Nurse Coordinator jobs at HCA Healthcare

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational skills, proficient knowledge of MS Excel, able to work on multiple screens simultaneously and be computer literate to keep up with the work. The team works in a very fast and productive environment. Further details to be discussed during our interview process. Remote position with location preference in MI, IL or WI Work hours: Monday- Friday: 8:30am -5:00pm EST. There is Saturday on call and holiday rotation. Michigan RN license is required. **Job Duties** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. + Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + Identifies and reports quality of care issues. + Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. + Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. + Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. + Supplies criteria supporting all recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and support to clinical peers. + Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in state of practice. + Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). + Experience working within applicable state, federal, and third-party regulations. + Analytic, problem-solving, and decision-making skills. + Organizational and time-management skills. + Attention to detail. + Critical-thinking and active listening skills. + Common look proficiency. + Effective verbal and written communication skills. + Microsoft Office suite and applicable software program(s) proficiency. **PREFERRED QUALIFICATIONS:** + Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. + Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. + Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - May provide consultation, resources and recommendations to peers as needed. - Care manager RNs may be assigned complex member cases and medication regimens. - Care manager RNs may conduct medication reconciliation as needed. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Ability to operate proactively and demonstrate detail-oriented work. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. - In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications - Certified Case Manager (CCM). - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

This is a general application which is applicable across all TRA locations and, all RN and Allied Travel and Local contracts. When you receive your offer letter, it will be customized for the specific position you are hired into. With TRA, you will receive greater contract security than with outside agencies while accessing exciting travel and local contracts across the nation. Why Choose TRA? Guaranteed Hours for Travel Contracts Preferred Booking Agreement for Local Contracts Company Matching funds for the 401K Holiday Pay TRA is preferred for all contract assignments within Tenet while receiving the same tenure as Tenet staff. Location: This is a general application link and, you can be hired into any specific position that fits with what location you are looking to be hired into. As mentioned above, your offer letter will be customized and specific for the position you and your Recruiter speak about.

*** Offering up to a $20,000 Sign-On for eligible Full Time, Registered Nurse candidates! *** Why MountainView Regional Medical Center? We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Team members across our organization enjoy working in team environments and making a difference in the health and well-being of the patients they serve. Their efforts are rewarded through numerous recognition programs and our affiliates also offer team member benefits, including: Competitive compensation Paid time off plans for vacations, holidays and illness Health insurance, including coverage for medical, dental, vision and prescription drugs 401(k) retirement plan Education & student loan assistance Life and disability insurance Flexible spending accounts About Who We Are We are a 168-bed Joint Commission accredited acute care facility serving Las Cruces and southern New Mexico. A legacy of rich history, culture and natural beauty; Las Cruces remains one of the Southwest's best kept secrets. With a thriving arts scene, a focus on downtown, adjacent national monuments and plenty of Southwest charm, there's always something for you and your family to do or see in Las Cruces. Often recognized nationally as a top place to live and retire, Las Cruces offers a welcoming community. MountainView Regional Medical Center is Las Cruces Strong! Start your new job search here and see why we are ….Proud to be MountainView! Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and maintaining compliance with federal, state, and accreditation standards. Essential Functions Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues. Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs. Refers cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions. Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients. Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning. Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements. Identifies and appropriately refers cases to Child/Adult Protective Services, ensuring compliance with legal and ethical standards. Provides professional assistance to patients, families, and physicians regarding discharge planning and post-hospital care options. Performs other duties as assigned. Complies with all policies and standards. Qualifications Bachelor's Degree in Nursing preferred 2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required 2-4 years of care management experience preferred Knowledge, Skills and Abilities Strong understanding of case management principles, discharge planning, and transitions of care. Knowledge of federal, state, and Joint Commission standards related to case management. Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams. Ability to assess complex situations, identify solutions, and implement care plans efficiently. Proficiency in electronic medical records (EMR) and documentation systems. Strong organizational and time management skills to prioritize tasks in a dynamic environment. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required BCLS - Basic Life Support required State Specific Requirements Alabama: Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred. New Mexico: Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications preferred.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - May provide consultation, resources and recommendations to peers as needed. - Care manager RNs may be assigned complex member cases and medication regimens. - Care manager RNs may conduct medication reconciliation as needed. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Ability to operate proactively and demonstrate detail-oriented work. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. - In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications - Certified Case Manager (CCM). - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. - Facilitates comprehensive waiver enrollment and disenrollment processes. - Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. - Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. - Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. - Assesses for medical necessity and authorizes all appropriate waiver services. - Evaluates covered benefits and advises appropriately regarding funding sources. - Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. - Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. - Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. - Identifies critical incidents and develops prevention plans to assure member health and welfare. - May provide consultation, resources and recommendations to peers as needed. - Care manager RNs may be assigned complex member cases and medication regimens. - Care manager RNs may conduct medication reconciliation as needed. - 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications - At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. - Ability to operate proactively and demonstrate detail-oriented work. - Demonstrated knowledge of community resources. - Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. - Ability to work independently, with minimal supervision and demonstrate self-motivation. - Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. - Ability to develop and maintain professional relationships. - Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. - Excellent problem-solving and critical-thinking skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. - In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications - Certified Case Manager (CCM). - Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. * Facilitates comprehensive waiver enrollment and disenrollment processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. * Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. * Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. * Assesses for medical necessity and authorizes all appropriate waiver services. * Evaluates covered benefits and advises appropriately regarding funding sources. * Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. * Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. * Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. * Identifies critical incidents and develops prevention plans to assure member health and welfare. * May provide consultation, resources and recommendations to peers as needed. * Care manager RNs may be assigned complex member cases and medication regimens. * Care manager RNs may conduct medication reconciliation as needed. * 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications * At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. * Ability to operate proactively and demonstrate detail-oriented work. * Demonstrated knowledge of community resources. * Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. * Ability to work independently, with minimal supervision and demonstrate self-motivation. * Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. * Ability to develop and maintain professional relationships. * Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. * Excellent problem-solving and critical-thinking skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. * In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications * Certified Case Manager (CCM). * Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational skills, proficient knowledge of MS Excel, able to work on multiple screens simultaneously and be computer literate to keep up with the work. The team works in a very fast and productive environment. Further details to be discussed during our interview process. Remote position with location preference in MI, IL or WI Work hours: Monday- Friday: 8:30am -5:00pm EST. There is Saturday on call and holiday rotation. Michigan RN license is required. **Job Duties** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. + Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + Identifies and reports quality of care issues. + Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. + Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. + Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. + Supplies criteria supporting all recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and support to clinical peers. + Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in state of practice. + Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). + Experience working within applicable state, federal, and third-party regulations. + Analytic, problem-solving, and decision-making skills. + Organizational and time-management skills. + Attention to detail. + Critical-thinking and active listening skills. + Common look proficiency. + Effective verbal and written communication skills. + Microsoft Office suite and applicable software program(s) proficiency. **PREFERRED QUALIFICATIONS:** + Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. + Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. + Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational skills, proficient knowledge of MS Excel, able to work on multiple screens simultaneously and be computer literate to keep up with the work. The team works in a very fast and productive environment. Further details to be discussed during our interview process. Remote position with location preference in MI, IL or WI Work hours: Monday- Friday: 8:30am -5:00pm EST. There is Saturday on call and holiday rotation. Michigan RN license is required. **Job Duties** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. + Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + Identifies and reports quality of care issues. + Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. + Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. + Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. + Supplies criteria supporting all recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and support to clinical peers. + Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in state of practice. + Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). + Experience working within applicable state, federal, and third-party regulations. + Analytic, problem-solving, and decision-making skills. + Organizational and time-management skills. + Attention to detail. + Critical-thinking and active listening skills. + Common look proficiency. + Effective verbal and written communication skills. + Microsoft Office suite and applicable software program(s) proficiency. **PREFERRED QUALIFICATIONS:** + Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. + Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. + Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and patterns to the CRC leadership. Provides expert application of evidence based medical necessity review criteria tool. Works collaboratively to review, evaluate and improve the denial appeal process. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines and coding guidelines, evidence-based medicine, community and national medical management and coding standards and protocols. * Performs reviews of accounts denied for DRG validation and DRG downgrades. * Documents in appropriate denial tracking tool (ACE). Maintains and distributes reports as needed to leadership. * Identifies payment methodology of accounts including Managed Care contract rates, Medicare and State Funded rates, Per-Diems, DRG's, Outlier Payments, and Stop Loss calculations. * Collaborates with Physician Advisors and CRC leadership when documentation-specific areas of concern are identified. * Maintains expertise in clinical areas and current trends in healthcare, inpatient coding and reimbursement methodologies and utilization management specialty areas. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Effectively organizes work priorities * Demonstrates compliance with departmental safety and security policies and practices * Demonstrates critical thinking, analytical skills, and ability to resolve problems * Demonstrates ability to handle multiple assignments and carry out work independently with minimal supervision * Demonstrates quality proficiency by maintaining accuracy at unit standard key performance indicator goals * Possesses excellent written and verbal communication skills * Detail oriented and ability to work independently and in a team setting * Moderate skills in MS Excel and PowerPoint, MS Office * Ability to research difficult coding and documentation issues and follow through to resolution * Ability to work in a virtual setting under minimal supervision * Ability to conduct research regarding state/federal guidelines and applicable regulatory guidelines related to government audit processes Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Includes minimum education, technical training, and/or experience required to perform the job. Education * Minimum Required: * Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment * RN License in the State of Practice * Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Preferred/Desired: * Completion of BSN Degree Program * CCDS certification or inpatient coding certification Experience * Minimum Required: * Three to Five years Clinical RN Experience * Three to Five years of Clinical Documentation Integrity experience * Must have expertise with Interqual and/or MCG Disease Management Ideologies * Strong communication (verbal/written) and interpersonal skills * Knowledge of CMS regulations * Knowledge of inpatient coding guidelines * 1-2 years of current experience with reimbursement methodologies * Preferred/Desired: * Experience preparing appeals for clinical denials related to DRG assignment. * Strong understanding of rules and guidelines, including AHA's Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS CERTIFICATES, LICENSES, REGISTRATIONS * Required: * RN, * CCDS or other related clinical documentation specialist certification, and/or AHIMA or AAPC Coding Credential CCS, CCA, CIC, CPC or CPMA * Preferred: BSN PHYSICAL DEMANDS 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. * Ability to lift 15-30lbs * Ability to travel approximately 10% of the time; either to client sites, National Insurance Center (NIC) sites, Headquarters, or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical record quality reviews WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * Interaction with facility HIM and / or physician advisors * Must meet the requirements of the Conifer Telecommuting Policy and Procedure As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $56,784.00 - $85,176.00 annually. Compensation depends on location, qualifications, and experience. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and patterns to the CRC leadership. Provides expert application of evidence based medical necessity review criteria tool. Works collaboratively to review, evaluate and improve the denial appeal process. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines and coding guidelines, evidence-based medicine, community and national medical management and coding standards and protocols. * Performs reviews of accounts denied for DRG validation and DRG downgrades. * Documents in appropriate denial tracking tool (ACE). Maintains and distributes reports as needed to leadership. * Identifies payment methodology of accounts including Managed Care contract rates, Medicare and State Funded rates, Per-Diems, DRG's, Outlier Payments, and Stop Loss calculations. * Collaborates with Physician Advisors and CRC leadership when documentation-specific areas of concern are identified. * Maintains expertise in clinical areas and current trends in healthcare, inpatient coding and reimbursement methodologies and utilization management specialty areas. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Effectively organizes work priorities * Demonstrates compliance with departmental safety and security policies and practices * Demonstrates critical thinking, analytical skills, and ability to resolve problems * Demonstrates ability to handle multiple assignments and carry out work independently with minimal supervision * Demonstrates quality proficiency by maintaining accuracy at unit standard key performance indicator goals * Possesses excellent written and verbal communication skills * Detail oriented and ability to work independently and in a team setting * Moderate skills in MS Excel and PowerPoint, MS Office * Ability to research difficult coding and documentation issues and follow through to resolution * Ability to work in a virtual setting under minimal supervision * Ability to conduct research regarding state/federal guidelines and applicable regulatory guidelines related to government audit processes Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Includes minimum education, technical training, and/or experience required to perform the job. Education * Minimum Required: * Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment * RN License in the State of Practice * Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Preferred/Desired: * Completion of BSN Degree Program * CCDS certification or inpatient coding certification Experience * Minimum Required: * Three to Five years Clinical RN Experience * Three to Five years of Clinical Documentation Integrity experience * Must have expertise with Interqual and/or MCG Disease Management Ideologies * Strong communication (verbal/written) and interpersonal skills * Knowledge of CMS regulations * Knowledge of inpatient coding guidelines * 1-2 years of current experience with reimbursement methodologies * Preferred/Desired: * Experience preparing appeals for clinical denials related to DRG assignment. * Strong understanding of rules and guidelines, including AHA's Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS CERTIFICATES, LICENSES, REGISTRATIONS * Required: * RN, * CCDS or other related clinical documentation specialist certification, and/or AHIMA or AAPC Coding Credential CCS, CCA, CIC, CPC or CPMA * Preferred: BSN PHYSICAL DEMANDS 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. * Ability to lift 15-30lbs * Ability to travel approximately 10% of the time; either to client sites, National Insurance Center (NIC) sites, Headquarters, or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical record quality reviews WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * Interaction with facility HIM and / or physician advisors * Must meet the requirements of the Conifer Telecommuting Policy and Procedure As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $56,784.00 - $85,176.00 annually. Compensation depends on location, qualifications, and experience. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The Transfer Center RN is responsible for coordinating direct admissions and hospital transfers to and from community hospitals with the intent to transfer each patient to an appropriate Tenet hospital. The position works collaboratively to foster relationships with referring facilities, physicians, and hospital staffs in representation of Tenet Healthcare Mission and Values. EDUCATION: Minimum: Education recognized by the State of Florida as qualification for Registered Nurse licensure. Preferred: BSN EXPERIENCE: Minimum of four (4) years clinical experience in an acute care setting, to include Charge Nurse, House Supervisor or other related management experience. REQUIRED CERTIFICATION/LICENSURE/REGISTRATION: Registered Nurse - licensed in the State of Florida. OTHER QUALIFICATIONS: · RN experience in an ER/ Critical Care. · Demonstrated professional leadership skills that include problem resolution capabilities. Demonstrated ability to handle multiple tasks and remain flexible. · Computer literacy in EMR's, Word Processing, and Excel spread sheets. #LI-HB1

The Registered Nurse (RN) provides patient-centered care through the nursing process of assessment, diagnosis, planning, implementation, and evaluation. This role is responsible for coordinating and delivering high-quality care based on established clinical protocols and physician/provider orders. The RN collaborates with physicians, nurses, and other healthcare professionals to ensure effective patient care and desired outcomes, while maintaining a supportive and compassionate environment for patients and their families. Essential Functions Coordinates and delivers high-quality, patient-centered care in accordance with organizational policies, protocols, and the nursing process. Conducts thorough patient assessments and documents findings accurately, reporting changes in condition to the appropriate care team members. Utilizes knowledge of human growth and development to provide age-appropriate care and education. Administers prescribed medications, monitors for side effects, and documents administration in accordance with standards of practice. Assists physicians during procedures within the scope of documented competency and skill level. Collaborates with the healthcare team to develop, implement, and evaluate individualized care plans based on patient assessments and needs. Responds to medical emergencies and participates in life-saving interventions, such as CPR and code team activities, as appropriate. Advocates for the rights and needs of patients, ensuring their voices are heard and respected in care planning and delivery. Provides patient and family education on medical conditions, treatment plans, and post-discharge care, ensuring understanding and adherence to instructions. Implements and adheres to infection control protocols to prevent the spread of healthcare-associated infections. Monitors and operates medical equipment (e.g., IV pumps, monitors, ventilators) as needed for patient care and safety. Promotes patient safety by adhering to National Patient Safety Goals and maintaining a clean, safe environment for patients and staff. Participates in audits, chart reviews, and compliance checks to ensure adherence to standards of practice and regulatory requirements. Demonstrates responsible decision-making in planning, delegating, and providing care based on patient needs and organizational policies. Documents patient care and education thoroughly and promptly in the medical record. Engages in professional development to maintain clinical competency and understanding of current nursing standards and regulations. Participates in performance improvement initiatives, including data collection and process development, to enhance patient outcomes and care delivery. Critical Care RN: Administers medications and other treatments as prescribed, including intravenous medications and therapies. Manages complex medical equipment, including ventilators, monitoring devices, and other life-support systems. Performs procedures such as inserting central lines, managing tracheostomies, and providing advanced cardiac life support. Emergency Services RN: Rapid Assessment and Triage: Evaluate patients' conditions quickly to determine the severity of their injuries or illnesses and prioritize care accordingly. Conducts emergency procedures such as intubation, wound care, and suturing. Implements interventions to stabilize patients, including administering medications, starting IV lines, and providing respiratory support. OR Services RN: Provides comprehensive care to patients before, during, and after surgery, including assessments, planning, and evaluation of nursing care. Scrubs in for surgeries, assisting the surgical team with instruments and supplies, and ensuring a sterile environment. Monitors patient vital signs, administers medications, and observes for changes in patient condition. Cardiac Surgery RN: Continuously assesses patients' condition, including vital signs, hemodynamic parameters, and ECG readings. Administers medications and IV drips, adjusting dosages based on the patient's condition. Proficient in operating and maintaining advanced life support equipment like ventilators, intra-aortic balloon pumps, and ECMO. After cardiac surgeries, monitors patients' recovery, manage chest tubes, pacing wires, and wound care. Endoscopy RN: Assesses patient needs, reviews medical history, explains procedures, obtains consent, and prepares the patient for procedure. Monitors patient vitals, administers medications, and assists the physician during procedure. Provides post-procedure care, monitors recovery, and educates patients about aftercare instructions. Ensures the endoscopy room is properly prepared, instruments are sterilized, and equipment is functioning correctly. Obstetrics/Labor and Delivery/Post Partum/Nursery RN: Educates patients about pregnancy, provides prenatal screenings, and prepares patients for labor and delivery. Assesses and monitors the new mother's physical recovery, including vital signs, postpartum hemorrhage, and potential complications like postpartum depression. Assists with epidurals and other pain management techniques during labor. Administers pain medication, induces labor, and manages other medication needs during labor and delivery. Assists during labor and delivery, monitors fetal well-being, administers medications, and provides pain relief. Monitors mothers and newborns after delivery, assessing their well-being, and providing education on postpartum care and breastfeeding. Assesses and monitors newborn health, taking vital signs, performing routine assessments, and educating parents on newborn care. Assists with gynecological exams and procedures, and provides education on reproductive health, contraception, and prenatal care. Educates patients about family planning, fertility, pregnancy, childbirth, and postpartum care. Interprets fetal heart rate patterns and assesses fetal well-being using electronic fetal monitoring. Oncology RN: Administers chemotherapy, manages side effects, monitors vitals, and manages pain. Explains treatments, answers questions, and provides information on resources. Provides emotional and psychological support to patients and their families. Orthopedics RN: Provides specialized care for patients with musculoskeletal conditions, injuries, and diseases. Provides care for Orthopedic patients encompassing pre-operative and post-operative care. Conducts peripheral/vascular assessments. Treats patients with immobilization devices. Provides pain management. Provides patient education. PACU RN: Assesses the patient's level of consciousness and responsiveness as they wake up from anesthesia. Evaluates pain levels and administers pain medications as prescribed. Observes any side effects of anesthesia, such as nausea, vomiting, shivering, or muscle aches. Monitors for and respond to any post-operative complications. Administers medications, including pain relievers and other post-operative medications, as prescribed. Regulates intravenous (IV) fluids and monitor fluid balance. Checks and changes dressings on surgical wounds. Ensures a clear airway and provide oxygen support as needed. Educates patients and families about post-surgery care, potential complications, and discharge instructions. NICU RN: Continuously assesses and monitors vital signs (heart rate, respiratory rate, blood pressure, oxygen saturation) and other signs of distress. Administers prescribed medications, intravenous fluids, and other treatments, including respiratory support and oxygen therapy. Manages feeding needs, including tube, breast milk feeding support, and ensuring adequate nutrition. Provides basic care tasks like diaper changes, bathing, and positioning. Performs procedures like inserting IV lines, administering medications, and assisting with intubation or ventilation. Operates and adjusts specialized medical equipment used in the NICU. Telemetry RN: Using telemetry equipment to track heart rhythms (EKG), blood pressure, oxygen saturation, and other vital signs. Analyzes telemetry data to identify trends, abnormalities, and potential problems, and reports these findings to physicians. Provides direct patient care, including medication administration, wound care, and patient education, with a focus on cardiac health. Recognizes and responds to emergencies, such as cardiac arrest, and implements appropriate interventions. Dialysis RN: Sets up and operates dialysis machines, monitors patients before, during, and after treatment, and adjusts treatment parameters as needed. Takes vital signs, monitors signs of complications, and responds to changes in patient condition. Educates patients and families about kidney disease, dialysis procedures, and the importance of adhering to treatment plans, diet, and medication. Inspects and maintains dialysis machines and equipment. Cath Lab RN: Pre-Procedure: Reviews medical history, assesses patient's overall health, and prepares them for the procedure. Intravenous (IV) Line Initiation: Starts and maintains an IV line for medication administration. Administers medications as prescribed by the physician. Educates patients and families about the procedure and what to expect. Verifies that surgical consents have been signed. During the Procedure: Assists the Cardiologist during the catheterization process. Closely monitors the patient's vital signs, hemodynamic data, and sedation levels. Ensures proper functioning of equipment and supplies. Manages potential complications and responding to emergencies. Post-Procedure: Continues to monitor the patient's vital signs and overall condition after the procedure. Administers post-procedure medications as needed. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications 0-2 years of experience in a clinical nursing role or student clinical rotations in an acute care setting required Knowledge, Skills and Abilities Strong knowledge of the nursing process and clinical nursing practices. Ability to perform thorough patient assessments and communicate findings effectively. Proficient in administering medications and monitoring for side effects. Effective communication and interpersonal skills to collaborate with interdisciplinary teams. Strong organizational skills and attention to detail in documenting patient care. Knowledge of safety standards, infection control, and quality improvement initiatives. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required BCLS - Basic Life Support required ACLS - Advanced Cardiac Life Support preferred PALS - Pediatric Advanced Life Support preferred NRP - Neonatal Resuscitation preferred Refer to facility or unit-specific guidelines for additional requirements.

The Transfer Coordinator - RN is responsible for coordinating patient transfers and admissions into and out of CHS facilities. This role performs initial admission screening using approved clinical criteria, ensuring each transfer aligns with policy and clinical standards. The Transfer Coordinator works closely with the Bed/Capacity Coordinator, hospital departments, and external healthcare providers to facilitate efficient patient flow and address barriers to patient throughput. Essential Functions Coordinates all aspects of patient transfers, admissions, or consultations from referring facilities, ensuring appropriate level of care and transport. Conducts admission screening using approved criteria to verify appropriateness of care level and bed assignments. Collaborates with Bed/Capacity Coordinator to prioritize transfers, bed assignments, and ensure patient information accuracy. Acts as a liaison between physicians, healthcare providers, patients, and families to streamline the admission/transfer process. Maintains and updates the Electronic Health Record (EHR) with accurate patient transfer information and outcomes. Identifies barriers to patient throughput, tracks trends, and recommends actions to improve efficiency and patient flow. Complies with regulatory and CHS policy standards, including EMTALA and quality initiatives, while adapting processes to ensure compliance. Utilizes medical necessity criteria to evaluate admissions, ensuring bed types and patient statuses are appropriate. Builds and maintains collaborative relationships with hospital staff, nursing units, and external healthcare providers to support quality patient care. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications Associate Degree in Nursing required Bachelor's Degree in Nursing preferred 1-3 years of clinical nursing experience in an acute care setting required Prior experience in transfer coordination or patient flow in ED or Critical Care preferred Knowledge, Skills and Abilities Strong clinical assessment and decision-making skills for managing patient transfers. Knowledge of healthcare regulations, including EMTALA and medical necessity guidelines. Excellent communication skills and ability to work effectively with multidisciplinary teams. Strong organizational skills with the ability to prioritize multiple tasks in a dynamic environment. Proficient in using electronic health record systems and standard office software. Ability to provide superior customer service and facilitate positive patient experiences. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of Tennessee required

The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. This role logs and reviews denials for trend reporting, provides feedback to facilities, and communicates payer updates to relevant stakeholders. The Appeal Specialist II collaborates with internal teams to ensure timely and thorough appeal resolution and supports initiatives that improve denial prevention and recovery processes. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, and 401k. **Essential Functions** + Reviews and resolves pre-payment insurance denials in collaboration with follow-up teams. + Coordinates with Denial Coordinators, Facility Denial Liaisons, and Managed Care Coordinators to ensure payer accountability and identify education opportunities. + Provides feedback to facilities regarding denials resulting in retractions or reimbursement impacts. + Monitors payer billing and coding updates and communicates changes to SSC and ancillary departments. + Tracks and logs denials and appeal activity according to established documentation and reporting guidelines. + Prepares and distributes reports summarizing appeal trends, project updates, and payer response activity. + Recommends process improvements to enhance appeal efficiency and reduce recurring denials. + Maintains up-to-date knowledge of payer policies, billing and coding practices, and reimbursement regulations. + Utilizes practice management systems and maintains documentation of appeal activity in compliance with departmental standards. + Performs other duties as assigned. + Maintains regular and reliable attendance. + Complies with all policies and standards. + This is a fully remote position. **Qualifications** + H.S. Diploma or GED required + Bachelor's Degree in Nursing preferred + 2-4 years of experience in healthcare revenue cycle or business office required + 1-3 years of experience in healthcare insurance or medical billing preferred **Knowledge, Skills and Abilities** + Proficiency in word processing, spreadsheet, and database applications. + Working knowledge of billing, coding, and reimbursement principles. + Strong analytical, research, and problem-solving skills. + Ability to communicate effectively with payers, facility staff, and leadership. + Strong organizational and documentation skills with attention to detail. + Ability to work independently and manage multiple priorities in a fast-paced environment. + Understanding of insurance claims processing and denial management workflows. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. The Shared Services Center - Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we're not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. Equal Employment Opportunity This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.

Behavioral Health Registered Nurse Position Type: Full Time Days Benefits: Health Insurance (Medical, Dental, Vision) 401(k) with matching Student Loan Repayment: Up to $20,000 Educational Assistance Paid Time Off Competitive salary and comprehensive benefits package Job Summary The Registered Nurse (RN) provides patient-centered care through the nursing process of assessment, diagnosis, planning, implementation, and evaluation. This role is responsible for coordinating and delivering high-quality care based on established clinical protocols and physician/provider orders. The RN collaborates with physicians, nurses, and other healthcare professionals to ensure effective patient care and desired outcomes, while maintaining a supportive and compassionate environment for patients and their families. Essential Functions Coordinates and delivers high-quality, patient-centered care in accordance with organizational policies, protocols, and the nursing process. Conducts thorough patient assessments and documents findings accurately, reporting changes in condition to the appropriate care team members. Utilizes knowledge of human growth and development to provide age-appropriate care and education. Administers prescribed medications, monitors for side effects, and documents administration in accordance with standards of practice. Assists physicians during procedures within the scope of documented competency and skill level. Collaborates with the healthcare team to develop, implement, and evaluate individualized care plans based on patient assessments and needs. Responds to medical emergencies and participates in life-saving interventions, such as CPR and code team activities, as appropriate. Advocates for the rights and needs of patients, ensuring their voices are heard and respected in care planning and delivery. Provides patient and family education on medical conditions, treatment plans, and post-discharge care, ensuring understanding and adherence to instructions. Implements and adheres to infection control protocols to prevent the spread of healthcare-associated infections. Monitors and operates medical equipment (e.g., IV pumps, monitors, ventilators) as needed for patient care and safety. Promotes patient safety by adhering to National Patient Safety Goals and maintaining a clean, safe environment for patients and staff. Participates in audits, chart reviews, and compliance checks to ensure adherence to standards of practice and regulatory requirements. Demonstrates responsible decision-making in planning, delegating, and providing care based on patient needs and organizational policies. Documents patient care and education thoroughly and promptly in the medical record. Engages in professional development to maintain clinical competency and understanding of current nursing standards and regulations. Participates in performance improvement initiatives, including data collection and process development, to enhance patient outcomes and care delivery. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications 0-2 years of experience in a clinical nursing role or student clinical rotations in an acute care setting required Knowledge, Skills and Abilities Strong knowledge of the nursing process and clinical nursing practices. Ability to perform thorough patient assessments and communicate findings effectively. Proficient in administering medications and monitoring for side effects. Effective communication and interpersonal skills to collaborate with interdisciplinary teams. Strong organizational skills and attention to detail in documenting patient care. Knowledge of safety standards, infection control, and quality improvement initiatives. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required BCLS - Basic Life Support required ACLS - Advanced Cardiac Life Support preferred PALS - Pediatric Advanced Life Support preferred NRP - Neonatal Resuscitation preferred Refer to facility or unit-specific guidelines for additional requirements. INDBH