Consultant nurse jobs near me - 279 jobs

As the Wound Care Nurse, you will provide primary skin care to guests, with an emphasis on treatment and therapy of skin disorders. You will also assist in modifying the treatment regimen to meet the physical and psychosocial needs of the guest, in accordance with established medical practices and the requirements of this state and the policies and goals of this facility. Apply promptly! A high volume of applicants is expected for the role as detailed below, do not wait to send your CV. Comprehensive health insurance - medical, dental and vision. ~DailyPay, a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. ~ Paid time off (beginning after six months of employment) and paid holidays. ~ Flexible scheduling. ~ Tuition reimbursement and student loan forgiveness. ~ Confers with the Director of Nursing and/or other licensed nursing personnel regarding dermatologic disorders of guests in the facility. Identifies, manages and treats specific skin disorders, pressure ulcers, and primary and secondary lesions, and any skin issues directed to by Director of Nursing. Consults with the IDT concerning assessment evaluations and assist in planning and developing the skin Implements and maintains established policies and procedures relative to skin care treatments and interprets these as required, to the physician and responsible party. Provides, within established protocols and under the supervision of the physician, treatment for skin disorders as ordered by the physician. Ensures that residents with decubitus ulcers, vascular ulcers, and various other skin conditions receive appropriate treatment and/ or prophylactic treatment such as daily inspection, turning and activity, nourishment and incontinence care. 1-3 years of experience in a long-term care setting preferred, but not required. ~ Current Registered Nurse (RN) licensure in the state. ~ At least two years experience working in wound care preferred. ~ Ciena Healthcare: We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. xevrcyc We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated **Appeals Nurse Consultant** to join our remote team. In this role, you will be responsible for processing the medical necessity of Medicare appeals for participating providers. **Key Responsibilities** + Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. + Must work independently as well as in a team environment while working remotely. + Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer. + Responsible for the review and resolution of clinical appeals. + Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for provider issues. + This is a full-time telework position with standard hours of Monday-Friday, 8:00 AM to 5:00 PM (local time). + No weekends or holidays required. **Remote Work Expectations** + This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. + Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. **Required Qualifications** + Must have active and unrestricted RN licensure in state of residence. + 3+ years clinical experience. **Preferred Qualifications** + Appeals, Managed Care, or Utilization Review experience. + Pre Certification or Pre Authorization experience + Proficiency with computer skills including navigating multiple systems. + Exceptional communication skills. + Time efficient, highly organized, and ability to multitask. **Education** + Associates Degree minimum OR Diploma RN required. + Bachelors Degree preferred. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/19/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

For more than 80 years, Kaplan has been a trailblazer in education and professional advancement. We are a global company at the intersection of education and technology, focused on collaboration, innovation, and creativity to deliver a best-in-class educational experience and make Kaplan a great place to work. The future of education is here and we are eager to work alongside those who want to make a positive impact and inspire change in the world around them. The Nurse Consultant role is pivotal in driving engagement and success for our nursing products, including nursing integrated testing products, NCLEX prep, virtual simulations, and graduate nursing certification prep resources. The Nurse Consultant will be instrumental in business development (pre-sales/sales) support, implementation, and post-implementation faculty/student engagement, while also serving as a thought leader in nursing education through regional presentations and webinars. Primary Responsibilities: Product Expertise Develop in-depth knowledge of all Kaplan nursing education products, including: Undergraduate programs: Integrated testing product suite, NCLEX preparation, core nursing Curriculum tools, and i-Human virtual simulations. Graduate programs: Advanced practice nursing certifications and graduate-level resources, including i-Human virtual simulations. Stay current with trends in nursing education, certification requirements, and teaching methodologies to ensure relevance and expertise in the field. Demonstrate a comprehensive understanding of nursing accreditation requirements for undergraduate and graduate levels (e.g. AACN, ACNE, CCNE) and how Kaplan's products align with these standards. Provide feedback to product development teams to enhance existing offerings based on customer interactions. Implementation Support Collaborate with the customer engagement team during implementation meetings to ensure smooth onboarding. Facilitate faculty and student orientation sessions to introduce platform functionalities, virtual simulations, and analytics tools. Business Development (Pre-Sales) Collaboration with Sales Teams Act as a subject matter expert during pre-sales discussions and product demonstrations. Partner with the sales team to understand client needs and tailor product presentations to address specific program goals. Deliver high-impact presentations to faculty, administrators, and decision-makers showcasing the value of our nursing education products. Post-Implementation Faculty Support Serve as a resource for faculty, offering ongoing support and best practices for integrating tools into their teaching, including new product releases and enhancements. Provide insights on leveraging analytics to track student progress and improve outcomes. Host regular check-ins with faculty to address challenges, answer questions, and recommend strategies to maximize platform effectiveness. Partner with customer engagement and sales teams to identify at-risk partners and develop strategic solutions to retain and strengthen the account relationship. Regional Presentations and Webinars Represent Kaplan at regional nursing conferences, workshops, and other regional events by delivering engaging presentations on educational trends and product innovations. Develop and host webinars for faculty and students on topics such as virtual simulation best practices, NCLEX prep strategies, and advanced nursing certifications. Be a thought leader by sharing expertise and fostering discussions around the evolution of nursing education. Develop product-specific resources for partners in collaboration with the academic content team and incorporate these resources into presentations to enhance their relevance and effectiveness. Customize platform demonstrations to align with institutional goals and curricula. Troubleshoot and address initial platform setup challenges with cross-functional teams to ensure a seamless experience for users. Recommended Credentials Master's degree or Equivalent required. Note: Either the Bachelor's or the Master's degree must be in Nursing. Unencumbered, active RN License Required 5 years of Nursing education experience required or 5 years in clinical practice Experience in nursing education, including Info Systems Experience, and/or familiarity with NCLEX and graduate Proficiency in virtual simulation platforms and data analytics for educational purposes. Exceptional communication and presentation skills, with a proven ability to engage both small groups and large audiences. Strong collaboration skills and ability to work effectively across departments. Familiarity with learning management systems and other technology tools Preferred Qualifications Certified Nurse Educator (CNE) preferred APRN certification desired We offer a competitive benefits package including: Remote work provides a flexible work/life balance Our Gift of Knowledge Program provides tuition assistance and substantial discounts for our employees and close family members Access to health and wellness benefits new hire eligibility starts on day 1 of employment Access to 401K Savings Plan company match provided after eligibility is met Employee Discounts enjoy discounts, rewards, and perks on thousands of the brands you love in a variety of categories And so much more! The hourly rate for this position is $40.00 At Kaplan, we believe in attracting, rewarding, and retaining exceptional talent. Our compensation philosophy is designed to be competitive within the market, reflecting the value we place on the skills, experience, and contributions of our employees, while taking into account labor market trends and total rewards. Location Remote/Nationwide, USA Additional Locations Employee Type Employee Job Functional Area Operations & Support Business Unit 00092 Kaplan Health Diversity & Inclusion Statement: Kaplan is committed to cultivating an inclusive workplace that values diversity, promotes equity, and integrates inclusivity into all aspects of our operations. We are an equal opportunity employer and all qualified applicants will receive consideration for employment regardless of age, race, creed, color, national origin, ancestry, marital status, sexual orientation, gender identity or expression, disability, veteran status, nationality, or sex. We believe that diversity strengthens our organization, fuels innovation, and improves our ability to serve our students, customers, and communities. Learn more about our culture here. Kaplan considers qualified applicants for employment even if applicants have an arrest or conviction in their background check records. Kaplan complies with related background check regulations, including but not limited to, the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. There are various positions where certain convictions may disqualify applicants, such as those positions requiring interaction with minors, financial records, or other sensitive and/or confidential information. Kaplan is a drug-free workplace and complies with applicable laws.

HEDIS work typically includes requesting records, abstracting/overreading medical records, performing claims research, preparing medical records for the NCQA HEDIS Auditor, etc. Abstracts medical record data from practitioner's files to support annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting for company's accredited products Conducts medical record reviews to support the annual reporting and responds to inquiries from provider, and their office staff, regarding the HEDIS initiative Review and abstract 40-50 medical records per day, based on NCQA and HEDIS technical specifications Document information clearly and concisely from patient record to paper document abstraction tool, or into company's electronic HEDIS application Ensure Health & Care Management are in compliance with HEDIS audit and technical specification standards Participate in the training of NCQA (national committee quality assurance) requirements with completion of Inter-Rater Reliability compliance Communicate with internal and external stakeholders by making appropriate follow-up phone calls for additional medical information to complete reviews Comply with regulatory standards, accreditation standards and internal guidelines Remain current and consistent with the standards pertinent to the Quality Management team Qualifications - Active and Unrestricted RN License with 4+ years of experience. (Need to have the license in the state in which they live but does not need to be compact since they are not working directly with members in Iowa.) - Strong clinical background and understanding of medical terminology, healthcare practices and electronic medical record systems. Ability to review medical records and technical specifications and draw defensible conclusions from available information. - Experience In health insurance, health care, managed care, or a related setting. A strong clinical background could also be considered - e.g., hospital medical records or research. - Excellent attention to detail and ability to analyze complex medical records, identify relevant data and abstract HEDIS measures accurately. - Strong written and verbal communication skills with ability to communicate and/or present complex information to team members and stakeholders. - Demonstrated success in roles that require strong time management and work-flow management skills. Ability to prioritize work independently, manage multiple assignments simultaneously, and meet deadlines. - Flexibility to adapt to changing requirements, regulations, and technology platforms related to HEDIS reporting. - Proficiency with Microsoft Office and Microsoft Teams. Technical aptitude to learn new systems quickly. Preferred Qualifications: - 2 years of experience in HEDIS abstraction and familiarity with HEDIS measure specifications. - Prior work in utilization management, quality management/review, accreditation, outpatient clinic setting or related area. Job Type & Location This is a Contract position based out of Des Moines, IA. Pay and Benefits The pay range for this position is $40.00 - $41.00/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 7, 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.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: * Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid holidays for full time staff * TeleDoc 24/7/365 access to doctors * Optional short- and long-term disability plans * Employee Assistance Plan (EAP) * 401K retirement accounts with company match * Employee Referral Bonus Program JOB SUMMARY: The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services by conducting pre-service, concurrent, and retrospective utilization management reviews. The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate medical services in compliance with medical and regulatory guidelines. ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. * Assess the medical necessity, quality of care, level of care and appropriateness of health care services for plan members * Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity * Conduct outreach to requesting providers which can include specialty physicians, ancillary providers and institutions to gather the appropriate/necessary clinical data * Apply clinical review criteria, guidelines, and screens in determining the medical necessity of health care services against the clinical data provided * Certify cases that meet clinical review criteria, guidelines and/or screens * Consult with physician when reviews do not meet clinical review criteria, guidelines, and screens * Refer cases to other professionals internally, including case management and medical consultation when indicated * Adhere to accreditation, contractual and regulatory timeframes in performing all utilization management review processes * Ensure that the Director of Medical Management or designee is made aware of any potential risk management issues in a timely manner * Other duties as assigned JOB REQUIREMENTS: * Maintain privacy and confidentiality of records, conditions, and other information relating to residents, employees and facility * Encourage an atmosphere of optimism, warmth and interest in patients' personal and health care needs * Develop and maintain collaborative relationships with providers and educate on levels of care * Ensure the integrity and high quality of utilization management services * Self-motivated * Ability to work independently and as part of a team * Able to work congenially with a wide variety of individuals * Maintain the highest level of confidentiality and professionalism at all times * Strong oral and written communications skills, including active listening * Proficient in navigating through multiple computer applications * Positive, engaging customer service skills * Critical thinking and decision-making skills * Successful completion of required training * Handle multiple priorities effectively * Independent discretion/decision making * Make decisions under pressure REQUIRED QUALIFICATIONS: * Experience: o At least 1 year experience in utilization management with a health plan or hospital-based UM department with use of Interqual or MCG o Prefer clinical experience o Broad knowledge of Medicare regulations and guidance o Trained in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures o Excellent customer service experience o Strong knowledge of medical terminology and CPT, ICD-10, and HCPCS codes o Proven ability to problem-solve and make solid decisions * License/Certification: o Current Certified Case Manager (CCM) credential is a plus o Current, active and unrestricted Registered Nurse (RN) license EQUAL OPPORTUNITY EMPLOYER This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

Job Description NCA is in search of an experienced Field Nurse Case Manager based near the following locations: San Francisco, CA San Jose, CA Modesto, CA Los Angeles, CA Portland, OR Las Vegas, NV Phoenix, AZ This position will be responsible for regional case management services responsive to special needs and elder client care and quality of life challenges. This position requires collaboration with the primary family caregivers, attorneys, financial planners and trustees that are also serving the client. Requirements Bachelor of Science in Nursing (BSN) required, CCM or CRRN preferred Minimum of 5 years clinical Nursing experience - experience in field case management or workers' compensation case management, preferred Experience with third-party benefits - health insurance, Medicaid, Social Security, Developmental Disability services Excellent communication skills - written and verbal Highly motivated self-starter comfortable working in a virtual company/office, with solid time management and organization skills Proficient in using MacOS and a variety of related software applications (including MS Office) Strong ability to quickly learn and adapt to new technologies and tools in a Mac environment Proven ability to collaborate as necessary to accomplish goals and work through conflicts Ability to research and develop solutions to challenges presented by the client Excellent customer service skills Overnight travel required regionally 1-2 times per month and occasional nationwide travel Willingness to meet timely documentation requirements This is a salaried position with competitive pay, excellent benefits, and a flexible work from home schedule.

Immunization Nurse Consultant - 20013627 (250007Y4) Organization: HealthAgency Contact Name and Information: Ryan F. Candidates chosen for an interview will be contacted directly.Unposting Date: OngoingWork Location: Health Department Building 246 North High Street 1st Floor Columbus 43215Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $31.74Schedule: Full-time Work Hours: M-F, 8a-5pClassified Indicator: ClassifiedUnion: 1199 Primary Job Skill: NursingTechnical Skills: Learning and Development, Public Relations, TrainingProfessional Skills: Adaptability, Managing Meetings, Verbal Communication Agency OverviewImmunization Nurse Consultant (Public Health Nurse Specialist) About Us: Our mission at the Ohio Department of Health (ODH) is advancing the health and well-being of all Ohioans. Our agency is committed to building a modern, vibrant public health system that creates the conditions where all Ohioans flourish.The goal of the Bureau of Infectious Diseases (BID) is to prevent and control the spread of infectious diseases (e.g., foodborne outbreaks, general infectious diseases, healthcare-associated infections, influenza, meningitis, tuberculosis, vaccine-preventable diseases, waterborne outbreaks, zoonotic diseases and vector-borne diseases).The bureau works closely with local health departments (LHDs), healthcare providers and laboratories to ensure that infectious disease reports are reviewed and investigated timely; the program provides technical expertise and coordination to LHDs, healthcare providers, laboratories and where appropriate, the general public.Job DescriptionWhat You'll Do:The Bureau of Infectious Diseases is seeking an Immunization Nurse Consultant to serve as the statewide expert on immunizations & vaccine-preventable diseases. This position will monitor & evaluate implementation of Get Vaccinated subgrants including review of local grant applications. Additional job duties may include:Write & assure accomplishment of CDC grant objectives related to immunization education interventions.Participate in immunization program phone duty responding to calls from providers & general public on immunizations, vaccine-preventable diseases, Vaccine for Children (VFC) issues & storage & handling guidelines.Ensure adherence to all applicable state & federal rules, regulations, laws, agency policies, procedures & protocols for immunization & vaccine preventable disease control educational program.Collaborate with other state &/or local agencies, educational institutions & advocacy organizations to develop & present coordinated educational activities, programs for health professionals & the general public.Research & identify ODH resources (e.g., ODH publications, employees with expertise on vaccine- preventable disease prevention & control) available to assist agencies in dealing with vaccine- preventable diseases.Training and development required to remain in the classification after employment: Biennial renewal of license to practice as registered nurse.Unusual working conditions: Travels overnight; exposed to unpredictable patient behavior.Normal working hours are Monday through Friday, 8:00am to 5:00pm. This is an hourly position, with a pay range of 12 on the Ohio Health Care SEIU/1199 Pay Range Schedule.Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.QualificationsCurrent & valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code AND 6 mos. trg. or 6 mos. exp. in nursing; must be able to provide own transportation. OREquivalent of Minimum Class Qualifications for Employment noted above may be substituted for the education & experience required, but not for the mandated licensure. Job Skills: NursingTechnical Skills: Learning and Development, Public Relations, TrainingProfessional Skills: Adaptability, Managing Meetings, Verbal Communication*Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:Bachelor's or advanced degree in nursing.12 months experience working as a nurse in a clinical setting, public health or community health setting.Experience working with vaccinations or in the vaccine field. Experience with computer software (e.g., Word, Excel, PowerPoint, TEAMS). Experience presenting, training, and/or public speaking.Experience in writing and implementing grants.Experience working on a committee or facilitating a group.Experience in analyzing health related data to produce reports.Experience working with healthcare providers and local health departments. Experience collecting health related data and information from studies, investigations, or reports.All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education, active disciplinary record, and work record. Supplemental InformationSupplemental InformationAll answers to the supplemental questions must be supported by the work experience/education provided on your civil service application.Application Procedures:All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.Status of Posted Position:You can check the status of your application online by signing into your profile. Jobs you applied for will be listed. The application status is shown to the right of the position title and application submission details.Background Check Information:The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration. ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

Immunization Nurse Consultant - 20013627 (250007Y4) Organization: HealthAgency Contact Name and Information: Ryan F. Candidates chosen for an interview will be contacted directly.Unposting Date: OngoingWork Location: Health Department Building 246 North High Street 1st Floor Columbus 43215Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $31.74Schedule: Full-time Work Hours: M-F, 8a-5pClassified Indicator: ClassifiedUnion: 1199 Primary Job Skill: NursingTechnical Skills: Learning and Development, Public Relations, TrainingProfessional Skills: Adaptability, Managing Meetings, Verbal Communication Agency OverviewImmunization Nurse Consultant (Public Health Nurse Specialist) About Us: Our mission at the Ohio Department of Health (ODH) is advancing the health and well-being of all Ohioans. Our agency is committed to building a modern, vibrant public health system that creates the conditions where all Ohioans flourish.The goal of the Bureau of Infectious Diseases (BID) is to prevent and control the spread of infectious diseases (e.g., foodborne outbreaks, general infectious diseases, healthcare-associated infections, influenza, meningitis, tuberculosis, vaccine-preventable diseases, waterborne outbreaks, zoonotic diseases and vector-borne diseases).The bureau works closely with local health departments (LHDs), healthcare providers and laboratories to ensure that infectious disease reports are reviewed and investigated timely; the program provides technical expertise and coordination to LHDs, healthcare providers, laboratories and where appropriate, the general public.Job DescriptionWhat You'll Do:The Bureau of Infectious Diseases is seeking an Immunization Nurse Consultant to serve as the statewide expert on immunizations & vaccine-preventable diseases. This position will monitor & evaluate implementation of Get Vaccinated subgrants including review of local grant applications. Additional job duties may include:Write & assure accomplishment of CDC grant objectives related to immunization education interventions.Participate in immunization program phone duty responding to calls from providers & general public on immunizations, vaccine-preventable diseases, Vaccine for Children (VFC) issues & storage & handling guidelines.Ensure adherence to all applicable state & federal rules, regulations, laws, agency policies, procedures & protocols for immunization & vaccine preventable disease control educational program.Collaborate with other state &/or local agencies, educational institutions & advocacy organizations to develop & present coordinated educational activities, programs for health professionals & the general public.Research & identify ODH resources (e.g., ODH publications, employees with expertise on vaccine- preventable disease prevention & control) available to assist agencies in dealing with vaccine- preventable diseases.Training and development required to remain in the classification after employment: Biennial renewal of license to practice as registered nurse.Unusual working conditions: Travels overnight; exposed to unpredictable patient behavior.Normal working hours are Monday through Friday, 8:00am to 5:00pm. This is an hourly position, with a pay range of 12 on the Ohio Health Care SEIU/1199 Pay Range Schedule.Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes: Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) *Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.QualificationsCurrent & valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code AND 6 mos. trg. or 6 mos. exp. in nursing; must be able to provide own transportation. OREquivalent of Minimum Class Qualifications for Employment noted above may be substituted for the education & experience required, but not for the mandated licensure. Job Skills: NursingTechnical Skills: Learning and Development, Public Relations, TrainingProfessional Skills: Adaptability, Managing Meetings, Verbal Communication*Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:Bachelor's or advanced degree in nursing.12 months experience working as a nurse in a clinical setting, public health or community health setting.Experience working with vaccinations or in the vaccine field. Experience with computer software (e.g., Word, Excel, PowerPoint, TEAMS). Experience presenting, training, and/or public speaking.Experience in writing and implementing grants.Experience working on a committee or facilitating a group.Experience in analyzing health related data to produce reports.Experience working with healthcare providers and local health departments. Experience collecting health related data and information from studies, investigations, or reports.All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education, active disciplinary record, and work record. Supplemental InformationSupplemental InformationAll answers to the supplemental questions must be supported by the work experience/education provided on your civil service application.Application Procedures:All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.Status of Posted Position:You can check the status of your application online by signing into your profile. Jobs you applied for will be listed. The application status is shown to the right of the position title and application submission details.Background Check Information:The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration. ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high quality, cost efficient medical outcomes for those enrollees with a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and outpatient medical services, notification of emergent hospital admissions, completes inpatient concurrent review, establishes discharge plans, coordinates transitions of care to lower/higher levels of care, makes referrals for care management programs, and performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical guidelines/ criteria to guide medical necessity reviews and will use effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to ensure members receive the appropriate level of care, prevent or reduce hospital admissions where appropriate. Job Description Key Outcomes: * Review prior authorization requests (prior authorization, concurrent review, and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and review. * Utilize evidenced-based criteria, governmental policies, and internal guidelines for medical necessity reviews. * Manage the review of medical claims disputes, records, and authorizations for billing, coding, and other compliance or reimbursement related issues * Collaborates with other members of the team, the MPHC Medical Directors, healthcare providers, and members to promote effective utilization of resources. This collaboration includes timely communications with in and out of network hospitals, post-acute care facilities, other providers, and internal departments to authorize services, establish discharge plans, assist to coordinate effective, efficient transitions of care. * Coordinates referrals to Care Management, as appropriate. * Manages health care within the benefits structures per line of business and performs functions within compliance, contractual and accreditation regulations, e.g. Department of Defense, Centers for Medicaid and Medicare, NCQA, Employer contracts and state insurance regulations, as applicable. Maintains knowledge of applicable regulatory guidelines. * Completes all documentation of reviews and decisions, in appropriate systems, according to process/ compliance requirements and within timeliness standards. * Participates as a member of an interdisciplinary team in the Health Management Department * May be responsible for maintaining a caseload for concurrent cases/ assisting in caseload coverage for the team * Establishes and maintains strong professional relationships with community providers. * Acts as a liaison to ensure the member is receiving the appropriate level of care at the appropriate place and time * Mentors new staff as assigned. * Maintains quality audit scores within department standards. * Maintains productivity within department standards. * Assists in creation and updating of department policies and procedures. * Participates in quality initiatives, committees, work groups, projects, and process improvements that reinforce best practice medical management programming and offerings. * Participates in the review and analysis of population data and metrics to inform development of programs and improved health outcomes. * Demonstrates flexibility and agility in working in a fast-paced, team-oriented environment, able to multi-task from one case type to another. * Assumes extra duties as assigned based on business needs, including weekend rotations Education/Experience: * 3+ years of clinical nursing experience as an RN, preferably in a hospital setting * Utilization management experience in a health plan UM department Required License(s) and/or Certification(s): * Compact RN License * Certification in managed care nursing or care management desired (CMCN or CCM) Skills/Knowledge/Competencies (Behaviors): * Demonstrates an understanding of and alignment with Martin's Point Values. * Maintains current licensure and practices within scope of license for current state of residence. * Maintains knowledge of Scope of Nursing Practice in states where licensed. * Maintains contemporary knowledge of evidence-based guidelines and applies them consistently and appropriately. * Ability to analyze data metrics, outcomes, and trends. * Excellent interpersonal, verbal, and written communication skills. * Critical thinking: can identify root causes and understands coordination of medical and clinical information. * Ability to prioritize time and tasks efficiently and effectively. * Ability to manage multiple demands. * Ability to function independently. * Computer proficiency in Microsoft Office products including Word, Excel, and Outlook. This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative action employer. Do you have a question about careers at Martin's Point Health Care? Contact us at: *****************************

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

**Telephonic Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. **Hours:** Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. **_***This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. **How you will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. + Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. + Coordinates internal and external resources to meet identified needs. + Monitors and evaluates effectiveness of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. + Negotiates rates of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management policies and procedures. **Minimum requirements:** + Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted RN license in applicable state(s) required. + Multi-state licensure is required if this individual is providing services in multiple states. _For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states._ **Preferred Capabilities, Skills, and Experiences:** + Certification as a Case Manager preferred. + Ability to talk and type at the same time preferred. + Demonstrate critical thinking skills when interacting with members preferred. + Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred. + Ability to manage, review and respond to emails/instant messages in a timely fashion preferred. + Minimum 2 years' experience in acute care setting preferred. + Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred. + Managed Care experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $69,616 - $120,912.00 Locations: Minnesota, Maryland, Columbus, OH In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._ * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

, however, candidates must reside in the State of TX or State of IL is a contract for about 9 months. Pay: $41/hour RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended For Medical Necessity, Contract Interpretation, Pricing; And To Initiate And/Or Respond To Correspondence From Providers Or Members Concerning Medical Determinations. Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation. Awareness of claims processes and claims processing systems. PC proficiency to include Microsoft Word and Excel and health insurance databases. Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings. Organizational skills and prioritization skills. :Registered Nurse (RN) with unrestricted license in state. 3 years clinical experience. Needs to be able to navigate MCG and Medical policies with the reviews.

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. JOB QUALIFICATIONS (Required): Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company. Knowledge of medical terminology and procedures. Verbal and written communication skills. JOB QUALIFICATIONS (Preferred): MCG or InterQual experience Utilization management experience LOCATION: REMOTE in Texas (Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties). POSITION: 6-month assignment SALARY: $38 - $40 hourly HOURS PER WEEK: 40 HOURS PER DAY: 8

This position is a critical part of utilization management within the emergency department setting. The role ensures that patient admissions meet medical necessity standards and that healthcare resources are used appropriately and efficiently. It combines clinical expertise, analytical skills, and communication abilities to support both patient care and organizational compliance. Responsibilities Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources Participate in telephonic discussions with emergency department physicians relative to documentation and admission status Enter clinical review information into system for transmission to insurance companies for authorization Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required Current and unrestricted RN license At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 2 years utilization management experience in acute admission and concurrent reviews Intermediate level experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) Experience in Microsoft Suite including Office and basic Excel Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-related pre-employment assessment(s) Preferred At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience within the hospital setting Bachelor's of Science in Nursing (BSN) Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC) Expectations Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication Shifts Requirements & Needs: Working between the hours of 9am EST and 9pm EST either for 8-hour, 10-hour or 12-hours shifts. All Full-Time required to work 4 Holidays per year All Full-time required to work every other weekend or 4 weekend shifts per month. Additional Shifts Available: Weekend FT Available - (3, 12 hours shifts, one shift worked during a weekday) Work schedules and shift assignments are subject to change based on evolving client needs and operational demands. While we strive to provide consistent scheduling, associates may be required to adjust their availability or work different shifts. Flexibility and adaptability are essential for success in this role. Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate. Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider. If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled. All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position. Netsmart's Job Applicant Privacy Notice may be found here.

Job Description Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans that address problems, goals, and interventions. Based on assessments and claims data creates a care plan for members to follow 70% Participate as a member of the Care Team during Interdisciplinary Team meetings to discuss the members health care needs, barriers to care and explore better outcomes for the member 20% Identify and link members with health plan benefits and community resources 5% Perform administrative work to maintain skills needed for job duties 5% 5% Experience: Required: 2 years LPN Nursing exp, preferred 3 + years experience. Regular and reliable attendance Familiar with community resources & services Strong organizational skills Works independently. Maintains professional relationships with the members we serve as well as colleagues. Communicates effectively and professionally verbally and in writing. Proficient with computer systems Knowledgeable in Microsoft Office Software Excellent customer service skills Has a dedicated home work space Position Summary: Looking for Columbus OH and immediate surrounding counties. The Care Manager Specialist is a member of the Care Team. The Care Manager Specialist is responsible for the care management of members that are enrolled in the Dual Special Needs Plan. These members are usually stratified as low medium stratification, or those with Social Determents of Care needs. The Care Manager will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the members health outcomes, address social determinants of health and connect members with community-based organizations. The Care Manager will assess members needs as well as gaps in care, communicate with the members Primary Care Provider (PCP), maintain updated individualized care plans, and participate in Interdisciplinary team meetings. Care Managers will be able to identify members whose needs require clinician involvement and transition members appropriately. Complete health screening questionnaires, assessments which may be market specific. Support reduction of population of unable to reach members by telephone and in -person visits. Ensure member has filled/received their medication(s) and has an understanding on how to take their ordered medications. Manage caseload of members with current stratification of monitoring, low and medium or those with high social determinants of care needs- frequency /contract guidelines Provides clinical assistance to determine appropriate services and supports due to members health needs (including but not limited to: Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports) Evaluation of health and social indicators Identifies and engages barriers to achieving optimal member health. Uses discretion to apply strategies to reduce member risk. Presents cases at case conferences for multidisciplinary focus to benefit overall member management. Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the members condition(s) and abilities to self-manage. Coordinates resources, assists with securing DME, and helps to ensure timely physician follow-up. Understands Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel. Updates the Care Plan for any change in condition or behavioral health status. Provide support to members in transitions of care Education: HS or equivalent, must be licensed LPN. What Days & Hours will the Person Work in this Position List Training Hours, if Different. M-F 8-5

Our vision aims to empower our clients by actively leveraging our broad range of services. With our global presence, we have career opportunities all across the world which can lead to a unique, exciting and fulfilling career path. Pick your path today! To see what career opportunities we have available, explore below to find your next career! Please be aware of employment scams where hackers pose as legitimate companies and recruiters to obtain personal information from job seekers. Please be vigilant and verify the authenticity of any job offers or communications. We will never request sensitive information such as Social Security numbers or bank details during the initial stages of the recruitment process. If you suspect fraudulent activity, contact us directly through our official channels. Stay safe and protect your personal information. Job Summary: Under general supervision of the Program Manager (PM) and reporting to the PM, the Medical Review Nurse (MRN) is responsible for the initial chart review and chart case management for medical exam/screening programs to verify that all medical information and exam components are accurate. The RN works directly with Physicians and Examinees to ensure all medical information is gathered and performs medical Quality Assurance on all charts in various process stages leading to a final determination. Salary is $66,560-$70,000. Duties and Responsibilities: • Performs medical review of incoming charts to determine if additional medical information is needed. • Collaborates with Physician(s) and other internal nursing staff members for chart review. • Performs medical Quality Assurance (QA) on all charts in various process stages. • Interfaces with Client's Medical Department as well as the on-site provider. • Contacts Examinee via telephone or email to clarify information necessary to complete the chart. • Develops a very good understanding of the specific contract's guidelines and addendums as required. • Masters the various software programs specific to the functioning of the exam program. • Implements and follows up on requests for further evaluation from the Examinee when required. • Works closely with other departments to provide accurate and quality outcomes. • Thoroughly cognizant of metrics and organizes workload to meet them. • Consistently learns and applies codified state and federal regulations specific to particular contract(s). • Serve as backup to other nurses for daily duties and assists with follow-up calls to facilities and Examinees as needed as well as other duties as assigned. • Opportunity to travel and assist on medical mobile events as either a site lead and/or RN as work or personal schedule permit. • May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain a specific level of knowledge pertaining to new developments, new task efforts, contract awards, and new policy requirements. • Supports marketing and sales objectives and efforts as requested. • Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training, and goals. Ensures safe operating conditions within an area of responsibility. Encourages co-workers to work safely. Identifies “close calls” and/or safety concerns to supervisory personnel. Maintains a clean and orderly work area. • Assists in the active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, and other mandated regulations/standards. • May serve on the OSHA VPP, Safety, and Wellness Committees. Qualifications: • 5-7 years of relevant experience. • Fully unencumbered nursing license required. • Proficiency with computer and common office equipment, as well as with MS Office products. • Must be able to multitask, be flexible, be organized, and have excellent oral and written communication skills as well as exceptional attention to detail. Preferred Qualifications: • COHN-S and/or CAOHC certifications • Bachelor's Degree with 5 years of relevant experience • Flexibility and availability to travel and assist to support medical mobile events as either site lead and/or RN Physical Requirements and Work Conditions: • Work is normally performed in a typical interior/office work environment. • Work involves sitting and standing for prolonged periods of time. • May require bending and lifting up to 15 lbs. • Constant use of computer and common office equipment required. Acuity International is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, national origin, age, protected veteran status, or disability status. For OFCCP compliance, the taxable entity associated with this job posting is: Acuity-CHS, LLC

Company Details Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker's successful and speedy return to work is good for people and good for Berkley's insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley's operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers' compensation cases. To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley's operating units with reliable results, and reduced time and expenses associated with case management. Responsibilities As a Telephonic Nurse Case Manager, you will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers. Coordinate and implement medical case management to facilitate case closure Timely and comprehensive communication with with employers, adjusters and the injured workers. Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction Acquire and maintain nursing licensure for all jurisdictions as business needs require Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services Document activities and case progress using appropriate methods and tools following best practices for quality improvement Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work. Engage and participate in special projects as assigned by case management leadership team Occasionally attend on site meetings and professional programs Foster a teamwork environment Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status. Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed. Obtain case management professional certification (CCM) within 2 years of hire Qualifications Minimum 2 years of experience in workers compensation insurance and medical case management preferred Minimum of 4 years medical/surgical clinical experience required Exhibit strong communication skills, professionalism, flexibility and adaptability Possess working knowledge of medical and vocational resources available to the Workers' Compensation industry Demonstrate evidence of self-motivation and the ability to perform case management duties independently Demonstrate evidence of computer and technology skills Oral and written fluency in both Spanish and English a plus Education Graduate of an accredited school of nursing and possess a current RN license. RN compact license preferred, CCM preferred, Bachelor of Nursing preferred Additional Company Details ****************** The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees • Base Salary Range: $80,000 - $88,000 • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients. The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx's products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Roles and Responsibilities: Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx's policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills - with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx's policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Applicants must live in the desired Time Zone Current RN License in good standing Bachelor's degree preferred 5+ years of clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+ years of case management 2+ years of experience in pharmaceutical/biotech industry a must Reimbursement experience a plus Must live in geographically assigned territory Bilingual or multilingual a plus #LI-Remote For applicants in the United States: The annual base salary hiring range for this position is $136,000.00 - $204,000.00 USD. This range reflects our good faith estimate at the time of posting. Individual compensation is determined using objective, inclusive, and job-related criteria such as relevant experience, skills, demonstrated competencies and internal equity. This means actual pay may differ from the posted range when justified by these factors. Because market conditions evolve, pay ranges are reviewed regularly and may be adjusted to remain aligned with external benchmarks. This job is eligible to participate in our short-term and long-term incentive programs, subject to the terms and conditions of those plans and applicable policies. It also includes a comprehensive benefits package, including but not limited to retirement savings plans, health benefits and other benefits subject to the terms of the applicable plans and program guidelines. At argenx, all applicants are welcomed in an inclusive environment. They will receive equal consideration for employment without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other applicable legally protected characteristics. argenx is proud to be an equal opportunity employer. Before you submit your application, CV or any other personal details to us, please review our argenx Privacy Notice for Job Applicants to learn more about how argenx B.V. and its affiliates (“argenx”) will handle and protect your personal data. If you have any questions or you wish to exercise your privacy rights, please contact our Global Privacy Office by email at privacy@argenx.com . If you require reasonable accommodation in completing your application, interviewing, or otherwise participating in the candidate selection process please contact us at **************** . Only inquiries related to an accommodation request will receive a response.

Job Title: Nurse Case Manager II Estimated Length of Assignment: 03+ Months with Possible Extension (The dates provided are only an estimate and not a guarantee) Negotiable Estd. Pay Range - $40.00/Hour to $45.00/Hour on W2 (USD) -All Inclusive Work Type: Wayne, Macomb, Barry, Van Buren, Kalamazoo, Calhoun, Branch, St Joseph, Cass, and Berrien Counties ): MI Schedule -Monday-Friday 8am-5pm EST Description: Field and Telephonic Add city/state, zip and county at the top of the resume Candidates should be either in one of these counties or very close to it. They will be traveling to this region. Sourcing for Wayne, Macomb, Barry, Van Buren, Kalamazoo, Calhoun, Branch, St Joseph, Cass, and Berrien Counties ): MI. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures Experience 3 years Clinical practice experience, e.G., hospital setting, alternative care setting such as home health or ambulatory care required. Healthcare and/or managed care industry experience. Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Effective communication skills, both verbal and written. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Typical office working environment with productivity and quality expectations? Position Summary The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license for MI. Education RN with current unrestricted state licensure for MI. Case Management Certification CCM preferred What days & hours will the person work in this position? List training hours, if different. Monday-Friday 8am-5pm EST