County nurse work from home jobs

Join Wilson Homecare's On-Call Float Program - CAREGIVERS WANTED! Up to $1500 Sign On Bonus & Full-Time Benefits & Salary! $Are you an experienced nurse aide or caregiver with a passion for providing exceptional care? Wilson Homecare is expanding its highly sought after on-call float program and is actively seeking skilled and compassionate individuals like you! Dive into a rewarding opportunity to care for a diverse range of clients across different areas of Oahu, offering competitive salaries and outstanding benefits. For a complete understanding of this opportunity, and what will be required to be a successful applicant, read on. Nurse Aide (FLOAT) - On-Call Program Lucrative Compensation - Competitive weekly salary ranging from $700 to $1,000, with additional sign on bonuses up to $1,500. Flexible Schedules -Customize your availability with options ranging from 2 to 7 days a week, each featuring varying compensation tiers. Career Advancement - Explore growth opportunities within our organization driven by your dedication and skills. Comprehensive Benefits - Access to medical, dental, and vision insurance, 401K retirement plans, and more. As an On-Call Float Nurse Aide, leverage your skills to provide comprehensive care to a wide ranging spectrum of clients utilizing various home healthcare equipment. Your role will involve addressing various client needs, including bed baths, showers, brief changes, transfers, alzheimers/dementia care, and many other skills. One year experience as a nurse aide or CNA certification. Immediate response to phone calls/text/emails during assigned On-Call shifts. If you possess the skills and passion for delivering exceptional care, contact our Recruiting department at (8 to explore joining our On-Call Float program. Virtual and in-person interviews are available Monday-Friday from 9 am to 4 pm. For more details about our company, visit our website at . Start the New Year off right with your new career at Wilson Homecare! xevrcyc Remote working/work at home options are available for this role.

We are hiring for: CAP Nurse / PT / Iredell County / Flexible Schedule / Primarily Remote Type: Regular If you are a positive and personable individual looking for a satisfying and fun opportunity to make a real difference in the lives of people with intellectual, developmental disabilities, and people facing mental health, and substance use challenges, join our team at RHA Health Services! The CAP Case Manager provides critical case management services to beneficiaries who are at risk of institutionalization, ensuring their health, safety, and well-being are maintained through person-centered care planning and coordination of essential services. The Case Manager works closely with families, RNs, and other interdisciplinary team members to assess needs, coordinate care, and provide ongoing support to help beneficiaries achieve the best possible quality of life. DUTIES AND RESPONSIBILITIES: Assessment and Care Planning: Conduct initial pre-screening and assessments of beneficiaries and their families to evaluate medical, psychological, behavioral, financial, social, cultural, environmental, legal, vocational, educational, and other areas. Consultation with the CAP beneficiary and primary caregiver to educate about waiver services, other Medicaid, and community resources to meet the beneficiaries' needs. Identify needs to prevent health and safety factors to assist in maintaining community placement. Develop and maintain individualized, person-centered care plans (emergency and disaster planning) to ensure the health, safety, and well-being of beneficiaries. Review and update care plans at least every 12 months or when the status of the beneficiary changes. Assist beneficiaries and families in understanding the plan of care and making informed choices. Coordination of Services: Link beneficiaries and their families to necessary services, equipment, and supplies to support care in the home. Collaborate with community resources, healthcare providers, and other agencies to ensure comprehensive care delivery. Initiate appropriate referrals and utilize community resources for planning and service coordination. Monitoring and Follow-Up: Provide ongoing monitoring of services through monthly phone calls and home visits, documenting observations, and beneficiary progress. Evaluate the effectiveness of care plans and services, recommending or implementing changes as needed to achieve desired outcomes. Maintain accurate, up-to-date case management documentation within the system, ensuring compliance with state and agency guidelines. Counseling and Support: Provide emotional support and basic counseling to beneficiaries and their families to strengthen their support systems. Assist families in navigating challenges, including long-term palliative care, behavioral issues, and medical needs. Documentation and Compliance: Assist in obtaining documentation from medical staff to confirm the need for specific CAP services. Maintain medical records for each beneficiary, ensuring documentation of current status, service changes, and referrals. Ensure compliance with 10A NCAC 27G.0202 and other regulatory guidelines. Complete all required records per agency policy and the State CAP manual, including discharge summaries when CAP services are completed. Review and ensure proper billing codes and compliance for case management, in-home aide documentation, paid live-in caregiver, re-certifications, and supply billing. Participate in NC Medicaid-certified training programs and ensure program compliance within 90 days of employment. Collaboration and Advocacy: Work closely with RNs and interdisciplinary team members to ensure a comprehensive approach to beneficiary care. Participate in case discussions and provide input to ensure quality care and service delivery. Advocate for program participants and their families to secure necessary resources and services. Serve as a liaison between beneficiaries, families, and external providers to address care needs effectively. Provide training and support to families to empower them in managing their child's care. Continuing Education and Professional Development: Complete all state-mandated training and agency-required continuing education annually. Stay current on CAP guidelines, best practices, and new developments to enhance service delivery. Ensure timely updates to the CAP Business system and other documentation systems as required. All other duties as assigned. SUPERVISORY RESPONSIBILITIES: This position has no supervisory responsibilities. MINIMUM QUALIFICATIONS: Strong understanding of Medicaid programs and compliance requirements. Excellent communication and interpersonal skills to work effectively with families and multidisciplinary teams. Ability to manage multiple priorities and maintain detailed records. Experience working with medically fragile children or in pediatric healthcare settings and physically disabled adults with complex care needs. Education and Experience: Candidates must meet one of the following criteria: Social Work Background: Bachelor's degree in social work from an accredited school of social work. Minimum of one year of directly related community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care). Completion of an NC Medicaid-certified training program within 90 calendar days of employment. Human Services Background: Bachelor's degree in a human services or equivalent field from an accredited college or university. Minimum of two years of community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care). Completion of an NC Medicaid-certified training program within 90 calendar days of employment. Non-Human Services Background: Bachelor's degree in a non-human services field with two or more years of related community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care). Completion of an NC Medicaid-certified training program within 90 calendar days of employment. Nursing Background: Current North Carolina Registered Nurse (RN) license with a two-year or four-year degree. At least one year of case management experience in homecare, long-term care, or personal care. Completion of an NC Medicaid-certified training program within 90 calendar days of employment. Note: An individual with a bachelor's degree or who holds a nursing license as described above, without the number of years of experience, may be designated as an apprentice and shall be hired to act in the role of case manager. The supervisor of the case management shall provide direct supervision and approve all CAP/C workflow documentation and tasks. PHYSICAL DEMANDS AND WORK ENVIRONMENT: Must be able to lift a minimum of 10 lbs. Must be able to pull a minimum of 20 lbs. Must be able to squat, kneel, crawl, crouch, climb, and stoop. Required to regularly stand and walk. RHA is an Equal Employment Opportunity Employer, prohibits discrimination based on the following protected categories: race, creed, color, national origin, nationality, ancestry, age, sex/gender, marital status, civil status, domestic partnership status, familial status, religion, affectional or sexual orientation, gender identity or expression, atypical hereditary cellular or blood trait, genetic information, liability for service in the Armed Forces of the United States, or disability. Pre-employment screening: Complete criminal background Name checked in the registries. (OIG exclusions database, Child Abuse Registry, and Offenders Against Individuals with Developmental Disabilities) Drug testing Education verification and other credentialing based on position requirements. Proof of employment history or references (if required) Positions that require driving Proof of driver's license, driver's insurance, and vehicle, IF required for providing transportation for individuals. We offer the following benefits to employees: Payactiv: early access to the money you've earned from hours you've already worked, before payday! Employee perks and discount program: to help you save money! Paid Time Off (full-time employees only) Health/Insurance (full-time employees only) 401(k) retirement savings program Wellbeing Programs: Physical, Emotional and Financial Chronic Disease management programs for hypertension and diabetes (for qualifying employees) Training: Free CPR, first aid, and job-specific training opportunities *contract/contingent workers and interns do not qualify for any of the above benefits EEO Statement RHA is an equal opportunity employer. In addition, we provide reasonable accommodation to qualified employees who have protected disabilities to the extent required by applicable laws, regulations, and ordinances. If you are an individual with a disability and need a reasonable accommodation to participate in the application process, please contact our solutions center. About RHA: At RHA Health Services, we help individuals with intellectual and developmental disabilities, mental health and/or substance use needs live their best lives. Our mission is to provide a safe and healthy environment while creating opportunities for personal outcomes. For over 30 years, the people we serve and support have remained at the very center of everything we do. RHA currently provides services in North Carolina, Georgia, Pennsylvania, Tennessee, and New Jersey. If you are ready to make a difference in the lives of people we serve and support apply to join the team today.

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.

Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse Coordinator is a Registered Nurse assigned to various Health Services operational units. These units include Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The role involves performing utilization management activities, including telephonic or onsite clinical reviews, case or disease management, care coordination, transition activities, or population health activities. The position requires working with a specific member population and may require bilingual skills in Spanish for certain roles. Responsibilities * Comply with HIPAA, Privacy, and Confidentiality laws and regulations. * Adhere to Health Plan, Medical Management, and Health Services policies and procedures. * Stay informed about clinical knowledge related to disease processes. * Communicate effectively, both verbally and in writing, with providers, members, vendors, and other healthcare providers. * Function as a collaborative member of the multi-disciplinary medical management team. * Identify and report quality of care concerns to management and appropriate departments. * Support and collaborate with team members in implementing and managing Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities. * Participate in the implementation, assessment, and evaluation of quality improvement activities. * Adhere to mandated reporting requirements and comply with regulatory standards. * Be positive, flexible, and open to operational changes. * Attend and actively participate in department meetings. * Participate in the development and evaluation of department initiatives aimed at improving member quality of care. * Stay updated on healthcare benefits and limitations, regulatory requirements, disease processes, treatment modalities, community standards, and professional nursing standards. Essential Skills * Utilization management and review experience. * Strong multi-tasking, organizational, and time-management skills. * Clinical knowledge of adult or pediatric health conditions and disease processes. * Ability to work both individually and collaboratively in a cross-functional team environment. * Excellent interpersonal and communication skills. * Ability to compose clear, professional correspondence. * Understanding of quality improvement theory and strategy. * Experience with HEDIS medical record abstraction. Additional Skills & Qualifications * Registered Nurse (RN) license. * Bilingual skills in Spanish may be required for certain roles. * Experience in case management and working with health plans and providers. Work Environment The role is based in an office setting where the services team works collaboratively. The team includes Case Management, Pharmacy, UM, and Pediatrics. It is a supportive and helpful environment with a mission-driven company that values its employees, offering catered lunches weekly. Job Type & Location This is a Contract position based out of Santa Barbara, CA. Pay and Benefits The pay range for this position is $47.00 - $47.00/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 Dec 20, 2025. 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 for other accommodation options.

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 Hourly Rate: $60/hr onsite and $50/hr travel time Work Location: Chicago, Illinois; 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!

Details ! 4 day RN Clinical Supervisor / Friday - Monday - 10 hours days Home Health experience and OASIS knowledge required Experience with Home Care Home Base is preferred POSITION OVERVIEW The CLINICAL MANAGER is a qualified professional responsible for the planning, coordination, and delivery of quality care services to the client. This individual is accountable for the agency's adherence to federal, state, and local laws, accreditation, company standards, compliance, and reimbursable client care services. A Registered Nurse with a Baccalaureate or higher degree in nursing or other health related field and two years clinical experience within the last three years in a home health agency is preferred; or A Registered Nurse with three years of clinical experience within the last five years in a home health agency, home care setting, or healthfacility is preferred.Essential Functions Complies with accepted ethical conduct and professional Standards of Nursing Practice as set forth by the American Nurses Association. Provides leadership in promoting and maintaining standards and compliance with accreditation and licensure. Supervises professional personnel in all aspects of their delivery of care. Develops work methods and procedures that facilitate the rendering of high quality care. Assists field staff in monitoring changing needs of the client and or family. Functions as a liaison with the community's health-related resources. Evaluates the employees under his/her supervision and submits the results to the Administrator for final approval. Performs and monitors the skill competencies and services of the field employees. Supervises the implementation of the Physician's Plan of Treatment. Coordinates the total Plan of Care with the appropriate resources based on ICD coding, PPS guidelines and input from billing/financial department, including insurance companies and authorizations as required. Responsible for maintenance of current and accurate client records. Participates in the selection and orientation of new employees. Assists with the planning and direction of in-service educational programs. Maintains ongoing communication with office staff and participates in staff conferences. Assures coordination of HHA schedules. Assists with performance improvement activities and serves as a member to the PI/QI Committee to assure total quality management. Interprets nursing policies and procedures to non-nursing personnel. Collaborates with Administration to provide necessary statistical and financial data for reimbursement of provider services. Ensures professional scheduling and assignments as appropriate based on client needs, staff expertise, and geographical locations. Ensures office filing/medical record functions are current, accurate, and effective. Participates in local professional organizations and activities, promoting agency services. Documents all client-related activities in a timely manner. Maintains consistent attendance. Submits all credentials in a timely manner. Performs all responsibilities in a professional manner that follows all agency rules of conduct. Provides oversight of all patient care services and personnel to include: Making patient and personnel assignments Coordinating patient care Coordinating referrals Assuring that patient needs are continually assessed Assuring the development, implementation, and updates of the individualized plan of care Reacts to change productively and performs other job-related tasks and duties as assigned. REQUIREMENTS: At least 1 year of supervisory experience preferred. Must be currently licensed (in good standing) in the state(s). Must meet educational/experience requirements outlined in the laws of licensure states. Knowledge of Medicare and Medicaid regulations and reimbursement principles is desired. While performing responsibilities of the job, the employee is required to talk, hear, sit and use hands. Required to stand, walk, reach with arms and hands, lift 15-20 pounds, climb, and kneel. Close vision is also required. Reasonable accommodations can be made to enable people with disabilities to perform essential functions of the job. While performing the duties of this job, the employee is occasionally exposed to moving mechanical parts, external vehicle fumes, major temperature changes, and various odors. Noise level in the work environment is moderate. WORKING ENVIRONMENT: Works indoors in Agency office and patient homes and travels to/from patient homes. RISK EXPOSURE: High risk LIFTING REQUIREMENTS: Ability to perform the following tasks if necessary: Ability to participate in physical activity. Ability to work for extended period of time while standing and being involved in physical activity. Moderate lifting. Ability to do extensive bending, lifting and standing on a regular basis. As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

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 Payactiv 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

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. The primary location for this position is remote (CST required). Expected schedule will be 3x12s (Monday-Wednesday or Wednesday-Friday) 7:00am-7:00pm CST. What You'll Do As a Pediatric Nurse Care Coordinator at Imagine Pediatrics, you are the primary point of contact for our families as you work to deeply know our patients through frequent virtual touchpoints and are the first line of defense when our patients are having a clinical problem. You leverage an integrated technology platform and are complimented by an entire interdisciplinary team including MDs, APPs, social workers, navigators, pharmacists, and dietitians. You will: Provide professional and friendly proactive care and triage for clinical issues. Embed a family centered care philosophy in care delivery. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Transition of care for ED/IP/UC care coordination with clinical providers following discharge. Perform a comprehensive assessment of a patient's clinical, psychosocial, discharge planning and financial needs. Establishes clinical milestones and goals related to these issues. Establish rapport and a relationship with the patient and family in order to understand their needs and expectations and to assist them in setting realistic and mutual goals. Integrate an awareness of cultural factors in the patient/family interview process and elicit clinically relevant cultural information. In conjunction with the physician, the patient and interdisciplinary team, establishes a comprehensive plan of care to appropriately address clinical milestones. Communicate plan of care, including changes and issues related to plan of care to patient/family, physicians and other members of the healthcare team. Gather sufficient information from all relevant sources to determine the effectiveness of the plan of care to assure it is done in an accurate, safe, timely and cost-effective manner. Document all care management assessments and interventions. Refer to Social Worker or Behavioral Health for complex psychosocial and discharge planning issues (per criteria) and ensures appropriate follow-up. Consults with other members of the interdisciplinary team (dietary, pharmacy, etc.) to provide safe discharge as appropriate. Perform other duties as assigned 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 special health care needs gets the care and support they deserve. You will need: Licensed RN in at least one state with eligibility to register for other state licensures. Bachelor's in nursing from an accredited university required. Pediatrics experience required in outpatient (primary care and/or subspecialty), home health, complex care, pediatric ICU, emergency medicine, etc. Minimum 1 year care coordination or case management experience preferred. Bilingual Spanish preferred Familiarity with Medicaid regulations and services a plus Value Based Care (VBC) experience a plus Virtual care experience a plus What We Offer (Benefits + Perks) The hourly rate for this position ranges from $40 - 47 per hour 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.

The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services, monitors consumer treatment through ongoing and continuous review to ensure that services are delivered based on consumer need and established clinical guidelines, and identifies and follows-up on clinical cases of concern and high-risk/special needs consumers to ensure enrollees are linked to appropriate treatment resources. The UM Clinical Specialist RN - PH may represent the unit in cross agency collaborative needs. This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed. Responsibilities & Duties Assesses the medical necessity of services Independently conduct medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times Ensure authorized services address appropriate service needs, intensity of service outcomes, and alternatives for consumers Provide a consistent application of medical necessity criteria for physical health services that promotes a holistic review of the member's needs Conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards Notify members of adverse benefit determinations while preserving members' Due Process rights Ensure compliance with performance measures outlined within all accrediting body standards Perform other related duties as required by the immediate supervisor or other designated Alliance Health administrators Compliance Comply with utilization management and quality improvement policies and procedures, utilization review laws and regulations, state standards Comply with Utilization Management Department focus on timeliness, effectiveness, quantity, quality, and cost of services for eligible enrollees Coordinate and Implement UM Processes Participate in the integration of the department and its functions into the organization's primary mission Take part in the Utilization Management Department collaboration to ensure an integrated department with Physical Health and Behavioral Health Collaborate with other departments Monitor for undesirable performance or deviations of practice standards that may have a negative impact on consumers. Respond through additional follow-up with consumer and providers, provider technical assistance and/or referral to other departments within the MCO. Maintain open, timely communication with staff, providers, community agencies and other stakeholders Minimum Requirements Education & Experience Graduation from a State accredited school of nursing or an Associate's Degree in Nursing from an accredited and five years of experience with five (5) years nursing experience OR Bachelor's degree in Nursing from an accredited college/university and three (3) years of nursing experience Special Requirement Current, active, and unrestricted North Carolina clinical license as a Registered Nurse, or a compact license Preferred Experience: Experience in Utilization Management Knowledge, Skills, & Abilities Knowledge of physical health and co-morbid health conditions Knowledge of diagnostic treatment guidelines/protocols, level of care criteria Proficient in the use of computer and multiple software programs. Written and oral communication skills Ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations. Knowledge of Utilization Management managed care principles and strategies Ability to analyze effectiveness of processes and adjust developed processes. Knowledge of and experience in acute clinical utilization review Knowledge of Authorization/re-authorization Utilization Management standards Knowledge of related duties in the delivery of patient care, management of patient care providers, or project management in a healthcare environment Ability to lead, delegate and problem solve Ability to develop and document workflows Ability to assist appeal efforts when medical care is denied by various payor entities in a timely fashion. Knowledge of and experience with NCQA Salary Range $68,227 - $86,990/Annual Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility

📍 Remote (U.S.) | FT | Reports to: Clinical Manager This role is HOT 🔥 - Help scale the fastest-growing virtual clinic for women in midlife health. About Midi Midi Health is the leading virtual care platform focused exclusively on women's midlife health. We provide compassionate, evidence-based care for women navigating perimenopause, menopause, and beyond - delivered by expert clinicians and supported by cutting-edge technology. We're growing fast, backed by world-class investors, and changing lives by helping women feel like themselves again. Join us and be part of the movement to bring modern midlife care to millions. 🌟 Role Overview As a Clinical Coordinator (CC) at Midi, you'll split your time between direct clinical RN duties and team coordination to support efficient and safe clinical workflows. You'll be the go-to for RN onboarding, coaching, daily staffing flow, clinical escalations, and quality assurance. This is a great fit for a nurse who loves blending patient care with operational leadership in a virtual-first environment. What You'll Do 📬 Daily Clinical & Operational Support (≈50% RN Duties) Work RN inbox tasks and resolve patient clinical questions per scope and protocols Provide real-time clinical guidance for escalations and edge cases Reallocate RN coverage to balance inbox volume across queues 📚 Onboarding, Training & Readiness (RNs & MAs) Own onboarding for new RNs (accounts, access, modules, shadowing, sign-offs) Support MA and RN onboarding with standardized competency check-offs Conduct 90-day MA performance reviews and coaching plans Maintain onboarding toolkit (checklists, SOPs, job aids) with CM and LMAs 🤝 Team Leadership & Workflow Management Meet daily with Lead MAs to review inbox SLAs, tasks, volume, and staffing Partner with Lead MAs to ensure task queues (provider comms, labs, RX, prior auths, Zendesk) are properly supported Approve time and complete administrative tasks in Rippling 🔍 Quality Assurance & Continuous Improvement Audit documentation and adherence to workflows; coach RN and MA teams Identify recurring workflow defects and collaborate with CM on SOP updates Track and socialize key team metrics (SLA, rework, onboarding checkpoint rates) 💬 Communication & Escalation Serve as first-line clinical escalation for Lead MAs Communicate with providers, schedulers, and support teams to resolve handoffs Contribute to monthly performance and enablement dashboards 🎯 What You'll Bring Must-Haves Active, unrestricted RN license (compact required; CA highly preferred) 3+ years of hands-on RN experience (telehealth or ambulatory strongly preferred) Proven ability to train and mentor peers in fast-paced clinical environments Comfort with digital platforms (Athena, Slack, portal comms, Google Workspace) Strong organizational judgment, follow-through, and compliance mindset Nice-to-Haves Experience working in virtual care with task-based Medical Assistant teams Background in QA/audits, workflow mapping, or SOP development Familiarity with Zendesk, CoverMyMeds, or cross-queue workflows 🛠 Tools You'll Use Athenahealth ▪ Zendesk ▪ Slack ▪ Google Workspace ▪ Midi Telehealth Platform ▪ Rippling ✅ Compliance & Licensure Maintain active RN licensure and complete all mandatory trainings Follow all Midi policies and uphold HIPAA/PHI standards Participate in incident reporting and periodic competency assessments Please note that all official communication from Midi Health will come from **************** email address. We will never ask for payment of any kind during the application or hiring process. If you receive any suspicious communication claiming to be from Midi Health, please report it immediately by emailing us at ********************. Midi Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Please find our CCPA Privacy Notice for California Candidates here.

The Clinical Operations Nurse is responsible for completing telephonic patient evaluations and assessments for WellSky's various payer programs. We invite you to apply today and join us in shaping the future of healthcare! Key Responsibilities Cultivate and maintain professional relationships with clients, patients, and stakeholders by providing sensitive and respectful care in line with diversity standards and human dignity. Conduct assessments with patients and providers to identify most appropriate level of care setting, identify potential gaps in care, and coordinate with stakeholders to provide resources to promote best possible outcomes and reduce readmissions. Coordinate and educate program expectations with providers, payers, and members to ensure appropriate referrals and optimized clinical outcomes. Advocate for patient needs through effective communication and service coordination and promote patient self-management and wellness by empowering patients and families to make informed choices and build supportive care systems. Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care and seamless care transitions. Responsible for making outreaches to emergency departments to provide care coordination and safe transitions for patients. Maintain accurate documentation, stay current on healthcare regulations and practices, and participate in team meetings and orientation activities to promote collaboration and continuous improvement. Perform other job duties as assigned. Required qualifications Bachelor's degree or equivalent work experience. At least 2-4 years of relevant work experience. RN Licensure in New York and/or Oklahoma and/or Compact. At least 2 years' experience in emergency departments. Preferred qualifications Experience in acute/ACO/post-acute care facility care coordination, discharge planning, social services, disease management, population health, home health, and/or post-acute care facilities. Job Expectations Willing to travel up to 30% based on business needs. Willing to work additional or irregular hours as needed/evening hours/holidays. Must work in accordance with applicable security policies and procedures to safeguard company and client information. Must be able to sit and view a computer screen for extended periods of time. #LI-PG1 #LI-Remote WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical, dental, and vision benefits Mental health benefits through TelaDoc Prescription drug coverage Generous paid time off, plus 13 paid holidays Paid parental leave 100% vested 401(K) retirement plans Educational assistance up to $2500 per year

Ready to Bring Your Acute Care Skills Home? Join Our Remote RN Team Supporting Our Military Communities! Are you a seasoned ER or Med-Surg nurse looking for a meaningful, mission-driven role that lets you care for others without the scrubs and long drives to the hospital? MPF Federal is hiring Remote Telehealth Triage Nurses (RNs) to join our 24/7 Nurse Advice Line-supporting veterans and their families-all from the comfort of your home. This isn't just a job; it's your chance to use your clinical expertise, empathy, and critical thinking skills to guide patients through their toughest moments-all while achieving better work-life balance. Pay & Perks $35.00/hr base rate Evening, night, and weekend differentials may apply 100% Remote - Work From Home Most schedules include Saturday and Sunday and do not rotate Shifts Available (Share Your Schedule Preference!) Day Shifts Evening Shifts Night Shifts Training Approximately 6 Weeks Paid Training | Monday-Friday, 8:00 AM - 4:30 PM Start Date: December 1, 2025 - You will be required to also work BOTH Christmas and New Years. What You'll Do Triage Symptoms: Assess callers using evidence-based protocols Deliver Immediate Care Advice: Recommend next steps, from self-care to urgent care, calmly and confidently Offer Health Education: Counsel patients on medications, test results, and chronic condition management Crisis Triage: Handle behavioral health, emergency, and complex calls with empathy and grace Document Interactions: Accurately chart calls in our EHR and follow compliance protocols Team Collaboration: Work closely with a supportive leadership team and fellow remote RNs If you're an experienced nurse with a calm voice, a critical mind, and a heart for service-this is your moment to make a real difference. Apply now and be the steady hand guiding military families when they need it most-right from your home. Requirements You're a Great Fit If You Have: 5+ Years of Recent Hands-On Acute Care RN Experience ER or Med-Surg strongly preferred Current Compact RN License in good standing from the state you are physically in BSN Degree from an accredited American university Confidence with phone-based care and multi-screen computer systems Strong clinical judgment, emotional intelligence, and documentation skills A mission-first mindset and passion for serving military-connected communities Bonus Points If You Also Have: Experience with behavioral health, mother-baby, and/or peds Past work in telehealth, triage, or call center nursing Familiarity with military healthcare systems or VA patients Tech & Work Environment: Must have a hard-wired Ethernet internet connection (Wi-Fi only, satellite, or radio internet is not acceptable) Quiet, distraction-free home office space with a door for HIPAA compliance Metrics-driven environment - you'll need to meet quality, handle time, and documentation goals Federal Requirements: Must be a U.S. Citizen Ability to pass a Public Trust Background Check & Drug Screening per federal guidelines Must be willing and able to obtain licenses in all 50 states (we support you here!) Benefits For nurses on our advice line, we will assist with licensure in all 50 states within the first 90 days of hire. MPF Federal is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status or on the basis of disability. We offer a competitive compensation package including a competitive salary, medical benefits, PTO, holiday pay and more.

Full time Shift: First Shift (Days - Less than 12 hours per shift) (United States of America) Hours per week: 40 Job Information Exemption Status: Non-Exempt Provides professional nursing care for clinic patients following established standard and practices. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson's Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization. Education Qualifications Bachelor's of Science in Nursing (BSN) Preferred Experience Qualifications 1 year Nursing experience. Preferred Skills and Abilities Skill in applying and modifying the principles, methods and techniques of professional nursing to provide on-going patient care. (Required proficiency) Skill in establishing and maintaining effective working relationships with patients, medical staff and the public. (Required proficiency) Ability to maintain quality control standards. (Required proficiency) Ability to react calmly and effectively in emergency situations. (Required proficiency) Licenses and Certifications Registered Nurse - KSBN Required What you will do Triage of all incoming phone calls by evaluating the physical and psychosocial health status of patients. Follows nursing protocols and guidelines for answering and directing calls. Record and reports patient's condition and reaction to drugs and treatments to interdisciplinary team. Provide instruction to patients/family regarding treatment. Maintains and reviews patient records, charts, and other pertinent information. Oversee appointment bookings and ensure preferences are given to patients in emergency situations. Arranges for patient testing and admissions. Refill prescribed medications per standing orders. Clarify medication orders and refills to pharmacies as directed by providers. Perform medication prior authorizations as needed by providing needed clinical information to insurance. Maintain timely flow of patient to include scheduling of follow up appointments if needed. Working of in-basket medication refill requests for providers. Provide education to patient and family on medications, treatments and procedures. Record and report patient's condition and reaction to drugs and treatments to interdisciplinary team, reviewing patient records and other pertinent information. Ensure patients receive appointments that align with triage disposition and that maintain timely flow of patients. Coordinate patient testing, referrals, and admissions Work collaboratively with on-site staff to provider coordinated patient care Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Not Patient Facing Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail's Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually. Remote Work Capability Full-Time Scope No Supervisory Responsibility No Budget Responsibility Physical Demands Balancing: Rarely less than 1 hour Carrying: Rarely less than 1 hour Eye/Hand/Foot Coordination: Occasionally 1-3 Hours Feeling: Rarely less than 1 hour Grasping (Fine Motor): Occasionally 1-3 Hours Grasping (Gross Hand): Rarely less than 1 hour Handling: Rarely less than 1 hour Hearing: Occasionally 1-3 Hours Kneeling: Rarely less than 1 hour Sitting: Frequently 3-5 Hours Standing: Rarely less than 1 hour Stooping: Rarely less than 1 hour Talking: Frequently 3-5 Hours Walking: Rarely less than 1 hour Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment. Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.

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: Registered Nurse Upon Start Current RN license and eligible to practice in VA or MD 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

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 - Part-time (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 responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. Work Hours for Part-time role (20 hours weekly): Monday-Friday, 8:00 AM to 5:00 PM (Central OR Eastern Time Zone) with potential occasional weekend coverage. Qualifications Required Qualifications/Experience: * Active, unrestricted Registered Nurse (RN) License in South Carolina, 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 knowledge of medical records, medical terminology, and disease process organization. Preferred Qualifications/Experience: * 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. * 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG). * Knowledge of Utilization Review Accreditation Commission (URAC) standards. * Knowledge of Medicare (CMS) guidelines. * 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. The benefits for this position include prorated Paid Time Off, participation in our 401(k) Plan, and EAP benefits. Additionally, regular part-time employees are eligible for education assistance, with a maximum benefit per year. This program provides support for tuition and other expenses related to the pursuit of a degree, as well as Continuing Education Unit (CEU) and Continuing Medical Education (CME) courses that are job-related. 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.

Department: 39733 Enterprise Corporate - Care Transitions Status: Part time Benefits Eligible: Yes Hours Per Week: 20 Schedule Details/Additional Information: Preferred qualifications: 3+ years RN: experience in case management, triage, with prior telephonic/remote experience. This is a weekend position, hours of operation 8am to 8:30pm. This is a remote work from home position. Must have high speed internet. Must live within 1 hour of Mint Hill Primary Care office. Potential to include holidays. Pay Range $37.50 - $56.25 Must live within an hour of Mint Hill 5 years of inpatient experience in the Med Surg area with additional experience in the ED/Clincic setting is a plus. Having experience talking with patients on the phone is also a plus, since all their work will be done via phone Job Summary Facilitates a lifelong, proactive partnership with patients to enhance and personalize management of health-related needs. The Care Manager assesses needs, plans, coordinates, and evaluates services of patients with the goal of equipping and empowering individuals and their families to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Care Managers focus on five primary areas: 1) population management, 2) patient self-management support, 3) transitions in care, 4) resource connection, and 5) appropriate resource utilization. Works collaboratively and maintains active communication with the multidisciplinary care team including providers, pharmacists, social workers, behavioral health specialists, and nurses to achieve timely, appropriate patient management. Essential Functions Utilizes RN process as a framework to focus the activities of the healthcare team on the achievement of optimal outcomes, resource utilization, clinical expertise, and improvement strategies. Interacts with patients, professionals, and the community to achieve continuity of care, coordination of services and to document plans of care across multiple care settings. Conducts or participates in comprehensive “all-system” needs assessment for identified patients; knowledgeable of appropriate care-related services to match identified needs disease management for health maintenance, and appropriate clinical goal expectations/outcomes for identified population. Develops and maintains accurate case records of each referred customer/patient. Documents fully and accurately; knowledgeable of and utilizes accurate computer databases and documentation systems. Maintains knowledge of various reimbursement criteria and documentation necessary for reimbursement, including Medicaid, Medicare, and Managed Care. Demonstrates leadership in the professional practice of nursing evaluating his or her own nursing practice in relation to professional practice standards and guidelines, relevant statues, rules and regulations. Physical Requirements Work requires walking, standing, lifting, reaching, bending, and stooping. Must lift a minimum of thirty-five pounds' shoulder high. Ability to travel/drive between various locations is required for this position. Requires frequent verbal and written communication in English. Must have intact sense of sight and hearing, finger dexterity, critical thinking, and ability to concentrate. Must be able to respond quickly to changes in assignments. Occasional intermittent noise and exposure to conditions such as dust, fumes, and chemicals. Education, Experience and Certifications BSN required. Masters preferred. Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or; if declaring a National License Compact (NLC) state as your primary state ofresidency, meet the licensure requirements in your home state; or for Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works. Two years' experience required in health care. Experience includes case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office, or Managed Care company. Appropriate professional certification required within 3 years of hire date for professional certification per departmental protocol. Clinical competence in disease management and case management principles. Must possess excellent interpersonal communication and negotiation skills, problem-solving skills, strong organizational and time management skills, and the ability to work independently and as a member of the care team. Requires demonstrated knowledge and proficiency in appropriate tools.BLS required per policy guidelines . Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

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: * PM shift: 3:00 PM - 11:30 PM * Variable Monday-Friday * Weekend and holiday rotation FTE: Flexible, 0.5 - 1.0 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: 16 Scheduled FTE: 0.4 Location: Encircle Health - Appleton,Wisconsin Overtime Exempt: No

Schedule: PRN | various shifts Job Type: In-person Your experience matters Sovah Health is a part of Lifepoint Health. At Lifepoint, we are committed to empowering and supporting a diverse and determined workforce that can drive quality, scalability, and significant impact across our hospitals and communities. As a member of the Health Support Center (HSC) team, you'll support those who are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier . More about our team The Student Nurse Extern (SNE 1) program provides nursing students with practical work experiences to facilitate their transition into the role of a registered nurse. Throughout the paid program, learning and nursing engagement occur on a 24-hour per unit basis in a broad range of acute care, critical care, emergency care, psychiatry, women's, & surgical/outpatient areas. SNEs gain hands-on experience in Patient Care. Teamwork, Critical Thinking, Communication Skills, and Professional Development. Why join us We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: What we're looking for The right candidate will, under the supervision of an RN, assist in assuring optimal patient care, while continuing as a Nursing Student in good standing. The SNE I may perform acts that are routine for any nursing assistant job description. SNE I may also perform additional acts that have been taught in their nursing education program, provided they are individually educationally prepared and clinically competent to perform these acts. Such acts include phlebotomy and straight catheterization. Professional Development: Ongoing learning and career advancement opportunities. How you'll contribute A Student Nurse Extern I who excels in this role: Performs clinical skills according to hospital policy and procedures. Performs technical skills according to policy and procedure. Maintains hospital and patient confidentiality. Demonstrates concern for patient welfare by performing activities other than primary care needs. Applies knowledge of age-related factors appropriately to patients, utilizing appropriate policies and procedures. Responds promptly to patient requests by answering call lights, greeting patients in a cheerful, positive manner, answering questions or fulfilling needs, and alerting the Registered Nurse as necessary. Tidies rooms, changes bed linens, and ensures rooms are clean, neat, and orderly. Assists with stocking items in rooms. Sets up oxygen flow meter, humidifier, and nasal cannula as requested. Performers courier duties to the lab and other hospital departments to deliver lab specimens (Urine, stool, sputum), or deliver and retrieve other requested items. Transports patients to and from various areas as needed. Answers phones and greets patients and visitors. Performs other related duties as assigned that will facilitate the achievement of quality patient care. Takes and records vital signs (blood pressure, temperature, pulse, and respiration), measures and records intake and output, and weighs patient as assigned. Observes patient's physical appearance, attitude, response to medications and treatments, appetite, etc., and reports observations to Registered Nurse. Performs or assists with routine procedures such as enemas, sitz baths, surgical preps, and turning patients, and explains procedures to patients to facilitate understanding and reduce anxiety. Gives bedpans, urinals, or assists patient to commode or bathroom. Assists patient with meals by preparing the patient's proper positioning, moving the tray, and feeding the patient as necessary. Ensures nourishments and water are given to the patient in accordance with the established schedule of as requested. Helps patients in and out of bed and/or wheelchair. Performs back rubs, converses with patients in a positive, friendly manner to reduce anxiety and encourage communication. Participates in various in-service and staff activities to contribute to the ongoing development of knowledge and to improve techniques. Performs age-specific patient assessment, demonstrating awareness of growth and development for each age group. Demonstrates knowledge of age-specific assessment, recognizing psychosocial levels and developmental patterns. Provides for age-appropriate stimulation and learning needs. Adheres to the Hospital's Standards of Performance. Minimum Education: High school diploma or equivalent required. Must be enrolled in a professional school of nursing program for "Registered Nurse" and have completed their first semester (Fundamentals of Nursing, including clinicals). Required Certifications/Licenses: Basic Life Support (BLS) American Heart Association is required. EEOC Statement: SOVAH Health - Martinsville is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status, or any other basis protected by applicable federal, state, or local law. Equal opportunity and affirmative action employers are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran