Utilization Review Nurse jobs at ICONMA

This is not a traditional RN role. This role is focused on training patients on how to use a medical device. Schedule: Flexible - you choose your weekly availability (0-5 trainings/week) ***MUST reside within 25 miles of hiring location Medford NY *** Schedule: Patient Trainers receive weekly assignment requests from the medical device company. They are allowed to accept or deny the request. Typically, they are allowed to take between 0-5 patients per week. This position allows for flexible scheduling. Example training session: 1 hour travel, 1 hour of training, 1 hour travel back, 30 minutes administrative time Assignments fluctuate- no guaranteed set number of assignments per week or per month. Assignments are auto assigned depending on trainer's roundtrip mileage on file Requested amount of assignments per week is not available, when trainer is Active, workload is expected to be completed. Pay Range: $35.00-$45.00 per hour. Patient Trainers are paid their hourly rate to travel to and from the patient's home. Additionally, they are paid the federal mileage reimbursement amount for travel. This job position does not offer any benefits. Job Description: A reputable medical device company is hiring a PRN Patient Trainers throughout the USA. Currently, one patient trainer is needed in each of the cities listed above. Patient Trainers go into patients' homes and train them on how to use INR (international normalized ratio, blood test) monitoring machines. Scheduling is very flexible and can be done anytime during the week. A typical training session takes about 1 hour. There is roughly 30 minutes of administrative paperwork to complete after each training session. The international normalized ratio (INR) blood test tells you how long it takes for your blood to clot. It is used to test clotting times in people taking warfarin (a medicine used to treat and prevent blood clots). Your doctor will use your INR result to work out what dose of warfarin you should take. RESPONSIBILITIES: The Trainer will: Remotely set up training appointment directly with the customer/caregiver Travel to the customers home setting within the general geographic location of the Trainer's home Provide personalized Face-2-Face training Explain reporting options and provide company resources Communicate and present themselves in a professional manner Accurately document and submit customer training records Maintain communications with the client by cell phone, email and internet access Work Environment: This is a remote position, requiring Patient Trainers to travel with their own reliable transportation. A typical travel radius is 50 miles from the listed work city. This varies depending on the location of patients. All supplies are provided to the trainer by the medical device company. The patient will have the INR machine and additional equipment already with them for the training. Masks are NOT required for this role but recommended. Preferred Qualifications: Home Health/In home care experience. Anticoagulation/ Cardiology experience. Medical Device training/ experience. If employed, has availability to train 0-5 customers per week in addition to primary employment (1 hour/ training). Availability to return phone calls, check systems and schedule trainings on a weekly basis. Requirements: Registered Nurse (RN) license. Pass a Background Check and Drug Test. Must be a resident of the hiring state or a neighboring state. Access to reliable transportation. COVID Vaccination or approved COVID Declination Form Techy Savvy Availability to train weekdays and weekends Must live within 15 miles of a hiring location (hiring locations listed above) If you have additional questions, please contact ****************************. HireGenics is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need reasonable accommodation to assist with your job search or application for employment, please contact us at ********************** or **************. status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics) does not discriminate against applicants based on citizenship. HireGenics does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b. The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws. #HGStaffing Benefits: 401(k) Work Location: In person

Full-Time | Monday-Friday | 8:00/8:30 AM - 5:00 PM Pay Range: $40-$50/hr (DOE) Travel Role - Must Have Reliable Transportation A leading ambulatory infusion organization is seeking an experienced Float Infusion Nurse (RN) to support multiple outpatient infusion centers across the St. Louis market. This is a full-time role offering autonomy, consistent weekday hours, and the opportunity for long-term or permanent placement. About the Role The Infusion RN will deliver outpatient infusion therapy to patients with chronic and complex conditions across several specialties, including neurology, rheumatology, gastroenterology, cardiology, and allergy/immunology. This role is ideal for nurses who thrive in a patient-centered, fast-paced infusion environment and enjoy working both independently and within small clinical teams. Key Responsibilities Prepare and administer IV and injectable medications in an outpatient setting. Access and manage central lines (PICC, port-a-cath). Provide patient and caregiver education regarding infusion therapies. Monitor patient response, safety, and treatment progression. Coordinate care with on-site teams, advanced practice providers, and ordering providers. Support daily center operations, including documentation, scheduling, and inventory. Float across multiple St. Louis locations as needed. Utilize WeInfuse EMR. Typical volume: 3-4 infusion chairs per site, 5-6 patients/day, small teams (1-2 RNs). Float Coverage Locations Flexibility available if one or two locations pose challenges. Richmond Heights, MO Ellisville, MO O'Fallon, MO Bridgeton, MO Required Qualifications Active, unencumbered Missouri RN license BSN required BLS (AHA) 2+ years of infusion, ICU, or ER experience (1 year infusion + 1 year other acute care considered) Valid driver's license and car insurance (for travel role) Strong IV therapy and vascular access skills Ability to work autonomously and communicate effectively Preferred Qualifications Ambulatory infusion experience CRNI, VA-BC, OCN certifications Home infusion or specialty infusion experience Soft Skills Strong customer service focus Reliable, punctual, and organized Adaptable to changing site needs Compassionate and patient-centered

The Medical Management Nurse is responsible for reviewing complex clinical cases that require advanced nursing judgment, critical thinking, and holistic assessment. This role evaluates whether requested services meet medical necessity criteria, collaborates with healthcare providers to clarify clinical information, and provides consultation on cases that require additional clinical insight. Key Responsibilities Review complex or challenging cases to determine medical necessity of requested services. Apply nursing judgment, clinical criteria, and holistic assessment to evaluate a member's overall clinical presentation. Communicate with healthcare providers to clarify the clinical picture and ensure appropriate care alignment. Serve as a consultation point for Medical Directors regarding unclear, atypical, or complex cases. Support clinicians by acting as a resource for clinical inquiries or escalations. Participate in special projects and contribute to the development and improvement of organizational policies and workflows. Analyze clinical information, interpret symptoms and documentation, and identify potential abnormalities or inconsistencies in care. Determine when services may not match diagnosis or expected level of care and recommend alternatives when appropriate. Collaborate with case management nurses on discharge planning, ensuring safe transitions with necessary equipment, education, and support. Provide nursing insight and guidance to providers and internal partners on select cases. Assist with orientation, training, and ongoing support for lower-level nursing staff. Participate in intradepartmental and cross-functional groups, initiatives, audits, and process-improvement efforts. Educate members about plan benefits and assist with case management tasks as needed. Contribute to quality audits and the development of corrective action plans. Qualifications ACMP experience preferred. Recent clinical experience in an acute care setting a plus. Associate's degree in Nursing (minimum). Minimum of 4 years of experience in care management or case management experience. Minimum of 2 years of clinical, utilization review, or managed care experience, or an equivalent combination of education and experience. Current, active, and unrestricted RN license in applicable state(s) or U.S. territory. Multi-state licensure required if providing services across multiple states. Must be in Tampa, Florida or the surrounding area.

Liberty Cares With Compassion At Liberty Healthcare and Rehabilitation Services, we promote a challenging, but rewarding opportunity in a caring environment. We are currently seeking an experienced: SUPPORT NURSE - LPN Job Description: Assist in assuring the best patient care possible by assisting nursing personnel (including charge nurse and Director of Nursing) on a specified unit during their assigned work hours. May be required to take call for staffing coverage. Assist in providing resident care, in accordance with the Nursing Practice Act, and under the supervision of a Registered Nurse. Delegates duties to non-licensed nursing personnel and monitoring performance under the supervision of a Registered Nurse and assists in preparation of a work schedule as needed. Assist in Quality Assurance data collection for analysis and corrective action implementation by the Quality Assurance Nurse. Assist with infection control for unit. Adheres to all regulations pertaining to cleanliness, infection control and Standard Precaution. Assist with records, orders, and assessment of new admissions to the unit. Assist with assuring the initial nursing assessment is completed. Completed assigned resident assessments as assigned by MDS Nurse or Director of Nursing. Attends Nurse Department meetings as scheduled. Assist with monitoring and measuring decubiti weekly and completing integument watch assessment forms accurately and works with other departments to implement needs for the unit and needs of patients on the unit. Reports any possible performance issues by employees within the facility to the RN for determination if disciplinary action is required. May be asked by the RN to send an employee home for the remainder of the shift if the RN determines that further investigation is needed. May document the performance concern on the appropriate form for review and use by the RN in the disciplinary process. Assist with lab request as ordered per facility policy using appropriate techniques. Responsible for reposting lab work as ordered on unit, reviewing results and notifying attending MD per established policies, protocols, and physician orders. Assist with emergencies arising while on duty. Performs CPR if needed. Assist with emergencies on other units if needed. Assist with notifying attending MD of any change or illness of patients in the unit. Notifies attending physician of emergencies and death of patients in the unit. Implement order of changes in orders as instructed or ordered by MD. Assist with other general duties which include rounds with doctors; checking MD orders, including update of orders; verification of completeness of nursing summaries timely and verification that all nursing records are complete and timely. May be asked to provide hall coverage as needed. Assist with coordinating the health care team including the rehab aides duties and assignments. Other duties as assigned by Director of Nursing in accordance to NC Board Of Nursing Practice Acts. Job Requirements: Must be a high school graduate Must be a Licensed Practical Nurse (LPN) graduated from an accredited School of Nursing, with a current, valid license as a Licensed Practical Nurse in North Carolina and submit proof of license renewal. Must provide quality-nursing care to patients, follow doctor's orders, and have a genuine interest in geriatric nursing. Must be CPR certified yearly and attend in-service training and other staff meetings as required. Must have ability to make decisions regarding nursing and unit problems realizing that errors and incompetence may have serious consequences for patients and/or staff. Must be able to work well under pressure, problem solve, and perform various jobs. Must read, know and follow personnel, department and facility policies and procedures and adhere to local, state and federal requirements. Must be able to maneuver medication carts, treatment carts and other nursing equipment. Visit ********************************* for more information. Background checks/drug-free workplace. EOE. PIdd72e8632bb3-37***********1

Lutheran Services Florida (LSF) envisions a world where children are safe, families are strong, and communities are vibrant. LSF is looking for a talented Program Nurse who wants to make an impact in the lives of others. The preferred ideal candidate will be bilingual and have experience with Microsoft! The schedule for this position is night shift, weekends, and on-call on a rotating basis (4 x 10 hours). Purpose and Impact: This position's primary role is to treat and care for the youth in this program as well as providing information about any treatment procedures or any aspect of their care. This individual works closely with the Nurse Practitioner, Medical Providers, Program Director, Assistant Program Director, and other related departments. Essential Functions: Manage and monitor the delivery of services to patients ensuring compliance in the performance of all aspects of youth care in accordance with Company policy and procedures, State and Federal guidelines. Prepare youth for examinations and record the medical intake, take vital signs, height and weight. Initiate routine lab tests after triage of a youth such as pregnancy tests. Assist the medical providers staff with examination procedures when is needed such as patient screening and triage. Administer medications under the providers' orders. Update youth charts in regards to allergies, medication use, and immunization history at each visit. Administer immunizations under standing orders from provider. Educate and counsel youth concerning their disease, treatment, and prevention of disease. Answer youth's questions after consultation with the provider or as per established procedures in that regard (to include but not limited to: health questions, medication refills, and lab results.) Continually assess for areas of improvement and develop plans and evaluation criteria for such. Oversee and direct all youth care staff to ensure adequate monitoring. Ensure delivery of safe and efficient quality care. Assist in health education classes when necessary. Obtain, compile, and maintain medical files on each intake. Ensure proper daily documentation and maintain hard copy of required documents and medical record. Schedule and comply with required medical appointments and timelines. Respond and comply to individual emergency medical needs immediately. Maintain and review for accurate and complete list of medical supplies, prescribed medications, and over-the-counter medication. Order medical supplies, and medication when necessary. Collect, maintain, and submit weekly, monthly, quarterly, and annual reports and audits to the supervisors. Facilitate and conduct self-administration of medication and side effects training to employees as required. Provide a fail-safe plan with medication count, label accuracy, and self-administration of medication, including over-the-counter drugs. Schedule and provide transportation when is needed to clients on medical appointments with assistance from other staff when necessary. Submit, review and follow up all the Significant Incidents Report regarding Medical Issues. Participate in Quality Improvement as required. Other Functions: Able to react to change productively and handle other essential tasks as assigned. Develop and maintain effective communication and working relationships with staff, co-workers, physicians, and youth. Develop and expand medical, specialty and dental services with local providers. Maintain Health Information Privacy HIPAA. The ability to maintain control and work under pressure to meet deadlines. Physical Requirements: Bending, stooping, and lifting a minimum of 15-25 lbs. required to complete daily tasks. Must have the ability to remain in standing position for extended periods of the workday. Education: Register Nurse degree from an accredited college or university in Nurse or Health Sciences, RN License according to State requirements. Must have graduated from an approved RN nursing program approved by the National Council of State Boards of Nursing (NCSBN) Must have passed the appropriate NCLEX-RN Exam Experience: Minimum 1 years of full-time direct service delivery experience Must possess medical assessment and treatment skills with diverse populations of children/adolescents. One (2-3) year of full-time experience in a hospital, clinic, medical record department or physician's office. One (2-3) year experience in file maintenance working with troubled adolescents or youth services; may include part-time, volunteer or internship experience. Why work for LSF? LSF offers 60 programs across the state of Florida serving a wide range of populations in need. Mission Driven staff members become part of the LSF community while transforming the lives of those in need. Our staff additionally find growth opportunities as they explore areas of interest within the organization. Amazing benefits package including : Medical, Dental and Vision Telehealth (24/7 online access to Doctors) Employee Assistance Program (EAP) Employer paid life insurance (1X salary) 13 paid holidays + 1 floating holiday Generous PTO policy (starting at 16 working days a year) Note: Head Start employees paid time off and holiday schedule may differ 403(b) Retirement plan with 3% discretionary employer match OR 3% student loan repayment reimbursement Tuition reimbursement LSF is proud to be an equal opportunity employer. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Discharge planning. Educate providers on utilization and medical management. Provide clinical knowledge. Perform onsite review of emergent/urgent and continued stay requests Qualifications 2+ years of clinical nursing experience in an acute care. Current state's RN license. Additional Information All your information will be kept confidential according to EEO guidelines.

Discharge planning. Educate providers on utilization and medical management. Provide clinical knowledge. Perform onsite review of emergent/urgent and continued stay requests Qualifications 2+ years of clinical nursing experience in an acute care. Current state's RN license. Additional Information All your information will be kept confidential according to EEO guidelines.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Schedule: Monday through Friday, 9:30 AM - 6:00 PM CST or PST (Local Time) A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Nurse Reviewer I is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensure proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * A current unrestricted RN license in applicable state(s) required. Preferred Experience, Skills, and Capabilities: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12 to $ 54.41. Locations: California; Illinois; Nevada In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Must be located in the state of California Schedule: 9:30am-6:00pm PST, ability to work weekends if necessary. New Grads are encouraged to apply! The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * Knowledge in Microsoft office. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $31.54/hr - $56.77/hr Locations: California In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Schedule: Monday through Friday: 11:30 AM - 8:00 PM, CST or PST (local time). Alternating weekends: 8:00am - 12:00pm, CST/PST (local time) and some holidays included. A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Appeals Nurse Reviewer I is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. How you will make an impact: * Validating appeal requests. * Manage Appeal requests that come via email, fax, mailed in letters, or live live. * Opening and closing appeal requests following established appeal processes to maintain quality, turnaround time, and compliance requirements. * Outreach to providers with appeal process instructions. * Clinical review for the RBM and Surgical solution on a client specific basis. * Notifying providers and/or members of appeal decisions. * Maintain personal log all appeal requests assigned to ensure completion, as needed. * Other duties as assigned. Minimum Requirements: * Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * A current unrestricted RN license in applicable state(s) required. Preferred Experience, Skills, and Capabilities: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $34.69 to $54.41. Locations: California, Illinois. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description: We are seeking a UR RN to work full time, M-F 8-5pm. This is a direct placement opportunity. Job purpose: RN is responsible to provide Utilization Review and approval during the admission process and to provide clinical information as required to Insurance Companies at admission and during stay. This position will work closely with Revenue Cycle staff and Discharge Planning to assist in the review and acceptance into the sub-acute rehab program. RN will coordinate the Quality Improvement monthly meetings and subsequent reports. RN will also coordinate the Risk Management process. Qualifications Qualifications Registered Nurse with current NYS License Preferred experience with QI/Risk Management/Utilization Review/Infection Control BSN Preferred Familiar with agency support availability PRI certification or within six months of employment Position Urgency: Quick Start Shifts: Working Mon-Fri, 8a-5p. No wends, no call Additional Information Regards, Riya Khem Life Science Recruiter Integrated Resources, Inc. IT Life Sciences Allied Healthcare CRO (Direct) 732-844-8721 | (W) 732-549-2030 x 311 | (F) 732-549-5549 “INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description: We are seeking a UR RN to work full time, M-F 8-5pm. This is a direct placement opportunity. Job purpose: RN is responsible to provide Utilization Review and approval during the admission process and to provide clinical information as required to Insurance Companies at admission and during stay. This position will work closely with Revenue Cycle staff and Discharge Planning to assist in the review and acceptance into the sub-acute rehab program. RN will coordinate the Quality Improvement monthly meetings and subsequent reports. RN will also coordinate the Risk Management process. Qualifications Qualifications Registered Nurse with current NYS License Preferred experience with QI/Risk Management/Utilization Review/Infection Control BSN Preferred Familiar with agency support availability PRI certification or within six months of employment Position Urgency: Quick Start Shifts: Working Mon-Fri, 8a-5p. No wends, no call Additional Information Regards, Riya Khem Life Science Recruiter Integrated Resources, Inc. IT Life Sciences Allied Healthcare CRO (Direct) 732-844-8721 | (W) 732-549-2030 x 311 | (F) 732-549-5549 “INC 5 0 0 0 's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions. Your Knowledge and Experience Bachelors of Science in Nursing or advanced degree preferred. Requires a current California RN License Requires at least 5 years of prior relevant experience Requires strong communication and computer navigation skills Desires strong teamwork and collaboration skills Requires independent motivation and strong work ethic Requires strong critical thinking skills Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEP Conducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliance Ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity and determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost-appropriate DC planning Prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination and communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirements Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate Refer to Case Management when there are acute inpatient needs affecting discharge Attend staff meetings, clinical rounds and weekly huddles Maintain quality and productivity metrics for all casework Buddy or support new employees Maintaining HIPAA compliant workspace for telework environment

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Schedule: Monday through Friday: 11:30 AM - 8:00 PM, CST or PST (local time). Alternating weekends: 8:00am - 12:00pm, CST/PST (local time) and some holidays included. A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Appeals Nurse Reviewer I is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. How you will make an impact: * Validating appeal requests. * Manage Appeal requests that come via email, fax, mailed in letters, or live live. * Opening and closing appeal requests following established appeal processes to maintain quality, turnaround time, and compliance requirements. * Outreach to providers with appeal process instructions. * Clinical review for the RBM and Surgical solution on a client specific basis. * Notifying providers and/or members of appeal decisions. * Maintain personal log all appeal requests assigned to ensure completion, as needed. * Other duties as assigned. Minimum Requirements: * Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * A current unrestricted RN license in applicable state(s) required. Preferred Experience, Skills, and Capabilities: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $34.69 to $54.41. Locations: California, Illinois. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description Job Title: Utilization Management Nurse Consultant Duration: 6 months (Possible ext) Location: Downers Grove, IL Responsibilities: · Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. · Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. · Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. · Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN (consideration for LCSW) with unrestricted active license. · Fundamental Components & Physical Requirements include but are not limited to · (* denotes essential functions) · Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members · Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care · Communicates with providers and other parties to facilitate care/treatment · Identifies members for referral opportunities to integrate with other products, services and/or programs · Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization · Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function · Background/Experience Desired · Managed Care experience preferred · 3-5 years of clinical experience required · Education and Certification Requirements · RN consideration for LCSW) with current unrestricted state license required. · Additional Information (situational competencies, skills, work location requirements, etc.) · Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding · Effective communication skills, both verbal and written. · Ability to multitask, prioritize and effectively adapt to a fast paced changing environment · Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. · Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. · Typical office working environment with productivity and quality expectations · Additional for Behavioral Health: · Experience in Behavioral Health required · Managed Care experience preferred. · Onsite location will be Downers Grove. · Work hours from 8:00 am until 5:00 pm with weekend rotation among the team of clinicians (approximated to rotate once every 1 & ½ to 2 months). · The ability to create and process clinical for Behavioral Health cases on a live phone queue, create and process clinical to of a determination to the provider. Additional Job Details: · Required to have computer skills. · Work with-toggle between up to 5-6 applications/systems at a time. · Travel Required: No Qualifications n/a Additional Information Kind Regards Sumit Agarwal 732-902-2125

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Schedule: Monday through Friday, 9:30 AM - 6:00 PM CST or PST (Local Time) A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Nurse Reviewer I is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensure proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * A current unrestricted RN license in applicable state(s) required. Preferred Experience, Skills, and Capabilities: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12 to $ 54.41. Locations: California; Illinois; Nevada In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description · The incumbent must possess medical management/clinical decision-making skills and sound skills in assessing, planning and managing member care. · Advanced assessment and teaching skills. · Problem solving skills. · Familiarity with legal terminology and liability issues and ability to handle ethical or risk management issues. · Utilization and Quality Management/Outcomes experience preferred. · Previous work experience with a managed care organization or provider is also preferred. · Prior experience in case management, home health, discharge planning, or Concurrent review. Qualifications · RN Diploma, RN Associate's degree or Bachelors of Science in Nursing (BSN) degree. · Minimum of 3 years clinical experience in an acute medical or acute surgical setting. · Proficiency with a Microsoft Windows operating system. · Must have valid license to practice nursing within the US and have started application for NC nursing license. Additional Information With Regards, Kavita Kumari Allied Healthcare Recruiter Integrated Resources, Inc IT REHAB CLINICAL NURSING Inc. 5000 - 2007-2014 (8th Year) Certified MBE I GSA - Schedule 66 I GSA - Schedule 621I I GSA - Schedule 70 Tel: 732-549-2030 x208 Fax: 732-549-5549 Direct: 732-549-5302

A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description · The incumbent must possess medical management/clinical decision-making skills and sound skills in assessing, planning and managing member care. · Advanced assessment and teaching skills. · Problem solving skills. · Familiarity with legal terminology and liability issues and ability to handle ethical or risk management issues. · Utilization and Quality Management/Outcomes experience preferred. · Previous work experience with a managed care organization or provider is also preferred. · Prior experience in case management, home health, discharge planning, or Concurrent review. Qualifications · RN Diploma, RN Associate's degree or Bachelors of Science in Nursing (BSN) degree. · Minimum of 3 years clinical experience in an acute medical or acute surgical setting. · Proficiency with a Microsoft Windows operating system. · Must have valid license to practice nursing within the US and have started application for NC nursing license. Additional Information With Regards, Kavita Kumari Allied Healthcare Recruiter Integrated Resources, Inc IT REHAB CLINICAL NURSING Inc. 5000 - 2007-2014 (8th Year) Certified MBE I GSA - Schedule 66 I GSA - Schedule 621I I GSA - Schedule 70 Tel: 732-549-2030 x208 Fax: 732-549-5549 Direct: 732-549-5302

+ Participates in the development and ongoing implementation of QM Work Plan activities. + Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives **Responsibilities:** + Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. + Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. + Data gathering requires navigation through multiple system applications. + Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information. + Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. + Works Potential Quality of Care cases across all lines of business (Commercial and Medicare). + Independently coordinates the clinical resolution with internal/external clinician support as required. + Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data + Prepares and completes QM documents based on interpretation and application of business requirements + Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements + Assists in the development and implementation of QM projects and activities + Accountable for completing and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE MEDCOMPASS or ASSURECARE exp. + MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization. **Education:** + Active and unrestricted RN licensure in state of residence **Questionnaire:** + Do you have experience with Medcompass? + Do you have experience with Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.