Nurse case manager jobs near me - 600 jobs

Explore opportunities with VNA of Maryland, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Transitional Case Manager (TCM), you will be facilitating seamless transitions for patients from facility settings to post-acute care. You will verify home health orders, assess care requirements, and ensure continuity of care. Your role includes assessing patients' health literacy, involving patients and families in care planning, and providing education to improve outcomes and promote self-management. You will implement rehospitalization reduction initiatives for patients at risk and communicate with healthcare providers throughout the transition. You'll enjoy the flexibility to work remotely as you take on some tough challenges. Primary Responsibilities: Educate patients on post-discharge follow-up, homebound criteria, and obtaining prescriptions Assess readmission risk using the LACE tool Ensure patients and families have agency contact information Coordinate ancillary services (DME, Infusion) as needed Assist in preparing for patient care post-discharge Liaise between the agency and healthcare providers Communicate patient transfers and coordinate resumption of care Provide feedback on readmissions and non-admit decisions Perform other duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN, LPN, or SW licensure in state of practice Current CPR certification 1+ years home health experience or 1+ years of hospital case management experience Current driver's license, vehicle insurance, access to a dependable vehicle or public transportation *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $48,700 to $87,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. #LHCJobs At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Duration: 03 Months Job Overview - Case Manager We are seeking a self-motivated, detail-oriented, and highly organized Case Management Coordinator to support Medicaid Long Term Care/Comprehensive Program members in Miami-Dade County, FL. This role is primarily field-based, requiring approximately 75% travel within the assigned region, with 25% work-from-home responsibilities. The coordinator will assess, plan, implement, and coordinate case management services to support members' medical, social, and wellness needs across home, assisted living, and nursing facility settings. Key Job Duties Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program enrollees Conduct telephonic and face-to-face assessments of members in homes, assisted living facilities, and nursing homes Perform comprehensive member evaluations using care management tools and data review Provide coaching, education, and support to empower members to make informed healthcare decisions Monitor, evaluate, and document care activities in compliance with regulatory and accreditation guidelines and internal policies Utilize case management and quality management processes consistently and accurately Experience & Qualifications Required Bachelor's Degree required, preferably in Social Work or a related field Case management experience required Long-term care experience preferred Bilingual Spanish/English strongly Schedule Monday-Friday, 8:00 AM - 5:00 PM (EST) 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, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Recruter Details: Name: Umar Farooq Email: ********************************** Internal Id #25-55185

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

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

This position provides medical case management referral services, crisis intervention and eligibility determination services to adults with HIV infection receiving medical services in the outpatient Infectious Diseases Clinic. A very small percentage of time may include services to patients with other infectious diseases. The employee will complete assessments and identify service needs, facilitate linkage to services and coordinate with community agencies. They may assist with transportation and housing needs. Responsibilities may include assisting clients in accessing financial benefit programs. The employee will work closely with the existing licensed social work team, medical providers, nursing staff, and benefits coordinators as part of an interdisciplinary team. Requires timely data entry and data management in an electronic medical record ( EPIC ), electronic databases and tracking systems. Successful employees possess a strong ability to multi-task in a fast-paced environment. Employees are required to attend meetings as directed. Required Qualifications, Competencies, And Experience Bachelor's degree in a Human Service field with clinical experience. Preferred Qualifications, Competencies, And Experience Experience with clinic population, electronic medical records, and data management preferred. Course work in Social Work. Work Schedule Monday - Friday, 8:00 AM - 5:00 PM; fully remote position

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

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

TITLE: Director Case Management / Utilization Management / CDI Now is your chance to join a Forbes magazine top 100 hospital where career growth and opportunity await you. They are committed to building healthcare teams whose care exceeds the expectations of their patients and community and are looking for quality talent who share the same values. They're nestled in a beautiful rural setting but close enough to the big city to enjoy that too! If that sounds like the change you are looking for, please read on… What you'll be doing: •Responsible for developing, planning, evaluating, and coordinating comprehensive patient care across the continuum, to enhance quality patient care while simultaneously promoting cost-effective resource utilization. Provides director-level oversight of Inpatient and ED Case Management, Utilization Management and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements. Monitors patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, and ensures that these functions are integrated into overall hospital operations. Coordinate and monitors activities with appropriate members of the health care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care, and reduce risk and liability. Collaborates closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives. •Responsible for identifying tracking mechanisms in order to evaluate and achieve optimal financial outcomes, to enhance quality patient care, and promote cost-effective resource utilization. •Uses data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity •Coordinates daily activities of the Case Management, UM, and CDI Department in order to promote quality patient care, efficient use of hospital resources, facilitate timely and adequate discharges, and reduce risk and liability. •Investigates and initiates follow-up on utilization denials, contract negotiations, and external regulatory agencies' requirements. •Directs operations of our Physician Advisor Program, including analysis of performance through reporting and committee involvement and oversight. •Actively serves on hospital committees and teams and facilitates opportunities for employees to do the same. •Develops, performs, and improves personal and departmental knowledge of computer software and reporting functions. •Organizes and oversees the maintenance of denial and appeal activity. Follows up with physicians and others when indicated. •Prepares or coordinates the preparation of periodic and special reports required by various agencies, insurance contracts, and for hospital committees. •Analyzes and trends data results in order to incorporate efforts and information results with existing systems to optimize the efficiency of operational systems through strategic quality leadership. •Facilitates growth and development of the case management program, utilization management ( including physician advisor program and clinical documentation integrity (CDI), in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities, as needed. •Develop new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and/or basic human needs for the community. •Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials, and physician reports cards, and collaboratively initiate improvements related to these areas. •Maintains hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines. •Maintains professional knowledge by participating in educational seminars and opportunities. •Participates in Population Health work at an organizational level, including active involvement with the System-Wide Care Management Team and Value-Based Care Delivery. Additional info: •Position will report to a Manager that is well respected in the organization. Position is open as the person is retiring. They use EPIC(EMR) and the facility has a lot of technology. Person would be over about 50-60 people between CM/UM/CDI. Great team to work with. •If you're a passionate Pharmacist and seeking a rewarding career in a collaborative healthcare setting, this is the opportunity you've been waiting for. Join us in east central Ohio, and become part of our exceptional team dedicated to delivering high-quality care to our community. Apply now and embark on a fulfilling career journey with us. Requirements What they're looking for: •Master's degree in nursing, Healthcare Administration, or Business Administration required. •Current Ohio RN licensure (or active multi-state licensure). •Certified Case Manager(CSM). •At least three (3) years of management or demonstrated leadership experience required. •Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning, and continuum of services offered within Genesis and externally. Knowledge of coding, mid-revenue cycle, CDI, physician advisor and payor relations. •Ability to perform data analysis and to utilize computer systems to record and communicate information to other services. •The ability to lead collaboration with other leaders in the organization, especially about the delivery of high-quality, timely, and right site of care. •Excellent leadership, verbal and organizational skills to order to steer the case management process. Benefits Hours and compensation potential: •The position is full time. •The range starts at $62.50hr($130K)-$75hr($156K) depends on years of experience. •Full benefits package being offered.

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

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

Gateway Rehab Center (GRC) has an outstanding opportunity for a Nurse Liaison Gateway Rehab who will be responsible for the pre-admission case management, ASAM level of care assessment, and coordination of admission to care for substance use disordered patients referred from a hospital setting. To be considered for the position, you must live within the Pittsburgh, PA area or surrounding counties. Responsibilities Assesses admission candidates' medical and psychiatric appropriateness for treatment. Determines level of care placement based on ASAM criteria. Pre-certifies admissions as required. Discusses treatment options with referral sources. Acts as liaison between Gateway and outside referral sources. Coordinates patient transfers from other facilities to Gateway Aliquippa/Westmoreland. Responds to needs of referral sources and managed care representatives. Interacts with the physician through coordination of patient assessments. Attends GRC mandatory training and in-services. Other duties as required. Knowledge, Skills, and Abilities Strong communication skills required. Able to work independently with minimal oversight. Knowledge of skilled nursing Requirements Pennsylvania RN or LPN licensure 3+ years nursing experience preferred. Experience identifying/treating drug and alcohol addictions. Experience in conducting assessments and evaluations. Additional Requirements Pass PA Criminal Background Check Obtain PA Child Abuse and FBI Fingerprinting Clearances. Pass Drug Screen TB Test Access to reliable and dependable internet connection. Work Conditions Favorable working conditions. Minimal physical demands Significant mental demands include those associated with working with patients with addictive disorders and managing multiple tasks. GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.

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

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

HEDIS work typically includes requesting records, abstracting/overreading medical records, performing claims research, preparing medical records for the NCQA HEDIS Auditor, etc. Abstracts medical record data from practitioner's files to support annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting for company's accredited products Conducts medical record reviews to support the annual reporting and responds to inquiries from provider, and their office staff, regarding the HEDIS initiative Review and abstract 40-50 medical records per day, based on NCQA and HEDIS technical specifications Document information clearly and concisely from patient record to paper document abstraction tool, or into company's electronic HEDIS application Ensure Health & Care Management are in compliance with HEDIS audit and technical specification standards Participate in the training of NCQA (national committee quality assurance) requirements with completion of Inter-Rater Reliability compliance Communicate with internal and external stakeholders by making appropriate follow-up phone calls for additional medical information to complete reviews Comply with regulatory standards, accreditation standards and internal guidelines Remain current and consistent with the standards pertinent to the Quality Management team Qualifications * Active and Unrestricted RN License with 4+ years of experience. (Need to have the license in the state in which they live but does not need to be compact since they are not working directly with members in Iowa.) * Strong clinical background and understanding of medical terminology, healthcare practices and electronic medical record systems. Ability to review medical records and technical specifications and draw defensible conclusions from available information. * Experience In health insurance, health care, managed care, or a related setting. A strong clinical background could also be considered - e.g., hospital medical records or research. * Excellent attention to detail and ability to analyze complex medical records, identify relevant data and abstract HEDIS measures accurately. * Strong written and verbal communication skills with ability to communicate and/or present complex information to team members and stakeholders. * Demonstrated success in roles that require strong time management and work-flow management skills. Ability to prioritize work independently, manage multiple assignments simultaneously, and meet deadlines. * Flexibility to adapt to changing requirements, regulations, and technology platforms related to HEDIS reporting. * Proficiency with Microsoft Office and Microsoft Teams. Technical aptitude to learn new systems quickly. Preferred Qualifications: * 2 years of experience in HEDIS abstraction and familiarity with HEDIS measure specifications. * Prior work in utilization management, quality management/review, accreditation, outpatient clinic setting or related area. Job Type & Location This is a Contract position based out of Des Moines, IA. Pay and Benefits The pay range for this position is $40.00 - $41.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 7, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Columbus Oncology is looking for a full-time Triage Nurse to join our team! Why work for us? Our culture is unique. We work every day to promote a culture that is positive, supportive and patient-centered. We offer our employees a competitive benefits package that includes Medical, Dental, Vision, Life Insurance, Short-term and Long-term disability coverage, a generous PTO program, a 401k profit-sharing plan. You get to be part of an organization that helps improve the lives of those facing cancer by providing access to the best community-based cancer care. What will you do? Work four days; usually until 5PM; no nights, no weekends Serve as a primary liaison across all disciplines to ensure comprehensive patient care Multi-task between patient calls, provider messages, and other related duties Acknowledge and perform provider orders in alignment with clinical standards Implement and manage individualized care plans; assess, document, and report patient conditions in accordance with established protocols. What will you need to be successful? BLS Provider credentialed from the American Heart Association (AHA) Registered Nurse credentialed from the Ohio Board of Nursing in good standing Diploma from an accredited school/college of nursing 5+ years of relevant experience (oncology or acute care preferred) Columbus Oncology Associates is an Equal Opportunity Employer and proudly a Drug-Free Workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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

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

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

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