Clinical research nurse work from home jobs - 396 jobs

This is a contract assignment that will start right away and end on June 28th 2024 Remote in TX Must Live in TX SUMMARY DESCRIPTION: RN or LPN with clinical experience and will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications. JOB REQUIREMENTS: • Degree, Diploma or Certificate from a school of nursing with clinical experience. • Licensed in the State of Illinois • Knowledge of medical terminology • Data entry and/or typing experience. • Clear and concise written and verbal communication skills. • PC proficiency to include Word, Excel and Lotus Notes. • Auditing experience preferred. DUTIES AND RESPONSIBILITIES: • Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines. • Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors. • Identify and report abstraction errors and provide measure re-education with for the abstractor. • Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s). • Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results. • Maintains productivity level as determined by the HEDIS Coordinator/QI Department. • Maintain compliance with all HIPPA and patient confidentiality requirements. • All other duties as assigned.

Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. What You'll Do: As Clinical Educator with Imagine Pediatrics, you will play a critical role in supporting the clinical development and education of all clinical health professionals. This position involves developing, implementing, and evaluating training programs to ensure the delivery of high-quality, family-centered care. The Clinical Educator will collaborate with interdisciplinary teams to enhance the competencies of clinicians, improve patient outcomes, and ensure adherence to value-based care principles. You will support various learning programs through in-person and remote training. You will: Develop and maintain new hire standards for onboarding and clinical orientation. Collaborate with program and regional leaders to design and deliver robust clinical onboarding experience that focuses on care delivery models, process improvement, tailored services, value-based care, and SDOH. Create, coordinate, and deliver training programs, workshops, and continuing education sessions for team members focusing on evidence-based practices, child/adolescent health, and our integrated care models. Oversee preceptor training by collaborating with clinical staff on current practices, interpersonal skills and EMR training. Create and present educational content with a focus on areas that support business objectives to include but not limited to transitions of care, disease management, and case management. Provide clinical coaching and mentorship to clinical health staff, focusing on skill development, case consultation, and clinical supervision. Foster a culture of continuous learning and improvement. Utilize clinical data, outcome measures, and performance metrics to assess the effectiveness of educational programs and make data-driven recommendations for program enhancements. Assist in the development and revision of clinical policies, procedures, and protocols to ensure compliance with regulatory requirements and alignment with Imagine Pediatrics care model. Create educational materials, guides, and resources for clinicians and families to support understanding of pediatric behavioral health conditions, treatments, and the value-based care model. Provide training for various electronic medical records and software. Design compelling training for wide audiences and skill levels for both online and instructor-led material. Travel to Imagine Pediatrics' offices to train on various content or reinforce adherence to process. This position will require up to 20% travel. What You Bring & How You Qualify First and foremost, you're passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support, they deserve. You want an active role in building a diverse and value-driven culture. Things change quickly in a startup environment; you accept that and are willing to pivot quickly to priorities. In this role, you will need: You hold an unrestricted RN and/or NP state license, including board certification, or the ability to become board certified within 2 years. You have strong comprehension of clinical standards of care and are focused on quality of life for your patients. You have proficiency in Microsoft products and general technological savviness. Experience with curriculum design platforms. Experience leading training efforts or as a Clinical Educator. Experience working with a pediatric population strongly preferred, virtual care experience a plus. Willingness to travel up to 20%. What We Offer (Benefits + Perks) The role offers a base salary range of $80,000 - $110,000 In addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We're guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward - together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Job Description Director, Behavioral Health Transfer Center $90,000 to $140,000 Base compensation based on experience Must be a licensed clinician, such as Registered Nurse. Would possibly consider a Licensed Clinical Social Worker or Licensed Professional Counselor depending on experience Must hold a multi-state license (e.g., RN Compact or equivalent) Position Overview The Director of the Behavioral Health (BH) Transfer Center provides senior-level leadership for a centralized, 24/7 behavioral health access and admissions operation supporting multiple facilities across several states. This role is accountable for operational performance, clinical integrity, regulatory compliance, and relationship management across a multi-state healthcare system. The ideal candidate is an experienced Behavioral Health leader at the Director level, highly operationally focused, data-driven, and comfortable leading remote clinical and non-clinical teams. This leader serves as the subject matter expert for BH transfer operations and works closely with executive leadership, hospital CEOs, and clinical teams to ensure safe, timely, and compliant patient transfers. Company Overview The Behavioral Health Transfer Center functions as a centralized, 24/7 hub responsible for the timely and appropriate placement of patients requiring acute behavioral health care. The center streamlines the transfer process by conducting clinical assessments, confirming bed availability, and coordinating transportation to ensure patients are placed in the appropriate level of care without delay across 18 facilities. Staffed by a multidisciplinary team of 31 experienced behavioral health professionals-including licensed clinicians, nurses, EMTs, and case managers-the Transfer Center serves as the primary liaison for referring facilities and manages more than 6,000 patient transfers each month. The mission is to reduce wait times, eliminate gaps in care, and ensure safe, seamless transitions for individuals experiencing mental health or substance use crises. This role offers the opportunity to work remotely within a high-volume, fast-paced, and purpose-driven environment focused on clinical excellence and operational efficiency. Key Responsibilities Provide overall leadership and accountability for Behavioral Health Transfer Center operations, including remote clinical (RNs/licensed clinicians) and non-clinical staff. Drive operational excellence through metrics, KPIs, service-level management, and continuous process improvement. Ensure appropriate clinical decision-making and level-of-care recommendations for behavioral health patients across all age populations. Partner with hospital CEOs, Directors of Nursing, Directors of Assessment, and executive leadership to ensure consistent admissions and transfer processes across all facilities. Maintain full compliance with EMTALA, CMS, TJC, HIPAA, and applicable multi-state regulatory requirements; lead regular audits and corrective actions. Collaborate with Workforce Management and Finance to ensure appropriate staffing models and resource allocation. Build and maintain strong relationships with physicians, referral sources, internal stakeholders, and external partners. Work closely with Training and Quality teams to audit calls, referral packets, and documentation to ensure quality and consistency. Identify and resolve operational gaps, service failures, and process breakdowns in a timely manner. Lead performance management, coaching, and development of staff; conduct annual and real-time performance evaluations. Support recruiting, hiring, onboarding, and retention of clinical and non-clinical transfer center staff. 10% travel requirement Must-Have Qualifications Director-level leadership experience in Behavioral Health (required). Strong operational mindset, with demonstrated success managing metrics, workflows, and scalable processes. Active clinical license required, preferably Registered Nurse (RN). Must hold a multi-state license (e.g., RN Compact or equivalent). Candidates with LCSW or LPC licensure may be considered if they hold appropriate multi-state licensure and possess significant leadership experience. Proven ability to communicate effectively and build relationships across all levels of the organization, including executive leadership and frontline clinical teams. Experience supporting or leading 24/7 healthcare operations. Preferred Qualifications Experience leading a Behavioral Health Transfer Center, Access Center, or centralized admissions function. Background managing remote or distributed clinical teams. Direct experience supporting a multi-facility, multi-state behavioral health system. Master's degree in Nursing, Social Work, Psychology, or Healthcare Administration.

Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly to communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine , which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers , which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes A Difference The Registered Nurse, Clinical Delivery (RN) in this role will manage the communication of critical and abnormal lab results to patients, ensuring compliance with state licensure requirements. This includes contacting patients, documenting communications, following up on lab escalations, and collaborating with providers to ensure all patient interactions are appropriately managed and documented. This role is also responsible for patient education, ensuring patients understand their lab results and any necessary next steps in their care, as well as providing study specific information that is tailored to the patient. Furthermore, they serve as a point of escalation for the Member Services team, addressing complex inquiries related to lab results and assisting in the resolution of patient concerns by providing clinical insights and ensuring patients receive accurate information and appropriate follow-up. The RN will liaise with the Clinical Conduct Team to investigate and resolve issues related to duplicate lab results or other concerning findings, as advised by the Medical Director. Lastly, they will assist in training and educating the Member Services team to improve patient interactions and enhance service quality. This role is critical in ensuring timely patient communication and maintaining compliance with clinical and legal standards. How You'll Make An Impact Receive and Review Lab Results from Pre-screening Program: Autonomously evaluate flagged abnormal, urgent, or critical lab findings to prepare them for patient communication, ensuring accuracy and timeliness. Patient Communication: Proactively contact patients to discuss abnormal and critical lab outcomes. Ensure focused and uninterrupted communication, adhering to protocols while delivering only legally permissible information within the RN scope of practice. Use communication techniques to convey complex medical information clearly in a way non-medical patients will understand. Understand that the results shared with the patients may have serious health implications for them and relay them in a compassionate manner. Patient Education: Develop and implement patient education initiatives to enhance understanding of lab result significance and promote informed decision-making. Ensure patients understand their lab results and any necessary next steps in their care. Critical Thinking: Independently utilize critical thinking to assess the urgency and implications of abnormal and critical lab results, prioritizing patient communication based on clinical significance. Documentation: Maintain comprehensive and precise documentation of communications in patient progress notes. Record abnormal and critical results, patient concerns, and subsequent actions. Ensure compliance with regulatory signature requirements. Time Management: Exhibit exceptional time management skills to efficiently manage multiple lab results and patient communications, prioritizing urgent cases promptly. Problem Solving Expertise: Apply advanced problem-solving abilities using medical training and experience to troubleshoot issues related to lab result discrepancies or data integrity. Data-Driven Decision Making: Leverage data analytics to identify patterns and trends in lab results, contributing to evidence-based practice and enhanced patient outcomes. Regulatory Knowledge: Maintain up-to-date knowledge of healthcare regulations and compliance standards to ensure all communications adhere to legal and ethical guidelines. Escalation to Providers: For questions beyond the RN's medical scope, escalate to a licensed, on call provider (NP/PA/MD/DO) and manage the completion of result delivery and accompanying required documentation. Member Services Team Escalations: Address lab-related escalations from the Member Services Team, such as result clarifications, data discrepancies, or additional test requests, and communicate resolutions back to the patient, documenting the outcome. The Expertise Required Strong analytical capabilities, exceptional communication skills, and a commitment to fostering a patient centered environment. Strong attention to detail and ability to manage multiple patients efficiently. Ability to work independently while collaborating with a larger clinical team. This role is pivotal in upholding clinical and legal standards through meticulous communication and patient care management. Precision in data analysis and documentation to ensure accuracy in lab results and reporting. Certifications/Licenses, Education, and Experience: Education: Active RN licensure with a commitment to compliance and regulatory standards. Compact Licensure required. Additional licenses may be required in addition. BSN or equivalent degree preferred. Experience: Minimum of 3 years of experience as a working nurse, clinical research, medical communications, and/or related field. Proficiency in Salesforce or other EMR systems for documenting patient interactions. Licensure Requirement: Compact licensure required, non-compact state license preferred. Willingness to maintain and obtain additional state licenses as needed. Must hold all licenses in good standing. Compact States [42]: RNs with compact licenses can practice in all 42 states in the compact, including Alabama, Arizona, Arkansas, Colorado, Florida, Texas, and more. Non-Compact States [8]: California, Nevada, Illinois, Hawaii, Alaska, Oregon, Minnesota, New York. How We Work Together This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role. PTO and On-Call Coordination: Work within a structured on-call system to ensure coverage when team members are on leave. Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************

Job DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review. ESSENTIAL DUTIES & RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary. 90% of time will be spent on one or more of the following activities depending on assignments: Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization: Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations. Conduct review of claim 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. Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns. May develop recommendations for further corrective action based on medical review findings. May refer for review, or implement, corrective action related to medical review activities. May process claims and complete project work in the appropriate computer system(s). The remaining 10% of time will be spent on the following activities depending on assignments: Identify providers needing education and individually educate providers who are subject to medical review processes: Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal. This may involve discussion with CMS leaders and leaders in the provider community. Participate in special projects as assigned. REQUIRED QUALIFICATIONS * Valid nursing degree * 2 years' clinical experience * Excellent written and oral communication skills * Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility) * Strong computer skills to include Microsoft Office proficiency * Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS * Inpatient Rehabilitation Facility Experience * Bachelor of Science in Nursing (BSN) * Insurance industry experience * Certified Coder ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

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. Principal Duties and Responsibilities: 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. Qualifications: 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 Benefits: Competitive hourly pay rate, including compensation for travel time. Flexible schedule to maintain work-life balance. Mileage reimbursement for travel expenses. Ongoing training and support to growth your clinical research skills Opportunity to make a meaning impact on patients' lives while contributing to cutting-edge medical research. Join our team and contribute to groundbreaking medical advancements through clinical research!

Registered Nurse / Clinical Editor / Proofer - Remote, New York State (#25297) Employment Type: Full-time Hourly Rate: $45/hr Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: We are seeking a detail-oriented Registered Nurse with strong editorial skills to review NYS Dispute Resolution and External Review determinations. This remote position combines clinical expertise with editorial precision to ensure accurate, compliant, and professionally presented case documents while improving team performance through error tracking and staff training. Why Join Us? Competitive Compensation: Earn $45 per hour Comprehensive Benefits: Vacation Leave 6 Major Paid Holidays per year 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act License Reimbursement after 1 year of employment Health insurance is subject to plan eligibility requirements 401k Matching eligibility after 1 year of employment Benefits from Paychex, such as Payactive GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc Work Schedule: Full-time, Remote. Sunday to Thursday (9:00 AM - 5:30 PM) Professional Growth: Gain valuable experience in healthcare policy and medical editing Impactful Work: Ensure accuracy and compliance in state healthcare dispute resolutions Qualifications: Education: Baccalaureate degree in Nursing or a graduate of an approved RN program Licensure: Active New York State RN license Experience: Must have a minimum of 2 years of experience in an acute care facility, preferably in medicine/surgery or special care units, and one to 3 years of experience in acute care utilization review. Must have post-graduate studies demonstrating proficiency in writing, editing, and proofing skills. Technical Skills: Must have knowledge and experience with electronic medical records, including coding, quality, and clinical charting. Soft Skills: Must have the ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff. Other requirements: A writing sample or publication is required. Key Responsibilities: This individual will review all NYS Dispute Resolution and External Review determinations for accuracy of decisions, mathematical determinations, content, grammar, punctuation, and state-required conventions. They will utilize their clinical knowledge and editorial skills to produce a final, clean copy for each case determination. They will track errors and retrain clinical and administrative staff to mitigate production errors. Conduct a thorough review of pre-final dispute determinations using checklist tools. Make clinical and mathematical edits to responses using provided case documentation, as necessary. Consult with team members and supervisors as necessary to improve the final product. Complete edits check of content, references, grammar, spelling, and punctuation before release of final product. Maintain tracking and trending of errors and use findings to analyze areas of concern and highlight areas of improvement. Will provide technical assistance and conduct/participate in staff huddles. Other activities as may be deemed necessary How to Apply: If you are an RN with strong editorial skills ready to apply your clinical expertise in a unique remote role, we want to hear from you! Submit your Resume/CV and writing sample to hr@glhstaffing.com or call our office at (800) 608-4025 to learn more about this opportunity. Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives

Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the medical necessity of services and the appropriate level of care. This position ensures compliance with national standards, contractual requirements, and a member's benefit coverage while providing recommendations to the medical team to promote quality and cost-effectiveness of medical care. Responsibilities + Perform medical necessity and clinical reviews of authorization requests to determine the appropriateness of care in accordance with regulatory guidelines and criteria. + Work with healthcare providers and the authorization team to ensure timely review of services and requests, ensuring members receive authorized care. + Coordinate with healthcare providers and interdepartmental teams to assess the medical necessity of member care. + Escalate prior authorization requests to Medical Directors as necessary to determine the appropriateness of care. + Assist with service authorization requests for member transfers or discharge plans to ensure timely discharge between levels of care and facilities. + Collect, document, and maintain all members' clinical information in health management systems to ensure compliance with regulatory guidelines. + Provide education to providers and interdepartmental teams on utilization processes to promote high-quality and cost-effective medical care to members. + Provide feedback on opportunities to improve the authorization review process for members. + Comply with all policies and standards. Essential Skills + Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing. + 2-4 years of related experience. + LPN - Licensed Practical Nurse - State Licensure required. + RN license required for Health Net of California and Superior Health Plan. + Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service. + Knowledge of Medicare and Medicaid regulations. + Familiarity with utilization management processes. Additional Skills & Qualifications + Experience with Medicaid line of business. + Experience reviewing outpatient service requests for medical necessity. + Familiarity with InterQual. + Experience working with medical directors and therapists. Work Environment The position involves working closely with healthcare providers, authorization teams, and interdepartmental teams. The role requires the use of health management systems to maintain compliance with regulatory guidelines. The work environment is collaborative, with a focus on ensuring timely and appropriate medical care for members. Job Type & Location This is a Contract position based out of Baton Rouge, LA. Pay and Benefits The pay range for this position is $34.00 - $38.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 21, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.

Nursing Service at Avel requires all nurses to practice at a competent level of nursing care and demonstrate a professional level of behavior in his/her role as an RN. The ANA Standards of Clinical Nursing Practice are exemplified within the service line. The RN is responsible for utilizing the nursing process to provide nursing care through innovative means for rural clinic sites through two way video technology. He/she assumes responsibility and accountability for his/her individual actions and outcomes of patient care delivered on his/her shift. General Hours of Work: Full Time, 40 hours per week Exempt/Nonexempt: Non-Exempt Department/Unit: Specialty Clinic FTE/Hours: 1.0 FTE/40 hours per week Schedule: Monday - Friday between the hours of 7:45am and 6:00pm ESSENTIAL FUNCTIONS 1. Demonstrates professionalism and excellent customer service when conducting assigned patient appointments, to include home phone/video visits and clinic visits. 2. Performs general nursing care as appropriate to virtual care. 3. Prepares the telemedicine equipment and assists provider during virtual clinic visits. 4. Assist site staff, as applicable with examinations, screenings, and assessments. 5. Creates Electronic Health Record (EHR) telemedicine encounters and document required items for each patient appointment. 6. Documents notes in EHR when applicable. 7. Assists site with troubleshooting equipment and technological issues. 8. Answers all inquiry calls in a timely fashion, offer and schedule assessments, complete the database and keep all information up to date. As the point of contact for all of eCare services, provide excellent customer service to all callers. 9. Communicates with nurses, sites, providers, and coordinators regarding patient readiness or patient needs. 10. Performs professionally in communication with patient and site staff via camera. 11. Assists with scheduling and completing patient appointments. 12. Performs camera and equipment checks with sites. 13. Maintain an environment conducive to open communications, cooperation, and staff development through the use of active listening and other effective communications skills. Suggests plans tosolve clinic problems to make improvements in the delivery of care. 14. Collaborate with site staff and patients regarding medications, treatment instructions, diagnostic process, and lab results. 15. Assumes other responsibilities with eCare Specialty Clinic projects, implementations, and activities assigned by the Director. EDUCATION and/or EXPERIENCE: Graduate from a CCNE or NLN accredited nursing program is strongly preferred. Graduate from an approved nursing program is acceptable. Two years of experience required. Bachelor's degree preferred. CERTIFICATION, LICENSURE, and/or REGISTRATIONS: Licensed as a Registered Nurse with one unrestricted state license is required. RN licensure required within the states that Specialty Clinic is providing service within 120 days of hire. ABOUT AVEL eCARE Avel eCare is a nationally recognized leader in telemedicine, operating one of the most extensive virtual healthcare networks in the world. Based in Sioux Falls, South Dakota, Avel partners with more than 650 health systems, rural hospitals, clinics, and facilities to deliver innovative telehealth solutions. Our services span Behavioral Health, Critical Care, Emergency, Hospitalist, Pharmacy, Specialty Clinic, Senior Care, and School Health - impacting nearly two million patients annually. For three decades, Avel has been at the forefront of healthcare innovation, developing telehealth solutions that reduce costs, save time, and remove barriers to quality care. Join our mission-driven team and help reshape the future of healthcare. MISSION “Every person and every community deserves access to high quality care. Avel's experts collaborate with local clinicians through telemedicine, to deliver high quality care when and where it's needed.” VISION “Avel eCare serves as a catalyst for change. We are creating a future of health care without boundaries through Service, Quality, Collaboration, and Innovation.” JOB CODE: 486

Thank you for considering a career at Ensemble Health Partners! Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. The Opportunity: AREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position starts at: $69,400. Final compensation will be determined based on experience. By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. The Clinical Documentation Integrity (CDI) Educator acts as a subject matter expert to educate, train, and develop/revise processes in coordination with leadership to assist in achieving CDI's goal of facilitating accurate and complete documentation for coding and the capture of severity, acuity, and risk of mortality and most accurate Diagnosis Related Group (DRG) assignments. Essential Job Functions: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. Implements and continuously develops onboarding for all new Clinical Documentation Specialists (CDSs) for mentoring and education needs. Leads and coordinates training of new CDI staff. Collaborate with CDI leadership and other clinicians to facilitate the ongoing relevance of department specific orientation content, educational materials, and training programs/resources. Formulates customized education to other healthcare professionals based on audience and areas of opportunity. Audiences include, but are not limited to CDS/Coders, providers, mid-levels, nursing, dietary, Quality, etc. Education provided includes 1:1 education and/or group education. Interacts with medical staff members, directors, and senior hospital leadership staff as needed. Makes recommendations for documentation improvement and queries to capture care and intensity of services as supported within the medical record documentation. Demonstrates understanding of complications, co-morbidities, severity of illness, risk of mortality, case mix index, secondary diagnoses, and the impact of procedures on the final Diagnosis Related Group (DRG). Educate members of the CDI team on the review functions within the CDI program to meet and maintain enterprise goals and objectives, regulatory compliance, policies and procedures and standard operating procedures. Assist with the development and maintenance of system CDI policies and procedures. Remain current on CDI guidelines and practices. Ensures program compliance by following coding guidelines and coding clinics. Remains current with coding information to ensure accuracy of codes assigned based on documentation. Serve as a key resource for accurate and ethical documentation standards and regulatory requirements. Demonstrates the ability to draft compliant queries as endorsed by AHIMA and ACDIS. Performs medical record reviews for completeness and accuracy in capturing severity of illness, risk of mortality and clinical validation. Determines if professionally recognized standards of quality care are met. Audits CDSs as needed to ensure that system objectives are met. Develops educational plan for individual CDS based on Quality Audit (QA) outcomes. Provides 1:1 mentoring as needed. Oversees and coordinates SMART related education, meetings, and requirements for the department and as instructed by the SMART department. May require periodic onsite coverage. Preferred Knowledge, Skills and Abilities: 3 + years of experience in CDI Detail oriented and self-motivated Strong organizational skills Excellent speaking and presentation skills Working knowledge of Microsoft applications, including creation of Power Point presentations Required License: Registered Nurse, current Required Certifications: Certified Clinical Documentation Specialist (CCDS) and/or Certified Documentation Improvement Practitioner (CDIP) and/or Certified Revenue Cycle Representative (CRCR) and/or Any coding related certifications or Other approved job relevant certification #LI-LL1 #LI-Remote Join an award-winning company Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 Innovation Work-Life Flexibility Leadership Purpose + Values Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include: Associate Benefits - We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs. Our Culture - Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation. Growth - We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. Recognition - We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company. Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories. Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact *****************. This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role's range. EEOC - Know Your Rights FMLA Rights - English La FMLA Español E-Verify Participating Employer (English and Spanish) Know your Rights

We are seeking a dedicated and compassionate Wound Care Nurse, Telehealth Coordinator within the skilled nursing environment. The Wound Care Nurse, Telehealth Coordinator is the link between healthcare providers and patients while providing dressing changes to wounds, under direct supervision, utilizing real-time, imaging technologies. If you are passionate about excellent wound care and recognize the role telehealth has for consistent, convenient attention to patients in need, we encourage you to apply for the Telehealth Coordinator position and join our dedicated team. Responsibilities: Act as the in-person, hands on assistant to conduct weekly virtual wound rounds using technology under the guidance of wound care specialists, nurses, or healthcare providers. Photograph wounds using designated telehealth technology and ensure accurate documentation of images for clinical review. Aid patients in navigating telehealth platforms, troubleshoot technical issues, and ensure a seamless virtual connection for appointments. Facilitate patient telehealth scheduling, provide education on virtual visits to patients and staff as needed. Administer all aspects of wound care as per evidence based practice and facility policies, including dressing changes and rounds. Maintain strict adherence to patient confidentiality and privacy regulations, including HIPAA compliance, during all telehealth interactions and documentation processes. Submit orders for wound care products. Qualifications: Graduate of an accredited school of nursing required. Must possess current CPR certifications. Minimum of one (1) year of Wound Care experience required, (2) years preferred. Wound care certification is preferred. Must possess a current, unencumbered, active license to practice as a RN or LPN in state of practice. Excellent communication skills with the ability to convey medical information clearly to physicians, staff, patients and family Empathy, patience, and a genuine desire to provide quality healthcare services to patients at the bedside as well as through telehealth technology. Commitment to maintaining patient confidentiality, privacy, and data security in accordance with healthcare regulations (e.g., HIPAA). Ability to multitask, and adapt to changing telehealth workflows, job requirements, and patient populations. Prior experience in SNF, LTC, or Assisted Living preferred. Travel to assigned facilities using your personal car, valid driver's license, and mileage reimbursement offered. Role starts out Part-Time with the opportunity to be Full-Time.

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE). Job Summary: The Clinical Auditor 2 performs audits of medical records on behalf of hospital clients for denials review, defense audits, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and Milliman (MCG) in addition to criteria established by state Medicaid programs or hospital policy. Audit and analysis must be accurate and consistently ensure a high level of quality, knowledge of laws, rules, regulations and guidelines necessary to ensure compliance and protection of information. Primary / Essential Functions: The Primary/ essential job duties may not be exhaustive. Clinical Staff Responsibilities: Performs audits of medical records to identify and/or defend charges, including: o Defense Audits o Patient Inquiry Audits o Disallowed Charges o Biller Requested Audits Completes analysis of records against established criteria, (e.g., InterQual, MCG, Medicare, Medicaid criteria), to determine if patient condition and/or care meets that criteria, including: o Avoidable day studies o Managed care, Medicare or Medicaid reconsiderations/appeals o Medicare or Medicaid RAC appeals or other specialized Audit Appeals (e.g. CERT, ZPIC, SMRC) Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and patient. Will compose appeal letters addressing and appealing both contract issues and medically related issues Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution. Enter audit findings and/or data into Client's computer based system. Proficiently utilize multiple computer based systems to complete and document work (both Savista and client) Client based billing, Internal based billing, medical record and quality systems Microsoft Outlook, Word and Excel Function in a professional, efficient and positive manner Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession Will help identify issues or challenges in the department, and come up with solutions or ideas to improve Maintain confidentiality of patient information and abide by all HIPAA related guidelines Competencies: · Puts Clients First · Drives for Results · Understands our Business · Thinks Innovatively · Values Differences · Builds Teamwork · Gains Trust · Communicates Effectively · Shows Accountability · Takes Action · Embraces Change · Makes Quality Decisions Physical / Mental Demands, Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to use hands to finger, handle or feel, sit, stand, walk, lift up to 20 pounds, stoop, clean, bend, and reach with hands and arms. Must communicate clearly in English. Requires the ability to speak, read, write, see, and hear to perform essential duties of the job. Effective and positive human relations skills are required, including confidentiality, in order to appropriately interface with staff and clients. Must be able to perform multiple tasks and detailed work, problem solve, reason, and perform basic mathematical calculations. Equipment Used: Telephone, fax, calculator, computer, monitor, printer, hardware and software packages, computer peripheral equipment i.e. mouse and keyboard; and Microsoft software. Minimum Qualifications: Must be RN/Case Management /Utilization Review/Coding clinical certification with a BS/BA preferred otherwise equivalent years of technical experience 3 to 5 years of clinical experience or 3 to 5 years of clinical auditing experience in either case management, Medicare appeals, utilization review or denials management Knowledge of Milliman (MCG) or InterQual criteria preferred Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization Fundamental knowledge of Medicare/Medicaid Guidelines Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling) Skilled with Microsoft Outlook, Word, Excel and EMR Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $28.00 to $38.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills. SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class. California Job Candidate Notice

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Clinical Reviewer - RN (Remote U.S.) to join our growing team. Job Summary: * Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews. Responsibilities: * Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services. * Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence. * Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool. * Ensure accurate and timely submission of all administrative and review-related documents to the company. * Perform ongoing reassessment of the review process to identify improvement and/or change opportunities. * Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process. * Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review. * Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies. * Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines. * Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs. * Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. Work Hours: * Monday through Friday, 8:00 AM until 5:00 PM within the Time Zone where you reside, plus: One day per week is a priority day that would be assigned to complete expedited cases received between 3:00 PM and 6:00 PM Central. Qualifications Required Qualifications/Experience: * Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license. * Associate's, Bachelor's degree (or Diploma) in Nursing. * 2+ years of clinical experience in an acute OR med-surgical environment. * 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. * 1+ years of knowledge of medical records, medical terminology, and disease process organization. * 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG). Preferred Qualifications/Experience: * Knowledge of current National Committee for Quality Assurance (NCQA) standards. * Knowledge of Utilization Review Accreditation Commission (URAC) standards. * Knowledge of Medicare (CMS) guidelines. * Experience with Medical Appeals. * Experience with Medicare Advantage plans. * Medical Record Abstracting skills. * Clinical assessment and critical thinking skills. * Excellent verbal and written communication skills. * Ability to work in a team environment. * Flexibility and strong organizational skills. * Proficient in Microsoft Office and Internet/Web Navigation. #LI-SD1 Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at Acentra Health EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay range for this position is listed below. "Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Pay Range USD $28.37 - USD $37.50 /Hr.

Our Virtual Urgent Care team is looking for a Physician Assistant or Nurse Practitioner to join their team. In this role, you will be providing virtual medical care to patients of varying type and acuity. . As we care for patients of all ages, we cannot consider Adult/Gerontology trained Nurse Practitioners. Qualifications Physician Assistant Required Master's Degree Graduate of an accredited Physician Assistant educational program LIC-Physician Assistant - STATE_MI State of Michigan Upon Hire required CRT-Physician Asst Certified (PA-C) - NCCPA National Commission on Certification of Physician Assistants Upon Hire required CRT-Basic Life Support (BLS) - AHA American Heart Association 90 Days required Or CRT-Basic Life Support (BLS) - ARC American Red Cross 90 Days required CRT-Pediatric Adv Life Support (PALS) - AHA American Heart Association 120 Days required CRT-Adv Cardiovascular Life Support (ACLS) - AHA American Heart Association 120 Days required Nurse Practitioner Required Master's Degree Nurse Practitioners who obtained their education and certification after 2000 must show evidence of completion of a master's, post-master's or doctorate from a Nurse Practitioner program that is accredited by the Commission on the Collegiate of Nursing Education or the National League for Nursing Accrediting Commission 3 years of relevant experience current, relevant clinical experience Previous experience functioning in a collaborative role as a Nurse Practitioner LIC-Nurse Practitioner (NP) - State of Michigan CRT-Basic Life Support (BLS) CRT-Neonatal Resuscitation Program (NRP) CRT-Pediatric Adv Life Support (PALS) Corewell Health West Medical Group The Corewell Health West Medical Group is part of a not-for-profit health system serving 13 counties in West Michigan. Corewell Health West is a region of Corewell Health™, formerly the BHSH System (Beaumont Health and Spectrum Health) that provides care and coverage with an exceptional team of 60,000+ dedicated people-including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving over 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. Corewell Health People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy, and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 65,000+ dedicated people-including more than 12,000 physicians and advanced practice providers and more than 15,500 nurses providing care and services in 21 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving more than 1.3 million members Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. For more information, visit corewellhealth.org. How Corewell Health cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance, pet insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - 515 Michigan St NE - Grand Rapids Department Name Urgent Care Virtual - Medical Group West Employment Type Part time Shift Variable (United States of America) Weekly Scheduled Hours 0.04 Hours of Work Variable Days Worked Variable Weekend Frequency Variable weekends CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling ************.

Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare. Benefits, with a whole-person approach to wellness - Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare About ThedaCare! Summary :The RN Clinical Nurse (Ambulatory) provides patient-centered, specialized, evidence-based nursing care across the continuum through an interprofessional approach to treatment, research, education, and advocacy. Contributes to the goals of the department by being accountable for the delivery of compassionate and safe care within the scope of practice as defined by the Wisconsin Board of Nursing and ThedaCare policy. Through collaborative practice with members of the care team, is responsible for patient outcomes that meet the high quality of care provided by ThedaCare. Furthers the professional practice of nursing at ThedaCare by promoting a culture of innovation and a commitment to growth and professional development.Job Description: Schedule: Night shift: 11:00 PM - 7:30 AM Variable Monday-Friday Weekend and holiday rotation KEY ACCOUNTABILITIES: Utilizes the nursing process, evidence-based practice, and specific competencies to assess the physical condition and nursing needs of patients, and develops a plan of care in a collaborative practice with the patient and interprofessional team. Plans for the care needs of the patient in collaboration with the interprofessional team to provide the highest quality of care and clinical outcomes. Demonstrates clinical expertise in the provision of care in the clinical specialty assigned, and performs all functions of the professional clinical nurse (RN), which are age appropriate, developmentally sensitive, and culturally specific. Identifies ways to improve the patient's experience of care, streamline care processes, and lower costs while promoting quality to improve patient, family, and team member satisfaction. Contributes to a professional environment that encourages mentoring, engagement, and development to retain expert clinicians. Provides consultation and maintains positive relationships with physicians and other interprofessional team members, collaborating to problem solve and improve patient care. Demonstrates, anticipates, and proactively manages risk to prevent crises. Performs skillfully in life threatening emergencies, matching demands and resources during crises situations. QUALIFICATIONS: Bachelor of Science in Nursing (BSN) preferred Associate's Degree in Nursing (ADN) required Current Wisconsin RN Licensure American Heart Association Healthcare Provider Basic Life Support (BLS). PHYSICAL DEMANDS: Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of Fifty (50) pounds without assistance Job classification is exposed to blood borne pathogens (blood or bodily fluids) while performing job duties • Manual dexterity and hand-eye coordination to perform patient care procedures WORK ENVIRONMENT: Frequent exposure to sharp objects and instruments Occasional exposure to moving mechanical parts, fumes or airborne particles, toxic or caustic chemicals, and risk of electrical shock Occasional high noise level in work environment Standing and/or walking for extended periods of time Transporting, transferring, positioning patients and/or equipment from one location to another; little likelihood for injury if proper body mechanics and procedures are followed Possible exposure to communicable diseases, hazardous materials, and pharmacological agents Occasional contact with aggressive and or combative patients. Position requires compliance with department specific competencies. Scheduled Weekly Hours:24Scheduled FTE:0.6Location:CIN 3 Neenah Center - Appleton,WisconsinOvertime Exempt:No

Inova Health is looking for a dedicated Registered Nurse (RN) Clinical Documentation Denials Auditor to join the team. This role will be fully-time remote, Monday-Friday, regular business hours 8:00 AM - 4:30 PM (flexible). Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Registered Nurse (RN) Clinical Documentation Denials Auditor Job Responsibilities: Evaluates specificity and completeness of physician documentation to ensure optimal coding (e.g. mortality outcomes using APR-DRG, SOI and ROM, appropriate reduction of complications based on PSI and HAC, revenue assurance outcomes based on reimbursement DRG (MS-DRG), documentation of significant chronic conditions affecting resource utilization based on HCC). Summarizes audit findings for individual records along with specific documentation guidelines to improve expected clinical outcomes for an individual physician, physician practice, or specialty. Conducts follow-up audits (i.e. concurrent or post-discharge) with routine feedback until documentation practice comes into line with expected clinical outcomes. Works with Clinical Documentation Improvement (CDI) Director and Lead Auditor on other work related to physician audits and education programs. Demonstrates proficiency with Cobius to access external audit work, record summary results and upload appeal letters. Demonstrates proficiency with Encompass 360 and HDM audit functions to review electronic medical records with advanced functions (i.e. ex, auto-suggest and search) and record detail coding audit results. Showcases proficiency in reviewing records in Epic electronic medical records - which may be the only option for audits of older records. Demonstrates proficiency in writing effective appeal letters that include appropriate coding guidelines and medical references. Identifies trends in external audit findings related to coding quality and physician documentation. Prepares educational communications related to these findings. Evaluates physicians' documentation, diagnostic reports, and clinical findings for validation of diagnoses. Processes the requests for second opinion reviews when clinical validity is not supported or in question. May perform additional duties as assigned. Minimum Qualifications: Certification: Certified Coding Specialist / Certified Clinical Documentation Specialist; ACDIS/AHIMA certification, CCDS or CDIP Licensure: Current RN license and eligible to practice in VA Experience: Seven years of recent CDI, DRG validation or coding audit experience in an acute hospital setting with clinician training as RN, BSN, NP, PA or MD; Coding certification CCS and CDI certification CCDS or CDIP Education: Associate Degree in Nursing or Medicine. Preferred Qualifications: Experience: Recent coding experience. Clinical background and coding + denials knowledge. Experience writing denials & appeals. Outpatient and/or inpatient experience. Knowledge to identify clinical indicators (example: sepsis). EPIC experience. Certifications: CCDS Skills: presenting Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV

Diana Health is a network of modern women's health practices working in partnership with hospitals to reimagine the maternity and women's healthcare experience. We are restructuring the traditional approach to care to create an experience that is good for patients and good for providers. We do that by combining a tech-enabled, wellness-focused care program that women love with a clinical system that helps us drive continuous quality improvement and ensure work-life balance for our care team. We work with clients across all life stages to empower and support them to live happier, healthier, more fulfilling lives. With strong collaborative care teams; passionate administrators and a significant investment in operational support, Diana Health providers are well-supported to bring their very best to the work they love. We are an interdisciplinary team joined together by our shared commitment to transform women's health. Come join us! Description We are looking for a full-time LPN passionate about all aspects of women's health to provide direct patient care as part of an interdisciplinary care team and to serve as the first line of communication with patients in our clinical phone and messaging triage during office hours. The ideal candidate thrives in a busy practice, loves women's health and building relationships with patients, is an excellent problem-solver and communicator, and is able to multi-task easily. Bilingual skills preferred with a preference for Spanish language, open to other languages. What you'll do Patient Care Act as the first line of call in clinical communications for patients, within guidelines/protocols Administer injections and medications Provide direct clinical care as needed for minor check in visits or lab draws Provide supporting paperwork and education for patients Support clinic visits as appropriate and per training when needed Administrative Support the everyday flow of clinic acting as back up support for MA Maintaining logs Cleaning of rooms as needed and sterilization of instruments Obtaining and transcribing patient medical records Additional workflow items as the need arises Qualifications Current certification as a Tennessee Licensed Practical Nurse 2+ years of experience in an outpatient preferred Excellent communication, interpersonal, and organizational skills Strong computer skills and familiarity with EMRs Lactation certification (IBCLC, CLC, CLE) preferred, but not required Bilingual, Spanish skills preferred Benefits Competitive compensation Health; dental & vision, with an HSA/FSA option 401(k) with employer match Paid time off Paid parental leave Diana Health Culture Having a growth mindset and striving for continuous learning and improvement Positive, can do / how can I help attitude Empathy for our team and our clients Taking ownership and driving to results Being scrappy and resourceful

firsthand supports individuals living with SMI (serious mental illness). Our holistic approach includes a team of peer recovery specialists, benefits specialists and clinicians. Our teams focus on meeting each individual where they are and walking with them side by side as a trusted guide and partner on their journey to better health. firsthand's team members use their lived experience to build trust with these individuals and support them in reconnecting to the healthcare they need, while minimizing inappropriate healthcare utilization. Together with our health plan partners, we are changing the way our society supports those most impacted by SMI. We are cultivating a team of deeply passionate problem-solvers to tackle significant and complex healthcare challenges with us. This is more than a job-it's a calling. Every day, you will engage in work that resonates with purpose, gain wisdom from motivated colleagues, and thrive in an environment that celebrates continuous learning, creativity, and fun. The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. This is primarily a day-shift role (8 hours/day, 8:30-4:30 PST or 8:30-4:30 PST), with occasional potential for nights or weekends. When not managing acute issues, Triage Nurses focus on care coordination, training, and related administrative tasks. Responsibilities of a Triage Nurse include: Triage and Escalation: Manage inbound clinical issues from firsthand staff and patients via phone; triage appropriately and escalate emergencies immediately. Collaboration: Work closely with peer mental health workers, social workers, and APPs to address acute issues comprehensively. Coordination: Coordinate care with patients' other providers to ensure seamless health management. Training: Develop and deliver training on basic medical topics for peer mental health workers and social workers Triage Nurses should have: Strong triage and prioritization skills, with the ability to rapidly assess and determine the appropriate level of care. Problem-solving expertise with a creative, patient-centered approach. Ability to provide condition-specific patient education and self-management guidance. Adaptability to varying team cultures and processes. Empathy, compassion, and approachability in patient and team interactions. Required experience includes: Active RN license through a Nurse Licensure Compact (NLC) state and willingness to obtain licensure in non-compact states. Bachelor of Science in Nursing (BSN). At least 3 (three) years of clinical care experience in an Emergency Department. Experience working with populations facing challenges such as behavioral health and/or substance use disorders. Care management and coordination experience. Bilingual in Spanish Bonus Points for: Certification in Psychiatric-Mental Health Nursing (PMH-BC) Washington state RN license Base salary range:$75,000-$75,000 USD We firmly believe that great candidates for this role may not meet 100% of the criteria listed in this posting. We encourage you to apply anyway - we look forward to begin getting to know you. Benefits For full-time employees, our compensation package includes base, equity (or a special incentive program for clinical roles) and performance bonus potential. Our benefits include physical and mental health, dental, vision, 401(k) with a match, 16 weeks parental leave for either parent, 15 days/year vacation in your first year (this increases to 20 days/year in your second year and beyond), and a supportive and inclusive culture. Vaccination Policy Employment with firsthand is contingent upon attesting to medical clearance requirements, which include, but may not be limited to: evidence of vaccination for/immunity to COVID-19, Hepatitis B, Influenza, MMR, Chickenpox, Tetanus and Diphtheria. All employees of firsthand are required to receive these vaccinations on a cadence/frequency as advised by the CDC, whereas not otherwise prohibited by state law. New hires may submit for consideration a request to be exempted from these requirements (based on a valid religious or medical reason) via forms provided by firsthand. Such requests will be subject to review and approval by the Company, and exemptions will be granted only if the Company can provide a reasonable accommodation in relation to the requested exemption. Note that approvals for reasonable accommodations are reviewed and approved on a case-by-case basis and availability of a reasonable accommodation is not guaranteed. Unfortunately, we are not able to offer sponsorship at this time.

Medcor is looking to hire a full-time Registered Nurse for our remote 24/7 Occupational Health triage call center! The hours for this position include 8-hour or 10-hour shifts between the hours of 12pm and 2am CST. Job Type: Full-time - 40 hours per week Salary: $28 per hour with additional shift differential pay available for evenings, nights & weekends. By joining our nursing team, you will be helping thousands of employers better manage their workplace injuries and improve the quality of healthcare for their employees. Nurses who are successful in this position must be able to talk on the phone for long periods while typing and navigating through various software applications simultaneously. Our nurses must be able to visualize an injury while on the phone and clarify details about the injury while following our propriety algorithms to guide the triage of the injured worker. Training: Training for this role will last 5-6 weeks, with 2.5 weeks of classroom instruction and 2.5 weeks of precepting. These first 5-6 weeks of training are held Monday through Friday, from 8a-4p CST. The training schedule is non-negotiable, and all training must be successfully completed within the 6-week time frame. Following training, you will transition to your permanent schedule between the hours of 12p and 2a CST with an every-other-weekend requirement and holiday rotation. Changes to the permanent schedule are not allowed within the first 12 months of employment. A typical day in the life of a Medcor Triage RN: Manage a rapid flow of incoming telephone calls from Medcor customers in a call center environment Document each call efficiently and accurately Monitor and track individual as well as call center goals, productivity metrics, and statistics Reflect all shift activities using the phone system and be responsible for personal schedule adherence Provide superior customer service to Medcor s clients and employees Complete accurate assessment of symptoms and/or concerns utilizing Medcor s Triage Algorithms Follow HIPAA Compliance Policies You Must Be bilingual, fluent in both the English and Spanish language Have a valid RN license and current BLS (CPR) certification Be able to handle a high volume of consecutive calls Have strong technological skills as well as a typing speed of at least 30 WPM Work a major U.S. holiday rotation Work every other weekend Have effective written, verbal, and interpersonal communication skills. Ability to read, analyze, and interpret triage tools and information along with care instructions to injured employees and their managers. Be able to talk and/or hear. You are required to sit and use your hands. Specific vision abilities required by this job include close vision for computers and written work with the ability to adjust focus Be able to work on a computer for long periods Have a private space in your home with 4 walls and a door for patient privacy Have access to high-speed internet (no satellite) within your primary residence Be able to receive and apply feedback It's a Plus If You have call center experience You have occupational health experience At Medcor, we re passionate about caring for our advocates as much as you are passionate about caring for your patients! Join our team and receive the support you need to be successful in your practice and to focus on your patients. In addition to a collaborative work environment, we offer great pay and benefits and emphasize your wellness. Here s why people love working for Medcor: Stability! We ve been around since 1984. Potential for retention and performance incentives Opportunities galore! Medcor has a lot more to offer than just this job. There are opportunities to move vertically, horizontally, and geographically. Annually, 20% of our openings are filled by internal employees. The fact is, opportunity exists here! Training! We believe in it and we ll train and support you to be the best you can be. We feel we offer more training than most other companies. We have an open-door policy. Do you have something to say? Speak your mind! We encourage it and we look forward to how you can help our organization. Benefits We don t just advocate for our clients and our patients; we also advocate for ourselves. Our benefits include paid time off, health and dental insurance, 401K with match, education reimbursement, and more. To learn more about Medcor s Culture click here . Medcor Philosophy Medcor embraces a set of simple, interconnected practices that everyone can tailor to their own life and work. To preserve our pioneering, entrepreneurial spirit, we impart our values through the ongoing Better@Medcor campaign: encouraging our advocates to make a conscious choice to practice our values, to celebrate and recognize each other via our peer recognition program, and to support one another during tough times. Medcor is a tobacco-free and smoke-free workplace! EOE/M/F/Vet/Disability We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.