for decision making.

BAYADA Home Health Care

Clinical Coding and OASIS Review Manager, RN, PT, OT, SLP

Posted on:

March 4, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates. BAYADA is celebrating 50 years of compassion, excellence, and reliability. Learn more about our 50th anniversary celebration and how you can join in here. BAYADA Home Health Care, Inc., and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.

Please note- Candidates must have COS-C, HCS-O or COQS and HCS-D or BCHH-C in order to be considered, there is no flexibility around this requirement. BAYADA Home Health Care has an immediate opening for a Full Time, OASIS and Coding Review Manager with OASIS and Coding certification to work remotely. RN, PT, OT, and SLP's with certifications will be considered for this role. BAYADA believes that our clients and their families deserve home health care delivered with compassion, excellence, and reliability. Apply your skills and knowledge of OASIS and ICD-10 coding to help clients receive the home health care services they need. BAYADA Perks: This is a fully remote position. Base Salary: $77,000 - $81,000 / year BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit, and employee assistance program

Competency in PC skills required to perform job function Active State RN Nursing License, Physical (PT), Occupational (OT) or Speech (SLP) Therapists with required certifications with a minimum of 2 years clinical experience. Please note, while this is a clinical opening, BAYADA does have non-clinical openings available COS-C or HCS-O or COQS OASIS Certification and experience required BCHH-C or HCS-D Home Health Care Coding Certification and experience required HCHB, SHP, and Coding Center experience, a plus! Be part of a caring, professional team that is instrumental in providing the highest quality care while developing your career with an industry leader. Apply now for immediate consideration. OASIS Review, Utilization Review, Quality Assurance, Remote, Home Health Coding, Coder, Medicare

Review clinical information for appropriateness, congruency, and accuracy as it relates to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. Perform final review and lock OASIS. Timely review and coding of OASIS documents with productivity maintained at the quarterly target set by the Director of MCM. Prevent or decrease the occasion of Medicare denials by assuring proper coding on the plan of care and accurate OASIS documentation. Provide support and communication to all disciplines within the service. Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS guidelines, Home Care Coding, PDGM guidelines and billing related issues. Provide ongoing communication with service offices via e-mail, zoom, or telephone (specific to the service office needs). Communication with service offices monthly and as appropriate with a focus on documentation trends, star ratings and potential revenue impact. Perform related duties, or as required or requested by Manager/Director.

Highmark Health

Clinical Transformation Partner RN (Remote)

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

This job works directly with network providers to support key clinical transformation programs with a focus on utilization of appropriate care. The team member works with internal and external stakeholders to ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. The team member will also work with providers to identify specific areas of improvement within the same domain and help providers develop meaningful action plans to improve performance. The team member is responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and resources, and improving provider performance.

Required: 5 years experience in any of the following healthcare areas:the provider environment (hospital, facility, PCP, specialist, supporting area(s)), or healthcare insurance industry, or healthcare administration in a provider office, hospital and/or health systems, or healthcare consulting in provider setting. 3 years of experience in utilization management/care management/QA/managed care Preferred: 3 years of experience in data analysis, interpretation, and outcomes strategic plan development. 1 year of lean, six sigma, TQI, TQC or other quality and/or project management certification SKILLS: Ability to analyze data, measure outcomes, and develop action plans Working knowledge of pertinent regulatory and compliance guidelines and medical policies Ability to multitask and perform in a fast-paced and often intense environment that requires flexibility Excellent written and verbal presentation skills, excellent interpersonal and negotiation skills, and ability to positively influence others.Engages with external stakeholders with a professional demeanor and customer-centered mindset. Be a team player who possesses strong analytical and organizational skills. EDUCATION Required: Bachelor’s degree in nursing OR licensed RN with associate's degree or RN diploma. Preferred: None LICENSES or CERTIFICATIONS Required: Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Preferred: PA Driver's license Certification in nursing area of expertise

Review provider performance according to accepted and established criteria, as well as other approved guidelines and medical policies. Analyze qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Educate providers and other relevant external stakeholders on medical policy clinical criteria used to authorize care on a proactive basis. Develop and sustain positive working relationships with internal and external customers. Respond to customer inquiries and offers interventions and/or alternatives. Other duties as assigned or requested.

Cadence

Licensed Practical Nurse (CA license required)

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

LPN/LVN

State License:

Compact / Multi-State

In the U.S., 60% of adults – more than 133 million people – live with at least one chronic condition. These patients need frequent, proactive support to stay healthy, yet our care system isn’t built for that level of attention. With rising clinician shortages, strained infrastructure, and reactive care models, patients too often end up in the ER or the hospital when those outcomes could have been prevented. At Cadence, we’re building a better system. Our mission is to deliver proactive care to one million seniors by 2030. Our technology and clinical care team extend the reach of primary care providers and support patients every day at home. In partnership with leading health systems, Cadence consistently monitors tens of thousands of patients to improve outcomes, reduce costs, and help patients live longer, healthier lives.

The Cadence Health team is seeking a Licensed Practical Nurse (internally known as a Clinical Navigator) to provide health coaching and deliver patient care remotely in partnership with our Registered Nurses and Nurse Practitioners. In this role, you will support patients enrolled in Cadence care programs by reinforcing care plans, encouraging medication adherence, and providing education that helps patients better manage their chronic conditions. You will work closely with the clinical care team to support timely interventions, promote positive health outcomes, and ensure patients feel supported, informed, and engaged throughout their care journey.

Licensure Requirements: Active compact multi-state LPN License Active California State LVN license Schedule Requirements: This role requires availability Monday through Friday Scheduled hours are 8am to 5pm PST OR 9am to 6pm PST What you need: Active multi-state compact Practical Nurse License. Active CA state LPN/LVN license is required. 5+ years of clinical experience as a Licensed Practical Nurse. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable wifi with strong upload and download speeds. A wifi speed test is required before participating in the interview process to verify that these standards are met. Highly skilled in behavioral-based coaching. Possesses excellent clinical acumen and competency in patient assessment. Excels in patient support and delivers a high level of service. Demonstrates a consistent track record of attendance and adherence to work schedules. Exceptional written, verbal, and interpersonal communication skills. Demonstrates reliability in meeting deadlines and fulfilling job duties. Works effectively with minimal supervision and is consistently punctual. Prior experience working in a high-growth, fast-paced startup environment while maintaining high clinical standards. Experience in patient education for individuals managing chronic conditions. Experience in supporting patients remotely is a plus.

Support delivery of health care to patients by performing a variety of activities and procedures which are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Provide one-on-one coaching and support to patients managing chronic conditions, including but not limited to type 2 diabetes, hypertension, and cardiovascular disease. Conduct comprehensive assessments of patients' health status, lifestyle behaviors, nutritional habits, and readiness to change. Help patients execute on their personalized care plans and goals, focusing on behavior modification, nutrition, physical activity, and self-management strategies. Monitor patients' progress, adherence to treatment plans, and health outcomes through regular check-ins and remote monitoring tools. Educate patients on disease management, medication adherence, symptom recognition, and prevention strategies.

Gainwell Technologies

Fraud and Abuse Review Nurse- Remote

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Alaska

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

As a Fraud and Abuse Review Nurse- Remote at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. What you should expect in this role Remote (work from home) environment Benefits on first day of employment 0-10% of travel

Job Qualifications: Graduate from an accredited School of Nursing. Active, unrestricted RN license in good standing. Preferred: Bachelor’s Degree in Nursing. Required Experience: Minimum of five years of clinical nursing experience with broad clinical knowledge. Experience in medical review and coding/billing audits for both professional and facility-based services. Strong understanding of medical terminology, CPT, ICD-9/10, HCPCS, and DRG coding requirements. Experience with government healthcare programs (Medicare, Medicaid, SCHIP).

Conduct objective desk and medical record audits to verify service documentation, determine appropriate administration, and validate coding/billing accuracy. Collaborate with internal teams (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to collect relevant documentation for investigations. Identify potential healthcare fraud, waste, and abuse by analyzing aberrant coding and billing patterns through utilization review. Communicate effectively with physicians and healthcare professionals during investigations. Prepare accurate and timely reports detailing audit findings for internal and external stakeholders. Provide provider education on best practices (e.g., coding) based on national/local guidelines, contractual obligations, and regulatory requirements. Identify process improvement opportunities and recommend system enhancements to optimize investigative outcomes and performance. Data analysis of claims and utilization of benefits to identify potentially aberrant billing patterns.

DataAnnotation

Care Transition Nurse

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

None Required

State License:

Mississippi

Welcome to DataAnnotation! We pay smart folks to train AI. We offer a remote, flexible work model- you choose your own hours and get to work when you want, whenever you want. Apply now through our open Job Listings.

We are looking for a Care Transition Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model. In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Clinical Documentation & HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement & Patient Safety, Regulatory Compliance, Accreditation & Medical Staff, Care Coordination & Case Management, Population Health & Value-Based Care, and Managed Care & Utilization Management.

Fluency in English (native or bilingual level) A current or in-progress medical or healthcare-related degree

Provide AI chatbots with diverse and complex healthcare-related problems Evaluate AI outputs for logic, accuracy, and performance Ensure the medical accuracy and overall quality of model responses

Vytalize Health

RN Case Manager (Remote)

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Vytalize Health is a leading value-based care platform. It helps independent physicians and practices stay ahead in a rapidly changing healthcare system by strengthening relationships with their patients through data-driven, holistic, and personalized care. Vytalize provides an all-in-one solution, including value-based incentives, smart technology, and a virtual clinic that enables independent practices to succeed in value-based care arrangements. Vytalize's care delivery model transforms the healthcare experience for more than 250,000+ Medicare beneficiaries across 36 states by helping them manage their chronic conditions in collaboration with their doctors.

The RN Case Manager works with the clinical department and acts as a liaison with our physician practices. The RN Case Manager advocates for personalized treatment options that address a patient’s unique care needs. The RN Case Manager has a patient-forward approach that is centered in the value-based care model, offers education and guidance for navigating complex medical decisions, and creates and manages the plan of care for patients with chronic or serious conditions.

Bachelor's degree in nursing preferred, or associate's degree in nursing, with relevant experience 5 years' experience as an RN or RN Case Manager providing complex care management Minimum of 3 years’ experience in Med Surg or Home Health position Experience providing Transitions of Care Startup experience preferred Unencumbered RN license, compact nursing license, or compact nursing license obtained within 6 months of hire. Accredited Case Manager (ACM) preferred Comfortable and able to adapt to rapid changes Excellent verbal and written communication skills Excellent organizational skills and attention to detail Entrepreneurial spirit, a sense of ownership and comfortable operating in ambiguity Solution oriented with the ability to think strategically and creatively in decision-making Able to work independently and engage as part of a fully remote team Coachable and able to take direction and feedback well, yet being forward-thinking to challenge the status quo Comfortable providing care management using telehealth capabilities Proficient with Microsoft Office Suite or related software. Ability to effectively and efficiently use various documentation tools and technological platforms, including EMRs. Comfortable with digital technologies. Demonstrate a positive attitude and respectful, professional customer service Acknowledge patient’s rights on confidentiality issues and follow HIPAA guidelines and regulations

You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs. You will deliver patient-centered care, provide exceptional customer service, and work within your scope of practice to provide evidence-based education, assessment, and care navigation. Identify patient/caregiver education needs through telephonic assessment/engagement and ensure that the patient/caregiver has adequate information to participate in the successful transition back to their home setting from an inpatient or post-acute facility stay. Conduct timely telephonic clinical outreach to identified patients. Collaborate with PCPs, NPs, and other members of the healthcare team to coordinate care for patients and actively help keep them stable at home. Serve as the point of contact and informational resource for patients, care teams, family/caregivers, payers, and community resources. Implement interventions that improve health outcomes, lower costs, and enhance the patient experience. Work collaboratively with provider offices, SNFs, hospitals, and other Clinical Services teams to support each patient’s needs efficiently and effectively. Assist in coordination across the continuum of care while maintaining confidentiality. Guide patients through the healthcare system and help them overcome barriers. Coordinate treatment and services for patients. Schedule medical appointments as needed. Communicate about a patient’s health condition with the patient and their family. Provide community resources to patients as needed and support resolution of SDoH. Maintain a comprehensive working knowledge of community resources. Assume accountability for the quality of care. Continually seek new knowledge and learning that supports clinical care coordination. Depending on market location, minimal travel may be required to visit provider offices to help enhance provider office engagement (less than 5%).

Shriners Children's

Authorization Denials Appeals Nurse

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

#LI-Remote Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families. All employees are eligible for medical coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected. Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

The Authorization Denials Appeals Nurse is responsible for managing authorization denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The appeals nurse will analyze pre- and post-service authorization denials to determine if there is clinical justification to submit a request for retro-authorization. The Authorization Denials Appeals Nurse will serve as a clinical resource to the Central Authorization Unit and provide peer-to-peer reviews when the payer allows a nurse to participate in the process. The Authorization Appeals Nurse will write sound, compelling factual arguments for appealing authorization denials. The person in this position will be responsible for maintaining a detailed knowledge of Third-Party Payers’ and Governmental Payers’ clinical/medical necessity/authorization criteria and will be responsible for filing compliant appeals in accordance with third-party and governmental contracts.

Required: 3 years of clinical healthcare/hospital experience Third Party Payor Appeals/Revenue Cycle experience Working experience with Utilization Review activities and criteria sets used to determine eligibility for acute care hospitalization Functional knowledge of DRG and CPT coding systems Proficiency in MS Office Active RN License in current State of employment Associate's Degree Preferred: Bachelor's Degree or BSN Experience with reviewing hospitals claims, denials and EOB's, appealing claims and working on claims in an audit

Screens denials for possible reconsideration, peer to peer, or formal appeal. Investigates denials and root causes and tracks and reports trends to remediate issues and assist with internal process improvement. Prepares and submits appeals per payer guidelines Leverages clinical knowledge and standard procedures to ensure timely attention to denials as requested by PFS and assists in the research and application of regulatory policies to support administrative appeals. Communicates pertinent clinical information to Physicians, Medical Directors, and other members of SCMG, as indicated, regarding evaluation of payer determinations. May educate other departments regarding payer changes and denial/appeal process. Understands clinically complex medical situations and communicates appropriately with insurers as needed. Utilizes working knowledge of basic coding guidelines for medical necessity and insurance authorization escalations and/or denials. Maintains expert knowledge of how to navigate payer websites to validate insurance eligibility and authorization requirements, as well as determine the method in which a payer requires appeal submission. This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Amerit Consulting

Utilization Review Nurse (100% REMOTE)

Posted on:

March 3, 2026

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

California

Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward.

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse. NOTE- THIS IS 100% REMOTE ROLE & ONLY W2 CANDIDATES/NO C2C/1099 *** Candidate must be authorized to work in USA without requiring sponsorship *** Position: Utilization Review Nurse (Job Id -3146173) Location: Los Angeles CA 90024 (100% REMOTE) Duration: 3 Months + Possible Extension We are seeking an experienced Utilization Management Review Nurse with a strong background in outpatient prior authorization within a health plan or managed care environment. The ideal candidate is a California licensed RN who can independently review clinical documentation, apply evidence based medical necessity criteria, and make sound authorization decisions in a high volume setting.

Current unrestricted Registered Nurse license in the state of California Minimum of 3 years of utilization management or prior authorization experience in an outpatient setting Direct experience performing prior authorization reviews for a health plan, managed care organization, IPA, MSO, or healthcare plan administrator Experience applying evidence based medical necessity criteria such as InterQual, Milliman, CMS, and health plan specific guidelines Demonstrated ability to independently review clinical documentation and determine medical necessity, level of care, approval, denial, or need for physician review Experience communicating medical necessity decisions to physicians, clinical staff, payers, and internal departments Strong background in abstracting and interpreting medical records to support utilization review decisions Working knowledge of Medicare, Medi Cal, and CCS utilization review requirements and regulations Experience collaborating with physician reviewers and interdisciplinary clinical teams to resolve authorization requests Proven ability to manage a high volume caseload in a fast paced remote or office based environment Must have prior authorization experience in an outpatient setting. (Must have health plan or healthcare plan administrator experience. Prior authorization nurse, clinical review nurse) Current unrestricted RN licensure in CA 3-5 years’ experience in utilization management, preferred. Self-directed, assertive and creative in problem solving, systems planning and patient care management in a high volume work environment. Demonstrates resourcefulness, effective written and oral communication, diplomacy, organizational, and analytical skills (Required). Proficient knowledge in evidence-based medical necessity criteria, health plan medical necessity criteria and CMS criteria. (Required) Strong critical thinking and the ability to apply knowledge Ability to work effectively and collaboratively with interdisciplinary teams. Proficient computer skills including Internet search capabilities, Microsoft Word, Excel and Managed Care software (i.e. EZ Cap, Diamond, IDX). (Required) Ability to effectively communicate to physician/staff the medical necessity/appropriateness/level of care criteria that is necessary for acute care hospitalization. Ability to effectively communicate to the payer the medical necessity/appropriateness/level of care criteria that is necessary for acute care hospitalization. Skill in setting priorities that accurately reflect the relative importance of job responsibilities. Skill in abstracting and interpreting medical information from patient records. Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of government programs such Medicare, Medi-Cal, and CCS. Clinical experience sufficient to understand and communicate medical diagnosis and courses of treatment to professional and non-professional personnel. Ability to develop an individualized case management plan that addresses physical, vocational, psychosocial, financial, and educational needs. _____________________________________

This role requires confident communication with physicians, payers, and internal teams, strong critical thinking skills, and a solid understanding of Medicare, Medi Cal, and health plan utilization review requirements. The Utilization Management Review Nurse is responsible for the review and evaluation of clinical information and documentation related to prior authorization requests for medical services. Reviews documentation and interprets data obtained from clinical records or systems and uses clinical decision-making to apply appropriate clinical criteria and policies in line with regulatory, accreditation, and departmental requirements. Independently coordinates the clinical resolution with clinician/MD support as required. Acts as a resource for external teams such as customer service and claims. Utilizes advanced practice nursing skills in the assessment, education, and coordination of care for an identified group of patients. Collaborates and consults with the multi-disciplinary team, including but not limited to Physicians, Nursing, Ancillary, Professional, Technical, and other clinical and/or department team members along with patients and families to ensure safe and effective coordination of care. Participates in performance improvement projects/processes and other duties as assigned.

Alignment Health

Manager, Case Management SNP (California RN License Required)

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Manager, Case Management SNP is responsible for the health care management and coordination of care for members with complex and chronic care needs. Assures compliance with SNP program requirements as outlined in the Model of Care. Monitors activities to support the timeliness of Health Risk Assessment (Initial and Reassessment) completion, Individualized Care Plan (ICP) development and Interdisciplinary Care Team (ICT) delivery for SNP members. Monitors and reports program performance, including vendor performance monitoring if activities are delegated. This position is responsible for the day-to-day operational performance of an integrated health management team while ensuring high-quality care management and adherence to regulatory and compliance standards for the appropriate program lines of business. Location: Fully Remote – California (Outside Bay Area preferred) Schedule: Full-Time | Monday–Friday Department: Case Management About the Role We are seeking a dedicated Manager, Case Management – SNP to lead a team focused on providing high-quality, patient-centered care to members with complex medical needs. This leadership position plays a key role in overseeing our Special Needs Plan (SNP) program, ensuring compliance with CMS regulations and promoting optimal health outcomes for our members. As a fully remote leader, you will manage daily operations, support care coordination activities, monitor team performance, and ensure adherence to the Model of Care. This is an exciting opportunity to lead a skilled interdisciplinary team making a real impact in the lives of vulnerable populations.

Education Required: Associate’s or Bachelor’s Degree in Nursing (RN) Preferred: BSN or MSN Experience Required: Minimum 5 years of clinical case management experience Minimum 1 year of experience working with SNP programs in a health plan California RN license required Willing to obtain an RN license in all of our states markets. Preferred: At least 2 years of supervisory or team lead experience in a managed care or health plan setting Licensure Required: Active, unrestricted RN license in the state of residence Preferred: Case Management certification (e.g., CCM, ACM) Skills & Knowledge: Strong knowledge of CMS SNP Model of Care and Medicare Managed Care Plans Experience with utilization review criteria (e.g., MCG guidelines) Ability to analyze performance data and manage case management programs Effective communication, leadership, and project management skills Comfortable navigating EHR systems and healthcare technology platforms Strong problem-solving and time-management skills

Lead and manage a high-performing case management team serving SNP members. Ensure timely completion of Health Risk Assessments, Individualized Care Plans (ICPs), and Interdisciplinary Care Team (ICT) meetings. Monitor program performance, identify trends, and develop strategies for improvement. Oversee audits, regulatory compliance, and quality assurance activities. Collaborate with departments such as Utilization Management, HEDIS/STARs, and Quality to ensure care continuity and integration. Provide coaching, performance reviews, and staff development to support team success. Analyze reports and operational data to support decision-making and program enhancements.

Walgreens

Registered Nurse, Specialist - Remote

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Founded in 1901, Walgreens (www.walgreens.com) has a storied heritage of caring for communities for generations and proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico, and leading omni channel platforms. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for retail pharmacy and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Responsible for patient focused programs which may include but is not limited to: collaborating with health care team in providing direction for maintaining high quality patient care, outcomes, and goals for patients; provides enhanced services support and assistance with contractually required Biopharma programs. Follows specific care modules or standard operation procedures approved by the Clinical and Professional Services Team including scripting, assessments, screenings, and education. Provides enhanced nursing services support, evaluating diagnoses and other clinical criteria to complete requests for prior authorization, specialty care specific to the department and patient needs in an effort to provide exceptional care and support. Administers clinical training and orientation programs and validates and educations subcontracted nursing providers knowledge base.

Associate's degree in Nursing Current license/registration as an RN (Registered Nurse) with the State Board of Nursing in the state in which the position resides Must obtain and maintain Nurse Licensing Compact multi-state license and necessary non-Nursing Licensing Compact state license within 6 months of employment start date (company sponsored); any and all exception to this timeline requires leadership approval 2 years' work experience in nursing Related work experience in a specialty pharmacy, PBM, and/or healthcare call center setting Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner Willing to travel up to/at least 10% of the time for business purposes (within state and out of state). Preferred Qualifications: Bachelor's degree in Nursing Active Nursing Licensing Compact multistate license and nursing license(s) in states not participating in Nursing Licensure Compact Experience working with contracting and contract requirements if necessary for the appropriate specialty Proven ability to work in a team environment Organized and detail oriented with proven problem solving skills Excellent written/verbal communication skills and interpersonal skills with the ability to lead, motivate, and communicate with internal and external customers Knowledge of customer service principles and processing including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction Basic skills in MS Office Suite

Completes initial screening for patients which may include: Assists with infusion pump programming and troubleshooting based on Plan of Treatment (POT); Completes system driven assessments such as Depression Screenings for select disease states; Conducts follow-up assessments and outreach to determine medication history and to improve medication adherence; Provides disease state education including medication administration, resources on side effect management, outreached to MDO, etc. Responsible for the daily nursing care activities, including completion of nursing coordination/plan of treatment forms, building supply lists, nursing assessments, initial screenings, and surveys for patients, programming and troubleshooting infusion pumps based on the Plan of Treatment (POT) established by a pharmacist, injection site/infusion site education training/techniques, obtaining nursing orders, assay management and patient clinical nursing management, and follow up calls to patients as appropriate per specialty. Audits and reports daily on team and individual performance metrics and quality statistics and assist with extrapolation of system applications to develop reports of data from regarding productivity trends. Assists in developing, updating, and implementing departmental Standard Operating Procedures related to system applications, programs, processes and merchandise. Provides support within the scope of practice for a nurse and escalating to pharmacist for patient specific medication questions, including side effect management and quality of life screening. May work with specific nursing specialties such as but not limited to: Infusion Care, Fertility Order, Nursing Network, Care Management. May have other responsibilities delegated as specific to nurse specialty and as designated by the specific department, other responsibilities as judgment or necessity dictate. Reviews prior authorization criteria for specified payers related to defined medications. Evaluates all requests for prior authorizations, appeals and accompanying tasks. Provides nursing network subject matter expert support; administers tracking pharma and payer related nursing documentation request; advises on complex cases and assists in quality care resolution. Acts as a liaison between physicians/practitioners, medical consultants and facility clinical staff. Participates in professional organizations and workshops to gain additional job related knowledge, in service programs and continuing education as required. Serves as Point of Contact for disease-specific operations teams.

CVS Health

Diabetes Health Coach Consultant - Registered Nurse

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Coaching

License:

RN

State License:

Compact / Multi-State

CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by simplifying health care one person, one family and one community at a time. Follow @CVSHealth on social media.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Must be a Certified Diabetes Care and Education Specialist (CDCES) This is a full-time telework role. Working schedule: Monday-Friday, standard business hours, including 2 evening shifts per week from 11:30am-8pm CST. Rotating Saturdays may be required about once per quarter following training. Work day consists of scheduled member appointments and member out reach.

Position Requirements: Must be an RN and a Certified Diabetes Care and Education Specialist (CDCES) A Registered Nurse with an active and unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states. 3+ years of clinical nursing experience post licensure Experience working with patients with diabetes Must possess or be willing and able to obtain high speed broadband internet access Preferred Qualifications: Previous coaching experience Managed care experience (MCO) Experience with Microsoft Word, Outlook, Excel, and comfortable using various computer programs Education: Associate's degree minimum required as a Registered Nurse

In this position the focus is on educating members with diabetes and other conditions as well as providing resources to the members. Assisting with closing gaps members may have in their care is also a priority. The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status. Assessment of members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. Enhancement of Medical Appropriateness & Quality of Care: Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. Using holistic approach consults with supervisors, Medical Directors and/or others to overcome barriers to meeting goals and objectives. Identifies and escalates quality of care issues through established channels. Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Interprets and utilizes clinical guidelines/criteria to positively impact members health Provides up-to-date healthcare information to help facilitate the member¡¦s understanding of his/her health status. Helps member actively and knowledgably participate with their provider in healthcare decision-making. Monitoring, Evaluation and Documentation of Care Develops and monitors established plans of care, in collaboration with the member and/or attending physician, to meet the member's goals. Utilizes internal policy and procedure in compliance with regulatory and accreditation guidelines.

Cadence

Licensed Practical Nurse (CA license required)

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

License:

LPN/LVN

State License:

Compact / Multi-State

In the U.S., 60% of adults – more than 133 million people – live with at least one chronic condition. These patients need frequent, proactive support to stay healthy, yet our care system isn’t built for that level of attention. With rising clinician shortages, strained infrastructure, and reactive care models, patients too often end up in the ER or the hospital when those outcomes could have been prevented. At Cadence, we’re building a better system. Our mission is to deliver proactive care to one million seniors by 2030. Our technology and clinical care team extend the reach of primary care providers and support patients every day at home. In partnership with leading health systems, Cadence consistently monitors tens of thousands of patients to improve outcomes, reduce costs, and help patients live longer, healthier lives.

The Cadence Health team is seeking a Licensed Practical Nurse (internally known as a Clinical Navigator) to provide health coaching and deliver patient care remotely in partnership with our Registered Nurses and Nurse Practitioners. In this role, you will support patients enrolled in Cadence care programs by reinforcing care plans, encouraging medication adherence, and providing education that helps patients better manage their chronic conditions. You will work closely with the clinical care team to support timely interventions, promote positive health outcomes, and ensure patients feel supported, informed, and engaged throughout their care journey. Licensure Requirements: Active compact multi-state LPN License Active California State LVN license Schedule Requirements: This role requires availability Monday through Friday Scheduled hours are 8am to 5pm PST OR 9am to 6pm PST

Active multi-state compact Practical Nurse License. Active CA state LPN/LVN license is required. 5+ years of clinical experience as a Licensed Practical Nurse. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable wifi with strong upload and download speeds. A wifi speed test is required before participating in the interview process to verify that these standards are met. Highly skilled in behavioral-based coaching. Possesses excellent clinical acumen and competency in patient assessment. Excels in patient support and delivers a high level of service. Demonstrates a consistent track record of attendance and adherence to work schedules. Exceptional written, verbal, and interpersonal communication skills. Demonstrates reliability in meeting deadlines and fulfilling job duties. Works effectively with minimal supervision and is consistently punctual. Prior experience working in a high-growth, fast-paced startup environment while maintaining high clinical standards. Experience in patient education for individuals managing chronic conditions. Experience in supporting patients remotely is a plus.

Support delivery of health care to patients by performing a variety of activities and procedures which are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Provide one-on-one coaching and support to patients managing chronic conditions, including but not limited to type 2 diabetes, hypertension, and cardiovascular disease. Conduct comprehensive assessments of patients' health status, lifestyle behaviors, nutritional habits, and readiness to change. Help patients execute on their personalized care plans and goals, focusing on behavior modification, nutrition, physical activity, and self-management strategies. Monitor patients' progress, adherence to treatment plans, and health outcomes through regular check-ins and remote monitoring tools. Educate patients on disease management, medication adherence, symptom recognition, and prevention strategies.

DataAnnotation

Clinical Appeals Nurse

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Welcome to DataAnnotation! We pay smart folks to train AI. We offer a remote, flexible work model- you choose your own hours and get to work when you want, whenever you want. Apply now through our open Job Listings.

We are looking for a Clinical Appeals Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model. In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Clinical Documentation & HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement & Patient Safety, Regulatory Compliance, Accreditation & Medical Staff, Care Coordination & Case Management, Population Health & Value-Based Care, and Managed Care & Utilization Management. Benefits Full-time or part-time remote position Choose which projects you want to work on Flexible schedule Projects are paid hourly starting at $50+ per hour Bonuses available for high-quality and high-volume work

Fluency in English (native or bilingual level) A current or in-progress medical or healthcare-related degree

Provide AI chatbots with diverse and complex healthcare-related problems Evaluate AI outputs for logic, accuracy, and performance Ensure the medical accuracy and overall quality of model responses

Sprinter Health

Family Nurse Practitioner - Remote (Illinois Licensed)

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

Illinois

Sprinter Health is an on-demand mobile health service that sends medical professionals to patients’ homes to perform blood draws, diagnostic and low acuity services, and wellness visits. We are building the clinical and technological infrastructure to realize a future of healthcare untethered. We have a rapidly growing team of visionary leaders who are passionate about increasing access to care, lowering healthcare costs, and improving outcomes for patients.

Are you ready to join the pioneering healthcare team at Sprinter Health? We're looking for dynamic Nurse Practitioners who are ready to revolutionize healthcare delivery by conducting virtual wellness visits directly to patients in the comfort of their homes. As a Nurse Practitioner with Sprinter Health, you'll leverage your medical expertise to offer a wide range of healthcare services that could include but not limited to virtual adult and/or pediatric wellness visits, health assessments, and more! Successful candidates will have prior experience performing wellness visits, along with key traits such as dependability, professionalism, and problem-solving abilities. A commitment to delivering exceptional customer service is essential, as is the ability to work autonomously while maintaining high-quality standards. Above all, we're seeking individuals who are friendly, compassionate, empathetic, and deeply invested in providing personalized care to every patient they serve. If you're ready to make a difference in patients' lives and shape the future of healthcare, we invite you to join us at Sprinter Health.

Board Certified as a Family Nurse Practitioner in Illinois Active Family Nurse Practitioner License in California Consistently exhibits the highest levels of professionalism, integrity, accountability, confidentiality, care and compassion to provide high quality health services Willingness to work in a revolutionary environment that sometimes necessitates last minute problem solving and out of the box thinking Technologically savvy and comfortable using tools such as laptops or mobile devices for charting and HIPAA secure messaging apps for care coordination Strong written and verbal communication skills Ability to work independently or in a team environment Pass national background check and valid clinical license search

Commencing the day… begin your day by reviewing your case load and preparing your technology, ensuring you have all of the right tools available to service your patients Navigating with ease… using easy and modern technology, you will navigate through your schedule for the day and partner with our clinical in-home team members (Sprinters) that will visit each patient’s home Creating meaningful bonds… you will have the opportunity to make a warm and welcoming connection with a diverse range of patients as you prepare to collect relevant information and perform various services Patient-centric, wellness exam… engage in proactive care by conducting thorough health risk assessments, medication reviews, cognitive screenings and empowering patients’ with educational information regarding their health and well-being Collaborative Patient Care … work directly with Sprinters to evaluate vital signs, arrange blood draws, and carry out necessary tasks to address the specific needs of the patient Comprehensive Care Coordination and Management… provide comprehensive care coordination and management, including preventive care interventions, medication management, referrals to specialists, community resources, and documentation of findings

Privia Health

Manager, CAL RN Operations

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

The Operations Nurse Manager, Care Advice Line provides operational leadership and oversight for Privia Health’s telephonic triage and after-hours care coordination platform. This role partners closely with the Clinical Nurse Manager to ensure seamless integration of clinical and operational functions. The Operations Manager is responsible for data-driven performance management, workflow optimization, staff scheduling, and resource planning to support safe, scalable, and cost-effective service delivery. The Operations Manager also oversees Health Advisors and operational support staff, ensuring adherence to protocols, communication standards, and service-level expectations. With a foundation in nursing practice and strong expertise in data and analytics, the Operations Manager will lead operational initiatives, monitor key performance indicators (KPIs), and drive continuous improvement in efficiency, quality, and patient satisfaction. This role serves as a strategic partner across the enterprise, supporting new service line integrations, aligning operations with value-based care goals, and collaborating with internal stakeholders to enhance technology, compliance, and innovation.

Active, unrestricted Registered Nurse (RN) license required in a compact state , Washington DC, California and Connecticut. Bachelor’s degree in Nursing (BSN) required; Master’s preferred. Minimum 3-5 years of recent healthcare experience, including leadership in call center, telehealth, or care coordination. Minimum 2 years in a nursing leadership or management capacity. Demonstrated expertise in data analytics, reporting, and KPI monitoring (Excel, Microstrategy, SQL, or BI tools preferred). Strong problem-solving and critical-thinking skills, with proven ability to apply data insights to operational decisions. Excellent communication, organizational, and leadership skills. Flexibility to provide occasional weekend/holiday coverage in alignment with CAL leadership team needs. Self-motivated, detail-oriented, and able to thrive in a fast-paced, remote work environment. Proficiency with EHR systems (Athena preferred), Clear Triage, and Microsoft Office/Google Workspace. Strong understanding of HIPAA, NCQA, and compliance frameworks in ambulatory care. Strategic thinker with an operational mindset and clinical credibility. Excellent communicator and team motivator. Demonstrated ability to analyze data and translate insights into action. Experience creating clinical pathways, SOPs, and staff development frameworks. Comfortable navigating ambiguity and leading through organizational growth

Provide direct operational oversight and operational support of teams, ensuring performance expectations and service standards are consistently met. Lead the design, monitoring, and optimization of scheduling, staffing, and queue management processes to maintain safe and reliable 24/7 coverage. Collaborate with the Clinical Nurse Manager to align operational workflows with clinical protocols, ensuring seamless patient care transitions. Serve as an escalation point for operational challenges, troubleshooting issues in real time and ensuring timely resolution. Assume clinical leadership and managerial oversight during the absence of other managers or coleads. This includes maintaining service continuity, ensuring efficient workflow, and coordinating staff. Leverage data analytics to monitor call volumes, response times, and KPI achievement, using insights to guide staffing, resourcing, and process improvements. Develop and maintain dashboards, reports, and scorecards to track operational performance and communicate results to leadership. Provide leadership development, onboarding, and ongoing training for Health Advisors and operational staff. Collaborate with leadership and care center partners to optimize operational models for value-based care and patient engagement. Contribute to the design and implementation of innovative programs that improve operational efficiency, patient experience, and provider satisfaction. Implement efficient staffing strategies and resource allocation models to optimize Nurse Care Manager coverage while reducing unnecessary costs. Other duties as assigned.

Mercor

Clinical Nursing Specialist

Posted on:

March 3, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Mercor is at the intersection of labor markets and AI research. We connect human expertise with leading AI labs and enterprises to train frontier models.

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey. Position: Medical Expert Type: Contract Compensation: $60–$160/hour Commitment: Flexible hours

Must-Have: Relevant higher education degree and professional certificates (e.g., Nursing license, MD, PhD). 3+ years of relevant experience. Demonstrated clinical experience in patient care settings. Strong understanding of medical terminology, procedures, and standards of care. Experience with clinical documentation, case review, or similar evaluative tasks. Excellent communication skills with attention to detail.

Review and validate clinical content, scenarios, and annotations for medical AI workflows. Provide domain-expert feedback on model outputs related to nursing and patient care practices. Advise on clinical guidelines, best practices, and potential safety concerns. Assist in crafting realistic clinical use cases and medical question sets. Communicate insights and recommendations clearly to technical and non-clinical teams.

Humana

RN, Field Care Manager (Adults and Pediatrics)

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Virginia

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Humana Healthy Horizons in Virginia is looking for RN, Field Care Managers (Field Care Manager Nurse 2) who performs primarily face to face and telephonic assessments to adult and pediatric members. The RN, Field Care Manager (Field Care Manager Nurse 2) will evaluate member's needs to achieve and/or maintain optimal wellness. This position employs a variety of strategies, approaches, and techniques to manage a member's health issues and identifies and resolves barriers that hinder effective care. They ensure members are progressing towards desired outcomes by continuously monitoring care through use of assessment, data, conversations with member, and active care planning. The RN, Field Care Manager (Field Care Manager, Nurse 2) understands professional concepts, regulations, strategies, and operating standards. They make decisions regarding work approach/priorities and follows direction.

Required Qualifications: Must reside in the Commonwealth of Northern Virginia Active Registered Nurse (RN) license in the Commonwealth of Virginia without disciplinary action. Two (2) years of prior experience in health care and/or case management. One (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria (adults, pediatrics populations at risk for chronic medical conditions and high social needs). Strong advocate and respect for members at all levels of care. Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook. Ability to use a variety of electronic information applications/software programs including electronic medical records. Exceptional oral and written communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders. Ability to work with minimal supervision within the role and scope. Ability to work a full-time schedule. Preferred Qualifications: Prior experience with Medicare, Medicaid and dual eligible populations. Bachelor's Degree Nursing (BSN). Case Management Certification (CCM). Experience with health promotion, coaching and wellness. Knowledge of community health and social service agencies and additional community resources. Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. See “Additional Information” section for more information. Additional Information: Workstyle: Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Travel: 50 - 75% field interactions with members, and their families and providers. May need to attend onsite meetings occasionally in Humana Healthy Horizons office in Glen Allen, VA. Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST). Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. WAH Internet Statement To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Responsible for managing a case load and completing assessments with members in their home or community-based setting, as well as telephonically. Provides clinical support and guidance, particularly for members with medical complexity. Develops and coordinates care plans ensuring that patients receive appropriate services to manage their health needs effectively. Addresses barriers to health care and advocating for optimal member outcomes. Reviews, assesses, and completes medical complexity attestations and clinical oversights. Ensures members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs. Develops and modifies Individual Care Plan and involve applicable members of the care team in care planning (Informal caregiver, coach, PCP, etc.). Focuses on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs. Collaborates with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs. Primary point of contact for the ICT and shall be responsible for coordinating with the member, ICT participants, and outside resources to ensure the member’s needs are met.

Molina Healthcare

Care Manager, LTSS - RNs OR Exp. Care Managers - Local Travel Required

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Iowa

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Opportunity for either an experienced Care Manager who is Bachelors or Masters trained in a social services field OR an Iowa licensed RN to join the LTSS team with our Iowa Health Plan. Responsibilities include conducting face-to-face and telephonic visits with our Medicaid members, completing assessments to determine the types of services we need to provide, and managing their care until they are discharged from your service. The ideal candidate will have experience as a Care Manager within a managed care organization (MCO) like Molina or have experience working with IHH assessments. Hours are Monday – Friday, 8 AM – 5 PM CST; 75% of your time will be spent in the field and the remainder you will work from your home office. Mileage is reimbursed as part of our benefit package. Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, and Teams as well as being confident in moving between different programs to complete the necessary forms and documentation. Due to contractual requirements with Iowa, we are unable to hire LPN/LVNs for this role. Job Summary: Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. Demonstrated knowledge of community resources. Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. Ability to operate proactively and demonstrate detail-oriented work. Ability to work independently, with minimal supervision and self-motivation. Ability to demonstrate responsiveness in all forms of communication, and remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. Excellent problem-solving, and critical-thinking skills. Strong verbal and written communication skills. Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications Certified Case Manager (CCM), License must be active and unrestricted in state of practice. Experience working with populations that receive waiver services.

Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. Facilitates comprehensive waiver enrollment and disenrollment processes. Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. Assesses for medical necessity and authorizes all appropriate waiver services. Evaluates covered benefits and advises appropriately regarding funding sources. Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. Identifies critical incidents and develops prevention plans to assure member health and welfare. Collaborates with licensed care managers/leadership as needed or required. 25-40% estimated local travel may be required (based upon state/contractual requirements).

Blue Cross Blue Shield of North Dakota

Quality Management Coordinator RN

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

North Dakota

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously. We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

Although this role supports remote, hybrid, or in‑office work, if the selected candidate chooses a remote arrangement, they must reside within approximately 300 miles of Fargo, ND, to allow for periodic travel as needed. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND. This position is eligible for internal Blue Cross Blue Shield employees and external applications. The Quality Management Coordinator (Registered Nurse) is responsible for supporting the overall functions of the Quality Management Program, ensuring the program’s activities are following state and federal regulations and all other recognized quality standards. Additionally, this position provides support, coordination, and facilitation of quality measures to participating providers.

An associate's degree in an RN program is required. A BSN is highly preferred. 5 years of experience in nursing, clinical quality management, accreditation, insurance, or related experience. North Dakota (ND) Registered Nurse (RN) License or RN License valid for work in ND is required. Must maintain an active and valid/unencumbered driver’s license which allows for standard driving privileges in North Dakota and Minnesota. Experience with Medicaid management care is highly preferred. Strong attention to detail and a high level of accuracy in all work. Ability to organize, prioritize, and manage workload effectively in a fast-paced environment. Solid technical and professional knowledge with the ability to learn and apply new skills. Ability to build and maintain positive working relationships with internal and external stakeholders. Skill in conducting research, analyzing data, and drawing meaningful conclusions. Effective presentation skills with the ability to communicate information clearly and professionally.

Supports Quality Management Program to ensure the effectiveness of the program. Identifies performance measures for the program’s activities, tracks performance against these measures and develops an action plan(s) to address issues. Supports the development, implementation and annual review of policies and procedures. Coordinates reporting of quality management activities to the various committees and Department of Insurance (DOI). Oversees annual collection, analysis and reporting of health care information to fulfill quality measures reporting requirements. Partners with internal departments, vendors, and auditors. Supports management of the accreditation and reaccreditation process, assures desktop submission requirements and timelines are met, facilitates onsite validation reviews, and educates staff on accreditation process and standards. Coordinates the activities for quality programs. Participates in scheduled group conference calls, provides program information to eligible providers, assists providers with application and submission and provides notification regarding designations. Reports program updates to internal committees and staff as appropriate. Serves as a resource and participates in appropriate special projects, audits or other activities as requested. Provides support, education and coaching to participating providers in meeting specific quality measures by facilitating conference calls and on-site visits. Partners with internal and external stakeholders to understand data needs and delivery of insightful solutions.

Piper Companies

Case Manager Registered Nurse

Posted on:

March 3, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

At Piper, we obsess about the success of our customers and consultants. We believe the development and growth of our people is paramount to that success. Piper Companies provides staffing and professional services in Enterprise IT, Cyber Security and Health Sciences. Everything we do is deeply rooted in creating meaningful partnerships that drive positive impact—we fuel careers, strengthen businesses, and support missions that shape the future. Simply put, we inspire growth to change lives.

Piper Companies is seeking a Case Manager Registered Nurse to support a prominent organization within the health insurance industry. This role focuses on telephonic case management, care coordination, and clinical assessment to drive positive member outcomes. The candidate will sit fully remote based out of NC or other eligible compact states.

Active AND Valid RN license with North Carolina or compact multi‑state licensure required 3+ years of clinical and/or case management experience, including telephonic case management Clinical background with experience supporting diverse or complex case types Strong assessment, care coordination, communication, and documentation skills

Conduct comprehensive telephonic assessments and develop individualized, member‑centric care plans Coordinate care across multidisciplinary teams, provider networks, and community resources Perform ongoing case management through scheduled follow‑ups, goal evaluation, and care plan adjustments based on member acuity Evaluate care delivery across the continuum and document all assessments, interventions, and outcomes according to standards

Carisk Partners

Remote Nurse Care Coordinator

Posted on:

March 2, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Carisk Partners, a Best Places to Work award winning organization, is a specialty risk transfer, care-coordination company servicing insurers, government entities, self-insured plan sponsors and other managed care organizations. Through its Pathways 2 Recovery care model, Carisk Partners aims to improve outcomes and reduce overall cost of quality care by applying best practices in a patient – centered approach to manage complex challenges for the group health, casualty and auto markets.

As a Workers' Compensation Care Coordinator, your responsibility is to ensure that the patient is receiving quality care that is appropriate, necessary and in alignment with the Care Coordination Plan designed specifically to meet the needs of each patient. In doing so, you will also anticipate the patient's future medical and behavioral health needs and aid in ensuring the proper mechanisms are put in place to meet maximum rehabilitation in the most efficient and cost-effective way possible. You will also assist in the development and presentation of Care Coordination Plans, working closely with Carisk’s experienced and strengths-based medical and behavioral health clinical team.

Required current, active, and unrestricted Nursing License (RN or LPN) Preferred Workers’ Compensation and Case Management Experience 1-2 years minimum Certified Case Manager (CCM) designation preferred Bilingual ability (English and Spanish) required Must be able to work 11:30am-8:00pm EST (all time zones accepted)

Assesses and analyzes the injured worker's medical, behavioral and/or vocational status, utilizing Carisk’s patient-centered, strengths-based biopsychosocial approach. Assists in developing a Care Coordination plan to help the patient achieve maximum functional improvement. Engages with the patient, current and potential providers as well as vocational and social support systems and other stakeholders externally. Engages with Carisk’s Clinical, Quality, Provider Relations and other teams internally. Manages a patient’s progress towards the desired outcomes via a customer facing monthly progress report. Arranges referrals, consultations, therapeutic services, and confers with other specialists regarding course of care and treatment. Accurately reports all cases, activity and hours associated in accordance with customer-specific guidelines and consistent with Carisk documentation practices. Attends all meetings and conference calls as requested by Carisk Clinical and Administrative teams. Maintains any required credentials and adheres to all codes of ethics required by these credentials. Performs various professional duties as assigned by management.

Provation

Medical Content Specialist - RN

Posted on:

March 2, 2026

Job Type:

Full-Time

Role Type:

Informatics

License:

RN

State License:

Compact / Multi-State

Provation is revolutionizing the way clinicians and care teams around the world work together to deliver quality healthcare for all. From pre-procedure patient intake to post-procedure follow-up, and everything in between, Provation’s data-driven solutions are proven to improve clinical workflows, staff satisfaction, and the patient experience. As the leading provider of integrated procedure documentation and workflow automation solutions, Provation is trusted globally in more than 5,000 hospitals, ambulatory surgery centers (ASCs), anesthesia groups, and medical offices, including nearly all of the Best Hospitals in the United States. In 2021, Provation was acquired by Fortive Corporation, a Fortune 1000 company that builds essential technology and accelerates transformation in high-impact fields like workplace safety, engineering, and healthcare.

The R&D Nurse Clinician is responsible for developing, reviewing, and maintaining high-quality medical content across Provation products. This role ensures clinical accuracy, regulatory compliance, and alignment with product strategy while fostering collaboration across cross-functional teams. The clinician plays a key role in driving innovation, integrating AI capabilities, and maintaining content standards that support patient safety and provider efficiency.

Education & Experience: Bachelor’s or advanced degree in a clinical discipline (PA, NP, APRN, RN) Minimum 7 years of clinical practice (post-clinical training) Minimum 3 years of procedural or surgical experience Active clinical experience and familiarity with EHR systems or healthcare SaaS platforms Occasional travel may be required. Other Preferred Knowledge, Skills, Abilities Or Certifications: Certifications in clinical informatics, clinical documentation improvement (CDI), or healthcare IT. Experience with health care regulatory compliance and audits (CMS, The Joint Commission, AAAHC) Knowledge of medical coding standards (e.g., ICD-10, CPT). Familiarity with agile methodologies and product development cycles. Familiarity with HL7, FHIR, and other interoperability standards.

Clinical Expertise: Act as resource for teams in developing high-quality, evidence-based medical content based on experience caring for patients. Use clinical expertise to research medical concepts and terminology for medical content development. Deep understanding of clinical workflows and documentation standards. Ensure clinical accuracy and relevance across healthcare SaaS platforms. Healthcare Compliance & Data Governance: Strong grasp of HIPAA, standards of care and best practices in medicine. Ensures content aligns with health care regulatory standards (CMS, The Joint Commission, AAAHC). Supports audit readiness and compliance documentation. Clinical Content Development : Creates and updates medical content based on clinical guidelines, user feedback, and regulatory standards. Ensures consistency and quality across platforms. Supports agile development cycles and product innovation. Cross-Functional Collaboration: Works closely with product, engineering, and quality teams to align content with platform capabilities. Facilitates integration of medical content into clinical workflows. Represent the organization in customer engagements and clinical forums. Innovation & AI Integration: Utilize AI-enabled tools for content validation, flag documentation anomalies, and generate clinician-ready narratives. Contributes to the evolution of intelligent content systems within healthcare SaaS platforms. Supports the design and implementation of AI-enhanced content updates and automation strategies.

Humana

Maternity Care Management Field Nurse

Posted on:

March 2, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Louisiana

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

The Field Care Manager Nurse 2 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Field Care Manager Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Maternity Field Care Management Nurse (Field Care Manager Nurse) assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Field Care Manager Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Field Care Manager employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. In this role you will report to the Manager of Care Management and be part of the Medicaid Maternity team. Workstyle: Combination remote work at home and onsite/home member visits Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM, over-time may be requested to meet business needs and requires approval. Screening: This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Required Qualifications: Licensed Registered Nurse (RN) in the state of Louisiana without restrictions Minimum two (2) years of clinical experience in maternity, Labor & Delivery, L&D, maternal child Proficient in using electronic information systems and Microsoft Office tools (Word, Outlook, Excel) to document, communicate, and collaborate effectively with internal partners and members. Demonstrates strong keyboard and web navigation skills, provides clear narrative documentation, and builds rapport through exceptional communication and interpersonal abilities. Ability to work with minimal supervision within the role and scope with the ability to adapt care plan to change in member status. Willing to travel up to 75% of the time to see members Preferred Qualifications: Case Management Certification (CCM) or willingness to obtain within two (2) years of employment Understanding of the current state Maternal/Child Mortality Morbidity Basic Breastfeeding knowledge Experience working with Medicare, Medicaid and dual-eligible populations Field Case Management Experience Health Plan experience Knowledge of community health and social service agencies and additional community resources Experience with health promotion, coaching and wellness Motivational Interviewing experience Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is required. Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Uses a holistic, member-focused approach to engage members and families in recovery and wellness programs Conducts telephonic and in-person assessments to identify member needs and guide to appropriate resources Supports optimal health and wellbeing through regular monitoring and evaluation of progress Develops individualized care plans using clinical judgment and changes in health status Collaborates with providers and community services to ensure quality, cost-effective outcomes Coordinates services for physical health, social determinants of health, and additional benefits Facilitates communication across the care team, including PCP and care transitions Provides relevant resources to families for health and wellness support Submits incident reports as required Participates in health promotion and community events

EmblemHealth

Care Manager, Utilization Management (NYCE)

Posted on:

March 1, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

Support the department’s quality of care and cost containment. Provide utilization management as needed to ensure coordination of health care delivery. Conduct medical appropriateness evaluations of acute care hospital admissions, post-acute care requests, and selected outpatient procedures. Facilitate the achievement of quality clinical outcomes by integrated and collaborative interventions with multiple disciplines, Pre/Post Service. Ensure that members are receiving the appropriate level of care in the appropriate setting for the appropriate length of time within the established guidelines and benefit sets; Pre-service, Concurrent Review, Post-acute and Care Management. Work with interdisciplinary team to utilize the SNP members' Plan of care to achieve improved health outcomes. Provide services per the NYCE contract.

EmblemHealth is one of America’s largest not-for-profit health insurers. With an 85-year legacy of serving New York communities, EmblemHealth offers a full range of commercial and government-sponsored health plans to employers, individuals, and families. We started back in the 1930s, at the height of the Great Depression. Out of hard times, the idea of health insurance was born — a system that would protect everyday people from financial misfortune if they had an accident or illness. Two companies from those early days of health insurance, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), would later merge and become EmblemHealth. And after 85 years, our purpose as a not-for-profit is still the same — to provide quality, affordable health insurance for New Yorkers and their families. We believe in what we’re doing. And we’re looking for passionate people to join us.

Associate Degree in Nursing; Bachelor’s preferred RN with an active, unrestricted nursing license (Concurrent Review, Medical Management, etc.) MCG Certification prefe4 – 6+ years of clinical experience Managed care experience Post-acute facility experience Care management experience Ability to work weekends and holidays on a rotating schedule Excellent communications skills (verbal, written, presentation, interpersonal) Effectively able to screen and stratify members who are appropriate for care management services Ability to: manage a caseload of members in need of care management; and apply the care management process as outlined by the CMSA standards and EH’s policies Ability to make appropriate referrals to internal and external programs that meet the member’s needs Ability to create and execute care management care plans and document per EH’s policies and procedures Ability to speak professionally with all necessary parties associated with the member’s care plan

Utilize MCG, CMS Guidelines, medical and administrative policies to evaluate medical necessity. Identify members at risk and refers for Care management and/or disease management as needed. Assess and evaluate member’s needs, coordinate care utilizing approved criteria(s). (Include member and family discussion as necessary). Maintain utilization time frames are met according to regulatory guidelines (i.e., initial determination decisions, adverse determination notification to providers and members). Provide appropriate case review; ensure timely notification and correspondence to facilities, members and providers. Utilize the member’s contract to determine coverage eligibility. Work with providers and take action in problem solving while exhibiting judgment and a realistic understanding of the issues. Prepare and present clinical detail to the Medical Director for final case determination in accordance with regulation and department policy. Ensure cost effectiveness and identified opportunities to reduce cost are captured (i.e. reinsurance reporting). Refer to Medical Director any questionable quality issues or inappropriate hospitalizations for immediate intervention and/or refer cases that do not meet established criteria for approval of selected procedure or service. Regular attendance is an essential function of the job. Perform other duties as assigned or required.

EmblemHealth

Care Manager, Complex & Disease Management (Transition of Care) - Remote

Posted on:

March 1, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

EmblemHealth is one of America’s largest not-for-profit health insurers. With an 85-year legacy of serving New York communities, EmblemHealth offers a full range of commercial and government-sponsored health plans to employers, individuals, and families. We started back in the 1930s, at the height of the Great Depression. Out of hard times, the idea of health insurance was born — a system that would protect everyday people from financial misfortune if they had an accident or illness. Two companies from those early days of health insurance, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), would later merge and become EmblemHealth. And after 85 years, our purpose as a not-for-profit is still the same — to provide quality, affordable health insurance for New Yorkers and their families. We believe in what we’re doing. And we’re looking for passionate people to join us.

Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members’ health care needs, identifying gaps in care and needed support, administering/coordinating implementation of interventions. Support and enable members to manage their physical, environmental and psycho-social concerns, understand and appropriately utilize their health plan benefits and remain safe and independent in their home or current living environment in collaboration with health care providers. Provide Care Management services to identified high risk members within the community, including but not limited to Physician Practices, Retail Centers/Neighborhood Care Centers, and members’ homes. Coordinate and provide care that is safe, timely, effective, efficient and member-centered to support population health, transitions of care, and complex care management initiatives. Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate and timely utilization of services across the continuum of care. Assist the entire Care Management interdisciplinary team in managing members with Care Management needs.

Bachelor’s degree RN required, with current active RN license - New York State CCM certification preferred Certification in utilization or care management preferred 4 – 6 years of clinical experience Organization/prioritization ability; and the ability to effectively manage a caseload of highly complex members Support an integrated care model tapping into appropriate resources both internally and external to the organization Experience in case management/care coordination, managed care, and/or utilization management Strong communication skills (verbal, written, presentation, interpersonal) Trained in the use of Motivational Interviewing techniques Experience working in medical facility or practice and/or with electronic medical records Computer proficiency: MS Office (Word, Excel, PowerPoint, Outlook); mobile technology (wireless phone/laptop, etc.) System user experience in a highly automated environment Bilingual ability (verbal, written) Strong cross-group collaboration, teamwork, problem solving, and decision-making skills Ability to work a flexible schedule (evenings, weekends and holidays) to meet member and/or caregiver and departmental scheduling needs

Assess and evaluate the needs of our most complex members, acting as the clinical coordinator collaborating with members, caregivers, providers, multi-disciplinary team, and health care and community resources through a variety of assessments to identify areas of (medical, financial, environmental, health insurance benefit, psycho-social, caregiving) concerns and potential gaps in care utilizing the most appropriate resources to support members’ needs. Identify appropriate goals, strategies and interventions that may include referrals, health education, activation of community-based resources, life planning, or program/agency referrals based on areas of concern. Develop, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high quality, cost effective continuum of care with the member, caregiver, provider(s) and multidisciplinary team. Include member and family as appropriate. Engage actively with the member PCP / designee. Engage with the member in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes for member. Work collaboratively with all stake holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences when appropriate. Assess the needs of members and align them with the appropriate member of the care team (wellness team, registered dietitian, social worker, community health workers). Act as the member’s advocate and liaison by completing or facilitating interventions with providers and/or private,non-profit, and governmental agencies. Ensure that all Care Management processes and reporting are compliant with all applicable federal and state regulations, and NCQA and company standards. Participate in delegation collaboration activities, as required. Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making care management recommendations. Enter and maintain documentation in the Electronic Medical Records System (EMR), meeting defined timeframes and performance standards. Maintain an understanding of Care Management principles, program objectives and design, implementation, management, monitoring, and reporting. Actively participate on assigned committees. Attend and complete all department-mandated training as well as satisfy educational in-service requirements. Perform other related projects and duties as assigned. Provide ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care. Develop, implement and coordinate plan of care and facilitate members’ goals. Coordinate interdisciplinary team tasks and activities, with the goal of maintaining team performance and high morale.

Mercor

Clinical Nurse Specialist | $190/hr Max

Posted on:

March 1, 2026

Job Type:

Part-Time

Role Type:

Primary Care

License:

RN

State License:

California

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Healthcare AI Evaluator Type: Contract Compensation: $150–$190/hour Location: Remote

Must-Have: 5+ years of real-world professional experience in Healthcare, supported by an associated expert degree (e.g., MD, DO, RN, NP, PA, PharmD, MPH, or equivalent). Experience in one or more of the following sub-domains: General Clinical Care, Specialty Medicine or Surgery, Diagnostics, Imaging & Laboratory Medicine, Public Health, Healthcare Systems & Administration. Significant experience using large language models (LLMs). Excellent writing communication skills for complex medical topics. Strong attention to detail and comfort in evaluating clinical reasoning and medical explanations. Preferred: Prior experience with RLHF, model evaluation, or data annotation work. Experience writing or editing high-quality medical or healthcare-related content. Experience in clinical documentation, charting, or patient communication. Familiarity with evaluation rubrics, benchmarks, or quality scoring systems.

Write and refine prompts to guide model behavior in healthcare scenarios. Evaluate LLM-generated responses to healthcare queries for accuracy, reasoning, clarity, and completeness. Conduct fact-checking of medical claims using trusted public sources and authoritative references. Annotate model responses by identifying strengths, areas of improvement, and factual inaccuracies. Assess tone, completeness, and appropriateness of responses for real-world healthcare use. Apply consistent evaluation standards by following clear taxonomies, benchmarks, and detailed evaluation guidelines.

Optum

Outpatient RN Case Manager - Remote in San Diego, CA

Posted on:

March 1, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

Optum CA is seeking an Outpatient Case Manager to join our team in San Diego, CA. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Reviews contracted Medical Group’s authorization requests for medical necessity, determines which requests need Medical Director review, obtains sufficient medical documentation for an informed decision. Processes all requests within established timeframes. Documents all steps of process in authorization system, utilizes industry standard denial language for denial letters. The work schedule will be Monday through Thursday 6:30am-5pm

Required Qualifications: Graduation from an accredited school of nursing Active, unrestricted Registered Nurse license through the State of California 1+ years of experience in case management or utilization review experience in clinical setting Proficient with computers and Microsoft windows environment Reside in the San Diego, CA area Preferred Qualifications: Bachelor of Science in Nursing, BSN 3+ years of experience working in acute care HMO experience

Reviews contracted Medical Group’s referral requests for medical necessity. Consideration is given to the appropriateness of the setting, place of service, health plan’s benefits and criteria of the requested services and utilizes service matrix for contracted providers. Documents process in authorization notes Refers all medical necessity denials to the physician for review. Processes denials within establishes timeframes. Documents in the authorization system the denial reason, utilizing the industry standard denial letter language, outlines alternative services available Reviews requests within established timeframes for urgent, routine and retro requests to maintain compliance with legislative and accreditation standards Obtains additional information for review of appeals. Coordinates with health plan to meet timeframes for expedited appeals You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Dignity Health

UM RN

Posted on:

March 1, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

As a Utilization Management RN, you will be crucial in ensuring accurate and compliant medical necessity decisions. Your responsibilities include reviewing medical records, authorizing services, and preparing cases for physician review. You’ll work closely with both Pre-Service and In-Patient Utilization Management teams to ensure appropriate and cost-effective care.

Minimum Qualifications: Minimum of 3 years’ recent clinical experience. Graduate of an accredited RN Program. Clear and current CA Registered Nurse (RN) license. Knowledge of nursing theory and ability to apply or modify as appropriate. Knowledge of ICD-10, CPT, HCPCS coding, medical terminology and insurance benefits. Knowledge of legal and ethical considerations related to patient information, PHI and HIPAA regulations. Preferred Qualifications: Utilization Management (UM) experience strongly preferred. Prior authorization experience strongly preferred. Bachelors of Nursing (BSN) preferred.

Authorization Review: Proactively, concurrently, or retroactively reviewing referral authorization requests, gathering necessary information, and escalating to the Medical Director when needed. Compliance & Accuracy: Meeting turnaround times and accuracy standards. Provider Network: Ensuring authorized services are with contracted providers and coordinating with contracting for new agreements. Care Coordination: Identifying cases for additional case management and collaborating with internal departments to coordinate patient care. Quality & Cost-Effectiveness: Adhering strictly to utilization management policies to promote quality, cost-effective care. Denial Notice Composition: Drafting compliant, clear, and member-specific denial letters in accordance with federal, state, and health plan regulations, as well as NCQA standards. This role requires strong attention to detail, adherence to regulatory guidelines, and a commitment to superior customer service in line with CommonSpirit’s values. You will function as a UM nurse reviewer, applying clinical expertise to ensure appropriate healthcare utilization. This position is work from home within California, preferrably within San Luis Obispo County.

SSM Health

RN-Utilization Review (S)

Posted on:

March 1, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

SSM Health is a Catholic, not-for-profit, fully integrated health system dedicated to advancing innovative, sustainable, and compassionate care for patients and communities throughout the Midwest and beyond. The organization’s 40,000 team members and 13,900 providers are committed to fulfilling SSM Health’s Mission: “Through our exceptional health care services, we reveal the healing presence of God.” With care delivery sites in Illinois, Missouri, Oklahoma and Wisconsin, SSM Health includes hospitals, physician offices, outpatient and virtual care services, comprehensive home care and hospice services, a fully transparent pharmacy benefit company, a health insurance company and an accountable care organization. It is one of the largest employers in every community it serves. For more information, visit ssmhealth.com

It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: Eligible candidates must reside within SSM Health's four state footprint - including Missouri, Illinois, Wisconsin or Oklahoma only. Job Summary: Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.

EDUCATION: Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE: Two years’ registered nurse experience REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Missouri Division of Professional Registration State of Work Location: Oklahoma Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Discusses with payor regarding criteria and payor decision. Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration. Documents outcome in electronic medical record. Participates with other members of team regarding opportunities for improvement in standard work. Performs review of pre-admission, perioperative, and post operative surgical cases. Performs other utilization management tasks as assigned. Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service. Performs other duties as assigned.

HealthTrust Workforce Solutions

Registered Nurse WFH (Work From Home

Posted on:

March 1, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Provides nurse advice and triage services to consumers calling with clinical questions. Summary Of Key Responsibilites Provide appropriate compassionate advice to callers using evidence based clinical decision tools to help callers make personal health decisions. Make cross referrals as indicated. Facilitate referrals and event registration through internal transfer mechanisms.

KNOWLEDGE, SKILLS AND ABILITIES: Demonstrates knowledge and understanding of organizational and departmental policies, procedures and systems Skills: Communicates clearly and concisely both verbally and in writing Establishes and maintains long-term customer relationships, building trust and respect Abilities: Demonstrates good judgment in handling situations not covered by written or verbal instructions Able to work effectively with internal and external customers Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly, and transcribe accurately Able to handle multiple priorities and manage stress appropriately Education: The position requires an entry knowledge level generally obtained through completion of an Associate's Degree or an equivalent in demonstrated work experience. Experience: Minimum of three (3) years of experience in acute care nursing, required, telehealth preferred. Please note that ACUTE is a critical aspect (Acute – In hospital care bedside) CERTIFICATE(s)/LICENSE(s): Active RN Compact license in state of residence required and ability to obtain licensure in all states served by HCA. Physical Demands, Working Conditions, Essential Functions Manual Dexterity, hand-eye coordination Repetitive arm/hand movements Sight Acuity – far, near, depth perception Sitting for prolonged periods of time Reaching, bending, stooping, kneeling, crawling

Utilizes nursing skill and along with approved protocols to provide telephone nurse triage and/or health advice to consumers with clinical questions or symptoms. Facilitates referrals for health services as appropriate via telephone and performs all components of call processing Ensures performance standards are met and accepts constructive feedback Speaks with a pleasant, professional phone voice and provides superior customer service to create an exceptional patient experience. Documents caller information and outcomes in a relational database system in accurately and as prescribed by current standards and policies Maintains confidentiality, HIPAA and PHI compliance Communicates appropriately and clearly with departmental management, co-workers and callers and exhibits willingness to master new work routines and methods Practices and adheres to HCA’s “Code of Conduct” and “Mission and Value Statement” Provides homecare, advice and/or education to callers that respects the cultural, spiritual, intellectual/educational, and psychosocial differences of individuals and preserves caller’s autonomy, dignity and rights. Maintains and contributes to a collaborative professional and ethical work environment. Actively participates in team meetings and engages in the processes of the contact center

BlueCross BlueShield of South Carolina

RN Managed Care Coordinator I (Utilization Management)

Posted on:

February 28, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year.

We are currently hiring for a Managed Care Coordinator I to join BlueCross BlueShield of South Carolina. In this role as Managed Care Coordinator I, you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Description Location This position is full time (40 hours/week) Monday-Friday from 8:30am – 5:00pm EST and will be fully remote. The candidate must reside at least 3 hours from Columbia, SC.

Required Education: Associates in a job-related field. Degree Equivalency: Graduate of Accredited School of Nursing or 2 years of job-related work experience. Required Work Experience: 2 years’ clinical experience. Required Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in typing, spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire. We Prefer That You Have The Following Preferred Education: Bachelor's degree- Nursing. Preferred Work Experience: Work experience in healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes.

Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Provides patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.

Elevance Health

Triage RN I - Virtual - CareBridge

Posted on:

February 28, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Iowa

CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Shift: Full time (40 hours a week) position. 8am to 5pm local time that will require holidays and weekend rotation. The LPN/LVN is responsible for the examination and treatment of patients under the direction of the physician.

Minimum Requirements: Requires an LPN or LVN and minimum of 2 years of experience as an LPN/LVN; or any combination of education and experience, which would provide an equivalent background. Current LPN/LVN license in the applicable state required. For Carelon Health business unit, satisfactory completion of a Tuberculosis test is a requirement for this position. Preferred Experience, Skills, and Capabilities: Bi-lingual (English/Spanish) preferred. Experience with Telephonic Triage preferred. Acute care experience (e.g., urgent care or ER) preferred.

Reviews patient medical records, interviews patients and records vital signs. Provides nursing interventions and coaching in accordance with the scope of practice and standing orders. Facilitates patient transfers to alternate level of care. Facilitates patient transfers to an alternate level of care as needed. Documents using standard templates. Ability to be on the phone engaging with patients up to 80% of the shift. Ability to work assigned weekends per standard team rotation. Reliable internet and a high level of customer service.

VECRA, Inc.

Registered Nurse – Nurse Advice / Telephone Triage Services

Posted on:

February 28, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Maryland

VECRA, Inc. is a service-disabled veteran-owned small business (SDVOSB), woman-owned small business (WOSB), minority business enterprise (MBE) consulting firm implementing proven methodologies that help our clients drive growth, transform businesses, and innovate breakthrough ideas. VECRA’s extensive experience with innovative software applications, reporting systems, facilities and supply chain management, program management and staffing support services are always: Vigilant * Efficient * Collaborative * Responsive * Accurate

VECRA is seeking full-time and part-time Registered Nurses VECRA, Inc. is seeking qualified Registered Nurses (RNs) with demonstrated clinical expertise in telephone triage, patient assessment, health education, and remote care coordination. The ideal candidate will have experience providing patient-centered guidance through on-demand Nurse Advice and Telehealth services, utilizing evidence-based nursing protocols to ensure timely, accurate, and culturally sensitive care. The Registered Nurse (RN) will provide 24/7 telephone-based nurse triage and patient advice services for patients of the Gallup and Shiprock Service Units under the Indian Health Service (IHS). This remote position requires strong clinical judgment, excellent communication skills, and the ability to deliver safe, culturally competent care using approved nursing triage protocols. Other Work Hours: Mountain Standard Time coverage (24/7/365 operations) Employment Type: Full-Time - Part-Time - On-Call Location: Remote

QUALIFICATIONS and REQUIRED SKILLS: Active Registered Nurse (RN) license in at least one U.S. state or territory Minimum of 2 years of recent experience in emergency, urgent care, or telephone triage Proficiency in nursing triage protocols and clinical algorithms Strong communication and critical-thinking skills for remote clinical assessment Knowledge of HIPAA, Privacy Act, and patient confidentiality practices Proficiency with electronic health record systems (EHRs) Ability to work flexible hours, including nights, weekends, and holidays Preferred Qualifications: Experience working with the Indian Health Service (IHS) or federal healthcare systems Familiarity with Native American health practices and cultural values Experience with telehealth or nurse advice call center operations

Provide telephone triage and nurse advice using approved clinical protocols Assess symptoms via the Rapid Triage Screening (RTS) Model to determine urgency and disposition Offer health education, counseling, and referrals in alignment with IHS standards Document all patient encounters in the IHS Electronic Health Record (EHR) in real time Coordinate with IHS providers, pharmacies, and departments for follow-up or escalation Facilitate interpreter services for patients with limited English proficiency Maintain compliance with HIPAA, the Privacy Act, and IHS confidentiality standards Work scheduled shifts aligned with Mountain Standard Time coverage (24/7/365) operations)

Twin Health

Registered Nurse Operations Manager: Implementation

Posted on:

February 28, 2026

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

At Twin Health, we empower people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care. Twin Health is the only company applying AI Digital Twin technology exclusively toward metabolic health. We start by building a dynamic model of each person’s metabolism — drawing on thousands of data points from CGMs, smartwatches, and meal logs — that maps their personal path to better health. Guided by a dedicated clinical care team, our members have lowered their A1C below the diabetes range, achieved lasting weight loss, and reduced or even eliminated medications, all while living healthier, happier lives.

Opportunity: Join us in one of our most critical clinician roles, inspiring behavior change and motivating members to adopt new behaviors and improve their health. As an RN at Twin you make a difference in people's lives every day by providing clinical guidance, support, education, and encouragement to empower your members seeking to prevent and reverse chronic metabolic diseases and improve their overall health. The RN Operations Manager role for Implementation is a great fit for you if you have experience managing large or complex operational initiatives, driving teams and their work, delivering on results and building rapport with departmental partners. You are also highly motivated and will focus on rolling out new things while also ensuring they are well-adopted and work in daily practice. You will oversee a team dedicated to one of our expanding strategic partners. You have led or have experience with implementing new technologies and clinical workflows from planning through go-live by partnering closely with engineering, design and training teams to translate clinical needs into requirements. You also manage direct reports and leverage data to understand metrics impacts and how to tie them to operational decisions. You are comfortable driving change management and ensuring standardization across processes that improve care coordination and efficiency. Join Us: This is an exciting role for a Registered Nurse with a diverse healthcare systems background. Join us to use your finely-tuned skills overseeing team successes in accomplishing outcomes. This role will report to Nursing Operations leadership and work within a team structure. A successful candidate for this role will be curious, collaborative and adaptable to member journey and team needs. You will be excited to jump into a day that may look a bit different than the day before, while making improvements along the way and building upon your highly-valued skill set.

Currently active and unencumbered RN license, compact preferred Minimum 5 years nursing experience with at least 3 years involvement in implementation or project-based efforts in clinical technology or workflow transformation; direct management overseeing direct reports Required, BSN from accredited school of nursing; MPH or informatics-related master’s favorable Hands-on experience driving or co-leading clinical technology implementations and go-lives - Especially for new care models, workflows or digital health tools (AI supported) Proven ability to translate clinical needs into technical requirements, partnering with product Experience driving team adoption of new workflows or tools (including testing, piloting, implementing and refining) Oversight of staffing, performance, escalation management and operational consistency Demonstrated ability to manage and effectively work in a fast paced environment Proficient with simultaneously navigating and multi-tasking with multiple electronic documentation systems and business tools (Google, Slack, etc.) Experience with or knowledge of process improvement methodologies (Lean, PDSA, CQI) Comfort with ambiguity and change Self-motivated and results-focused Quick learner who integrates new knowledge Organized and detail-oriented Ability to handle competing demands with diplomacy and enthusiasm Ability to work collaboratively with clinical infrastructure and hierarchies Excellent time management and ability to prioritize work assignments Passion for Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases This remote opportunity based out of the U.S. Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

Responsible for daily operations of direct reports while driving operational initiatives Leads clinical implementation efforts within an assigned team or partner for new technologies and workflows, which includes working in close partnership with operations leaders, product, engineering and design teams Addresses clinical and administrative concerns such as troubleshooting and issue resolution, ensuring staff coverage and gathering feedback on care delivery systems to ensure safety, compliance, accuracy and standardization Drives change management and adoption of new tools and workflows at team level by partnering with training and peer leaders. Serves as a subject matter expert between technical and frontline teams and incorporates post-implementation analysis, feedback In partnership, helps design and evolve workflows by assessing current to future-state needs that maintain quality and safety standards Works with teams to collect data, insights and front-line feedback to help inform decisions and and standardize processes across assigned teams to support scalable work Achieves and upholds Twin service care goals and standards, which includes monitoring and managing team performance, meeting SLAs and targets Guides development, organization and communication of nursing/team policies and procedures Supports recruitment, training and mentoring Aligns and collaborates with cross-functional team leaders, and serves as team representative and/or subject matter expert on initiatives and projects Promotes member self-care management by utilizing clinical judgment, critical thinking skills Collaborates closely with team colleagues including nurses, health coaches, providers, and operations teams to drive a seamless experience for members Provides timely responses and feedback to colleagues regarding member care, escalations and issue resolution Organizes accurate records and maintains confidentiality according to federal law and Twin Generates and analyzes reports as needed for management, identifying trends, any concerns Participates in on-going education and performance improvement activities Additional duties as assigned Other duties as assigned

Twin Health

Virtual Treatment Nurse- Full Time Contract

Posted on:

February 28, 2026

Job Type:

Contract

Role Type:

Primary Care

License:

RN

State License:

California

At Twin Health, we empower people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care. Twin Health is the only company applying AI Digital Twin technology exclusively toward metabolic health. We start by building a dynamic model of each person’s metabolism — drawing on thousands of data points from CGMs, smartwatches, and meal logs — that maps their personal path to better health. Guided by a dedicated clinical care team, our members have lowered their A1C below the diabetes range, achieved lasting weight loss, and reduced or even eliminated medications, all while living healthier, happier lives.

Opportunity: Join us in one of our most critical member care management roles, inspiring behavior change and motivating members to adopt new behaviors and improve their health. As an RN at Twin you make a difference in people's lives every day by providing clinical guidance, support, education, and encouragement to empower your members seeking to prevent and reverse chronic metabolic diseases and improve their overall health. This job is a great fit for you if you have expertise with building rapport with members, are highly motivated, energetic, and focused on enhancing the quality of healthcare. You have demonstrated the ability to work collaboratively with an interdisciplinary care team in the adoption of new technologies to coordinate care, engage in shared decision making, and achieve successful clinical outcomes. You are comfortable leveraging data in observing trends and developing corrective action plans to facilitate the transformation of member lives. Join Us: This is an exciting role for a Registered Nurse with a diverse healthcare systems background. Join us to use your finely-tuned skills in assessing physical and psychological-social needs. You will support a dynamic care team in identifying member goals, health priorities and learning opportunities. This will include utilizing motivational interviewing techniques and designing interventions with members to build engagement and improved health outcomes. Other skill set considerations include ability to work efficiently and with competing priorities, comfort with technology and data, as well as employing knowledge of care management principles. This role will report to a nurse manager and work within a team pod structure. A successful candidate for this role will be curious, collaborative and adaptable to member journey and team needs. You will be excited to jump into a day that may look a bit different than the day before, while making improvements along the way and building upon your highly-valued skill set. The schedule for this position is Monday - Friday, three shifts from 9am-5pm and two shifts from 11am-7pm EST. This is a 4 month contract position with full time hours.

Currently active and unencumbered RN license within the state in which patient care is occurring Minimum 4 years of nursing experience in various healthcare systems such as hospitals, Federally Qualified Health Care centers, ambulatory care environments (primary care, internal medicine, family practice, surgical/multi-specialty), health payor systems (case management), etc. Experience preferred in one or more of the following areas: Case/care management, value-based care, population health, care coordination or transition care management Required, BSN or MSN from accredited school of nursing Preferably skilled in motivational interviewing and driving behavior change Comfort and enthusiasm for adopting the latest technologies and integrating data and technical outputs in patient care Demonstrated ability to manage large caseloads and effectively work in a fast paced environment Proficient with simultaneously navigating the internet and multi-tasking with multiple electronic documentation systems and business tools (Google, Slack, etc.) Comfort with ambiguity and change Experience in a high-growth, or other quickly changing environment Professional telephone and video skills Self-motivated and results-focused Client service excellence Quick learner who integrates new knowledge Organized and detail-oriented Ability to handle competing demands with diplomacy and enthusiasm Ability to work collaboratively with clinical infrastructure and hierarchies Excellent time management and ability to prioritize work assignments Passion for Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases Bilingual, fluent in Spanish preferred

Delivers remote clinical monitoring and member education via software, video conferencing, and the Twin Health electronic medical record Promotes member self-care management by utilizing clinical judgment, data analysis and critical thinking skills Evaluates member progress toward goal achievement, including identification and evaluation of barriers to meeting or maintaining plan of care and/or health status Prioritizes and manages individual members along the Twin journey by monitoring health condition reversal trends, conducting lab reviews, supporting medication management Collaborates closely with team colleagues including nurses, health coaches, providers, and operations teams to drive a seamless experience for members Engages the nursing philosophy to capture a holistic picture of the member’s clinical status from Intake to ongoing care management Gives appropriate health guidance by utilizing clinical knowledge, training and protocols Leverages the nursing processes to triage member alerts and inquiries Strictly adheres to Standard Operating Procedures for member management and escalations Provides timely responses and feedback to colleagues regarding member care Conducts detailed monitoring to support medication reconciliation and adherence Collaborate with members and pharmacies to identify solutions to defray costs for members and reduce gaps in coverage Organizes accurate records and maintains confidentiality according to federal law and Twin policies Generates and analyzes reports as needed for management, identifying trends, anomalies and areas of concerns Contributes to the development and improvement of clinical care that enhances cost effectiveness while ensuring quality care Participates in on-going education and performance improvement activities Additional duties as assigned

Precision Financials

Healthcare Financial Professional RN NP

Posted on:

February 28, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Oregon

At Precision Financials, we are a team of driven financial professionals dedicated to empowering individuals and families through financial education and leadership. We believe that financial literacy is the cornerstone of true financial independence—and our mission is to equip our clients with the knowledge, tools, and confidence they need to take control of their financial future

Work From Home Opportunity — Ideal for Nurses (RNs, NPs) Founded by an ER RN | Helping People Beyond the Bedside 100% Remote | Work from Anywhere with Wi-Fi Flexible Schedule | Part-Time or Full-Time High Income Potential | Full Training Provided Please Read the Full Description Before Applying Are you a Registered Nurse or Nurse Practitioner who’s passionate about helping people—but seeking a career that offers more freedom, less burnout, and long-term financial stability? You’re not alone. Many healthcare professionals are discovering a new way to serve others—without sacrificing their own health, time, or family life. This opportunity was founded by a career Emergency Room RN who spent years on the frontlines, and now empowers nurses and other purpose-driven professionals to transition from bedside care to financial care. This is a commission-based (1099) opportunity. It’s ideal for nurses who are ready to build a meaningful new career—helping others plan, protect, and thrive financially. This is not a temporary or internship-style position, and not suitable for full-time students. We’re looking for individuals ready to invest in their future and create lasting impact. If you’re ready to shift from healthcare to wealthcare and still change lives apply today and discover how to help others without the burnout.

Financial Professional (No Experience Required) As a licensed Financial Professional, you'll educate families, individuals, and small business owners on how to protect and build wealth through services such as: Life Insurance with Living Benefits Retirement Planning (401k rollovers, indexed accounts, annuities) College Savings Plans Business Protection Strategies You’ll receive full training, licensing support, mentorship, and ongoing professional development—even if you have no prior experience in finance or business.

CVS Health

Telehealth Registered Nurse

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

••work from Home- Candidate may reside in Texas or Arizona•• At CVS Health, we believe we can change the world by improving patient lives, one call at a time. Our Telephonic Registered Nurses (RN) have patient contact in the uniqueness of a telephonic practice setting, where they are impacting lives across the country. You will continue to experience the reasons you became a nurse without having to be in a bedside patient care environment. Shift and Hours for our Telehealth Registered Nurse role: ****This is a Monday-Friday role with hours starting from 10:30am -7:00 pm (CST) These are set hours, and this is a fulltime hourly position. RN, Registered Nurse, Case Manager, Nurse, Home Health, Autoimmune, Oncology, Telehealth, Telephone, Telephonic, Health Management, Assessment, Education, Training

A Registered Nurse with an unrestricted current compact license in their state of residence and the ability to be licensed in multiple states A Registered Nurse must hold an unrestricted license in their state of residence, with multi- state/compact privileges and have the ability to be licensed in all non-compact states, territories and the District of Columbia based on the needs of the business. Many states’ licensing bodies have their own specific state requirements. Nursing boards may add more requirements from time to time and our nurses are required to meet such requirements. Candidate must be based in TX or AZ for this particular requisition 3+ years of clinical RN experience Experience using Microsoft Office, including Word, Excel and Outlook COVID Vaccine Required: N/A COVID Requirements: N/A Preferred Qualifications: Previous Telephonic Nursing experience EPIC systems experience Bachelor’s degree preferred Licensure in multiple states preferred Education: RN Diploma, Associates or Bachelors in Nursing

Working from home, you will be part of a specialized team on the cutting edge of patient care. Working collaboratively with health care professionals, you will provide a meaningful patient experience, while using your critical thinking skills to develop, implement, and evaluate comprehensive plans of care for multiple disease state patients. As a Telephonic Registered Nurse, you will a profound effect on the lives of the patients and caregivers via each outbound call, providing education and support for their new medication. Along with the Compliance and Persistency team, you are the continuity of care supporting defined patient populations through the use of our state-of-the-art telecommunications nursing outreach programs. To be successful in this Registered Nurse position, you must have excellent written and verbal customer service skills, as well as advanced computer skills in order to interact with patients. Our Registered Nurses redefine the way health care is delivered every day. When you join our team, you'll play an integral role in educating patients with medication adherence and disease state training. As a national leader in the healthcare industry and a Fortune 7 company, we seek special RNs who not only possess strong clinical expertise with innovative ideas, but who have the deep compassion and sensitivity it takes to treat our patients.

Eventus WholeHealth

Part Time remote Teletriage Nurse Practitioner/Physician Assistant- NC, IN or KY license required

Posted on:

February 27, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

NP/APP

State License:

North Carolina

Eventus WholeHealth was founded in 2014 to provide physician-led healthcare services for residents and patients of skilled nursing and assisted living facilities. With our highly-trained team of physicians, psychiatrists, nurse practitioners, physician assistants, psychotherapists, podiatrists, optometrists, audiologists, and support staff, our comprehensive, evidence-based model provides collaborative interdisciplinary care with the seamless and vital integration of a wide range of specialties. Our differentiated approach not only empowers the facilities to reach their own goals and objectives but also ensures better patient outcomes. For more information, please visit www.eventuswholehealth.com.

Eventus WholeHealth delivers an integrated model of care to adults who reside in a variety of settings including but not limited to skilled nursing facilities, assisted living facilities, independent living and in personal homes. These services are provided through a network of Eventus WholeHealth providers who include Physicians, Nurse Practitioners, Physician Assistants, Care Team Advocates, and in-house Support Staff.    Telemedicine uses videoconferencing equipment to send and receive patient medical information and pictures. Eventus WholeHealth telemedicine providers deliver medical services to patients at assigned contract sites according to site-specific protocols. Telemedicine providers also render medical consultations with family, facility staff and specialty providers when necessary. Medical services are provided via telemedicine.

Knowledge: Knowledge of theory, practice, and regulations to give and evaluate patient care. Knowledge of rules and regulations of bodies governing health care. Knowledge of Eventus WholeHealth policies and procedures. Knowledge of common safety hazards and precautions to establish/maintain a safe work environment. Skills Required: Skill in gathering and analyzing physiological, socioeconomic, and emotional patient data. Skill in accurately evaluating patient problems and providing appropriate advice, intervention, or referral. Skill in documenting clinical services Skill in using computer technology Skill in exercising a high degree of self-direction, judgment, and discretion. Abilities:Ability to communicate clearly and establish/maintain effective working relationships with patients, medical staff, and the public. Ability to react calmly and effectively in emergency situations. Ability to interpret, adapt and apply guidelines and procedures. Ability to work collaboratively with all members of the health care team. Ability to make responsible decisions within the scope of the provider’s license Ability to evaluate and make recommendations for continuous quality improvement. Ability to handle confidential and sensitive information. Physical/Mental Demands: Sedentary physical demands. Ability to lift equipment and small items which is generally not more than 10 pounds needed. Flexibility of schedule at times may be required. Work may be busy and demand multi-tasking. Qualifications/Education: Master’s degree in Nursing from an accredited educational institution and a current and valid license to practice advanced practice nursing issued by the state where you are providing tele triage. All certifications necessary to perform one’s responsibilities must be current and valid. Specialization in geriatric, family, or internal medicine desired. Licensed in NC. Additional state licenses may be required as requested. OR Have graduated from a physician assistant educational program that is accredited by a National Commission on Accreditation of Allied Education Programs. Have passed the national certification examination of the National Commission on Accreditation of Certification of Physician Assistants. Licensed in NC. Additional state licenses may be required as requested. Specialization in geriatric, family, or internal medicine desired.

Provide primary-care telemedicine services in accordance with Eventus site-specific protocols and consistent with the standard of care for the specialty of family medicine, geriatric medicine, and/or internal medicine. Perform other duties and activities as appropriate and/or assigned by Eventus Management as pertains to providing quality or timely medical care and or administrative responsibilities. Manage facility and other partners relationships, organization, patient consents, CCM and billing. Provide on call tele triage per established protocol policy. Confirm treatment and telehealth consents are signed prior to telemedicine visit. Follow Eventus telehealth visit etiquette protocols. Include family members in the visit, as appropriate. Be familiar with telemedicine equipment, delivery platform and software. Ensure the patient has the proper equipment available. If a patient, family, or site staff report faulty or lack of equipment, the provider is to notify the director of tele triage. Providers are to complete documentation and sign all orders specific for the telemedicine visit immediately after completing the visit. All narcotic prescriptions are to be managed per Eventus RX Policy. Notify patient’s regular provider of visit and triage treatment plan via EMR. On-call telehealth scheduling may be modified as needed. Providers are expected to adhere to the newest agreed upon triage schedule. Establish and maintain open and positive communications with facility staff and administration. Provide verbal and/or written instruction or feedback regarding medications and other pertinent caregiver information. Give time for questions to be asked by patient, family, or staff members. Establish when the patient should be seen next. All required data to be collected and documented same day. Be knowledgeable of and adhere to Eventus standards, policies, and procedures. Be aware of and adhere to all legal and regulatory agencies' rules, guidelines, and professional ethical standards. Comply with all regulatory agencies governing health care delivery. Always conduct self in a professional manner, this includes avoiding gossip, avoiding negative comments about other staff or competitors, maintaining appropriate interpersonal boundaries, and avoiding dual relationships (this includes refraining from offering medical or psychotherapy services to facility staff or family members, avoiding accepting gifts from patients, etc.), and observing appropriate professional attire when on call. Perform other duties and activities as appropriate and/or assigned by Eventus Management. Always maintain patient confidentiality including appropriate use of Cell phone, emails text messaging, patient charts and EMR. Agrees to abide by and be knowledgeable of HIPAA rules and regulations Maintain multiple practice licenses and comply with each state’s practice regulations, as requested by Eventus.

Pear Suite

Nurse Practitioner - Telehealth

Posted on:

February 27, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Pear Suite is a mission-driven healthcare technology company transforming how community-based care is delivered. Our platform empowers community health workers, doulas, and other frontline providers with tools to coordinate care, track outcomes, and improve health equity. We partner with organizations serving Medicaid and Medicare populations, delivering social and preventive care at scale. Pear Suite Provider Group, P.A. a wholly owned subsidiary of Pear Suite, Inc. is a provider group connecting patients to Community Health Worker services, helping them overcome barriers to care, improve stability and achieve better health outcomes.

We're seeking a compassionate, experienced Nurse Practitioner to provide telehealth based primary care with a focus on addressing social determinants of health (SDOH). In this role, you will conduct clinical assessments enabling patients to access Community Health Worker (CHW) services, helping them overcome barriers to care, improve stability and achieve better health outcomes. This is a patient-centered role that blends clinical judgment with care coordination in a value-based, whole-person care model. Why this role matters: For many patients, health outcomes are shaped as much by housing instability, transportation challenges, and access to resources as by clinical conditions. This role plays a critical part in identifying those barriers and activating the right supports. As a Nurse Practitioner on this team, you serve as the clinical gateway to CHW services, helping reduce avoidable emergency department use, improve continuity of care, and ensure patients receive the right support at the right time.

Active unrestricted Nurse Practitioner license with prescriptive authority. Multistate compact licensure preferred (especially AZ, CA, CO, DE, FL, HI, KS, KY, LA, MI, NV, NM, NY, OH, RI, WA, WI) Primary care experience preferred, telehealth experience a plus. Experience working with Medicaid and Medicare populations. Strong understanding of social determinants of health and their impact on patient outcomes. Comfortable with telehealth platforms and building rapport virtually. Excellent communication skills and ability to engage patients from diverse backgrounds. Familiarity of state and federal requirements for CHW referrals or a willingness to learn.

Conduct telehealth visits (typically 99202/99203 level). Perform comprehensive clinical assessments to identify health needs and social barriers to care. Provide medical clearance and referrals for CHW services, including care coordination and community based support. Develop individualized care plans addressing both clinical needs and social determinants of health factors. Collaborate closely with Community Health Workers to support patient engagement and follow-through. Manage prescription refills and ongoing primary care needs as appropriate. Document visits accurately to meet state, federal, payor and program requirements, Help patients navigate complex healthcare systems and connect to community resources.

US Tech Solutions

Clinical Reviewer RN

Posted on:

February 27, 2026

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

Duration: 5-month contract (With possible extension) *Note: Candidate must hold an unrestricted Massachusetts RN license. Compact licensure is not required. Overview: We are seeking an experienced Inpatient RN Utilization Reviewer to independently manage a clinically complex inpatient caseload across multiple care settings, including acute, subacute, rehabilitation, and LTAC. This role is responsible for determining medical necessity and benefit coverage across multiple lines of business, including government-sponsored health plans. The ideal candidate is a self-directed clinical professional with strong utilization management experience, sound judgment, and the ability to balance clinical decision-making with health plan business objectives.

Education & Licensure: Registered Nurse with a current, unrestricted state license BSN preferred Experience: Minimum 3 years of clinical nursing experience Minimum 3 years of utilization management experience (inpatient or managed care preferred) Skills & Competencies: Strong clinical judgment and decision-making skills Excellent communication, negotiation, and interpersonal skills Ability to work independently in a fast-paced environment Strong time management and organizational skills Proficiency with or ability to learn UM systems and web-based communication tools Working knowledge of Microsoft Word, Excel, and related applications Flexibility to manage shifting priorities and caseloads Additional Notes: Holiday and weekend rotation may be required Role requires frequent interaction with providers and internal stakeholders

Perform inpatient utilization management and discharge planning activities. Apply nationally recognized clinical criteria (e.g., InterQual, MCG) to determine medical necessity, level of care, and readiness for transition. Make timely, clinically appropriate, and cost-effective coverage determinations. Manage a complex caseload independently while collaborating with internal clinical teams. Communicate effectively with providers to facilitate care transitions across the continuum. Apply product-specific payment and reimbursement models such as DRG, case rate, or per diem structures. Identify issues requiring escalation and collaborate with leadership and cross-functional teams. Maintain accurate documentation in accordance with departmental standards. Participate in quality activities, audits, mentoring, and special projects as assigned.

Curana Health

Care Navigator - Georgia (remote)

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

None Required

State License:

Georgia

At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you.

The Care Navigator supports Curana providers and care managers with non-clinical tasks. The ideal candidate possesses a strong background in medical administration, excellent communication skills, and the ability to adapt to virtual platforms.

Required Education and Experience: High school diploma or equivalent. 1+ years of experience working in a medical office, Senior Living Community engagement, or other related fields 1+ years of experience in Electronic Health Record (EHR) documentation or other practice management tools. Required Skills: Extensive understanding of medical terminology. Ability to interpret medical records, lab results, and appointment notes. Equipped with the basic knowledge of reviewing patient screening tools and the ability to identify changes over time. Ability to work in an environment that is free of distractions. Excellent organizational and time management skills with the ability to prioritize tasks. Skilled at handling multiple tasks simultaneously. Proficient computer skills and ability to adapt to various technology platforms Preferred Education and Experience: Prior experience with virtual triage. Bilingual or multilingual communication skills. Travel Requirements: 100% remote position requiring a reliable high-speed internet connection.

Patient Support: Address patient and durable power of attorney (DPOA) inquiries via telephone. Respond to patient or caregiver messages received via the Curana Patient Portal. Assist patients with scheduling follow-up appointments with Curana Providers or specialists. Provider Support: Manage electronic health records (EHR) and ensure accurate and up-to-date patient records. Coordinate documents needed for review or signature by a provider. Facilitate provider orders and escalate findings. Maintain patient rosters for patients enrolled in Advanced Primary Care Management (APCM) and Guiding an Improved Dementia Experience (GUIDE) Support Provider scheduling. Assists with prior authorizations. Obtains patient records and diagnostic test results. Communication Support: Answer and manage incoming calls professionally and courteously. Collaborate with the Curana Interdisciplinary Care Team to ensure seamless communication within our health network. Other duties as assigned

Curana Health

Utilization Management Nurse

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Texas

At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you.

The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The role includes providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures. This includes providing prior authorizations, concurrent review, proactive discharge/transition planning, and high dollar claims review. There is a heavy emphasis on concurrent review and proactive transition planning, and high dollar claims review. There is a heavy emphasis on concurrent review and proactive transition planning for members in the hospital and skilled nursing facility. This is primarily a remote telephonic position with normal business day hours, with one weekend day per month coverage. This position serves as a liaison to the Plan Medical Director working closely with appeals and medical decisions.

Minimum 2 years clinical experience as RN, LPN/LVN required. Minimum 1-year managed care or equivalent health plan experience preferred. Demonstrated experience in health plan utilization management, facility concurrent review discharge planning, and transfer coordination required. Medicare Advantage experience preferred. Experience with InterQual or MCG authorization criteria preferred. Excellent computer skills and ability to learn new systems required. Strong attention to detail, organizational skills and interpersonal skills required. Demonstrated ability to problem solve and manage professional relationships. Certificates, Licenses and Registrations: Active unrestricted Nursing license required.

Performs concurrent and retrospective reviews on all facility and appropriate home health services. Monitors level and quality of care. Responsible for the proactive management of acutely and chronically ill patients with the objective of improving quality outcomes and decreasing costs. Evaluates and provides feedback to member’s providers regarding a member’s discharge plans and available covered services, including identifying alternative levels of care that may be more appropriate. As part of the hospital prior authorization process, responsible for determining “observational” vs “acute inpatient” status. Integral to the concurrent review process, actively and proactively engages with member’s providers in proactive discharge/transition planning. Actively participates in the notification processes that result from the clinical utilization reviews with the facilities. Prepares CMS-compliant notification letters of NON-certified and negotiated days within the established time frames. Reviews all NON-certification files for correct documentation. Maintains accurate records of all communications. Monitors utilization reports to assure compliance with reporting and turnaround times. Addresses care issues with Director of Quality and Care Management and Chief Medical Officer/Medical Director as appropriate. Coordinates an interdisciplinary approach to support continuity of care. Provides utilization management, transition coordination, discharge planning and issuance of all appropriate authorizations for covered services as needed for providers and members. Coordinates identification and reporting of potential high dollar/utilization cases for appropriate reserve allocation. Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum. Clarifies health plan medical benefits, policies and procedures for members, physicians, medical office staff, contract providers, and outside agencies. Responsible for the early identification of members for potential inclusion in a Chronic Care Improvement Program. Assists in the identification and reporting of Potential Quality of Care concerns. Responsible for assuring these issues are reported to the Quality Improvement Department. Work as interdisciplinary team member within Medical Management and across all departments. Other duties as assigned.

CVS Health

Health Coach Consultant - Registered Nurse

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Coaching

License:

RN

State License:

Compact / Multi-State

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary This is a full-time telework role. Working schedule: Monday-Friday, standard business hours, including 2 evening shifts per week from 11:30am-8pm CST. Rotating Saturdays will required about once per quarter following training. Will have back-to-back appointments scheduled with members each day. Position Summary: The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status.

Required Qualifications: Active and unrestricted RN licensure in the state of residence. 3+ years of clinical experience Must possess or be willing and able to obtain high speed broadband internet access Preferred Qualifications: Compact RN Licensure Previous coaching experience Managed care experience Experience with Microsoft Word, Outlook, Excel, and comfortable using various computer programs Education: Associate's degree required

Assessment of Members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. Enhancement of Medical Appropriateness & Quality of Care: Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. Using holistic approach consults with supervisors, Medical Directors and/or others to overcome barriers to meeting goals and objectives. Identifies and escalates quality of care issues through established channels. Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Interprets and utilizes clinical guidelines/criteria to positively impact members health. Provides up-to-date healthcare information to help facilitate the member¡¦s understanding of his/her health status. Helps member actively and knowledgably participate with their provider in healthcare decision-making. Monitoring, Evaluation and Documentation of Care Develops and monitors established plans of care, in collaboration with the member and/or attending physician, to meet the member's goals. Utilizes internal policy and procedure in compliance with regulatory and accreditation guidelines.

Sedgwick

Telephonic Case Manager

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Tennessee

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

PRIMARY PURPOSE OF THE ROLE: While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

EDUCATION AND LICENSING: Current unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.

Performs initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems. Effectively communicates and builds relationships with the claims’ examiner, client, injured worker, attorney and supervisor. Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approach Negotiates treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality. Identifies opportunities to expedite care for cost containment and timely medical recovery. Provides recommendations for alternate clinical resources to support claim resolution. Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

Sedgwick

RN Clinical Consultation Full Time

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

RN Clinical Consultation Full Time We are looking to add 2 full time nurses. If you can work any of these shifts, please apply. This class starts 3/30-no exceptions. 1130am-8pm CST M-F with a weekend rotation 6pm-230am CST M-F with a weekend rotation PRIMARY PURPOSE OF THE ROLE: To triage calls to assess needs, giving appropriate care advice and disposition to appropriate level of care treatment while promoting cost-effective outcomes and safely facilitate return to work. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. Enjoy flexibility in your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

EDUCATION AND LICENSING: Bachelor's degree in nursing (BSN) preferred. Active unrestricted RN compact licensure required along with two year (2) years of recent clinical practice experience. Should be proficient in multiple screens and multiple computer applications,. TAKING CARE OF YOU BY: Seeks innovative customer solutions . Craves cutting edge opportunities. Wants dynamic company culture. Passion about creativity. Seeks ongoing learning as a person and professional. Thrives when solving challenging problems. Wants achievements to be celebrated. We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

Applies all phases of the nursing process, i.e. assessment, planning, implementation and evaluation when triaging calls. Identifies the needs of caller by triaging, obtaining general health information and/or physician services referral. Evaluates need for alternative treatment through telephonic contact and assessment with service provider. Triages patient using defined triage protocols to obtain pertinent data; and enters data into computer system. Identifies life-threatening emergencies and recommends appropriate interventions. Refers issues requiring physician interventions to physician in a timely manner; directs patients to appropriate level of care including but not limited to the nearest emergency room, urgent care facility, primary treating physician or selfcare. Demonstrates effective verbal communications skills. Adheres to quality assurance standards. Serves as resource to triage team members.

DataAnnotation

Clinical Appeals Nurse

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

None Required

State License:

New Jersey

Welcome to DataAnnotation! We pay smart folks to train AI. We offer a remote, flexible work model- you choose your own hours and get to work when you want, whenever you want. Apply now through our open Job Listings.

We are looking for a Clinical Appeals Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model. In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Clinical Documentation & HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement & Patient Safety, Regulatory Compliance, Accreditation & Medical Staff, Care Coordination & Case Management, Population Health & Value-Based Care, and Managed Care & Utilization Management. Benefits Full-time or part-time remote position Choose which projects you want to work on Flexible schedule Projects are paid hourly starting at $50+ per hour Bonuses available for high-quality and high-volume work

Fluency in English (native or bilingual level) A current or in-progress medical or healthcare-related degree

Provide AI chatbots with diverse and complex healthcare-related problems Evaluate AI outputs for logic, accuracy, and performance Ensure the medical accuracy and overall quality of model responses

Prista Corporation

Clinical Application Specialist (RN Preferred)

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Prista Corp's ActionCue CI is a centralized Clinical Intelligence platform designed to deliver efficient management of healthcare facilities, providing Quality, Risk and Performance Improvement insights for healthcare providers. With ActionCue, hospitals use one system across multiple locations to take a proactive approach to improving quality while simplifying reporting.

As a Clinical Application Specialist, you are responsible for the implementation and support of Prista’s software solutions, ensuring a seamless experience for clients. You will work directly with healthcare organizations to deploy ActionCue Clinical Intelligence, provide training, resolve issues, and contribute to continuous improvement initiatives. Additionally, you will research and monitor healthcare regulations and quality metrics from accrediting bodies and communicate updates internally. Mission — Why This Role Exists The Clinical Application Specialist ensures that healthcare organizations achieve meaningful improvements in quality, risk, and performance through effective use of ActionCue CI. This role bridges clinical expertise, regulatory intelligence, and technology to support compliance, data-driven decision making, and enhanced patient outcomes.

Skills & Qualifications: 5+ years of relevant clinical experience. Degree in Nursing or a related clinical field, or equivalent experience. Knowledge of healthcare regulations. Strong background in healthcare quality and risk management. Subject matter expertise in quality assessment performance improvement (QAPI), regulatory compliance, and clinical risk management. Strong understanding of patient safety and quality metrics. Experience in training and educating healthcare professionals on quality and risk-related topics. Certification in healthcare quality or risk management (e.g., CPHQ, CPHRM) is a plus. Excellent critical thinking and problem-solving skills. Strong communication abilities. Ability to manage multiple priorities. Proficient with healthcare IT systems and Microsoft Office. Team-oriented with proactive mindset.

Lead the implementation of ActionCue CI for new clients, ensuring timely and effective onboarding. Conduct audits of client instances and resolve findings to support continuous improvement. Deliver ongoing training and education to clients to enhance the clients’ overall experience. Provide front-line support via the help desk, troubleshooting and resolving user issues in a timely manner. Develop resources (User Guides) for ActionCue CI. Maintain and update internal training documentation. Collaborate with product teams to represent customer needs. Participate in special projects and cross-functional initiatives as needed.

Reimagine Care

Clinical Program Coordinator, RN

Posted on:

February 27, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Tennessee

At Reimagine Care, we start with a simple truth: people facing cancer need support that meets them where they are, when they need it most. They deserve to thrive as whole human beings, surrounded by the support they need. We partner with oncology providers to make this possible through an AI-enabled care platform that extends compassionate, expert care beyond clinic walls. Our technology doesn't replace the human touch; it amplifies it. By providing 24/7 access to oncology-trained clinicians and resolving 95% of patient needs virtually, we reduce avoidable emergency visits and free physicians from the constant cycle of after-hours calls and administrative burden. The result is transformative for everyone: patients receive proactive, whole-person support for their clinical, emotional, and social needs, while oncologists reclaim the capacity and joy that drew them to medicine in the first place. Our vision: harness the power of AI to make cancer care profoundly more human, accessible, and sustainable for everyone it touches. We're building the trusted standard for how patients and providers navigate cancer together.

The Clinical Program Coordinator, RN, supports the execution, maintenance, and continuous improvement of Reimagine Care’s clinical programs while maintaining active clinical practice within the Virtual Care Center (VCC). This hybrid role partners with Clinical Programs, Operations, Clinical Leadership, Implementation, Product, and Technology teams to ensure programs are operationalized effectively and grounded in real-world patient care. By combining frontline clinical experience with program coordination, this role helps translate strategy into day-to-day workflows and supports the delivery of safe, high-quality virtual oncology care. This role supports the Clinical Program Manager in operationalizing clinical programs, translating program design into day-to-day workflows, and ensuring deliverables, timelines, and clinical standards are met. Time allocation between program coordination and direct patient care will be defined based on organizational needs. This role is expected to take night and weekend calls.

Registered Oncology Nurse (RN) with a Bachelor of Science in Nursing 1–4 years of oncology, care coordination, navigation, or virtual care experience Preferred OCN Certification Experience with remote monitoring, virtual care, or care management programs Experience with clinical workflows, pathway development Comfort working with product and technology teams Strong organizational, communication, and documentation skills Ability to work cross-functionally in a fast-paced environment High attention to detail and process orientation This is a remote position, but the employee must reside in the United States.

Clinical Program Operations & Coordination: Support the Clinical Program Manager in executing clinical programs across new and existing clients and products Develop and maintain clinical program documentation, workflows, and pathway materials Track milestones, decisions, and action items across program workstreams Identify workflow improvement opportunities and escalate recommendations​​​​​​. Product & Technology Collaboration: ​​​​​​​Provide frontline clinical input into product workflows and pathway design Assist in translating clinical workflows into structured documentation Participate in user acceptance testing and pilot activities Support Clinical Program Managers in preparing materials for new features, enhancements, and program updates Help identify gaps between intended workflows and real-world clinical practice Virtual Care Center Clinical Practice: ​​​​​​​Deliver direct patient care through the Virtual Care Center, including symptom assessment, triage, education, and care coordination for oncology patients Review patient-reported outcomes and physiologic monitoring data and support escalation pathways Bring frontline insights back into program design, workflow improvements, and product requirements Support quality reviews, audits, and identification of safety improvement opportunities

Mercor

Clinical Nurse Specialist

Posted on:

February 27, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Mercor is at the intersection of labor markets and AI research. We connect human expertise with leading AI labs and enterprises to train frontier models.

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey. Position: Medical Expert Type: Contract Compensation: $60–$160/hour Commitment: Flexible hours

Must-Have: Relevant higher education degree and professional certificates (e.g., Nursing license, MD, PhD). 3+ years of relevant experience. Demonstrated clinical experience in patient care settings. Strong understanding of medical terminology, procedures, and standards of care. Experience with clinical documentation, case review, or similar evaluative tasks. Excellent communication skills with attention to detail.

Review and validate clinical content, scenarios, and annotations for medical AI workflows. Provide domain-expert feedback on model outputs related to nursing and patient care practices. Advise on clinical guidelines, best practices, and potential safety concerns. Assist in crafting realistic clinical use cases and medical question sets. Communicate insights and recommendations clearly to technical and non-clinical teams.

Prudential Financial

Clinician (Virtual)

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

New Jersey

For over 100 years, Prudential’s diverse and talented employees have been committed to helping customers and their families grow and protect their wealth through a variety of products and services, including Group Insurance. We are known for delivering on our promises and are recognized as a trusted brand and one of the world’s most admired companies.

The Business: Prudential is a company of smart, ambitious professionals working together across a multitude of disciplines. Together, we are building a better financial future for our customers and our communities around the globe. At Prudential, we understand that a company is only as good as its people. This simple fact is central to all that we do. The current EWA for this position is Fully Virtual. While this position does not require your on-site presence on a regular basis, depending on business preferences, there may be occasions where you are required to be on-site at a Prudential office. What you can expect: In this role, you will be reviewing medical documentation in case files to make determinations on medically supported restrictions and limitations for clients. Our clinicians work in collaboration with our claim’s teams, our physicians, our return-to-work coordinators, and vocational departments to resolve the best course for claim management.

Currently licensed RN or Nurse Practitioner. 3+ years of clinical experience preferred. Excellent time management and organizational skills. Possess excellent analytical and critical thinking skills to assist in strategy development. Effective written and verbal communication skills to document clinical assessment.

Review and assessment of primarily complex illness and injury claims. Identify restrictions and limitations based on physiological, psychological, and social factors to assist claim management staff in their claim handling activities. Assist in strategy as well as identifying appropriate utilization of additional clinical, vocational, or other resources which will require excellent analytical and critical thinking skills. Apply effective written and verbal communication skills to document clinical assessments; contact Treating Providers; engage in discussions with other resources including but not limited to Disability Claim Team Members, Clinical Peers, and Vocational Rehabilitation Counselor Resources. Demonstrate urgency and adaptability to address the demands of a fast-paced environment, while consistently achieving established quality and quantity performance standards. Ability to work independently with minimal direct supervision.

Devoted Health

Clinical Guide Part A: Utilization Management (Inpatient, Behavioral Health & Post-Acute)

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Massachusetts

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Schedule: This role supports our weekend operations and requires availability every Saturday and Sunday. The weekly schedule is a 5-day (8-hour) schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET. A bit about this role: The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient, behavioral health, and/or post-acute authorization review in alignment with CMS and Medicare Advantage regulations. Reviews medical records to evaluate the medical necessity and appropriateness of requested inpatient and/or post-acute services in accordance with established clinical criteria and CMS guidelines.

Required skills and experience: Unrestricted RN license with a minimum of 4 years of clinical experience. Minimum 3 years of Utilization Management or Inpatient UR experience within a health plan or hospital setting. Strong knowledge of CMS regulations and Medicare Advantage requirements. Experience preparing cases for Medical Director review Able to work in a fast paced environment that is constantly evolving. Desired skills and experience: Experience with AI/LLM Certified in InterQual

Review Medical Records: Conduct prospective (pre-service), concurrent, and retrospective utilization review to evaluate medical necessity, appropriate level of care (Inpatient vs. Observation), and post-acute services in accordance with established clinical criteria and CMS guidelines. Evaluate Treatment Plans: Assess the appropriateness, timing, and setting of requested services, ensuring alignment with medical necessity criteria and Medicare Advantage requirements. Recommend alternative levels of care when clinically appropriate. Inpatient & Behavioral Health Review: Perform initial, concurrent, and discharge reviews for inpatient and behavioral health admissions. Ensure admission status accuracy and regulatory compliance with CMS timeliness (TAT) standards. Post-Acute Review: Conduct initial authorization and concurrent review for post-acute services (SNF, LTACH, ARU, Home Health), evaluating ongoing medical necessity and appropriate length of stay. Issue NOMNC when coverage criteria are no longer met. Medical Director Collaboration: Refer cases that do not meet criteria to the Medical Director for secondary review and final determination. Prepare clinical summaries and coordinate peer-to-peer (P2P) discussions. Manage authorization reopen requests as appropriate. Resource Stewardship: Monitor utilization of inpatient and post-acute services to promote appropriate resource use while maintaining high-quality, member-centered care. Regulatory & Documentation Compliance: Maintain accurate, defensible documentation of all determinations. Ensure adherence to CMS regulations, Medicare Advantage requirements, and internal compliance standards.

Devoted Health

Clinical Guide: UM Nurse (Outpatient Prior Authorization)- REMOTE

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Massachusetts

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Schedule: This role supports our weekend operations and requires availability every Saturday and Sunday. The weekly schedule is a 5-day (8-hour) schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET. A bit about this role: As a Clinical Guide, you'll have the opportunity to make a difference in the lives of our members. You'll be responsible for providing clinical review of cases using standard criteria to determine the medical appropriateness of inpatient and outpatient services while supporting our members through assessment, care, and conservation. You'll serve as an advocate for our members, coordinating care and ensuring they have the necessary resources and support to achieve their health goals (recovering from an illness, improving quality of life, overall well-being, etc.) Our Clinical Guide is committed to integrity and excellence and empowering members to confidently navigate the healthcare system and live healthier lives. Our ideal Clinical Guide is caring, compassionate and solutions-oriented, and is enthusiastic about providing outstanding experience for Devoted Health’s members.

Required skills and experience: Ability to work in a startup, fast paced environment. An unrestricted RN license. A minimum of 4 years of RN experience. A minimum of 3 years’ experience doing utilization management at a health plan. The ability to comfortably multi- task: you’ll be listening, talking, and typing all at the same time. Team player mentality with a can-do attitude. Understanding of CMS guidelines and MA requirements. Desired skills and experience: A desire to make a change in the health care experience: you love to serve and make a difference. Proven success in building relationships. The ability to adjust your tone and approach to different people. The ability to articulate and break down complex information. Adaptability and comfort in a dynamic, startup environment. Transparency in your work - what’s going well and what’s not.

Engage with members and understand their needs, using technology and data to better understand the member and any unspoken needs. Performs initial, concurrent, and discharge reviews of all cases, including using medical guidelines to determine the medical appropriateness of inpatient and outpatient services; assessing, interpreting, and responding to the needs or requirements of patients; identifying, escalating and resolving complex cases or issues as required. Reviews current charts for appropriateness and correct admission status (inpatient, observation, bedded outpatients). Alerts and collaborates with appropriate leadership concerning patients who do not meet medical appropriateness criteria. Obtains admission and continued stay certification or recertification. Communicates with an attending physician regarding patients who do not meet criteria to identify additional documentation needs or potential status change. Coordinates care and discharge planning. Makes arrangements for appropriate post-hospital care, including physical and behavioral medicine, transportation, equipment, home health care, etc. Identifies, documents, and communicates potential quality assurance or risk management issues as appropriate. Conduct holistic assessment to identify co-morbid conditions, ED/ hospitalization history, medications, psycho-social factors, and member values and preferences. Collaborate with our PCP partners. Develop care plans in partnership with members and their caregivers - problems, goals, interventions - continuously evaluating the member’s progress. Work closely with Local Service Guides to identify community-based organizations to support the members in meeting their goals. Collaborate with members, providers, and caregivers to ensure a positive outcome. Explain complicated medical terms in plain language. Educate members on appropriate care and settings based upon their healthcare needs. Support members in understanding diagnostic tests and treatments, including costs, risks, and alternatives so they can make an informed decision. Prepare members for their inpatient and outpatient treatments and coordinate post-treatment care. Support and coach members to improve management of their chronic conditions, including medication adherence and compliance.

HealthCare Recruiters International

Licensed Practical Nurse (LPN/LVN)

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

HCRI is dedicated to both the healthcare and medical manufacturing recruitment field working with major medical facilities and institutions, as well as pharmaceutical and medical product manufacturers. We focus in the areas of middle, upper and executive management, operations, IT, clinical & technical education, sales support and sales, marketing, R&D, etc. Recruiting for healthcare institutions and medical corporations is our primary business and we have been doing it since 1984.

Licensed Practical Nurse (LPN/LVN) – Care Team - Remote Full-Time | Compact (NLC) License Required We are hiring experienced LPNs/LVNs to support Medicare-aged patients enrolled in structured Chronic Care Management (CCM) and Principal Care Management (PCM) programs. This is a fully remote, phone-based care coordination role. Not a home health or hospice visit position.

Active LPN/LVN license with Compact (NLC) privileges Direct CCM and/or PCM experience Experience working with Medicare or elderly populations Strong documentation and workflow adherence Comfortable working independently in a remote setting Competitive compensation based on experience. Structured scheduling. Fully remote.

Manage a defined CCM/PCM patient panel Conduct structured follow-up calls Reinforce RN-developed care plans Document time-based services for Medicare compliance Identify and escalate clinical concerns Coordinate referrals and ongoing care needs

Montage Health

Health Plan Quality RN - Aspire Health

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We’re proud to be a community-centered organization backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Hospital. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It’s the care you need from people you know.

The Health Plan Quality RN plays a key role in leading quality and performance improvement initiatives with a primary focus on CMS Medicare Star Ratings. This position is responsible for the identification, development, and implementation of strategic programs that enhance the health plan’s quality performance and regulatory compliance. The Quality RN provides clinical insight into appeals and grievances, oversees potential quality issues (PQIs), and collaborates across internal teams, provider partners, and external vendors to drive continuous improvement in quality, member outcomes, and satisfaction. Aspire Health is an equal opportunity employer. Pay rate: $64.91 per hour Assigned Work Hours: Full time. Remote Position Type: Regular

Experience: Minimum Required: RN with at least 2 years of health plan experience in the area of Quality (including HEDIS or Stars). MA plan experience preferred. Must have at least 3 years of clinical practice experience. Preferred: Experience in project management in healthcare industry. Experience in health plan quality performance and ratings. Certifications/Licenses RN license state of California (unrestricted). Preferred: Certifications such as CPHQ, CCM, or PMP.

Leads the clinical strategic management of Star Ratings and other value-based performance strategies across the medical management division. Ensures alignment of Stars and quality activities with the organization’s mission and performance goals. Provides oversight and analysis of all regulatory guidance, rules and data related to Star Ratings to continuously monitor performance and proactively identify risks and barriers. Provides education, understanding and subject matter expertise regarding the performance measures; highlights the significant impacts of improved ratings with community partners. Coordinates activities throughout the organization to drive clinical improvements in provider engagement, clinical care, data integrity, customer satisfaction, and communication with members and providers. Develops, implements, and monitors the Stars Program and tactical work plan through complete understanding of the CMS Medicare Star Ratings. Tracks and reports progress toward organizational clinical quality goals, ensuring accountability across teams. Understands organizational clinical and operational activities related to Stars measures and other value-based performance measures to ensure alignment and identifies opportunities for collaboration and continuous improvement. Facilitates the integration of quality initiatives within daily operations and clinical workflows. Designs and implements tools as needed to monitor performance. Conducts clinical measure risk assessments to proactively identify risks to measure performance and creates cross-functional plans to mitigate risks. Performs preliminary clinical review of appeals and grievances cases with SBAR for CMO to review. Creates and manages the PQI process, including investigations, provider communication, and peer review preparation. Ensures alignment with delegated responsibilities by line of business (Medicare Advantage and employer plans). Uses data to drive initiatives. When necessary, manages external vendor relationships as they relate to value-based performance activities. Is highly-organized and collaborative, demonstrating the ability to work independently and meet deadlines. Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge and abilities to perform, within scope, role specific functions Other duties as assigned

HealthSnap

Care Navigator (Remote LPN)

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

HealthSnap (healthsnap.io) empowers patients and their physicians to improve health outcomes using an innovative platform for modern, proactive patient care. We help healthcare organizations easily manage chronic conditions remotely, and deliver personalized patient experiences when it's needed most. Be part of an organization built on teamwork, innovation, mutual respect, and equality for all. We believe in the power of prevention over treatment, after our co-founders experienced how modern healthcare failed their loved ones, they knew there had to be a better way. We believe that every patient deserves to receive the right care, at the right time, and in the right location - regardless of their condition or status. We lead with empathy above all else, and place the patient at the center of everything we do. Working at HealthSnap means being part of a family and a team where if you win, we all win, no matter how big or small the accomplishment. We take ownership - and lead with empathy - and expect each employee to recognize that real patients rely on HealthSnap every day.

We are hiring LPNs in multiple states to support patients who are enrolled in chronic care management and/or remote patient monitoring programs. This is done in partnership with the patients’ care team which may include primary or specialty physician practices or healthcare systems. Successful candidates will bring experience in educating patients on chronic diseases such as hypertension and diabetes. This is a full-time position that operates Monday through Friday, 9:00 am to 5:30 p.m. Eastern Time, unless otherwise specified. As a Care Navigator, you will be trained in HealthSnap’s remote patient monitoring platform and will be responsible for communicating with enrolled patients in conjunction with the patients’ care team. Care Navigators typically have an assigned group of patients for which the Care Navigator is responsible for assisting throughout the month. Care Navigators also assist with other patients or patient tasks as assigned. Above all else, you will play an essential role in establishing a relationship with assigned patients that allows you to empower them to manage their chronic illnesses and improve their health. ** Massachusetts Nursing License Required ** Please note: Pay is state-specific. The posted range applies to MA residents; candidates in other states will receive compensation aligned with their state of residence. ** Additional Compact Nursing License Preferred **

Education: A current, valid, and in good standing Multistate/Compact Nursing License (LPN/LVN) Additional state licenses may be required and will be reimbursed by HealthSnap Experience: 3+ years of experience in primary care practice, cardiology, internal medicine, home care, or chronic care management/remote patient monitoring Skills: Strong communication and interpersonal skills Excellent organizational and time management abilities Proficiency in using electronic health records (EHR) and care management software Ability to work independently and as part of a team Empathy and a patient-centered approach to care Technical Requirements: Reliable internet connection and HIPAA-compliant work area and proficiency with virtual communication tools (e.g., Zoom, Slack)

Patient Support: Complete phone consultations with patients enrolled in care management and/or remote patient monitoring programs providing support and education about their chronic conditions. Education and Empowerment: Educate patients about their health conditions and empower them with lifestyle and behavior strategies to actively manage their chronic conditions. Assist patients to set and reach goals in line with their provider-approved care plans. Documentation: Maintain accurate and up-to-date patient records, ensuring all interactions and care plans are documented per protocol. Problem Solving: Address patient concerns and barriers to care, working to find practical solutions to improve patient adherence and outcomes. Communication: Provide clear, compassionate, and effective communication to patients. Follow approved workflows regarding communicating patient needs to their providers. Continuous Improvement: Participate in training sessions, team meetings, and quality improvement initiatives to enhance the care navigation process and patient experience. Evaluation and Responding: Respond to remotely transmitted patient data such as blood pressure, blood glucose, weight, and pulse oximetry according to approved partner workflows.

HealthSnap

Care Navigator - New York License Required

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

Compact / Multi-State

HealthSnap (healthsnap.io) empowers patients and their physicians to improve health outcomes using an innovative platform for modern, proactive patient care. We help healthcare organizations easily manage chronic conditions remotely, and deliver personalized patient experiences when it's needed most. Be part of an organization built on teamwork, innovation, mutual respect, and equity for all. We believe in the power of prevention over treatment, after our co-founders experienced how modern healthcare failed their loved ones, they knew there had to be a better way. We believe that every patient deserves to receive the right care, at the right time, and in the right location - regardless of their condition or status. We lead with empathy above all else, and place the patient at the center of everything we do. Working at HealthSnap means being part of a family and a team where if you win, we all win, no matter how big or small the accomplishment. We take ownership - and lead with empathy - and expect each employee to recognize that real patients rely on HealthSnap every day.

As pioneers of the next generation of healthcare, we are seeking a highly motivated, compassionate candidate dedicated to clinical excellence for our Care Navigator position to directly impact patient health through HealthSnap’s remote care solutions. We are hiring New York-certified LPN/LVNs to support patients who are enrolled in chronic care management and/or remote patient monitoring programs. This is done in partnership with the patients’ care team which may include primary or specialty physician practices or healthcare systems. Successful candidates will bring experience in educating patients on chronic diseases such as hypertension and diabetes. This is a full-time 40-hours-per-week role Monday-Friday. As a Care Navigator, you will be trained in HealthSnap’s remote patient monitoring platform and will be responsible for communicating with enrolled patients in conjunction with the patient’s care team. Care Navigators typically have an assigned group of patients for which the Care Navigator is responsible for reaching throughout the month. Care Navigators also assist with other patients or patient tasks as assigned. Above all else, you will play an essential role in establishing a relationship with assigned patients that allows you to empower them to manage their chronic illnesses and improve their health. ** New York Nursing License Required ** ** Additional Compact Nursing License Preferred **

A current, valid, and in good standing New York Nursing License (LPN/LVN) A current, valid, and in good standing Multistate/Compact Nursing License (Preferred) 3+ years of experience in cardiology practice (preferred) or primary care practice, home care, or chronic care management Experience in remote monitoring and/or virtual care management program(s) (preferred) Employee must have a HIPAA-compliant area to work remotely Employee must have a distraction-free work environment Employee must provide reliable internet of 100mbps download minimum and 10mbps upload minimum

High level of computer literacy, comfortable learning and using digital health portal Conducts virtual consultations with patients, focusing on patient education for lifestyle and behavior as it relates to clinical status Patient load assigned based on practice need Following approved partner workflows, reviews and responds to remotely transmitted patient data such as blood pressure, blood glucose, weight, and pulse oximetry. Documents patient communication in patient records Responsible for assisting patients in setting up their device Works collaboratively with other team members when help is needed Able to work independently Possess excellent time management and organizational skills Engaging personality with the desire to learn new topics in lifestyle medicine Ability to acquire, interpret, and convey clinical research Pays attention to detail for each task Additional duties as assigned

Medix™

UM RN/LVN (Inpatient) - 250642

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.

The Inpatient Review Nurse supports patients through the continuum of care by collaborating with physicians, case managers, discharge planners, ancillary service providers, and community resources. This role ensures patients receive the most appropriate, cost-effective, and safe level of care. RN Pay: $45-$52 LVN Pay: $37-$43 Shift: Tuesday - Saturday OR Sunday - Thursday (8am-5pm PST)

Active, unrestricted RN or LVN license in California 2 years of experience conducting concurrent review for inpatient services in a managed care setting Medicare Advantage experience heavily preferred 1+ year applying UM criteria (CMS LCD/NCD). 1+ year experience applying clinical criteria (MCG)

Conduct inpatient reviews for patients with complex medical and social needs. Review inpatient admissions promptly, applying evidence-based guidelines to determine level of care and continued stay. Coordinate care with contracted ancillary providers, community agencies, and IPA/MGs as necessary. Perform follow-up reviews in ambulatory or lower levels of care settings. Communicate effectively with patients, families, physicians, and care teams to support safe, coordinated care. Identify members needing complex or chronic case management post-discharge; facilitate warm handoffs to ambulatory care teams. Oversee daily activities of CCIP Coordinators. Record all communications and care activities in EZ-Cap and/or case management systems. Participate in multidisciplinary patient care conferences and rounds. Monitor, document, and report clinical criteria in line with UM policies and procedures. Track and report utilization patterns, including overutilization and underutilization. Refer cases as appropriate to the Quality Management department. Enter data for case management reporting. Provide regular updates on open cases to the Medical Director, Director of Healthcare Services, and UM Manager.

WEP Clinical

Clinical Research Nurse - Home Visits (PRN)

Posted on:

February 26, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

At WEP Clinical, we operate as a specialist CRO with a proven track record of excellence in designing, managing, and executing Clinical Trials, Expanded Access Programs (EAPs), and Commercialization Solutions across the globe. Through our strong customer service and proactive project management, we are committed to scientific integrity, regulatory compliance, and patient-centric research, helping Sponsors advance their life-changing therapies while providing greater access opportunities for patients.

Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse – Home Visits (PRN), you’ll provide high-quality nursing care directly in patients’ homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work. Key Points to Know: You’ll use your own vehicle to visit patients in their homes, typically within 1–2 hours of your location. Shifts are PRN / per diem, meaning you’ll work only when projects are available in your area; project frequency may vary. Orientation, training, and project-specific instructions are provided before each assignment. You will be compensated for all time spent on training, travel, and patient visits, including documentation. Position: Clinical Research Nurse – Home Visits (PRN) Job Type: Contract, PRN, Per Diem Work Location: Drive up to 1–2 hours to patient homes in your area (travel time compensated!) Job Description: As a Clinical Research Nurse – Home Visits (PRN), you will play a crucial role in ensuring the successful execution of research studies in patient homes. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your expertise and caring nature will help us maintain compliance with each study's protocol and safeguard the well-being of study patients.

Relevant Nurse Licensure CH-GCP Certificate Graduate from an accredited BSN or Associate Degree in Nursing or Nursing Diploma program Minimum 2 years’ post qualification acute care experience Clinical Research experience preferred BLS certification required Experience and knowledge of working in clinical research trials with ICH-GCP (Good Clinical Practice) Certification - (training can be provided) Good basic IT skills, utilizing mobile devices and Microsoft systems Trained in Handling and Transport of Hazardous Substances (training can be provided) A flexible schedule is essential Unencumbered driver’s license, reliable car

Deliver competent, high-quality nursing care to study patients in their homes. Accountable for the competent and confident delivery of high-quality clinical care to patients/participants. Ensure compliance with each study’s protocol by providing thorough review and documentation at each subject study visit. Administer investigational medications/products as needed; Perform patient assessments to determine presence of side effects; notify Principal Investigator of findings/issues. Perform medical tests as outlined in protocol, including, but not limited to: vital signs, specimen collection, electrocardiograms; Process specimens and ship specimens per protocol. Provide patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment. Responsible for adherence to clinical research policies to ensure ethical conduct and protect vulnerable populations. Communicate effectively, promoting open and trusting relationships.

Curai Health

Nurse Practitioner : Weekend Shift 12:00pm - 12:00am PST

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Compact / Multi-State

The pioneer in deploying machine learning into clinical workflows, Curai Health is an AI-powered virtual clinic delivering primary care to more people at a fraction of the cost. Easy-to-use and convenient, Curai Health partners with insurers and health systems to keep patients engaged in their care over time, improving health outcomes and reducing costs. Curai Health has been combining the expertise of clinicians with the efficiencies of artificial intelligence since its founding in 2017. We’re building a diverse, world-class team across multiple disciplines. If you’re interested, we’re always looking for the best kind of people.

At Curai, we believe that access to high-quality healthcare is a fundamental human right, not a privilege. Our mission is to radically transform healthcare by harnessing the power of artificial intelligence and clinical expertise to make care more affordable, accessible, and effective for everyone. We are currently seeking a compassionate, experienced Family Nurse Practitioner to join our weekend care delivery team to provide high-quality, patient-centered, virtual-first primary care to patients across the U.S. Our group practice model is designed to keep you connected, valued and set up for success - wherever you are. The role provides primary care through video visits, live chat and secure messaging supported by Curai’s advanced AI-powered technology and proprietary EMR. In addition to patient-facing shifts, we provide scheduled administrative time for clinical work and professional development activities.

Board-certified Family Nurse Practitioner required 5 or more years of primary care experience required Active, unrestricted Nurse Practitioner license in a minimum of 15 states required: Required to have 2 of the following states: California, Texas, Florida Preference given to state licenses in: California, Colorado, Florida, Illinois, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Texas, Washington Willingness to obtain additional state licenses upon hire is required Telehealth experience strongly preferred Possess excellent communication, clinical judgement and patient engagement skills Self-motivated and independent, with a strong capacity for teamwork and collaboration Proficient in EMR systems preferable Exceptional organizational skills and attention to detail , with the ability to manage time effectively in a remote work environment Adaptable to evolving technology, including AI-driven tools and digital platforms

Conduct comprehensive virtual assessments, diagnoses and evidence-based treatment for patients across various ages and backgrounds utilizing text-based, phone and video visits Manage and coordinate care for chronic conditions Provide preventive care, wellness counseling, and health education to promote holistic well-being Produce clear and efficient encounter visit notes that showcase strong medical decision-making, comprehensive differential diagnoses, and relevant, well-structured care plans Work closely with physicians in collaborative agreements for states that require it

CircleLink Health

Compact RN Care Coach - Remote | High Performance | Unlimited Upside

Posted on:

February 26, 2026

Job Type:

Contract

Role Type:

Coaching

License:

RN

State License:

Compact / Multi-State

CircleLink's AI-enabled care management platform solves patient engagement and enrollment pain-points to boost care management programs. With zero upfront cost, and near zero staff workload, deployment of our platform increases revenue and improves patient outcomes, all while maintaining 98% patient satisfaction. Our latest offering combines AI + RNs to offer the industry's first agentic solution for Medicare's APCM program, including reimbursable gaps-in-care closure.

Contract | Remote | We're hiring 10 elite nurses CircleLink Health is building a team of top-tier Compact Registered Nurses who want more than a typical remote role. This is a performance environment for nurses who thrive on ownership, efficiency, and measurable impact — and who want their income to reflect their output. If you want predictable shifts and low expectations, this isn't the role for you. If you want autonomy, scale, and the ability to grow your earnings, keep reading. The Opportunity You'll manage a large panel of Medicare patients with chronic conditions, delivering monthly clinical calls that drive real outcomes and reduce hospitalizations. This role is built for nurses who can operate independently, manage complexity, and execute consistently at a high level. We expect our Care Coaches to treat this role as their primary professional focus, not a side gig. This Role Is for You If: You want autonomy instead of micromanagement You're comfortable being measured on performance You want your effort to directly impact your income You thrive in structured, fast-paced environments You take pride in efficiency and ownership You want to build a serious remote nursing career

Requirements: Current unrestricted Compact RN license 3+ years clinical experience Strong internet and dedicated workspace Confident with multiple software platforms Strong communication and critical thinking skills Strongly preferred: Case management or chronic disease management EHR experience Motivational interviewing Diabetes education

Run monthly clinical calls with chronic care patients Drive behavior change through coaching and education Maintain precise, compliant documentation using our platform Close preventive care gaps and coordinate services Update care plans and track interventions Support transitions of care to reduce readmissions Manage your panel efficiently and consistently

Health Business Solutions

Clinical Appeals Nurse

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Florida

Founded in 2002, Health Business Solutions (HBiZ) is a high-impact, transitional outsourcing firm that provides near-term relief to overturn denied claims and accelerate cash while concurrently working with providers and health systems to address Revenue Cycle under-performance.

Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview: The Clinical Appeals Nurse supports HBiz’s revenue cycle operations by reviewing denied claims for clinical accuracy and medical necessity, developing evidence-based appeal strategies, and drafting payer-ready appeal documentation. This role plays a critical part in overturning denials, improving reimbursement outcomes, and ensuring compliance with payer policies and clinical standards.

Required: Active Registered Nurse (RN) license in the United States Minimum 3–5 years of clinical nursing experience Strong understanding of medical necessity criteria and payer review processes Experience reviewing medical records and clinical documentation Excellent written communication skills with the ability to translate clinical information into persuasive appeal narratives Preferred: Prior experience in utilization review, case management, CDI, or clinical appeals Familiarity with CMS guidelines, InterQual, Milliman, or similar criteria Experience in hospital or payer-facing environments Bachelor of Science in Nursing (BSN) Core Competencies: Clinical judgment and analytical thinking Strong written and verbal communication Detail-oriented documentation review Ability to manage multiple appeals and deadlines Collaboration across clinical and operational teams Success Measures: Appeal overturn rate and recovery contribution Quality and clarity of appeal documentation Timeliness of appeal submission Identification of systemic denial trends and improvement opportunities

Review medical records and payer denial rationale to determine appeal opportunities Assess medical necessity using clinical guidelines, payer policies, and regulatory standards Draft clear, concise, and evidence-based appeal letters for multiple levels of appeal Collaborate with coding, CDI, denial recovery, and operations teams to strengthen appeal strategy Identify documentation gaps and recommend improvements to reduce future denials Support peer-to-peer review preparation and provide clinical insight when needed Track appeal outcomes and contribute to reporting on overturn rates and trends Maintain compliance with HIPAA, payer requirements, and client confidentiality standards Participate in process improvement initiatives to enhance appeal success and efficiency

Quantum Health

RN, Registered Nurse- Pre-Certification Pharmacy Review (Utilization Management Pharmacy experience required)

Posted on:

February 26, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Ohio

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®. We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

The Pre-Certification Review Nurse – Pharmacy is responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications, to include site of care assessments, for enrollees of Quantum Health’s employer groups. The nurse is responsible for acquiring all clinical documentation to appropriately process the service request within the designated time frames indicated. A successful individual will apply critical thinking to achieve proper clinical decisions when performing clinical reviews. The role requires use of multiple systems, acquisition of all relevant clinical documentation, and other clinical resources to achieve proper decisions in utilization management reviews. The Pre-Certification Review Nurse – Pharmacy will work and collaborate with a multi-disciplinary clinical team of Pharmacists and Medical Directors to provide a customer-centered experience within service level expectations. Location: This position is located at our Dublin, OH campus with hybrid flexibility.

License/Certification: Current and Active license as a Registered Nurse (RN) in the state of Ohio. Licensed Practical Nurses (LPNs) currently employed by Quantum Health may also be considered. Education: Bachelor’s degree in nursing or closely related field or equivalent experience Experience: Minimum of 2 years of direct care nursing experience Ability to obtain additional licenses, as needed (with support from Quantum Health) Strong working knowledge of Network Medical guidelines Experience with Specialty Pharmacy/Pharmaceuticals preferred Makes clinical decisions quickly and at times decides and acts with limited information Excellent critical thinking skills Strong interpersonal skills Excellent verbal and written communication skills Self-directed, organized with excellent time management skills Excellent computer skills including Microsoft applications Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies. Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently. Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.

Review and process all requests for specialty medications and site of care assessment/transitions. Maintain a working knowledge of all clinical processes and workflows, as well as all employer benefit plans and how to access needed information. Work with Medical Director/Physician reviewer and Pharmacy Services team for all requests requiring physician review. May serve as a Subject Matter Expert (SME) for a clinical process or content area. Communicate with members, provider, facility, and all internal work groups regarding outcome of requests. Identification of members who may be appropriate for case management services (Complex, High cost, Transplant) Identify care coordination opportunities and work with clinical teams on as needed basis. All other duties as assigned.

Providence Health & Services

Clinical Program Coordinator RN - Remote

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Washington

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence Health Plan welcomes 100% remote work for applicants who reside in the following states: Washington Oregon

Required Qualifications: 5 years Clinical nursing experience. Upon hire: Current unencumbered Registered Nurse License in state of residency. Experience working with physicians in the collaboration and management of patient care. Preferred Qualifications: Bachelor's Degree in Nursing or health education. Current nursing experience in the following areas: cardiology, endocrinology, pediatrics, obstetrics, oncology, respiratory, health education.

The purpose of this position is to provide care coordination services to Providence Health Plans(PHP) members. Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease. Case management including: triage and referral, transition of care planning, end of life care planning, other acute and catastrophic case management. These services are offered to members and their families who have acute and complex health care needs; members with chronic conditions at risk for poor health outcomes and members who are terminal and nearing end of life. Care management services include nurse education, care coordination and general assistance with managing day to day functional needs; assisting with the management of member health plan benefits and offering assistance finding alternative services when benefits are exhausted. This position works within the health plan framework of managing medical expenses while also working to improve access and quality care to our members.

IntePros

Utilization Review Nurse

Posted on:

February 25, 2026

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.

Utilization Management Nurse Remote – Must Reside in the Tri-State Area (PA, NJ, or DE) Overview: We are seeking an experienced and detail-oriented Utilization Management RN. This position is ideal for a nurse with a strong background conducting inpatient or outpatient reviews in insurance environments.

Experience: Minimum 3 years of acute care clinical experience in an insurer setting. Experience in discharge planning, utilization management, or precertification preferred. Skills & Competencies: Excellent critical thinking, problem-solving, and communication skills. Strong organizational and time management abilities with attention to detail. Proficiency with Microsoft Word, Excel, Outlook, SharePoint, and Adobe; ability to learn new systems quickly. Ability to work effectively in a team-oriented, remote environment. Adaptable, resourceful, and comfortable with change and evolving technology. Committed to diversity, equity, and inclusion, and respectful collaboration with colleagues across all levels.

Evaluate member clinical conditions through detailed medical record reviews to determine medical necessity for requested services. Apply advanced clinical judgment using InterQual, Care Management Policies, Medical Policies, and other resources to make utilization determinations. Contact servicing providers to clarify treatment plans and obtain additional medical information as needed. Review treatment plans and proposed procedures for medical appropriateness and ensure they align with benefit coverage and policy criteria. Refer cases not meeting established criteria to the Medical Director for further evaluation. Identify discharge planning needs early and collaborate with case management or physicians to ensure timely and appropriate transitions of care. Monitor and report utilization trends or potential quality issues, recommending process improvements where applicable. Maintain compliance with state, federal, and accreditation standards for utilization review and documentation. Meet or exceed turnaround and productivity goals for authorization requests. Accurately document all activities in accordance with Care Management and Coordination policies.

SPECTRAFORCE

Grievance and Appeals Nurse – Medicare

Posted on:

February 25, 2026

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Arizona

Position Title: Grievance and Appeals Nurse Work Location: Remote Assignment Duration: 14+ Weeks Work Arrangement: Remote Position Summary: This position serves as a clinical and administrative subject matter expert for Part C and Part D grievance and appeal functions; investigating and identifying member, provider and/or claim processing appeals and customer service grievances issues; and ensuring that investigation, resolution and responses are processed promptly in accordance with CMS requirements and timelines.

Working knowledge of CMS Managed Care Manual Chapter 13 - Beneficiary Grievances, Organization Determinations, and Appeals and CMS Prescription Drug Benefit Manual Chapter 18 - Part D Enrollee Grievances, Coverage Determinations, and Appeals, knowledge of healthcare billing and claims adjudication processes. Familiarity with medical terminology, ICD, CPT, HCPCS, and DRG codes, accurate and efficient keyboarding skills, and the ability to work effectively with common office software. Math, communications and business skills normally demonstrated by a high school degree or equivalent. Demonstrated ability to evaluate and interpret medical records and health plan benefit documents to make appropriate benefit determinations. Must possess highly developed interpersonal skills and communications skills, with a strong customer service orientation. 5 years of work experience with CMS member services, prior authorizations, appeal and grievance, or claims functions. Associate’s Degree in a healthcare field of study or Nursing Diploma. Licensed Practical Nurse or Registered Nurse with a current, active, unrestricted nursing license in the state of Arizona (a state in the United States).

Maintains a thorough understanding of our organization operations and business unit processes, work flows and system requirements, including, but not limited to, plan benefits as outlined in the Explanation of Coverage (EOC) documents, authorizations, referrals, network and non-network provider claims, and regulatory compliance. Maintains a current knowledge of CMS rules and regulations relating to the grievance and appeal processes. Participates in CMS and other audits and related activities as required. Coordinates investigation and resolution of complex grievance and appeal issues, reviews information provided by members, providers, and other interested parties regarding grievance and appeal cases, collects and analyzes supporting documentation, and makes the appropriate decisions involving grievance and appeal determinations. Performs all assigned functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides an excellent service experience to internal and external customers by consistently demonstrating our core and leadership behaviors each and every day. The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. Perform all other duties as assigned.

EVERSANA

Senior Nurse Navigator - Remote

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

At EVERSANA, we are proud to be certified as a Great Place to Work across the globe. We’re fueled by our vision to create a healthier world. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us! Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs. We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve. We are EVERSANA.

*This is a remote position covering the US. The Senior Nurse Navigator for the Thera Nurse Navigator Program serves as both a hands-on clinical navigator and a program leader responsible for overall program execution. This role ensures high‑quality patient education, engagement, and support while providing direct oversight, coaching, and quality assurance for the Nurse Navigator team. The Senior Nurse Navigator acts as a key partner to the Executive Director of Nursing Program Deployment, supporting strategic program objectives, driving operational excellence, and delivering consistent, compliant, patient‑centered services. This position is accountable for team performance reporting, quality control monitoring, and the professional growth and evaluation of the nursing team

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES: The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required. Education Bachelor’s degree in nursing or a related healthcare field from an accredit college or university. Associates degree in nursing with relevant experience considered. Experience and/or Training Minimum 3-5 years of experience in patient support programs, care coordination, specialty pharmacy, nursing leadership, or patient engagement roles. Comfortable using virtual communication platforms and electronic documentation systems Excellent communication (written, verbal, and presentation) skills with the ability to interact with all levels of management Ability to manage, mentor, train, and develop employees Commitment to process improvement with the ability to execute Experience with injectable therapies Previous team leadership, precepting, or coaching experience required. Strong understanding of patient education principles, clinical workflows, and specialty therapy navigation. Excellent communication, coaching, problem‑solving, and critical thinking skills. Ability to manage multiple priorities in a fast-paced environment while maintaining high‑quality standards. Exhibits confidence in decision making, demonstrates empathy for employees and customers, and inspires team to deliver while being accountable for results Licenses/Certificates Active, unrestricted Registered Nurse (RN) license required Must hold an active RN license and obtain licensure in all states within the assigned territory within 90 days of hire. Active licensure in compact state preferred. Technology/Equipment Moderate knowledge of Word, PowerPoint, Excel, Outlook and videoconferencing platforms (Teams, Zoom, GoTo Meeting) PREFERRED QUALIFICATIONS: Experience within EVERSANA, pharmaceutical support services, or HUB/Nurse Navigator programs. Prior involvement in quality assurance activities, program performance monitoring, or similar operational quality functions. Knowledge of medical documentation platforms, CRM systems, and healthcare data reporting tools. Advanced skill level with Microsoft Word, PowerPoint, Excel, Outlook, and virtual meeting platforms (e.g., Microsoft Teams, Zoom, GoTo Meeting). Advanced practice degree such as Nurse Practitioner, Physician Assistant, PharmD, or MSN (preferred but not required). Bilingual (English/Spanish) CORE COMPETENCIES: Patient‑Centered Communication Leadership & Team Development Quality & Compliance Focus Operational Excellence Analytical & Reporting Capability Collaboration & Cross‑Functional Coordination

Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by: Program Leadership & Execution Oversee full operational execution of the Thera Nurse Navigator Program, ensuring alignment with program goals, compliance standards, and client expectations. Serve as a player‑coach by balancing direct patient support responsibilities with leadership duties for the broader team. Collaborate with internal stakeholders to optimize workflows, technology utilization, and patient experience enhancements. Patient Education & Engagement Deliver high‑quality patient education on therapy, disease state, expectations, and adherence support. Serve as a subject matter expert on patient engagement best practices and continuously elevate team capabilities in patient-centric communication. Monitor patient engagement metrics and implement strategies to improve outreach, education quality, and patient satisfaction. Engage in telephonic and virtual interactions with patients and healthcare providers to provide support, guidance, and disease-state education in accordance with brand policies and compliance guidelines. Team Leadership, Coaching & Development Provide coaching, guidance, and ongoing mentorship to Nurse Navigators to ensure adherence to program protocols, SOPs, and quality standards. Conduct annual performance reviews for the Nurse Navigator team, evaluating competencies, productivity, and professional development needs. Lead team huddles, training updates, and professional development initiatives. Serve as a point of escalation for calls requiring a higher degree of clinical expertise or discretion to resolve customer issues or complaints. Quality Control & Compliance Implement and oversee quality control monitoring processes to ensure compliant, accurate, and consistent program delivery. Partner with Quality Assurance and Compliance teams to maintain high standards of documentation, privacy adherence, and clinical accuracy. Continually evaluate the efficiency, productivity and accuracy of the clinical team and take initiative to improve efficiency, improve quality, and develop best practices Identify gaps in performance or process and initiate corrective action plans or training solutions as needed. Reporting & Metrics Management Prepare and deliver monthly team activity reports, including patient engagement metrics, operational performance, quality outcomes, and improvement opportunities. Utilize data insights to inform program improvements and support strategic decision‑making. Ensure timely escalation of risks, challenges, or compliance concerns to leadership with solutions. All other duties as assigned.

Mercor

Clinical Nurse Specialist | Max $190/hr

Posted on:

February 25, 2026

Job Type:

Part-Time

Role Type:

Primary Care

License:

RN

State License:

California

Mercor is at the intersection of labor markets and AI research. We connect human expertise with leading AI labs and enterprises to train frontier models.

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey. Position: Healthcare AI Evaluator Type: Contract Compensation: $150–$190/hour Location: Remote

Must-Have: 5+ years of real-world professional experience in Healthcare, supported by an associated expert degree (e.g., MD, DO, RN, NP, PA, PharmD, MPH, or equivalent). Experience in one or more of the following sub-domains: General Clinical Care, Specialty Medicine or Surgery, Diagnostics, Imaging & Laboratory Medicine, Public Health, Healthcare Systems & Administration. Significant experience using large language models (LLMs). Excellent writing communication skills for complex medical topics. Strong attention to detail and comfort in evaluating clinical reasoning and medical explanations. Preferred: Prior experience with RLHF, model evaluation, or data annotation work. Experience writing or editing high-quality medical or healthcare-related content. Experience in clinical documentation, charting, or patient communication. Familiarity with evaluation rubrics, benchmarks, or quality scoring systems.

Write and refine prompts to guide model behavior in healthcare scenarios. Evaluate LLM-generated responses to healthcare queries for accuracy, reasoning, clarity, and completeness. Conduct fact-checking of medical claims using trusted public sources and authoritative references. Annotate model responses by identifying strengths, areas of improvement, and factual inaccuracies. Assess tone, completeness, and appropriateness of responses for real-world healthcare use. Apply consistent evaluation standards by following clear taxonomies, benchmarks, and detailed evaluation guidelines.

CVS Health

Utilization Review Nurse Consultant - Oncology and Transplant (Remote)

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. About Us: American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.

Position Information Schedule: Monday-Friday 11:30am-8:00pm EST Location: 100% Remote (U.S. only) Join a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect. Remote Work Expectations: This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications: Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed. Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review, or prior authorization 3+ years of experience in Acute clinical Oncology or Oncology/Transplant. Strong decision-making skills and clinical judgment in independent scenarios. Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms. Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications: 1+ years of Managed Care (MCO) preferred. 1+ years of experience working in a high-volume clinical call center environment. NCCN (National Comprehensive Cancer Network) guideline experience/exposure. Remote work experience. Education: Associate's degree in nursing (RN) required, BSN preferred.

Conduct medical necessity reviews for oncology and transplant-related services, both inpatient and outpatient. Collaborate with healthcare providers to gather and assess clinical documentation via phone and electronic systems. Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors when needed. Navigate multiple computer systems efficiently while maintaining accurate and timely documentation. Work primarily in a sedentary setting involving extended periods of sitting, talking, listening, and computer use. Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.

Evolent

Appeals Nurse

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Virginia

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures while complying with timeliness guidelines. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes for the Clients and Members we serve. Collaboration Opportunities: The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for collaboration include all-team and individual team meetings, Teams chats, and monthly communication on team metrics and accomplishments.

1-3 years' experience and as an RN - Required Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality improvement environment- Required Able to work in a rotation to work 10:30am to 7pm CST (which includes 30-minute unpaid lunch break) 3 days/week, to meet the business needs of nurses providing coverage until 7:00pm CST. - Required Must be able to exercise independent and sound judgment in clinical decision making. - Preferred Able to navigate through internal and external computer systems. Working knowledge of Microsoft Office Product Suit - Preferred Strong organizational and effective time management skills; demonstrated ability to manage multiple priorities. – Preferred Outstanding interpersonal and negotiation skills to effectively establish positive relationships both internally and externally, including strong written and verbal communication skills. - Preferred: To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures. Documents communications with medical office staff and/or MD provider as required. Interfaces with other departments to satisfactorily resolve issues related to appeals and retrospective reviews. Provides optimum customer service through professional and accurate communication while maintaining accreditation and health plan's required timeframes. Refers cases to appropriate internal reviewers according to the business needs of the particular health plan. Reviews requests for Urgent appeals compared to expedited criteria for downgrade to Standard processing, documenting accordingly. Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals. Other duties as assigned.

SCAN

Medical Review Nurse - RN

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

Provide clinical review of medical claims and post service appeals. Facilitate appropriate investigation of issues and management of medical services and benefits administration while maintaining SCAN timeframe standards.

Associate's Degree or equivalent experience required Current and active California RN License in good standing required Bachelor's Degree or equivalent experience preferred Certified Professional Coder preferred. 3-5 years of related experience in clinical decision making relative to Medicare patients. Certifications deemed to be reasonable to function at this level. Performs work under minimal supervision. Handles complex issues and problems and refers only the most complex issues to higher-level staff. Possesses comprehensive knowledge of subject matter. Technical expertise - Strong technical skills for functional area Problem Solving - Strong problem-solving skills Communication - Good communication and interpersonal skills Ability to work as part of a team. Oral and written communication skills. Problem-solving skills. Attentiveness. Interpersonal skills

Review and analyze pre and post payment of complex health care claims from a medical perspective. Perform audits/reviews of medical claims per established criteria, identify need for medical record review, necessary documentation to support decision making process regarding appropriateness of claim, billed charges, benefit coverages Provide guidance to other staff members and accurately interpret and apply broad Centers for Medicare and Medicaid Services (CMS) guidelines to specific and highly variable situations Conduct review of claims data and medical records to make clinical decisions on the coverage medical necessity, utilization, and appropriateness of care per national and local policies as well as accepted medical standards of care) as assigned and as necessary and appropriate Process workload and complete project work in the appropriate computer system(s). Contribute to team effort by accomplishing related results as needed. Route identified clinical and/or risk issues to appropriate personnel eg, Medical Director, Quality of Care (QOC) Nurse, Medical Management Specialist, Member Services, etc Review/prepare potential claims denials in conjunction with Medical Director Collaborate with Medical Director pursuant to adjudication of claims and post service appeals Participate in special projects/workgroups/committees (eg, interdisciplinary workgroups, report analysis, independent review entity (IRE) etc. as assigned and as necessary and appropriate. We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Actively support the achievement of SCAN’s Vision and Goals. Other duties as assigned.

Abby Care

RN Intake Coordinator

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving. Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home. Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide. We are rapidly expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We’re supported by top, mission-driven VCs to empower families throughout the country.

We're looking for a passionate Registered Nurse to join our team as a RN Intake Coordinator position. This role will report into the Director of Nursing in Indiana. This is a Full-Time remote opportunity based in Indianapolis, IN. The RN Intake Coordinator at Abby Care is responsible for overseeing the clinical intake process and service determinations of home health and personal care patients, ensuring appropriateness of home care services, regulatory compliance, and timely start-of-care. This role requires a nurse with excellent organization, time management, and strong communication abilities, and dedication to providing high-quality patient care. The RN intake coordinator with work closely with our operations and growth teams, as well as our RN case managers to ensure optimal patient outcomes.

Active Registered Nurse (RN) license in Indiana (or compact state, as applicable) Strong clinical assessment and critical-thinking skills Ability to determine service appropriateness and level of care Exceptional organizational and prioritization skills in a fast-paced intake environment Proficiency with Google Workspace (Sheets, Docs, Gmail) Comfort learning and navigating EHRs, intake platforms, and telehealth tools Ability to adapt workflows and priorities as business needs change

Service determinations Review medicaid eligibility and submitted intakes documentation to determine appropriateness of potential home health and personal care patients Collaborate with operations, growth, and clinical leadership to support timely and accurate service decisions in compliance with organization?? standards Identify potential clinical and operational barriers to service and escalate concerns to the Director of Nursing as needed Documentation review Timely identify missing, inconsistent, or unclear documentation to ensure… PATIENT’S PREPAREDNESS FOR TA Maintain accurate and organized intake records to support audits, quality assurance, and continuity of care Telehealth assessment Conduct telephonic or video-based clinical intake assessments to gather health history, current condition, and care needs Assess patient safety, functional status, and appropriateness for home-based services in a remote setting Provide professional, compassionate education to patients and caregivers regarding services, expectations, and next steps Technology & Data Management Utilize Google Sheets and Excel to track intake volumes, start-of-care timelines, and clinical metrics Collaborate with cross-functional teams using shared documents and data tools to ensure transparency and coordination Communication and Collaboration Participate in weekly team meetings to ensure alignment

LifeMD

Nurse - Clinical Quality & Patient Safety

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

New York

LifeMD is a leading digital healthcare company committed to expanding access to virtual care, pharmacy services, and diagnostics by making them more affordable and convenient for all. Focused on both treatment and prevention, our unique care model is designed to optimize the patient experience and improve outcomes across more than 200 health concerns. To support our expanding patient base, LifeMD leverages a vertically-integrated, proprietary digital care platform, a 50-state affiliated medical group, a 22,500-square-foot affiliated pharmacy, and a U.S.-based patient care center. Our company — with offices in New York City; Greenville, SC; and Huntington Beach, CA — is powered by a dynamic team of passionate professionals. From clinicians and technologists to creatives and analysts, we're united by a shared mission to revolutionize healthcare. Employees enjoy a collaborative and inclusive work environment, hybrid work culture, and numerous opportunities for growth. Want your work to matter? Join us in building a future of accessible, innovative, and compassionate care.

The Clinical Quality Nurse is responsible for ensuring high-quality, safe, and compliant clinical care across a telehealth organization. This role focuses on performing ongoing clinical quality chart audits for nurse practitioners and physicians, identifying trends, and partnering with clinical leadership to drive continuous improvement. The Clinical Quality Nurse will also own patient safety reporting, root cause analyses, and process improvement initiatives in collaboration with clinical stakeholders. This role requires strong clinical judgment, exceptional attention to detail, and the ability to translate data and findings into actionable insights.

Basic Qualifications: Active, unrestricted Registered Nurse (RN) license Bachelor’s degree in Nursing (BSN) required; MSN or related advanced degree preferred 3+ years of clinical nursing experience Prior experience with clinical chart audits, quality improvement, or utilization review Strong knowledge of clinical documentation standards and patient safety principles Experience working with data tracking tools, reports, and dashboards Preferred Qualifications: Experience in a telehealth or virtual care environment Familiarity with root cause analysis methodologies (e.g., RCA, FMEA) Quality or patient safety certifications (e.g., CPHQ) Experience auditing advanced practice providers and physicians Strong analytical and critical-thinking skills Excellent written communication skills with the ability to present findings clearly High attention to detail and strong organizational skills Ability to work independently while collaborating across teams Comfort navigating change in a fast-paced, remote-first environment

Clinical Quality Audits: Conduct daily/weekly clinical chart audits of nurse practitioners and physicians in accordance with internal quality standards, regulatory requirements, and evidence-based best practices Evaluate documentation quality, clinical decision-making, adherence to protocols, and patient safety indicators Identify trends, gaps, and opportunities for improvement across providers and service lines Reporting & Feedback: Prepare clear, concise written audit summaries and reports for clinical leadership Provide actionable feedback and recommendations to support provider performance improvement Track audit outcomes over time to monitor progress and effectiveness of interventions Data Tracking & Analysis: Maintain accurate audit data and dashboards to support quality findings and improvement initiatives Analyze quality and safety metrics to identify systemic issues and emerging risks Support leadership with data insights related to clinical quality, compliance, and patient safety Patient Safety & Quality Improvement: Own and manage patient safety reporting processes, including event intake, documentation, and follow-up Lead or support root cause analyses (RCA) for patient safety events and near misses Partner with clinical and operational teams to develop, implement, and monitor corrective actions and process improvements Contribute to the ongoing development and refinement of clinical quality and safety programs Collaboration & Compliance: Collaborate closely with clinical leadership, providers, and cross-functional partners Stay current on telehealth regulations, accreditation standards, and clinical quality best practices Support regulatory, accreditation, and internal quality reviews as needed

LanceSoft, Inc.

RN-Behavioral Health (Utilization Management)- Remote

Posted on:

February 25, 2026

Job Type:

Contract

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Job Title: RN-Utilization Management Nurse- Behavioral Health Duration: 6 plus month with possible extension Location: Fully Remote Pay Range: $37-$38.00/hr

Standard schedule: Monday–Friday, 8:00 AM–5:00 PM Arizona time. Occasional holiday or weekend coverage required through rotation. Will consider RNs with an active compact license who focus in BH Top 3 Skills: Behavioral Health Utilization Management Ability to review clinical information, apply medical necessity guidelines, and make UM decisions (initial, concurrent, and discharge planning). Includes strong discharge planning skills to support safe, appropriate transitions of care. Must have a strong understanding of community behavioral health resources to support referrals and continuity of care. Ability to coordinate effectively across multiple stakeholders to support timely care and utilization decisions

Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions. Analyze medical records and clinical data to ensure services align with evidence-based standards and quality benchmarks. Coordinate and communicate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions. Conduct concurrent reviews to monitor ongoing inpatient or outpatient treatment and support continuity of care. Identify members who may benefit from care management programs and facilitate appropriate referrals. Provide urgent or emergent clinical interventions when required, including triage and crisis support. Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care. Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines. Develop and support initiatives that enhance quality effectiveness and benefit utilization. Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and track utilization management outcomes.

ROM Technologies, Inc.

LPN/RN - Pilot

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

We are seeking a dedicated and licensed LPN or RN with compact licensure to join our telehealth pilot program on a contract basis. This role is designed to expand patient access and enhance care delivery through innovative remote services. Bilingual (English & Spanish) a plus! As part of this program, you will provide patient support, education, and care coordination in a virtual setting, while contributing to the development of new healthcare delivery models. While some initiatives may include Chronic Care Management (CCM), the primary focus is on telehealth-based patient engagement and coordinated care

Conduct telehealth outreach to patients, providing education, follow-up, and support Monitor patient progress and assist with care coordination activities Collaborate with a multidisciplinary clinical team to support patient care goals Participate in pilot program workflows and provide feedback to improve processes Accurately document patient interactions in compliance with regulations and organizational policies

Sedgwick

RN Clinical Consultation-PART TIME

Posted on:

February 25, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

RN Clinical Consultation-PART TIME We are looking to add 7 part time nurses. If you can work any of these shifts, please apply. This class starts 3/30-no exceptions. The part time shifts are listed in Central Time Zone and will vary according to preference and can either be two 9hr weekend shifts, or three 6hr shifts, Sat/Sun with a weekday as well (18 hours per week) . Start times for these shifts will be: 5a- 7a- 10a- 11a- 12p- 2p- 4p- PRIMARY PURPOSE OF THE ROLE: To triage calls to assess needs, giving appropriate care advice and disposition to appropriate level of care treatment while promoting cost-effective outcomes and safely facilitate return to work. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. Enjoy flexibility in your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

EDUCATION AND LICENSING: Bachelor's degree in nursing (BSN) preferred. Active unrestricted RN compact licensure required along with two year (2) years of recent clinical practice experience. Should be proficient in multiple screens and multiple computer applications,. TAKING CARE OF YOU BY Seeks innovative customer solutions . Craves cutting edge opportunities. Wants dynamic company culture. Passion about creativity. Seeks ongoing learning as a person and professional. Thrives when solving challenging problems. Wants achievements to be celebrated. We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

Applies all phases of the nursing process, i.e. assessment, planning, implementation and evaluation when triaging calls. Identifies the needs of caller by triaging, obtaining general health information and/or physician services referral. Evaluates need for alternative treatment through telephonic contact and assessment with service provider. Triages patient using defined triage protocols to obtain pertinent data; and enters data into computer system. Identifies life-threatening emergencies and recommends appropriate interventions. Refers issues requiring physician interventions to physician in a timely manner; directs patients to appropriate level of care including but not limited to the nearest emergency room, urgent care facility, primary treating physician or selfcare. Demonstrates effective verbal communications skills. Adheres to quality assurance standards. Serves as resource to triage team members.

Guideway Care

Triage Nurse (Telehealth) [Full-Time]

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Guideway Care is the Patient Activation Company™. We help healthcare organizations move beyond engagement to measurable activation, so patients follow through on the next right step in their care journey. Our approach is built on Activation Science and operationalized through our proprietary Motivational Patient Guidance (MPG) Framework, a practical operating system that blends behavioral science with real-world barrier removal. MPG integrates proven disciplines from motivational interviewing, behavioral economics, social psychology, and adult learning theory to reduce friction, strengthen confidence, and sustain action. We partner with hospitals, health systems, payers, and provider organizations to improve outcomes that matter: adherence, experience, utilization, capacity, and financial performance.

We are seeking an experienced and compassionate Registered Nurse to join our elite team of remote triage professionals. This RN will serve as the front line of clinical support for patients, delivering high-quality assessment, guidance, and care coordination services via telephone and digital communication platforms. This role requires a confident, autonomous nurse with a strong clinical foundation, excellent judgment, and a deep commitment to patient-centered care. You will work remotely in a structured and supportive environment, contributing to improved outcomes and experiences for patients across a variety of primary care and specialty settings. Shifts available: Monday - Friday: 10:00 AM - 7:00 PM CST

Required Skills/Abilities: Active, unencumbered Registered Nurse license in a compact licensure state; Minimum of 5 years’ experience in working in a variety of direct patient care settings including Emergency Department, Labor and Delivery, Critical Care. Women's Health or Labor and Delivery experience preferred. Prior remote RN triage experience or experience with telephone-based care delivery strongly preferred. Demonstrated clinical proficiency with strong critical thinking, problem-solving, and decision-making skills. Excellent verbal and written communication skills, with the ability to convey empathy and clinical clarity via phone and written messages. Proficiency in using EMRs (e.g., Epic, Cerner, Greenway) and standard office software (Microsoft Office, Adobe, fax, etc.). Ability to work independently within scope, while maintaining alignment with clinical protocols and best practices. Supervisory Responsibilities: None Travel Requirements: 0% Work Authorization: Sequence Health does not offer Immigration or work visa sponsorship Total Rewards: The pay rate is $30 per hour. Physical Demands: Ability to hear in normal range and wear a headset / earpiece Good visual acuity to read computer screens, scripts, forms etc. May sit 100% of the time when taking calls Access to the electronic medical record (EMR) system may require the use of your personal mobile device for authentication purposes.

Conduct thorough clinical assessments and triage patients based on established evidence-based protocols and clinical guidelines. Respond to patient inquiries via inbound and outbound calls, as well as secure patient messaging portals. Provide appropriate recommendations for care or escalate concerns to the appropriate provider or care team member. Document assessments, communications, and care coordination activities in electronic medical records (EMRs) with accuracy and clarity. Support administrative functions related to patient care including FMLA, ADA, STD/LTD documentation, and coordination. Collaborate with healthcare providers, clinical teams, and practice administrators to ensure continuity and quality of care. Uphold Sequence Health’s commitment to clinical excellence, integrity, and service in every interaction. Any other duties necessary to drive our values, fulfill our mission, and abide by out company values. This role requires regular, reliable attendance during scheduled hours, as consistent presence is essential to preforming the core duties of the position. Able to work remotely at home in a private HIPAA compliant workspace Able to house company equipment needed to perform job Broadband Internet Access Internet download speed must be at least 24 mbps and upload speed at least 4 mbps Immigration or work visa sponsorship will not be provided

Classet

Remote RPM Coordinator (CMA/RMA or LPN)

Posted on:

February 25, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

Classet automates the most time-consuming recruiting tasks with voice AI. Our view is that recruiters provide the highest level of impact to candidates when they spend their time building relationships and helping candidates succeed. Transform your hiring with Classet's AI-powered instant interview solution. Automate screening, schedule effortlessly, and hire top talent faster than ever. Experience the future of recruitment now! We don't use AI to replace the human touch desperately needed in recruiting - we use AI to augment and accelerate it, while providing a best-in-class candidate experience!

Chronic Care Staffing is Hiring a Remote RPM Coordinator (CMA/RMA or LPN)! Location: Remote Employment Type: Full-Time Pay Range: $19.50 - $24.00 per hour Overview Chronic Care Staffing is seeking a detail-oriented and patient-focused Remote RPM Coordinator to support patients managing chronic and high-risk conditions through Remote Patient Monitoring (RPM) services. In this role, you will monitor biometric data, provide device education, identify abnormal readings, and coordinate care with providers to improve patient outcomes and reduce hospitalizations. This position is ideal for healthcare professionals who thrive in a structured, remote care environment.

Must-Have Criteria Active, unencumbered CMA/RMA certification OR compact LPN/RN license Current BLS certification Strong knowledge of CCM/RPM protocols and billing requirements Proficiency in EHR systems and Google Suite Recent experience in a clinical, chronic care, or CCM setting Ability to work independently in a HIPAA-compliant home office Strong communication, documentation, and problem-solving skills Ability to meet call volume and productivity expectations Nice to Have Prior experience in care coordination, chronic care, transitional care, or remote patient monitoring Familiarity with community resources and patient/family education Background in quality measures, reporting, or CMS compliance Demonstrated ability to work collaboratively in a remote team environment Additional certifications or coursework in care or case management Home Office Requirements HIPAA-compliant workspace with a locking door and distraction-free environment Reliable high-speed internet connection CCS-approved computer setup with dual monitors

Conduct onboarding and device education calls for new RPM patients Monitor incoming biometric data (blood pressure, glucose, weight, oxygen saturation) daily Identify abnormal readings and escalate findings according to established protocols Perform monthly engagement calls to assess patient condition and address concerns Troubleshoot device connectivity and usage issues Communicate effectively with patients and caregivers regarding care goals and progress Promote adherence to individualized care plans and encourage self-management Accurately document patient interactions in EHR and RPM platforms Ensure compliance with CMS RPM billing and documentation guidelines Maintain productivity standards for monitoring and outreach

Intermountain Health

Registered Nurse Medical Imaging Pre-Screen

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Utah

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. With more than 68,000 caregivers on a mission to help people live the healthiest lives possible, Intermountain is committed to improving community health, and is widely recognized as a leader in transforming healthcare. We strive to be a model health system by taking full clinical and financial accountability for the health of more people, partnering to proactively keep people well, and coordinating and providing the best possible care.

The Imaging Services Nurse is responsible for providing comprehensive support to all modalities within the Imaging Services Department. This role involves patient care management including patient assessment, education, and follow-up. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings. We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Rhode Island, Vermont, Washington. About the Medical Imaging RN Role: Join our dynamic Medical Imaging team as a Pre-Screen Nurse, where you’ll play a key role in preparing patients for surgery. In this position, you’ll conduct pre-screening calls, review medical histories, and ensure patients are informed and confident about their upcoming imaging procedures. We’re looking for a compassionate RN with strong communication skills and a commitment to evidence-based care. You’ll collaborate with physicians, anesthesiologists, and imaging specialists to streamline patient preparation and deliver exceptional care. The RN will follow the established guidelines, Cardiac Implantable Electronic Devices Procedure to ensure the safety of patients who have implanted cardiac devices (pacemaker, ICD, biventricular) undergoing an MRI at MKD, IMED, UVH, and STG hospitals. Why Work With Us Autonomous Practice: Take ownership of patient interactions by guiding them through pre-surgical imaging requirements, while knowing you have the full support of an experienced medical team. Skill Advancement: Strengthen your expertise in patient education, surgical preparation, and imaging protocols with ongoing training and professional development opportunities. Collaborative Environment: Partner with surgeons, anesthesiologists, and imaging specialists to ensure patients are well-prepared and confident before their procedures.

Minimum Qualifications: Current RN License in the state of practice. Basic Life Support Certification (BLS) and ACLS for healthcare providers. Effective verbal and written communication skills. Basic computer proficiency. Bachelor’s Degree in Nursing (BSN) from an accredited institution. *Bachelor of Science in Nursing (BSN) is required as of the job description's last update on 4/27/2025. Employees hired or promoted prior to this date will be held to the minimum requirements that were in place at the time of their promotion or hire. Preferred Qualifications: Bachelor’s Degree in Nursing (BSN) from an accredited institution. Critical Care Experience Understanding of basic x-ray principles and practices. Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies. Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations. Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc. Expected to lift and utilize full range of movement to transfer patients. Will also bend to retrieve, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items. Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items. Often required to navigate crowded and busy rooms (full of equipment, power cords on the floor, etc.) May be expected to stand in a stationary position for an extended period of time. For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Conduct Pre-Screening Calls: Reach out to patients prior to surgery to review medical history, imaging requirements, and ensure readiness for their upcoming procedure. Coordinate Care: Collaborate with physicians, anesthesiologists, and support staff to streamline patient preparation and scheduling. Assess Patient Needs: Evaluate patient information during pre-screening to identify potential concerns, ensuring safety and comfort before surgery. Educate and Support: Provide clear instructions about imaging procedures, answer patient questions, and offer reassurance to reduce anxiety. Documentation: Accurately record patient interactions and pre-screening outcomes to support continuity of care.

UBC

Registered Nurse (Call Center) - WEEKENDS ONLY

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

United BioSource LLC (UBC) is the leading provider of evidence development solutions with expertise in uniting evidence and access. UBC helps biopharma mitigate risk, address product hurdles, and demonstrate safety, efficacy, and value under real-world conditions. Underpinned by our scientific expertise, data and analytics, and innovative technologies, we offer our customers flexible solutions generating the relevant real-world data necessary to make more informed decisions earlier, meet stakeholder requirements, and ultimately, drive better patient outcomes.

Provides telephonic professional nursing services in support of client funded contracts. This includes telephonic patient support and resource, referral source, data collector and nurse educator to patients, consumers, and healthcare professionals.

Minimum- associate degree and professional nursing license Registered Nurse License in good standing in the state in which you work and/or cross-licensed in other states Telephonic nursing roles are required to have a Compact State License in eligible states; additionally, employee must be willing to obtain Compact State license at such time as their state elects to adopt Compact legislation Telephonic nursing roles are required to have a California State License and the employee must be willing to obtain additional Single State Licenses upon request. 2-5 years’ experience Basic database and office navigation skills Ability to maintain a high level of customer interaction/service skills while talking with patients, prescribers and/or specialty pharmacies via phone; ability to multitask in both PC/Phone related tasks and maintain adherence to approved scripted materials. Ability to interpret information shared by the patient to determine next steps as the individual case may warrant.

Adheres to principles as stipulated by program specific contractual agreements and company practices which may include Patient Support: Make outbound phone calls to patients who have opted into a patient program, make additional calls as directed and be available to support these patients by phone at all other times. Receive inbound phone calls from patients, healthcare professionals and consumers and provide a professional resource for inquiries. Resource: Answer patient, consumer and healthcare professional questions and suggest appropriate resources patients. Referral Source: Make appropriate referrals for additional training, support groups, program materials, or literature, and to recommend that the patients contact personal physicians for additional information, directions, and care. Collect Data: Assemble accurate, timely, clear data and complete summary of follow up phone calls, patient inquiries, and outcomes Educator: Complete patient teaching in relation to the use of products 75 % Participates in program specific customer meetings and training sessions. 10 % Participates in program specific orientation meetings and demonstrates clinical competency on electronic/written tests. 5 % Performs special projects and performs other duties as it pertains to specific contract performance 10 %

DataAnnotation

Nurse

Posted on:

February 24, 2026

Job Type:

Contract

Role Type:

License:

RN

State License:

New York

We are looking for a Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model. Physicians & Advanced Practice Clinicians In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include: Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses. Therapists Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists. Diagnostic & Laboratory Professionals Radiologic Technologists, Sonographers, MRI & Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology & Genetics Technicians. Public Health & Specialized Roles Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses. Benefits This is a full-time or part-time REMOTE position You’ll be able to choose which projects you want to work on You can work on your own schedule Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work

Fluency in English (native or bilingual level) A current or in progress medical degree

Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs Evaluate the quality produced by AI models for correctness and performance Ensure the medical accuracy of model performance

Evolent

Clinical Reviewer, Nurse (Medical Oncology)

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek to connect the fragmented health care system and ensure people receive the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and the autonomy they need to get things done. We believe people do their best work when they're supported to live their best lives and feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

The Experience & Qualifications You’ll Need (Required): Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license in your state of residence High School Diploma or equivalent required Minimum of three years of direct clinical patient care (acute, inpatient, or critical care setting); strongly prefer direct Oncology experience. Strong computer skills, including MS Office Suite Strong interpersonal, oral, and written communication skills. Availability for 9 AM-6 PM Monday through Friday shift with weekend & holiday rotation. Finishing Touches (Preferred): Experience with clinical decision-making criteria sets (NCCH, Clinical Pharmacology) UM/UR experience Clinical experience in Oncology ONS/ONCC Chemotherapy Immunotherapy Certificate or OCN certification Remote work experience

The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed within the RN/LVN/LPN scope of practice, under the Medical Director's direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum and working with the health care delivery team to maintain high-quality, cost-effective care. Perform pre-certification utilization reviews of Oncology treatment requests (chemotherapy) Determines medical necessity and appropriateness of services using clinical review criteria. Accurately documents all review rationales and determinations. Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director. Appropriately identifies and refers quality issues to UM Leadership. Collaborates with physicians and other providers to facilitate the provision of services throughout the health care continuum. Performs accurate data entry. Communicates appropriate information to other staff members as necessary/required. Participates in continuing education initiatives. Availability on some weekends and holidays may be required. Performs other duties as assigned.

Imagine360

Interdisciplinary Care Team, Behavioral Health, RN

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

Imagine360 is an integrated health plan addressing one of the greatest challenges on behalf of self-funded employers: healthcare costs are harming the bottom line, they're increasingly unaffordable for employees, and the experience remains poor. We help businesses and their employees navigate through clutter and chaos and bring deep cost savings that protect everyone’s well-being and budgets. It’s way more than a health plan. It’s a promise. We’ve helped hundreds of self-funded clients. Our solutions are ready to be implemented. The results are proven and impactful. Imagine360’s innovative payment model includes preferential contracting with providers and health systems, and additional price protection through reference-based pricing, saving employers 15-30% on average compared to the national carriers.

Imagine360 is seeking an IDCT, Behavioral Health, RN to join the team!  The Interdisciplinary Care Team, Behavioral Health, RN is responsible for providing telephonic coaching and educational resources to people with chronic health conditions. Coaching topics include medication compliance, nutrition, physical activity, and care coordination. Responsibilities include assessment, coordination, planning, monitoring, and evaluation. Position Location: 100% remote

Required Education: Nursing Degree from an accredited college or university. Required Experience: 2+ years of experience in direct participant coaching. Skills and Abilities: Must have intermediate knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software Licenses or Certification: Active and unrestricted Compact Registered Nurse License required

Provide telephonic coaching, and information and referral services to program participants managing various chronic health conditions with clinical oversight assistance Assess participant needs using scripted assessments Communicate, as needed, with service delivery partners, physicians, and other health professionals to provide care coordination Review pertinent medical history, current diagnosis, and pharmaceutical data via information database system with clinical oversight Assist participant in forming realistic goals related to overall health Determine and provide relevant community and/or healthcare resources that help support participant's goals Promote wellness and provide education regarding preventative care measures Effectively assess, coach and graduate clients from care, resulting in appropriately managed caseloads Document participant activities and coaching sessions in established format in the case tracking software Registered Nurses are involved in clinical decision-making and patient education. The scope of practice for nursing work includes, but is not limited to: Rationale for the effects of medications and treatments Implement measures to promote a safe environment for clients and others Accurately report: Administration of medication and treatments Client response Contact with other health care team members The client's status including signs and symptoms Nursing care (education) rendered Respect the client's right to privacy by protecting confidential information Promote and participate in education and counseling to a participant based on health needs Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner Know, recognize, and maintain professional boundaries of the nurse-client relationship

Classet

Remote Care Coordinator (LPN)

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Illinois

Classet automates the most time-consuming recruiting tasks with voice AI. Our view is that recruiters provide the highest level of impact to candidates when they spend their time building relationships and helping candidates succeed. Transform your hiring with Classet's AI-powered instant interview solution. Automate screening, schedule effortlessly, and hire top talent faster than ever. Experience the future of recruitment now! We don't use AI to replace the human touch desperately needed in recruiting - we use AI to augment and accelerate it, while providing a best-in-class candidate experience!

Chronic Care Staffing is Hiring a Remote Care Coordinator (LPN)! Employment Type: Full-Time Location: Remote (Work from Anywhere) Pay Range: $21 - $24 per hour Schedule: Monday-Friday, No Weekend Work Overview: Chronic Care Staffing is seeking an experienced and compassionate Remote Care Coordinator (LPN) to join our growing chronic care management team. This role is ideal for licensed practical nurses who enjoy supporting patients virtually, coordinating care plans, and improving outcomes through consistent engagement. As a Care Coordinator, you will work directly with patients managing chronic conditions, helping them stay on track with treatment plans while ensuring smooth communication between patients and providers. Your work will play a key role in long-term patient success and care continuity.

Must Have: Active, unencumbered LPN/LVN license Current BLS certification High proficiency in EHR systems Experience in a clinical or CCM care coordination setting Strong communication, problem-solving, and clinical reasoning skills Proficiency in Google Suite Ability to work independently in a HIPAA-compliant home office environment Excellent verbal and written communication skills Nice to Have: Prior experience in care coordination, chronic care management, or remote patient monitoring Familiarity with community resource navigation Experience in patient and family education for chronic conditions Knowledge of quality measures, CMS compliance, or reporting Strong team-oriented mindset in a remote work environment Home Office Requirements: HIPAA-compliant workspace (distraction-free, private area) Reliable high-speed internet connection Dual-monitor setup (provided or approved by CCS)

Conduct monthly Chronic Care Management (CCM) outreach calls and verbal enrollments Perform health risk assessments and support Transitional Care Management services Assist with Remote Patient Monitoring (RPM) and chronic condition tracking Educate patients and families on diagnoses, medications, and care plans Collaborate with healthcare providers and internal teams to ensure coordinated care Encourage adherence to treatment goals and support patient self-management Document all patient interactions and interventions accurately in EHR systems Maintain productivity and call volume expectations while demonstrating empathy and professionalism Ensure compliance with HIPAA, CMS, and CCS quality standards

Optum

Part-Time Weekend RN TeleHealth After Hours Triage - Kelsey Seybold Clinic

Posted on:

February 24, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Texas

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

A registered nurse who is responsible for incoming calls from patients, physicians and healthcare organizations. Using the nursing process and software protocols, the nurse will assess the patient and based upon Triage guidelines, will offer appropriate options for care. The nurse will facilitate referrals to primary care providers, specialists, healthcare facilities, and community resources. The nurse will facilitate communication with providers and healthcare organizations as appropriate

Required Qualifications: Associates of Applied Science in Nursing RN from an approved school of nursing with current license to practice professional nursing in the State of Texas 5+ years progressive clinical RN experience in acute care setting for adult and/or pediatric patients Proven basic PC skills including Windows Operating System Demonstrated typing skills of 30 WPM Preferred Qualifications: Bachelor of Science in Nursing 3+ years RN experience in an Emergency Department 1+ years of Triage nurse experience Proven excellent communication skills

Provide accurate and complete information about available resources Records significant health history for caller. Assign relevant health risk tag(s) to caller Demonstrates excellent communication skills Maintains a customer-driven professional attitude Close call by thanking caller and offer service for future inquiries for 90 percent of inbound calls Functions as an interdependent and supportive team member, as well as a team leader, providing direction and established resources Facilitated productivity, team building and high team moral in the clinic Maintains a sense of pride and “ownership” for the program Demonstrates knowledge and expertise in triaging callers properly such that all callers receive a timely and appropriate response Introduces self and service with each inbound call Consistently communicates in a professional and courteous manner while maintaining a calm and purposeful demeanor Accepts incoming calls from patients who request assistance with acute or chronic medical issues Establishes and maintains a positive rapport with callers and/or family members as an advocate to assist them though the healthcare system Complete registration information and/or confirm current patient data for all inbound calls Consistently and accurately records patient complaints, symptoms and problems as well as nursing assessment following departmental documentation guide lines Directly addresses and seeks to rectify complaints or concerns from all callers while Documenting and forwarding them to management Duties and responsibilities that are performed in the telephone consultation department require the ability to analyze information of a complex nature; the ability to organize and prioritize multiple conflicting complex tasks; and the ability to solve problems and make decisions quickly The position involves two-way communication with patient’s families, care givers, physicians, and operators-often when all parties are under pressure Specific job requirements or physical location of some positions allocated to this classification may render it security-sensitive, thereby subject to provisions of section 51.215, Texas Education Code Is organized, able to set priorities Remains calm and purposeful, responds competently when giving direction to callers on emergent or chaotic situations Refers inquiries to appropriate source Assumes responsibility for remaining current on job-related knowledge and skills and ongoing education/in-service/credentialing/certification requirements in accordance with policy and procedures To be familiar with all equipment and demonstrate the ability to utilize equipment and resources in a cost-effective and safe manner Utilizes knowledge in referencing the appropriate triage guideline for 100 percent of callers Facilitates appropriate disposition based on assessment information, triage parameters, and clinical judgment Creates progress notes that document the assessment, information provided, and the disposition in the event that a pertinent database resource document does not exist Documents all inquiries for medico legal/statistical purposes Schedules call-back within 24 hours for 10 percent of all emergency referrals to determine compliance with recommendations Performs related duties as required Participates in committees and in meetings for improvements in telephone nursing You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Eleanor Health

Certified Medical Assistant (CMA) or Licensed Practical Nurse (LPN)

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

LPN/LVN

State License:

Massachusetts

At Eleanor Health we are helping people affected by addiction live amazing lives. We work to fulfill this goal by building and growing the first addiction and mental health services provider designed to deliver a longitudinal, whole-person, value-based model of care for each community member. Our team is ambitious and committed to this unique opportunity, and understands the importance of attracting strong and experienced talent to make our vision for Eleanor Health a reality every day, and for every recovery journey we are entrusted to be a part of.

Eleanor Health is seeking a compassionate and dedicated Certified Medical Assistant (CMA) or Licensed Practical Nurse (LPN) with a compact license to join our multidisciplinary team as a Per Diem team member. The CMA/LPN will play a crucial role in supporting our mission to provide comprehensive and compassionate care to individuals recovering from substance use disorders. The ideal candidate will possess strong clinical skills, excellent communication abilities, and a deep commitment to improving patient outcomes. Our care model is delivered both virtually and in-clinic and this role will perform both functions: being present in our Hickory, NC clinic when needed and having the ability to work remotely when not in the clinic. This position is Full Time.

Education & Certification: High school diploma or equivalent required. Completion of an accredited Medical Assistant or LPN program. Current certification as a Certified Medical Assistant (CMA) from a recognized certifying body (e.g., AAMA, AMT, NCCT) or compact licensure as a Licensed Practical Nurse (LPN). Experience: Minimum of 1-2 years of experience in a clinical setting, preferably in a substance use disorder treatment facility or behavioral health environment. Experience with EHR systems and medical documentation. Skills & Abilities: Strong clinical skills, including medication administration, and basic laboratory procedures. Excellent organizational and multitasking abilities. Strong interpersonal and communication skills, with a focus on patient-centered care. Ability to work collaboratively in a fast paced, team-oriented environment. Compassionate approach to patient care with a strong understanding of the complexities of substance use disorders. Comfortable with ambiguity and taking on a variety of tasks, as needed

Member Care: Conduct initial member intake and assessments, including social history, medical history, current medications, and overall member needs. Assist with the coordination of member care plans, ensuring adherence to prescribed treatments and protocols. Provide direct member care, including administering medications, injections, and other clinical tasks as directed by healthcare providers. Support members through the intake process, monitoring for withdrawal symptoms and providing appropriate interventions. Helps cultivate a distinctive and engaging workplace culture grounded in mission focused care, proactive initiative, ethical conduct, and strong team collaboration. Clinical Support: Prepare and maintain examination and treatment areas, ensuring a clean, safe, and organized environment. Perform routine in-clinic laboratory tests, including urine drug screens, ensuring accurate documentation and reporting of results. Manage and document member information in electronic health records (EHR) systems accurately and efficiently. Assist with obtaining prior authorizations and pre-certifications as appropriate. Serve as the first point of contact for medication-related questions, ensuring timely and appropriate escalation to the medical teams. Administrative Duties: Schedule and coordinate member appointments, follow-ups, and referrals. Maintain inventory of medical supplies and equipment, ensuring proper stock levels and functionality. Provide member education and resources on health maintenance, medication management, and substance use disorder recovery. Assists with front office tasks, including telephone reception, scheduling, check-in and time-of-service collections. Team Collaboration: Participate in interdisciplinary team meetings to discuss member progress, challenges, and care strategies. Communicate effectively with members, families, and team members, demonstrating empathy and cultural sensitivity. Support continuous improvement initiatives and contribute to the development of best practices in substance use disorder treatment.

Maximus

Health Specialist, CDC INFO (RN, temporary, remote)

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

We’re moving people forward by providing transformative technology services, digitally enabled customer experiences, and clinical health services that change lives. Our employees share an authentic desire to make vital services available to the public and support the missions of our customers.

Date: Wednesday, February 18, 2026 City: Remote Country: United States Working time: Full-time Maximus is currently hiring for an RN, Health Specialist to support our CDC (Centers for Disease Control) Call Center. This is a remote opportunity. The Health Specialist role is to provide advanced and accurate clinical inquiry responses to health related, disease control and prevention issues, including questions related to bioterrorism, first responders and national emergency situations from medical and other health care professionals, educators, and government agencies. This is a temporary, limited-service position expected to conclude August 31, 2026. This position requires an active, valid RN license. Must be available to work 8:00 AM – 4:30 PM Eastern time. Additionally, must be available to work the occasional weekend or holiday depending on business needs. You must provide your own computer equipment for this position. Computer or Laptop, head set with microphone and monitor required. Windows or Mac (Tablets, iPads, and Chromebooks are not permitted) OS for Windows 10 or Windows 11 OS for Mac Big Sur (11.0.1+); Catalina (10.15); Monterey (12.3) Must reside and work within the continental United States.

Bachelor’s Degree in Nursing and current RN license, or combination of education and experience required Experience in medical, scientific and public health discipline Clinical knowledge of and experienced in CDC related topics Proficient internet search skills Working knowledge of Microsoft Office and ability to learn and utilize software applications Excellent listening, comprehension, communications (verbal and written), problem solving and customer service skills Ability to work independently and communicate effectively Must have demonstrated excellent interpersonal and leadership skills and the ability to organize simultaneous tasks Provide advanced clinical inquiry responses (verbal and written) to health-related inquiries from consumers, educators and medical/health professionals including State and local health departments and other government offices. Provide subject matter expertise on CDC topics covered by CDC-INFO which includes HIV/AIDS, Immunizations, Environmental Health, NIOSH; Tuberculosis and Statistics, to name a few Respond to inquiries resulting from current events, such as food outbreaks, natural disasters and other events Perform advanced database searches Perform assigned work in accordance with quality assurance measures Respond to medical personnel and clinicians in both verbal and written formats *** This position requires that you provide your own device - personal computer or laptop.*** Home Office Requirements: Computer or Laptop, head set with microphone and monitor required. Windows or Mac (Tablets, iPads, and Chromebooks are not permitted.) OS for Windows 10 or Windows 11 OS for Mac Big Sur (11.0.1+); Catalina (10.15); Monterey (12.3) Hardwired internet via ethernet connection. Required Internet speeds Minimum download 25mbps or higher and minimum upload speed 10mbps or higher (you can test this by going to (www.speedtest.net). Private work area and adequate power source. Internal video calls may be requested on occasion. Proper background and attire are required. Minimum Requirements: High School diploma or equivalent with 2-4 years of experience. May have additional training or education in area of specialization.

Provides advanced clinical inquiry responses (verbal and written) to health-related inquiries from consumers, educators or medical/health professionals. Provides medical subject matter expertise. Performs advanced database searches. Composes documents, reports, and correspondence. Documents all incoming inquiries. Participates in special projects as required.

Evry Health

Care Coordination (RN) - REMOTE

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Evry Health is seeking a tech-savvy Nurse to join our team for Care Coordination. As a Care Coordinator you work with members to improve their wellness and engage with our health plan's benefits. You build good relationships with both our health plan members and our medical providers through phone calls, emails, and texts. This is an exciting role allowing the ability to work with members across the continuum. Our teams are 100% virtual. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone.

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Experience And Skills Desired: You have 1-2 years of experience working at a health plan, preferably with a commercial population You have 3-5 years of nursing experience in a clinical setting assisting with direct patient care, such as a hospital or ambulatory setting Must have a current, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume Diploma from an accredited school/college of nursing required You have working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology You have experience outreaching and educating members telephonically You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system Bonus: Familiarity with Salesforce/Healthcloud/CareIQ Bonus: Experience working in a call center Bonus: Spanish fluency (conversational) Telecommuting Requirements: This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. Required to have a dedicated work area established that is separate from other living areas and provides information privacy Ability to keep all company sensitive documents secure Must live in a location that receives an existing high-speed internet connection/service

Communicate and provide education to members and providers on insurance plan benefits and digital health solutions Use negotiation and motivational interviewing techniques to increase engagement Pro-active and reactive support for members, including outbound phone/email/text outreach Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls Accurately track and document work on a variety of internal software tools and platforms Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care

Clarity Pediatrics

Nurse Care Coordinator

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

California

Clarity Pediatrics is building a new, virtual, evidence-based model for pediatric chronic care, beginning with ADHD. Our mission is to expand into additional chronic conditions—includingasthma, allergies, and obesity—and deliver affordable, science-backed care to the 1 in 3 children living with chronic conditions.

The Nurse Care Coordinator (RN) is an integral member of Clarity Pediatrics' interdisciplinary care team, collaborating with physicians, advanced practice providers, psychologists, and therapists. Under the direction of clinical leadership, the Nurse Care Coordinator ensures seamless care delivery for children with chronic conditions by coordinating clinical appointments, providing patient and family education, managing medication authorizations, and serving as a primary point of contact between families, providers, and pharmacies.

Required: Active Registered Nurse (RN) license in good standing (Associate's, Bachelor's, or Master's degree in Nursing accepted) Demonstrated proficiency with multiple technology platforms and electronic health record (EHR) systems Strong organizational, communication, and interpersonal skills Ability to manage competing priorities and work collaboratively in a remote, virtual environment Comfort working with diverse, medically and socially complex pediatric populations Reliable internet connection and a dedicated workspace suitable for remote work Preferred: Bilingual English/Spanish Experience in pediatric, chronic care, or care coordination settings Familiarity with prior authorization processes and payer requirements Experience working in underserved or urban environments Familiarity with San Francisco Bay Area community resources

Care Coordination & Scheduling: Coordinate, schedule, and reschedule clinical appointments across the care team Manage referrals to specialist and external clinical services Proactively follow up with families to reduce gaps in care and no-show rates Support care transitions and continuity across the interdisciplinary team Patient & Family Education: Provide evidence-based education to families regarding chronic condition management Explain medication regimens, treatment plans, and care goals in accessible language Respond to patient and family inquiries via messaging and phone in a timely manner Support health literacy and empower families to engage actively in their child's care Medication Management & Pharmacy Coordination Initiate and manage medication prior authorization requests with insurance payers Communicate with pharmacies to resolve dispensing issues and coordinate refills Track authorization status and escalate delays to the appropriate clinical team member Maintain accurate medication records and document all pharmacy communications Documentation & Team Collaboration: Document clinical interactions accurately and in a timely manner across multiple EHR and care management platforms Participate in interdisciplinary case conferences, team huddles, and quality improvement meetings Report patient progress and care gaps to clinical supervisors Identify workflow inefficiencies and contribute to process improvement solutions

Pro Care Innovations

MA/LPN - Care Team Coordinator or Patient Enrollment Specalist

Posted on:

February 24, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Oklahoma

Pro Care Innovations is hiring for two positions within our CCM program—Patient Enrollment Specialist (PES) (enrollment + transition) and Care Team Coordinator (CTC) (ongoing monthly care coordination). This combined posting helps streamline recruiting and allows us to match candidates to the role that best fits their skills and experience. Final role placement will be determined during the interview process.

We are hiring for two roles within our CCM program: Care Team Coordinator (CTC) and Patient Enrollment Specialist (PES). Both roles support patient-centered care through Chronic Care Management (CCM). Final role placement (CTC or PES) will be determined during the interview process based on experience, strengths, and team needs. This is an excellent opportunity for someone who thrives in a collaborative, patient-centered environment and enjoys a mix of communication and administrative responsibilities. Role Tracks (You may be considered for either position) Care Team Coordinator (CTC) – Ongoing Care Coordination As a CTC, your primary focus is ongoing monthly patient care. You will build relationships with patients, support continued CCM engagement, and ensure accurate, compliant documentation. This role may include some onboarding/enrollment support as needed.

MA or LPN licensure (role level and pay based on licensure and experience) Strong communication skills with a patient-first approach Detail-oriented with excellent documentation and follow-up habits Ability to work independently while contributing to a collaborative team Experience in healthcare, care coordination, or customer service preferred Schedule Full-Time Monday–Friday Remote / work-from-home opportunities available

Patient Enrollment Specialist (PES) – Enrollment & Transition As a PES, you will serve as the first point of contact for new patients. Your primary focus is educating patients on CCM services, obtaining consent, completing initial documentation, and ensuring a smooth transition to the long-term care team. What You’ll Do (CTC or PES, based on track) Conduct outreach calls to educate patients on the CCM program and obtain patient consent Develop and document the first care plan in alignment with CCM requirements Complete the initial CCM report (and transition patients to the long-term care team when applicable) Ensure documentation is accurate, timely, and compliant with regulatory standards Address patient questions and concerns with a patient-first approach Support administrative tasks related to enrollment and care coordination Collaborate with internal teams to ensure a smooth patient experience Additional CTC Responsibilities (Ongoing Care) Maintain ongoing relationships with an assigned panel of patients Complete monthly CCM touches and documentation requirements Support care coordination needs over time and track follow-ups Additional PES Responsibilities (Enrollment & Handoff) Focus on initial enrollment workflow and timely transition to the long-term Care Team Coordinator Coordinate handoff details to ensure continuity and a smooth patient transition

SUN Behavioral Houston

Remote Admissions Nurse

Posted on:

February 23, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

We work towards solving the unmet needs of the mentally ill in Houston and surrounding areas. SUN Behavioral Health partners with communities to solve their unmet needs for behavioral health services. We improve psychiatric services for communities by providing compassionate and respectful care to save lives and enhance the quality of life for our patients and their families.

Receives inquiry calls and assists the caller with scheduling a face-to-face assessment or provide triage to the appropriate community referral based on patient need. Assesses or ensures necessary assessment by a licensed RN for patients who present for assessment. Upon assessment of the patient, coordinates with the physician to ensure appropriate treatment is provided either at the hospital or another appropriate provider in the community. Ensures appropriate screening of medical and behavioral emergency conditions. Completes all administrative processes of the admission for treatment including, as appropriate, the initial authorization of care with the insurance company/third-party payor. Able to work through and accept referrals through various platforms, Kno2, Carelink, Open Beds, Xferral, Bed Board.

Education Required: Meeting state requirements, a Bachelors or Masters degree in Nursing, RN license. Maintains education and development appropriate for position. Required: Active unencumbered nursing license in the state of Texas. Experience Required: One to three years of experience in a behavioral health setting. Preferred: Previous assessment and evaluation experience in a behavioral health setting.

Clinical / Technical Skills (40% of performance review): Demonstrates excellent phone skills including inquiry calls, explanation of assessment processes, scheduling appointments and successful closure of a call while avoiding phone therapy. States the procedure for managing a crisis call and identifies when to activate EMS services. Identifies safety and risk of each call. Documents all inquiry calls, completely, to include all applicable information on prospect form in Wellsky. Makes appropriate referrals to community resources if not scheduling an assessment States the process and reasoning for all follow up calls either to confirm an assessment, inquire about no-show status, or rescheduling an assessment to include documentation reflecting same. Enters all inquiry calls into Wellsky with all data needed to further action or follow up Shows competency and understanding of the review of the medical screen; as appropriate, notifies the RN for additional review and action. States the working definition and procedure for managing medically and psychiatric emergencies according to EMTALA guidelines as well as hospital policies. Identifies and triages emergent patients and prioritizes care based on same. Completes the clinical screening and assessment tool (intake assessment) with concise, clear documentation. As applicable, identifies the need for additional screening for substance use, nutrition needs, functional needs, and abuse for children/adolescents, school and development screening. Demonstrates understanding of admission criteria for inpatient, partial hospitalization, intensive outpatient hospitalization and outpatient levels of care. Documents any special needs related to spiritual or cultural needs. Demonstrates a working knowledge of community mental health and substance use programs/referral to be offered for all patients not at imminent risk nor requiring services at a higher level of care as provided at the hospital. By demonstrating competency and thorough clinical understanding, ensures that each patient is seen by a physician or has had a consult by a physician to obtain treatment recommendations and disposition. Upon admission to a treatment program within the hospital, notifies the unit staff of the patients level of acuity, chief compliant and history of illness leading to admission, medical concerns and attending physician. Evidences understanding of all hospital required forms for admission and completion of these admission forms for each department as applicable. Knowledge of state local laws, ordinances and practices governing involuntary hospitalization and ensure compliance with same. Ensure correct information on EMTALA log to include all timelines and no blanks in documentation. Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the Utilization Management team for concurrent reviews. Demonstrates an ability to be flexible, organized and function well in stressful situations. Treats patients and their families with respect and dignity, ensures confidentiality of patients records. Interacts professionally with patient/family and provides explanations and verbal reassurance as necessary. Ensures that documentation meets current standards and policies. Answers the telephone in a polite manner and communicates information to the appropriate staff/family member. Individuals with a Registered Nurse license: Enter orders into Wellsky for admission and other orders as needed. This includes the follow up documentation required for PRN medication and first dose monitoring Knowledgeable of medications, including psychotropic drugs, and their correct administration based on the age of the patient and their clinical condition as demonstrated by observation of education completed with the patient/family members Conducts nurse to nurse report. Perform other duties as required Safety (15% of performance review): Strives to create a safe, healing environment for patients and family members Follows all safety rules while on the job. Reports near misses, as well as errors and accidents promptly. Corrects minor safety hazards. Communicates with peers and management regarding any hazards identified in the workplace. Attends all required safety programs and understands responsibilities related to general, department, and job specific safety. Participates in quality projects, as assigned, and supports quality initiatives. Supports and maintains a culture of safety and quality. Teamwork (15% of performance review): Works well with others in a spirit of teamwork and cooperation. Responds willingly to colleagues and serves as an active part of the hospital team. Builds collaborative relationships with patients, families, staff, and physicians. The ability to retrieve, communicate, and present data and information both verbally and in writing as required Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word. Demonstrates adequate skills in all forms of communication. Adheres to the Standards of Behavior Integrity (15% of performance review): Strives to always do the right thing for the patient, coworkers, and the hospital Adheres to established standards, policies, procedures, protocols, and laws. Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence. Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources. Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership Exemplifies professionalism through good attendance and positive attitude, at all times. Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws. Ensures proper documentation in all position activities, following federal and state guidelines. Compassion (15% of performance review): Demonstrates accountability for ensuring the highest quality patient care for patients. Willingness to be accepting of those in need, and to extend a helping hand Desire to go above and beyond for others Understanding and accepting of cultural diversity and differences