Utilization Review Nurse jobs at Cambia Health Solutions

RN CASE MANAGER LIAISON NURSE - INPATIENT DISCHARGE PLANNING - ONSITE: ST. PETER HOSPITAL - OLYMPIA ** SIGN-ON BONUS OF $5,000 APPLIESTO ELIGIBLE EXTERNAL HIRES! ** VARIABLE MON-FRI - 8AM-4:30PM - EVERY OTHER WEEKEND ROTATION - ROTATING HOLIDAYS BENEFITS ELIGIBLE POSITION! Job Summary: The Care Manager will work in two settings on a periodic rotating schedule, planning the discharges and follow up care for Kaiser Foundation Health Plan of Washington patients hospitalized at a nearby network facility and carrying a case load of patients in one of the Kaiser Foundation Health Plan of Washington medical centers. Some weekends and holidays are required, and scheduled days of the week are variable. Primary responsibility is to focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care resources. Working closely with primary care teams, specialty care teams and medical providers, the Liaison Nurse will establish a collaborative plan of care to assure adherence to the medical plan, improvement in functional status, and improved ability to self-manage. Serves as the liaison across the internal KFHPW care continuum and between KFHPW and all externally contracted providers, facilities, and resources and provides feedback to the organization regarding the service and quality of contracted services. The Liaison Nurse collects data and provides input to leadership regarding issues or concerns related to utilization, cost, quality, service and care delivery to patients. Essential Responsibilities: Ensures patients referred to case management meet established case management criteria. Assess all patients referred for case management to determine physical, mental, financial, psychosocial status, utilizing comprehensive, standardized criteria to identify existing and potential needs. Develop patient centered case management plan based on assessments and including patient goals, objectives, and outcomes with specific time frames (long/short term). Evaluate ability and availability of designated caregiver(s) to provide patient support. Coordinate and implement interventions using evidence based guidelines. Recommend additional services to PCP as determined in the case management plan. Conduct ongoing assessment of progress against original goals. Continuously update needed services. Maintain ongoing communication with patient/family and care team. Acts as an advocate for patient care needs. Documents all responses of patient to case management interventions. Collaborates with other health care professionals regarding the plan of care, variances in plan implementation, achieved outcomes or expected outcomes. Monitor and evaluate short and long term patient responses to therapeutic interventions and analyze patterns of variance from clinical information and outcomes. Recommend alternative settings for care based on health care needs and appropriate utilization of health care resources. Document interventions and interactions with patients or caregivers according to KFHPW and Care Management policy and procedure. Participate in the measurement of the effectiveness of the case management program. Directs and guides the plan of care to result in a seamless continuum of care. Facilitates as needed, referrals for home health care, long term care, hospice, and other care facilities or services. Participation in care conferences to provide problem solving for patients with complex care needs (limited basis). Collects needed data needed to evaluate the effects of care coordination on quality outcomes, fiscal parameters, patient satisfaction and systems improvement. Understands and utilizes health plan requirements and patient benefits in making care management decisions. Assists patient to understand and comply with their medical treatment plan. Supports patient education and activation through referral to specific chronic illness classes, group visits or community resources. Basic Qualifications: Experience Minimum three (3) years of recent RN medical/surgical/ambulatory clinical experience required. Minimum two (2) years of RN experience in ambulatory case management, care coordination or disease management. Education Bachelors degree License, Certification, Registration Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire Basic Life Support required at hire Case Manager Certificate within 36 months of hire Additional Requirements: Effective, independent nursing judgment and skills, and use of evidence based clinical decision making criteria. Knowledge in management of chronic disease process, nursing process and collaborative care planning. Demonstrated skill and experience in effectively collaborating with care team members. Preferred Qualifications: Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination or disease management. Bachelors of science in nursing.

Description: ** SIGN-ON BONUS OF $5,000 APPLIES TO ELIGIBLE EXTERNAL HIRES! ** RN CASE MANAGER LIAISON NURSE- INPATIENT DISCHARGE PLANNING - ONSITE: ST. PETER HOSPITAL - OLYMPIA VARIABLE MON-FRI - 10PM-10:30AM - EVERY OTHER WEEKEND ROTATION - ALTERNATING HOLIDAYS MUST HAVE PRIOR ER OR CASE MANAGEMENT WORK EXPERIENCE - NIGHT SHIFT DIFFERENTIAL APPLIES! Job Summary: The Care Manager will work in two settings on a periodic rotating schedule, planning the discharges and follow up care for Kaiser Foundation Health Plan of Washington patients hospitalized at a nearby network facility and carrying a case load of patients in one of the Kaiser Foundation Health Plan of Washington medical centers. Some weekends and holidays are required, and scheduled days of the week are variable. Primary responsibility is to focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care resources. Working closely with primary care teams, specialty care teams and medical providers, the Liaison Nurse will establish a collaborative plan of care to assure adherence to the medical plan, improvement in functional status, and improved ability to self-manage. Serves as the liaison across the internal KFHPW care continuum and between KFHPW and all externally contracted providers, facilities, and resources and provides feedback to the organization regarding the service and quality of contracted services. The Liaison Nurse collects data and provides input to leadership regarding issues or concerns related to utilization, cost, quality, service and care delivery to patients. Essential Responsibilities: Ensures patients referred to case management meet established case management criteria. Assess all patients referred for case management to determine physical, mental, financial, psychosocial status, utilizing comprehensive, standardized criteria to identify existing and potential needs. Develop patient centered case management plan based on assessments and including patient goals, objectives, and outcomes with specific time frames (long/short term). Evaluate ability and availability of designated caregiver(s) to provide patient support. Coordinate and implement interventions using evidence based guidelines. Recommend additional services to PCP as determined in the case management plan. Conduct ongoing assessment of progress against original goals. Continuously update needed services. Maintain ongoing communication with patient/family and care team. Acts as an advocate for patient care needs. Documents all responses of patient to case management interventions. Collaborates with other health care professionals regarding the plan of care, variances in plan implementation, achieved outcomes or expected outcomes. Monitor and evaluate short and long term patient responses to therapeutic interventions and analyze patterns of variance from clinical information and outcomes. Recommend alternative settings for care based on health care needs and appropriate utilization of health care resources. Document interventions and interactions with patients or caregivers according to KFHPW and Care Management policy and procedure. Participate in the measurement of the effectiveness of the case management program. Directs and guides the plan of care to result in a seamless continuum of care. Facilitates as needed, referrals for home health care, long term care, hospice, and other care facilities or services. Participation in care conferences to provide problem solving for patients with complex care needs (limited basis). Collects needed data needed to evaluate the effects of care coordination on quality outcomes, fiscal parameters, patient satisfaction and systems improvement. Understands and utilizes health plan requirements and patient benefits in making care management decisions. Assists patient to understand and comply with their medical treatment plan. Supports patient education and activation through referral to specific chronic illness classes, group visits or community resources. Basic Qualifications: Experience Minimum three (3) years of recent RN medical/surgical/ambulatory clinical experience required. Minimum two (2) years of RN experience in ambulatory case management, care coordination or disease management. Education Bachelors degree License, Certification, Registration Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire Basic Life Support required at hire Case Manager Certificate within 36 months of hire Additional Requirements: Effective, independent nursing judgment and skills, and use of evidence based clinical decision making criteria. Knowledge in management of chronic disease process, nursing process and collaborative care planning. Demonstrated skill and experience in effectively collaborating with care team members. Preferred Qualifications: Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination or disease management. Bachelors of science in nursing.

Description: CASE MANAGER LIAISON NURSE - OUTPATIENT - COMPLEX CASE MANAGEMENT ONSITE (3) DAYS - REMOTE (2) DAYS PER WEEK (MON & WED) - CAPITOL HILL/SEATTLE WA 5/8-S - MONDAY THROUGH FRIDAY - 8:00 AM - 4:30 PM Job Summary: The Care Manager will work in two settings on a periodic rotating schedule, planningthe discharges and follow up care for Kaiser Foundation Health Plan of Washington patients hospitalized at a nearby network facility and carrying a case load of patients in one of the Kaiser Foundation Health Plan of Washington medical centers. Some weekends and holidays are required, and scheduled days of the week are variable. Primary responsibility is to focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care resources. Working closely with primary care teams, specialty care teams and medical providers, the Liaison Nurse will establish a collaborative plan of care to assure adherence to the medical plan, improvement in functional status, and improved ability to self-manage. Serves as the liaison across the internal KFHPW care continuum and between KFHPW and all externally contracted providers, facilities, and resources and provides feedback to the organization regarding the service and quality of contracted services. The Liaison Nurse collects data and provides input to leadership regarding issues or concerns related to utilization, cost, quality, service and care delivery to patients. Essential Responsibilities: Ensures patients referred to case management meet established case management criteria. Assess all patients referred for case management to determine physical, mental, financial, psychosocial status, utilizing comprehensive, standardized criteria to identify existing and potential needs. Develop patient centered case management plan based on assessments and including patient goals, objectives, and outcomes with specific time frames (long/short term). Evaluate ability and availability of designated caregiver(s) to provide patient support. Coordinate and implement interventions using evidence based guidelines. Recommend additional services to PCP as determined in the case management plan. Conduct ongoing assessment of progress against original goals. Continuously update needed services. Maintain ongoing communication with patient/family and care team. Acts as an advocate for patient care needs. Documents all responses of patient to case management interventions. Collaborates with other health care professionals regarding the plan of care, variances in plan implementation, achieved outcomes or expected outcomes. Monitor and evaluate short and long term patient responses to therapeutic interventions and analyze patterns of variance from clinical information and outcomes. Recommend alternative settings for care based on health care needs and appropriate utilization of health care resources. Document interventions and interactions with patients or caregivers according to KFHPW and Care Management policy and procedure. Participate in the measurement of the effectiveness of the case management program. Directs and guides the plan of care to result in a seamless continuum of care. Facilitates as needed, referrals for home health care, long term care, hospice, and other care facilities or services. Participation in care conferences to provide problem solving for patients with complex care needs (limited basis). Collects needed data needed to evaluate the effects of care coordination on quality outcomes, fiscal parameters, patient satisfaction and systems improvement. Understands and utilizes health plan requirements and patient benefits in making care management decisions. Assists patient to understand and comply with their medical treatment plan. Supports patient education and activation through referral to specific chronic illness classes, group visits or community resources. Basic Qualifications: Experience Minimum three (3) years of recent RN medical/surgical/ambulatory clinical experience required. Minimum two (2) years of RN experience in ambulatory case management, care coordination or disease management. Education Bachelors degree License, Certification, Registration Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire Basic Life Support required at hire Case Manager Certificate within 36 months of hire Additional Requirements: Effective, independent nursing judgment and skills, and use of evidence based clinical decision making criteria. Knowledge in management of chronic disease process, nursing process and collaborative care planning. Demonstrated skill and experience in effectively collaborating with care team members. Preferred Qualifications: Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination or disease management. Bachelors of science in nursing.

The Legacy nursing philosophy focuses on patients and their families. Our nurses embody this philosophy in everything they do, as advocates, communicators, problem-solvers and caregivers. Their expertise is sought after and respected by our health care team. In short, they are the face of wellness at Legacy. Does this sound like an environment in which you could thrive? If so, we invite you to consider this opportunity. Legacy Emanuel Medical Center in North Portland plays a vital role as a local and regional leader in serious clinical illness or injury. With around-the-clock expertise for critical health issues, including experts in trauma, heart care, burns, significant wounds, stroke, brain surgery and more, Legacy Emanuel is central to the health of our community and critical to the care of the Northwest. Legacy Emanuel Medical Center is a Level 1 Trauma Center, Regional Burn Center and serves the needs of both adult hospital population as well as Randall Children's Hospital at Legacy Emanuel. Responsibilities: Responsible for patient care within an assigned department/unit and participates as a member of the health care team in cooperation with and under the direction of the clinical manager or designee as defined by the relevant Standards and Scope of Practice for the Registered Nurse. The RN Staff Nurse assesses, analyzes, plans, implements and evaluates patient care following established patient care standards for Legacy Health System including those for patient assessment and transfer. Qualifications: Education: As required by licensure. BSN or degree in progress strongly preferred. BSN may be required for specific assignments; experienced RNs without a BSN may be hired based on clinical experience with approval of the site CNO. Experience: One-year registered nursing experience or completion of either the Legacy Health RN Residency program or a nursing program that is equivalent in content, curriculum and duration. Additional clinical experience requirements may vary dependent upon the specific department in which the position is utilized. Previous interventional cardiovascular recovery unit experience or critical care experience preferred. Knowledge/Skills: Demonstrated ability of positive interpersonal and communication skills with colleagues, patients, families, physicians and the community. Keyboard skills and ability to navigate electronic systems applicable to job functions. Licensure: Current applicable state RN license required. AHA BLS for Healthcare Providers. Pay Range: USD $54.37 - USD $81.21 /Hr. Our Commitment to Health and Equal Opportunity: Our Legacy is good for health for Our People, Our Patients, Our Communities, Our World. Above all, we will do the right thing. If you are passionate about our mission and believe you can contribute to our team, we encourage you to apply-even if you don't meet every qualification listed. We are committed to fostering an inclusive environment where everyone can grow and succeed. Legacy Health is an equal opportunity employer and prohibits unlawful discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion or creed, citizenship status, sex, sexual orientation, gender identity, pregnancy, age, national origin, disability status, genetic information, veteran status, or any other characteristic protected by law. To learn more about our employee benefits click here:

Additional Position Details: FTE: 1.000000 | Full Time | 1st Shift - Days Starting Wage: $49.33-$67.84 per hour, depending on experience This position requires carrying out the following key elements of case management for their assigned department: (1) admissions coordination and marketing, (2) internal case management: IRF-PAI data collection and coordination, utilization review and insurance authorization, and (3) discharge planning and coordination. Qualifications and Requirements Education * A bachelor's degree in nursing or an allied health field is preferred. Experience * Minimum 2 years of progressive nursing experience in an acute care setting, preferably within discharge, utilization, and/or case management, or the equivalent combination of education and/or experience, is required Licensure/Certifications * RN: Registered Nurse licensed by the Oregon State Board of Nursing (OSBN) required upon start. * CCM: Certified Case Manager is preferred What We Offer * Competitive starting wage * Comprehensive benefits including medical, dental, vision, and wellness * Excellent retirement package with up to 6% employer contribution * Generous Earned Time Off * Tuition reimbursement after one year of service About Asante and Southern Oregon Asante is a local, community-owned and governed, not-for-profit organization that provides comprehensive health care services to more than 550,000 people in a nine-county area of Southern Oregon and Northern California. It includes Asante Ashland Community Hospital in Ashland, Asante Rogue Regional Medical Center in Medford, Asante Three Rivers Medical Center in Grants Pass, Asante Physician Partners throughout the Rogue Valley, and additional health care partnerships. Virtually all medical specialties and services are represented within an organization dedicated to providing exceptional care. With over 5,000 employees, Asante's entities offer outstanding opportunities for career advancement and professional growth. At Asante, your work positively impacts your family, friends, neighbors, and the community. Experience the difference in how you work, how you live, and how you connect. At Asante, we are defined by our values - traits that guide us as we serve patients and the community: Excellence - Respect - Honesty - Service - Teamwork Asante is an equal opportunity employer. We are committed to employ and advance in employment women, minorities, qualified individuals with disabilities and protected veterans.

**Your Future Evolves Here** 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. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse, you will routinely interact with leadership and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors (FMDs). **What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. + Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. + Documents all communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately. **Qualifications Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse- **Required** + Associate or Bachelors in Nursing (Must be a Registered Nurse) - **Required** + You must be able to work a minimum of 30 hours/week- **Required** + Strong interpersonal and communication skills - **Required** + Proficient computer skills; must be able to talk and type simultaneously- **Required** + 5+ years clinical experience- **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. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $34-$37/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**Your Future Evolves Here** 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. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse, you will routinely interact with leadership and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors (FMDs). **What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. + Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. + Documents all communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately. **Qualifications Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse- **Required** + Associate or Bachelors in Nursing (Must be a Registered Nurse) - **Required** + You must be able to work a minimum of 30 hours/week- **Required** + Strong interpersonal and communication skills - **Required** + Proficient computer skills; must be able to talk and type simultaneously- **Required** + 5+ years clinical experience- **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. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $34-$37/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**Your Future Evolves Here** 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. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse, you will routinely interact with leadership and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors (FMDs). **What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. + Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. + Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. + Documents all communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately. **Qualifications Required and Preferred:** + Current, unrestricted state licensure as a Registered Nurse- **Required** + Associate or Bachelors in Nursing (Must be a Registered Nurse) - **Required** + You must be able to work a minimum of 30 hours/week- **Required** + Strong interpersonal and communication skills - **Required** + Proficient computer skills; must be able to talk and type simultaneously- **Required** + 5+ years clinical experience- **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. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $34-$37/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

**Your Future Evolves Here** 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. **What You'll Be Doing:** **Your Future Evolves Here** 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. **What You'll Be Doing:** 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 in concert with the health care delivery team to maintain high-quality, cost-effective care delivery. + Perform pre-certification utilization reviews of **Oncology treatment requests** + 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. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license. + 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 weekend holiday rotation. **Finishing Touches (Preferred):** + Experience with clinical decision-making criteria sets (i.e., Milliman, InterQual) + Minimum of one year of experience with medical management activities in a managed care environment + UM/UR experience + Clinical experience in Oncology, ICU, ED, or other critical care environment + Remote work experience 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. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $32-$37 /hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

JOB TITLEUtilization Review NurseREPORTS TOUtilization Review, ManagerSTATUSFT, ExemptWAGE RANGEGrade 20 (2024) DEPARTMENTUtilization ManagementWORK LOCATIONRemote (occasional travel as required) The Utilization Management Nurse is responsible for evaluating clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role applies professional nursing judgment to conduct prior authorization reviews, facilitate care coordination, and support transitions across care settings. The nurse ensures compliance with Oregon Health Plan (OHP), Medicare, and applicable regulatory guidelines, while a assuring member access to appropriate services. Through collaboration with interdisciplinary teams and community providers, the Utilization Management Nurse promotes integrated, high-quality care and contributes to continuous improvement in utilization management processes. ESSENTIAL JOB RESPONSIBILITIES Performing clinical assessments of various medical service requests to determine medical necessity, appropriateness, and alignment with evidence-based guidelines and benefit coverage. Conduct prior authorization and HRS flex reviews, applying nursing judgment to ensure timely, cost-effective, and high-quality care delivery. Identify and escalate complex or non-standard cases to Medical Directors; request and evaluate additional clinical documentation as needed. Collaborate with care coordinators, discharge planners, and interdisciplinary teams to support integrated care and safe transitions across care settings. Maintain up-to-date knowledge of Oregon Health Plan (OHP), Medicare, and applicable regulatory frameworks (OAR, ORS, CFR, CMS, DMAP). Serve as a clinical liaison with internal departments (e.g., Third-Party Recovery, Customer Care) to resolve eligibility, coordination of benefits, and stop-loss concerns. Ensuring access to appropriate services in the least restrictive setting, while supporting continuity and quality of care. Participate in discharge planning for members transitioning from acute, long-term, or residential care to community-based services, ensuring holistic support for physical and behavioral health needs. Conduct departmental audits and contribute to quality improvement initiatives by identifying trends and recommending process enhancements. Provide training and mentorship to new and cross-functional staff on clinical workflows and UM protocols. Build and maintain collaborative relationships with community providers and service organizations to support member care plans. Ensure compliance with organizational policies, clinical standards, and all applicable federal and state regulations. Conduct work independently and in collaboration with the Utilization Management (UM) team to ensure accurate and appropriate determinations. Perform other nursing-related duties as assigned. CHALLENGES Working with a variety of personalities, maintaining a consistent and fair communication style. Satisfying the needs of a fast paced and challenging company. QUALIFICATIONSMinimum Qualifications Licensure: Active, unrestricted Registered Nurse (RN), BSN (Bachelor of Science in Nursing, MSN (Master of Science in Nursing) license in the state of Oregon or a compact state. Education: Graduation from an accredited nursing program. Experience: Minimum of five (5) years of direct patient care experience in a clinical setting, such as a medical office, hospital, or long-term care facility. Core Competencies & Skills Clinical Nursing Expertise: Deep understanding of medical terminology, diagnoses, procedures, and care modalities. Experienced in interpreting clinical documentation and applying nursing knowledge to support utilization review and care decisions. Utilization Management: Proficient in InterQual criteria, UM software, and evidence-based guidelines. Skilled in reviewing requests for medical services and ensuring appropriate use of resources. Regulatory Compliance: Strong working knowledge of NCQA standards, Oregon Health Plan (OHP), and Coordinated Care Organization (CCO) regulations, including OAR, ORS, CFR, CMS, DMAP, and the Prioritized List of Health Services. Medical Coding & Insurance: Familiar with ICD and CPT codes, health insurance processes, and state-mandated benefits. Technology & Documentation: Proficient in Microsoft Office (Word, Excel, Outlook), EHR systems, and managed care platforms. Accurate typing at 45+ WPM. Communication & Collaboration: Excellent interpersonal, written, and verbal communication skills. Builds strong relationships with providers, community services, and internal teams. Organization & Problem Solving: Highly organized and detail-oriented. Capable of managing multiple priorities, analyzing complex situations, and developing effective solutions. Ethical Standards: Maintains compliance with federal healthcare program requirements. No suspension, exclusion, or debarment from Medicare/Medicaid. Preferred Qualifications Two (2) years of utilization review or case management experience in a managed care organization or commercial insurance. Oregon residency and Oregon nursing license. Proficient in electronic systems for data entry and retrieval. Strong critical thinking, time management, and organizational skills to meet goals and deadlines. Demonstrated ability to work independently and collaboratively in fast-paced environments. Committed to continuous learning and expanding responsibilities. Knowledgeable in contractual benefits and alternative coverage options. Maintains patient confidentiality and secure health record practices. Current clinical certification and up-to-date knowledge base. Capable of conducting quality improvement audits and reporting findings. Effective in managing multiple priorities with attention to detail and accuracy. Experience working on diverse teams and considering equity impacts in decision-making. Bilingual capabilities or translation experience is a plus. PHYSICAL DEMANDS & WORK CONDITIONS A typical office environment requires standing, sitting, walking, bending, and lifting up to 25 plus pounds. Ability to travel and drive to in-person meetings or be on-site as required. May be exposed to patient and environment conditions such as unpleasant sights, smells and contagious diseases (clinic only). EQUAL EMPLOYMENT OPPORTUNITYUH is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. UH makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, read through our EEO Policy. ACKNOWLEDGEMENTI have reviewed the attached as outlined above and understand that I am responsible for all duties as outlined and other tasks as may be assigned. I understand that if I need accommodation to perform the essential functions of my job that I must contact my supervisor or Human Resources as soon as possible to begin an interactive process.Note: This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. EMPLOYEE SIGNATUREDATE About Umpqua Health At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health. Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law. Powered by JazzHR H8CdP55VL3

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. This is a 100% remote position, must sit in or near Oregon. Prefer an RN with a compact license. + Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member + Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members + Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines + Reviews member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities + Collaborates with care management on referral of members as appropriate + Performs other duties as assigned + Complies with all policies and standards **Education/Experience:** Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification** + LPN - Licensed Practical Nurse - State Licensure required + RN compact license preferred Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Avalon Health Care Management, Inc. has an exciting opportunity for an experienced Registered Nurse for a Regional Nurse Consultant position! Travel required. Avalon is seeking an experience skilled nursing facility director of nursing who is ready to take the next step in their career as a regional nurse consultant or an experienced regional nurse consultant with a background working as a director or nursing in a skilled nursing facility. Must have DON or Regional Nurse experience in Skilled Nursing $140,000 - $160,000 Full-time are eligible for: * 401K * Medical, Dental & Vision * FSA & Dependent Care FSA * Life Insurance * AD&D, Long Term Disability, Short Term Disability * Critical Illness, Accident, Hospital Indemnity * Legal Benefits, Identity Theft Protection * Pet Insurance and Auto/Home Insurance Responsibilities The Regional Nurse Consultant will be responsible for the provision of expert advice and oversight to facility management personnel and line staff to ensure that systems are maintained to effectively and efficiently operate the facility in a manner to safely meet residents' needs in compliance with federal, state and local requirements. * Resident Assessment/Care Plan Development * Delivery of Resident Care * Facility Support * Supervision * Customer Service * Residents' Rights * Resident Comfort and Safety * Pharmacy Knowledge * Lab Values * Infection Control * Continuing Education Qualifications * Previous Director of Nursing and/or Nurse Consulting experience for a Skilled Nursing Facility is required. * Understanding of CMS regulations and experience with the survey process. * A current, active license to practice as a Registered Nurse (RN) * Ability to travel to assignments. * Ongoing pursuit of Continuing Education Credits in clinical subjects, management, personal growth and development. * Demonstrate working knowledge of infection control principles and practices. * Ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, and policies and procedures that are necessary for providing quality care. * Proven ability to communicate effectively and positively with staff, residents and family members. * Basic understanding of computer technology. * Proven written and oral communication skills. * Proven decision-making and analytical skills. * Able to relate positively, favorably and cooperatively with others, including employees, residents, family members, and personnel of outside agencies and organizations. Avalon Health Care Group is an Equal Opportunity Employer. If you believe this posting does not comply with WA law, send notice to **************************.

Avalon Health Care Management, Inc. has an exciting opportunity for an experienced Registered Nurse for a Regional Nurse Consultant position! Travel required. Avalon is seeking an experience skilled nursing facility director of nursing who is ready to take the next step in their career as a regional nurse consultant or an experienced regional nurse consultant with a background working as a director or nursing in a skilled nursing facility. Must have Previous DON or Regional Nurse experience in the Skilled Nursing industry $130,000 - $160,000 Full-time are eligible for: * 401K * Medical, Dental & Vision * FSA & Dependent Care FSA * Life Insurance * AD&D, Long Term Disability, Short Term Disability * Critical Illness, Accident, Hospital Indemnity * Legal Benefits, Identity Theft Protection * Pet Insurance and Auto/Home Insurance Responsibilities The Regional Nurse Consultant will be responsible for the provision of expert advice and oversight to facility management personnel and line staff to ensure that systems are maintained to effectively and efficiently operate the facility in a manner to safely meet residents' needs in compliance with federal, state and local requirements. * Resident Assessment/Care Plan Development * Delivery of Resident Care * Facility Support * Supervision * Customer Service * Residents' Rights * Resident Comfort and Safety * Pharmacy Knowledge * Lab Values * Infection Control * Continuing Education Qualifications * Previous Director of Nursing and/or Nurse Consulting experience for a Skilled Nursing Facility is required. * Understanding of CMS regulations and experience with the survey process. * A current, active license to practice as a Registered Nurse (RN) * Ability to travel to assignments. * Ongoing pursuit of Continuing Education Credits in clinical subjects, management, personal growth and development. * Demonstrate working knowledge of infection control principles and practices. * Ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, and policies and procedures that are necessary for providing quality care. * Proven ability to communicate effectively and positively with staff, residents and family members. * Basic understanding of computer technology. * Proven written and oral communication skills. * Proven decision-making and analytical skills. * Able to relate positively, favorably and cooperatively with others, including employees, residents, family members, and personnel of outside agencies and organizations. Avalon Health Care Group is an Equal Opportunity Employer. If you believe this posting does not comply with WA law, send notice to **************************.

Avalon Health Care Management, Inc. has an exciting opportunity for an experienced Registered Nurse for a Regional Nurse Consultant position! Travel required. Avalon is seeking an experienced skilled nursing facility director of nursing who is ready to take the next step in their career as a regional nurse consultant or an experienced regional nurse consultant with a background working as a director or nursing in a skilled nursing facility. Must have DON or Regional Nurse experience in Skilled Nursing $140,000 - $160,000 Full-time are eligible for: * 401K * Medical, Dental & Vision * FSA & Dependent Care FSA * Life Insurance * AD&D, Long Term Disability, Short Term Disability * Critical Illness, Accident, Hospital Indemnity * Legal Benefits, Identity Theft Protection * Pet Insurance and Auto/Home Insurance Responsibilities The Regional Nurse Consultant will be responsible for the provision of expert advice and oversight to facility management personnel and line staff to ensure that systems are maintained to effectively and efficiently operate the facility in a manner to safely meet residents' needs in compliance with federal, state and local requirements. * Resident Assessment/Care Plan Development * Delivery of Resident Care * Facility Support * Supervision * Customer Service * Residents' Rights * Resident Comfort and Safety * Pharmacy Knowledge * Lab Values * Infection Control * Continuing Education Qualifications * Previous Director of Nursing and/or Nurse Consulting experience for a Skilled Nursing Facility is required. * Understanding of CMS regulations and experience with the survey process. * A current, active license to practice as a Registered Nurse (RN) * Ability to travel to assignments. * Ongoing pursuit of Continuing Education Credits in clinical subjects, management, personal growth and development. * Demonstrate working knowledge of infection control principles and practices. * Ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, and policies and procedures that are necessary for providing quality care. * Proven ability to communicate effectively and positively with staff, residents and family members. * Basic understanding of computer technology. * Proven written and oral communication skills. * Proven decision-making and analytical skills. * Able to relate positively, favorably and cooperatively with others, including employees, residents, family members, and personnel of outside agencies and organizations. Avalon Health Care Group is an Equal Opportunity Employer. If you believe this posting does not comply with WA law, send notice to **************************.

Avalon Health Care Management, Inc. has an exciting opportunity for an experienced Registered Nurse for a Regional Nurse Consultant position! Travel required. Avalon is seeking an experience skilled nursing facility director of nursing who is ready to take the next step in their career as a regional nurse consultant or an experienced regional nurse consultant with a background working as a director or nursing in a skilled nursing facility. Must have DON or Regional Nurse experience in Skilled Nursing Starting at $130,000 /yr Full-time are eligible for: * 401K * Medical, Dental & Vision * FSA & Dependent Care FSA * Life Insurance * AD&D, Long Term Disability, Short Term Disability * Critical Illness, Accident, Hospital Indemnity * Legal Benefits, Identity Theft Protection * Pet Insurance and Auto/Home Insurance Responsibilities The Regional Nurse Consultant will be responsible for the provision of expert advice and oversight to facility management personnel and line staff to ensure that systems are maintained to effectively and efficiently operate the facility in a manner to safely meet residents' needs in compliance with federal, state and local requirements. * Resident Assessment/Care Plan Development * Delivery of Resident Care * Facility Support * Supervision * Customer Service * Residents' Rights * Resident Comfort and Safety * Pharmacy Knowledge * Lab Values * Infection Control * Continuing Education Qualifications * Previous Director of Nursing and/or Nurse Consulting experience for a Skilled Nursing Facility is required. * Understanding of CMS regulations and experience with the survey process. * A current, active license to practice as a Registered Nurse (RN) * Ability to travel to assignments. * Ongoing pursuit of Continuing Education Credits in clinical subjects, management, personal growth and development. * Demonstrate working knowledge of infection control principles and practices. * Ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, and policies and procedures that are necessary for providing quality care. * Proven ability to communicate effectively and positively with staff, residents and family members. * Basic understanding of computer technology. * Proven written and oral communication skills. * Proven decision-making and analytical skills. * Able to relate positively, favorably and cooperatively with others, including employees, residents, family members, and personnel of outside agencies and organizations. Avalon Health Care Group is an Equal Opportunity Employer. If you believe this posting does not comply with WA law, send notice to **************************.

Job Posting: Nurse Case Manager Hospice Starting at $55.00 per hour Company: VistaRiver HealthcareJob Description VistaRiver Healthcare invites qualified nursing professionals to apply for the position of Nurse Case Manager Hospice. This essential role is designed for a compassionate and dedicated individual ready to make a significant difference in the lives of patients and their families during sensitive times. As a Nurse Case Manager specializing in Hospice care, the successful candidate will deliver exceptional patient-centered care grounded in empathy and medical expertise. This is a Full-Time opportunity that requires onsite presence, as it is not a remote position. The chosen candidate will be part of a devoted healthcare team, working to ensure the continuity and quality of care within the community-based settings of our patients. Duties and Responsibilities Completes initial, comprehensive, and ongoing assessments of patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illnesses. Utilizes all elements of the nursing process to provide professional nursing care. Assesses and evaluates patient's status by writing and initiating a plan of care, regularly re-evaluating patient and family/caregiver needs, and participating in revising the plan of care as necessary. Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the physician's plan of care. Counsels the patient and family in meeting nursing and related needs. Provides health care instructions to the patient as appropriate per assessment and plan, assisting the patient with activities of daily living and facilitating the patient's efforts toward self-sufficiency and optimal comfort care. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload. Completes, maintains, and submits accurate and relevant clinical notes regarding patient's condition and care given. Communicates with the physician regarding the patient's needs and reports changes in the patient's condition; obtains/receives physicians' orders as required. Communicates with community health-related persons to coordinate the care plan and teaches the patient and family/caregiver self-care techniques as appropriate. Provides and maintains a safe environment for the patient, assists the patient and family/caregiver and other team members in providing continuity of care. Participates in on-call duties as defined by the on-call policy. Ensures that arrangements for equipment and other necessary items and services are available. Supervises ancillary personnel and delegates responsibilities when required. Actively participates in quality assessment performance improvement teams and activities. Requirements Registered nurse with current licensure to practice professional nursing in the state of Oregon. Graduate of National League for Nursing accredited school of nursing. Maintains a current CPR certification. Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order. Minimum of two years' experience, at least one of which is in the area of public health, home care, or hospice nursing is preferred. Self-directed and able to work with minimal supervision. Experience in supervising hospice aides is not required but responsible for supervising when necessary. Demonstrates excellent observation, problem-solving, verbal, and written communication skills; nursing skills per competency checklist. Ability to organize and prioritize workload independently. Prolonged or considerable walking or standing. Able to lift, position, and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping bending, kneeling, and/or crouching. Visual acuity and hearing to perform required nursing skills.

Job Posting: Nurse Case Manager Hospice Starting at $55.00 per hour Company: VistaRiver HealthcareJob Description VistaRiver Healthcare invites qualified nursing professionals to apply for the position of Nurse Case Manager Hospice. This essential role is designed for a compassionate and dedicated individual ready to make a significant difference in the lives of patients and their families during sensitive times. As a Nurse Case Manager specializing in Hospice care, the successful candidate will deliver exceptional patient-centered care grounded in empathy and medical expertise. This is a Full-Time opportunity that requires onsite presence, as it is not a remote position. The chosen candidate will be part of a devoted healthcare team, working to ensure the continuity and quality of care within the community-based settings of our patients. Duties and Responsibilities Completes initial, comprehensive, and ongoing assessments of patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illnesses. Utilizes all elements of the nursing process to provide professional nursing care. Assesses and evaluates patient's status by writing and initiating a plan of care, regularly re-evaluating patient and family/caregiver needs, and participating in revising the plan of care as necessary. Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the physician's plan of care. Counsels the patient and family in meeting nursing and related needs. Provides health care instructions to the patient as appropriate per assessment and plan, assisting the patient with activities of daily living and facilitating the patient's efforts toward self-sufficiency and optimal comfort care. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload. Completes, maintains, and submits accurate and relevant clinical notes regarding patient's condition and care given. Communicates with the physician regarding the patient's needs and reports changes in the patient's condition; obtains/receives physicians' orders as required. Communicates with community health-related persons to coordinate the care plan and teaches the patient and family/caregiver self-care techniques as appropriate. Provides and maintains a safe environment for the patient, assists the patient and family/caregiver and other team members in providing continuity of care. Participates in on-call duties as defined by the on-call policy. Ensures that arrangements for equipment and other necessary items and services are available. Supervises ancillary personnel and delegates responsibilities when required. Actively participates in quality assessment performance improvement teams and activities. Requirements Registered nurse with current licensure to practice professional nursing in the state of Oregon. Graduate of National League for Nursing accredited school of nursing. Maintains a current CPR certification. Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order. Minimum of two years' experience, at least one of which is in the area of public health, home care, or hospice nursing is preferred. Self-directed and able to work with minimal supervision. Experience in supervising hospice aides is not required but responsible for supervising when necessary. Demonstrates excellent observation, problem-solving, verbal, and written communication skills; nursing skills per competency checklist. Ability to organize and prioritize workload independently. Prolonged or considerable walking or standing. Able to lift, position, and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping bending, kneeling, and/or crouching. Visual acuity and hearing to perform required nursing skills.

Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details. Ventura MedStaff benefits represent the care and compassion we provide for our clients. • Health, dental, vision, life, disability benefits and 401k • Tax free stipends when applicable • Gym discounts • Weekly pay • $750.00 referral bonus Please apply or contract us at: *********************** or ************

NOW ACCEPTING APPLICATIONS FOR JULY AND AUGUST 2026 COHORTS This application is only for the units listed below Available departments (See full descriptions below) * 1 North - Medical Nephrology * 2 East - Ortho/Neuro Unit * 2 South - General Surgery Unit * 3 East - Onc/Neuro/Gen Med * 3 North - Medical Unit * Nursing Resource Team Program Overview The Kootenai Nurse Residency Program is an incredibly supportive program that transitions newly graduated nurses to the hospital setting. The program accepts only the most outstanding and committed applicants. The Nurse Residency is a full-time (36-40 hours/pay period), paid program that prepares new professional nurses with exemplary skills, knowledge, and experience in inpatient areas. This is a year-long program that provides an innovative, person-centered support structure for the acquisition of evidence-based practice, standardization of knowledge, and skills to ensure our nurses are confidently prepared, supported, and engaged in their work. Nurse Residents learn through a combination of educational seminars, peer support discussions, simulation, and authentic patient experiences with the support of experienced preceptors/mentors. Kootenai Health is committed to providing Nurse Residents with the teaching, training, mentoring, and expertise needed for a successful career in nursing. Hiring Process * Begin by submitting your formal application on our website. * Next, we'll reach out by email with a request to complete a one-way interview through Spark Hire. * A Talent Acquisition Consultant will connect with you to provide a list of unit descriptions and gather your top unit preferences. While not every unit may be available in each cohort, we're committed to helping you find a great fit. * After your Spark Hire interview, your application and video will be reviewed by unit managers, starting with your first preferred choice. If you're not selected for your top choice, don't worry-your application and video will be forwarded to the next unit on your list. * Once reviewed, the Talent Acquisition Consultant will reach out to schedule an interview. For this interview, the unit manager will ask follow up questions to your video interview, provide more insights on unit specifics, and answer any questions you may have. You may have the chance to speak with multiple units to find the best match for you. * If selected for the program, the Talent Acquisition Consultant will reach out with the details of your offer, including unit placement and compensation. Things to know * Units will aim to offer residency positions in each cohort; however, availability can vary per cohort. Please note that not every unit will offer positions in every cohort. * If your top unit preference isn't available in the cohort you're applying to, you'll automatically be considered for your next choice. * This application is only for the units listed above. * Most Nurse Resident positions are night shift. Day shift Nurse Resident positions may not be available. As a Nurse Resident, you will receive * Socialization and networking support * Didactic, targeted teaching, and learning experiences * Monthly workshops with social networking and didactic experiences * 24-hour access to a robust, interdisciplinary on-site library * Three to six months of direct bedside preceptor and leadership support * Training in national certification courses that are integral to your specialty practice, such as BLS, ACLS, TNCC, NRP, PALS, and many more * Specialty-specific education courses as applicable * A professional nursing culture and education environment consistent with the ANCC Magnet designation - the national standard for nursing excellence in the United States. * Early leadership opportunities Eligibility to participate in the Nurse Residency Program includes * Graduate of a nationally accredited nursing program. BSN preferred * Less than 12 months of experience as an RN * Less than 6 months of hospital experience required at the time of hire * RN with less than 3 years' patient-facing nursing experience at time of hire are required to be enrolled in a baccalaureate (or higher) degree program in nursing within 1 year of employment, with completion within 3 years of hire * RN with at least 3 years' patient-facing nursing experience at time of hire, ADN or diploma required; BSN or higher preferred * State of Idaho Registered Nurse OR licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the "multistate privilege to practice" compact with Idaho prior to start date. * A nursing work gap greater than 12 months from your most recent experience will require successful completion of a Learning Needs Assessment conducted by a KH Nursing Education Specialist * ACLS to be provided and completed, if applicable * BLS Required. Current AHA Healthcare provider, American Red Cross, AHA Health Saver or KH BLS during General Orientation Learn more about our teams Cardiac Medical (3N) is a cardiology focused medical surgical unit. The population is primarily made up of patients with the following diagnosis: CHF, bradycardic and tachycardic arrhythmias, chest pain, NSTEMI, and pulmonary embolism. Many of these patients require continuous telemetry monitoring which is monitored by a central monitoring studio. Interventions typically seen for this patient population include echocardiograms, stress tests, cardiac catheterizations, pacemaker placement, heparin drips and antiarrhythmic medications. The cardiac medical unit does not care for patients requiring continuous antiarrhythmic drips or vasopressors. Further education consists of a basic cardiac rhythm interpretation class. 3N continues to take medical and surgical overflow patients as needed within scope. Nephrology/Circle of Life (1N) the Nephrology population consists of patients with kidney disease (acute and chronic), a history of kidney transplants, significant electrolyte imbalances, fluid shifts and heart/liver failure. Both hemodialysis and peritoneal dialysis are common treatments for our Nephrology patient population- both are done on the unit. Circle of Life patients are those who are near or at the end of life and are also cared for within our designated area of the unit. These important work facilitates giving patients the opportunity to be free of pain with family present, and to find comfort in their final moments. Caring for patients at the end of life is an opportunity for rich professional development and personal fulfillment for the nurses who have the privilege to do so. General Surgical (2S) is a 30 bed medical/surgical unit that specializes in post-operative recovery of patients after the Recovery Room such as general surgical, genitourinary, general cardiothoracic, and general vascular. Additionally, 2 South cares for patients who may being cared for throughout the surgical care continuum such as pre-operative complications, post-operative complications as well as a variety of medical patients. Due to the wide variety of patients cared for on 2South, one could also expect to see multiple drains such as chest tubes, JP drains, ostomies, and foley catheters just to name a few. Orthopedic/Neurosurgical (2E) Patient population consisting of our specialties in orthopedics, neuro surgeries, and traumas, as well as general medical/surgical patients. The unit does have remote telemetry monitoring if it is required. Our orthopedic patients are often treated for injuries of the bones and occasional elective joint surgeries. Neurosurgery is the specialty focused on surgical treatment of disorders that affect the brain, spinal cord, and cerebrovascular system. Often, we work with patients recovering from Craniotomies, Laminectomies and many other types of surgeries performed by our experienced care teams which is currently expanding. Our Trauma team treats everything from minor injuries including lacerations to fractures, to major complicated trauma involving multiple body systems. We have a heavy focus on getting our patients mobilized and back on their feet. 2 East has a culture of collaboration and teamwork. Nurse Resource Team (NRT) is a float pool department where new graduates or nurse residents work in a variety of hospital wide service lines/care areas. The entry level float cluster includes the 5 medical-surgical departments, behavioral health your and adult units, and the Addiction Recovery unit. There are advanced float cluster tiers to advance into. Following completion of additional competencies and training some NRT support higher acute care areas including the Progressive Care unit, Emergency Department, and Critical Care. This department requires nurses to be efficient with time management and flexible in working with a variety of teams throughout the various service lines it supports. Nurses in the NRT participate in caring for a wide variety of patient populations and acuity's and must maintain competency and a high level of understanding in all specialties they work in. Oncology/Neurology/Medical (3E) is a 37-bed acute care unit, Level 3 Epilepsy Center accredited by the National Association of Epilepsy Centers, and a Level 2 Stroke Center designated by The Idaho Time Sensitive Emergency Council. The unit is comprised of 9 bariatric life rooms, 5 positive pressure rooms, 3 negative pressure rooms, and 2 rooms equipped for epilepsy monitoring. Serving an adult population which includes active/acute seizure and/or seizure disorder, acute/history of stroke or stroke like symptoms, oncology/chemotherapy, Circle of Life, medical/neuro, and medical/surgical overflow. 3 East competencies include Stroke Care/National Institutes of Health Stroke Scale (NIHSS), Epilepsy Monitoring (EMU), and Oncology/Chemotherapy administration. The unit culture is based on the Kootenai Health Way incorporating safety, compassion, engagement and the compassion care bundle. Start your Nursing career at Kootenai Health! Contact Email [email protected] or call ************** We look forward to getting to know you better! Kootenai Health complies with applicable federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.