Nurse Case Manager remote jobs

The Case Manager III (CM III), a key member of the primary care interdisciplinary team, provides services for patients with complex care needs. This position conducts patient outreach, engagement and psychosocial service assessment, assists in developing a patient-centered care plan, is the lead implementer of Enhanced Case Management (ECM) and coordinates service referrals and delivery. The case manager meets clients in home, clinic, or community as appropriate or required by the specific program/site. The CM III provides services to specific populations that have multiple complex health and social services needs and often provides care outside of a traditional health center setting, such as home visits, hospitals, supportive housing sites, encampments and shelters. In addition they provide comprehensive housing navigation support to clients. This is a grant funded, full time, benefit eligible opportunity, at our Oakland locationS (Medical Respite & Street Medicine) This position is represented by SEIU-UHW. Salaries and benefits are set by a collective bargaining agreement (CBA), and an employee in this position must remain a member in good standing of SEIU-UHW, as defined in the CBA. LifeLong Medical Care is a large, multi-site, Federally Qualified Health Center (FQHC) with a rich history of providing innovative healthcare and social services to a wonderfully diverse patient community. Our patient-centered health home is a dynamic place to work, practice, and grow. We have over 15 primary care health centers and deliver integrated services including psychosocial, referrals, chronic disease management, dental, health education, home visits, and much, much more. Benefits Compensation: $29.20 - $33.85/hour. We offer excellent benefits including: medical, dental, vision (including dependent and domestic partner coverage), generous leave benefits including ten paid holidays, Flexible Spending Accounts, 403(b) retirement savings plan. Responsibilities Outreach, via telephone and in person at LifeLong, community and residential sites, to patients who meet case management program eligibility criteria or are prioritized by LifeLong for this service Proactively meet and engage with patients to build effective relationships and assess strengths and needs through use of standard intake, screening tools, and health, and social services records review Actively involve patients and caregivers, as appropriate, in designing and delivering services, including development of care plans, assuring alignment with patients' values and expressed goals of care Provide and facilitate referrals for internal and external resources, and collaborate with the patient to complete required applications, forms, or releases of information Maintain a patient caseload in accordance with LifeLong standards for the specific population served or site requirements Utilize data registries and reports to manage caseload, meet program requirements, maintain grant deliverables, and promote high quality care Provide health education and training to patients, including but not limited to, harm reduction and disease risk-mitigation strategies that empower patients to manage their own health and wellness (e.g. overdose prevention, mitigating spread of communicable diseases) Assist patients with accessing and retaining public benefits and insurance (e.g. MediCal, SSI/SSDI, CalFresh, General Assistance), and affordable/subsidized housing Respectfully and routinely communicate with patients, their care team members, external partners, and identified social supports Maintain knowledge of patients' medical/behavioral health treatment plans and facilitate utilization of services by providing resources such as accompaniment, transportation, in-home care, reminder calls etc. Participate in team meetings to coordinate care, support patient goals, and reducing barriers to accessing services Provide case management services to patients with multiple complex acute or chronic medical or behavioral health conditions (e.g. HIV/AIDS, Hep C, congestive heart failure, severe diabetes, severe hypertension, psychosis, pregnancy, and homelessness) Provide general housing case management services that includes document readiness, housing problem solving, and assessments for Coordinated Entry System Assess patients to identify cognitive and/or behavioral health needs and provide brief interventions and short-term support using standardized tools and effective approaches for patient care Co-facilitate patient groups Provide intensive case management to a caseload size in accordance with site or program standards focusing on a subset of the highest acuity patients Provide specialized housing navigation services to patients who are matched to a housing resource through Coordinated Entry System Lead crisis intervention response, de-escalation procedures, notification of the local mental health department and/or crisis response team, and follow-up care Provide and document billable services to eligible populations that result in revenue generation for LifeLong Advocate on behalf of patients to get their needs met and/or support patients to learn advocacy strategies for themselves. Keep current on community resources and social service supports to effectively serve the target population Document patient contacts/services in required data systems (EHR, HMIS etc.) according to LifeLong policy Specific activities may vary depending on the requirements of the program and funder. Promote diversity, equity, inclusion, and belonging in support of patients and staff Represent LifeLong positively in the community and advocate on behalf of underserved populations Qualifications Commitment to working directly with low-income persons from diverse backgrounds in a culturally responsive manner Commitment to harm reduction, recovery, housing first, age-friendly and patient centered care Strong organizational, administrative and problem-solving skills, and ability to be flexible and adaptive to change while maintaining a positive attitude Excellent interpersonal, verbal, and written skills Ability to prioritize tasks, work under pressure, and complete assignments in a timely manner Ability to seek direction/approval on essential matters, yet work independently, using professional judgment and diplomacy Works well in a team-oriented environment Conducts oneself in external settings in a way that reflects positively on your employer Ability to be creative, mature, proactive, and committed to continual learning and improvement in professional settings Job Requirements High School diploma or GED At least three (3) years of progressively responsible work or volunteer experience in a community-based health care or social work setting or at least one (1) year of experience as a Case Manager II or equivalent position or registration or certification as a Certified Alcohol and Drug Counselor by one of the two certifying bodies in California Proficient skills using Microsoft Office applications like Word, Excel, and Outlook, as well as the ability to work in and/or manage databases Access to reliable transportation with current license and insurance Bilingual English/Spanish Job Preferences Bachelor's Degree in Social Work, Health or Human Services field Lived experience of homelessness, incarceration, foster care, mental health services, substance use services or addiction, or as a close family member of someone who has this experience

OverviewAt Advocate, our mission is to empower Americans to obtain the government support they've earned. Advocate aims to reduce long wait times and bureaucratic obstacles of the current government benefits application process by developing a unified intake system for the Social Security Administration, utilizing cutting-edge technologies such as artificial intelligence and machine learning, crossed with the knowledge and experience of our small team of EDPNA's and case managers. We are seeking a highly organized and dedicated Case Manager to join Advocate and oversee the progress of disability cases at the Initial Application (IA) and Reconsideration (Recon) levels. You will manage a large caseload and work directly with claimants, ensuring they receive regular updates and assistance throughout the process. Your role will include analyzing medical records, filing recon appeals, and collaborating with SSA/DDS to resolve case-related issues. If you have strong time-management skills and thrive in a fast-paced, client-focused environment, this position will allow you to make a meaningful impact on the lives of claimants.Job Responsibilities Conduct Welcome Calls, file appeals, take action on claims needing attention, respond to Claimant calls, SMS, and emails, and other claim management work streams Offer an empathetic, best-in-class experience for our claimants Proactively communicate with claimants, ensuring they are informed of the progress of their cases. Collaborate with SSA/DDS to resolve case-related issues and keep the case on track. Use our technology to support claimants through the application and adjudication process Help improve our technology and operations, providing feedback to strengthen our ability to help claimants Proactively identify challenges and offer solutions. Qualifications Minimum of one year of SSDI/SSI case management experience is required. Strong organizational and time-management skills to handle a large caseload. Thorough knowledge of Social Security's disability process and familiarity with DDS/SSA forms. Ability to work in a fast-paced environment while maintaining attention to detail and task completion. Preference for a small start-up environment with high ownership and high responsibility. Desire to transform the disability application and adjudication process. Ability to quickly pivot, change process, and adopt new ways of doing things. Familiarity with Salesforce or a similar CRM This is a remote position and Advocate is currently a fully remote team. Advocate is an equal opportunity employer and values diversity in the workplace. We are assembling a well-rounded team of people passionate about helping others and building a great company for the long term.

Job Details Austin, TX - Austin, TX Hybrid Part-Time High School Diploma/GED Up to 50% RotatingDescription JOB PURPOSE: The Department of State's Reception and Placement program provides assistance for refugees to settle in the United States. It supplies resettlement agencies a one-time sum per refugee to assist with meeting expenses during a refugee's first three months in the United States. The Reception and Placement Case Manager is responsible for orchestrating and managing essential services for refugees newly arrived in the Austin, TX area. This includes managing logistics prior to their arrival, executing resettlement services as mandated by the Cooperative Agreement, and ensuring meticulous record-keeping in client case files and logs. The role also involves substantial external communication, requiring the associate to liaise effectively with clients, volunteers, other social service agencies, and the community at large. Qualifications ESSENTIAL JOB RESPONSIBILITIES: Coordinate housing, arrange airport pickup, and offer comprehensive case management services to include home visits, individualized service plans, interpretation services, arranging and providing transportation to essential appointments such as medical check-ups and language classes, and other services that contributes to clients' successful long-term integration in the community. Assist clients in accessing a variety of social services, such as public benefits, schooling, and employment services, for which they are eligible. Make referrals to community service providers for additional support in areas such as counseling, immigration legal services, and other needs refugees may have. Communicate externally with clients, volunteers, U.S. ties, and social service agency representatives. Actively represents and supports clients' interests within the broader community. Provide cultural orientation and assistance in navigating the local community, including understanding cultural norms, laws, and systems. Maintain accurate records of client interactions, services provided, and outcomes achieved. Prepare monthly and quarterly reports as needed. Other duties as assigned. Demonstrate Exceptional customer service, in Everything you do, by placing the child, family, Veteran or client first to support our mission to "Empower people to build better lives for themselves, their families, and their communities." ESSENTIAL QUALIFICATIONS: EDUCATION: High School Diploma or GED required. Bachelor's degree in behavioral sciences, human services, or social service fields preferred. EXPERIENCE: Must have at least 1-2 years of experience working with refugee or migrant populations and have basic understanding of resettlement best practices, or quality assurance or compliance. Understanding of fundamental client management techniques including determining eligibility, assessing needs, identifying resources, making referrals, and conducting follow-ups. English fluency required. Fluency in one of the following languages is preferred: Dari, Pashto, Spanish, Swahili, or French. ATTENDANCE: Must maintain regular and acceptable attendance at such level as is determined in the employer's sole discretion. LICENSE: Driver's License with clear record. VEHICLE: Must have daily use of a vehicle without prior notice. OTHER: Hybrid - the Reception and Placement Case Manager must be able to work from home in a virtual capacity and go into the office. The candidate must be 21 years or older. Must be available and willing to travel to various locations and with such frequency as the business need dictates. Operational needs may require occasional evenings or weekend supervision. Must not pose a direct threat or significant risk of substantial harm to the safety or health of himself/herself or others.

Under the direction of the Vice President of Case Management, the USPI Director of Case Management is responsible for supporting case management services within the USPI surgical hospitals in all markets. This position is responsible for leading USPI case management functions. The person in this role will develop and implement relevant education, ensure consistent and standard processes and workflows across all surgical hospitals related to case management and utilization review and partner on strategies related to readmission prevention. Serves as a member of Case Management leadership team responsible for Level of Care, Length of Stay and Clinical Denial Prevention performance for USPI surgical hospitals. Leads continuous improvement initiatives and case management revenue cycle and patient throughput best practice strategies in the assigned hospitals to achieve organizational goals through standardized processes. Works in alignment with USPI Clinical Services and consistently demonstrates ability to: Case Management Integration & Standardization: * Overseeing the integration of national standards into case management processes. * Standardizing processes and workflows across sites, including discharge planning, case management, utilization review, and reporting dashboards. * Coordinating with the sites to ensure appropriate staffing of case management teams in all hospitals, addressing gaps, and overseeing recruitment or temporary coverage as needed. * Identifying and implementing best practices for discharge planning, reducing length of stay, and optimizing level of care. * Supporting utilization management and working with the Sr. Director of Utilization Review, to ensure medical necessity, appropriate levels of care, and preventing denials. * Ensuring compliance with federal and state regulations, as well as accreditation standards (e.g., TJC). Education & Training: * Onboarding new Case Managers and ensuring consistent training practices. * Leading educational initiatives for Case Managers to improve patient experience. * Providing analysis and education on changes in regulations or clinical practices that affect hospital operations and reimbursement. Process Improvement & Implementation: * Oversee the collection and analysis of data related to length of stay, case management performance, discharge planning efficiency, and clinical denials across the hospitals to identify performance improvement opportunities * Develop, implement, and track key performance indicators (KPIs) for case management teams, ensuring targets are met. * Monitoring and improving efforts to reduce patient readmissions. * Overseeing action plan development and monitoring progress toward KPIs, goals, addressing barriers, and adjusting as necessary Service Culture & Patient Experience: * Promoting a strong service culture that enhances patient experience across the continuum of care. * Building and maintaining relationships with hospital and market leaders. Other Duties: * Performing any additional tasks as needed. Key focus on leading and supporting case management staff and services within the USPI surgical hospitals in all markets. This leadership position builds strong performance-based relationships, manages through roadblocks and barriers to success, and builds processes and protocols to ensure continued sustainability of initiatives and business processes. This position will have high visibility with USPI leadership. He/She will work directly with Tenet and CBO leaders, along with market and hospital administrative leaders, to develop and execute market strategies and tactics that are in alignment with company goals.Manage multi-disciplinary process improvement by utilizing excellent communication and servant leadership skills to challenge status quo and positively influence administrative teams and physicians to change processes to improve performance. May assist with the designing of and providing input needed for implementation and optimization of documentation systems (Cerner ACM, etc.) to standardize workflow and achieve key indicators. Requirements: * RN candidates must possess an active RN license and BSN is required. * Social Work candidates must possess an active Social Worker license and master's degree is required. * A minimum of 5 years of Case Management leadership experience in an acute hospital or surgical hospital setting required. * Must be able to travel regionally up to 75%. Selected candidate will be required to pass a Motor Vehicle Records check. * Strong Presentation skills a must- development and presentation of content. * Analytical ability is required to perform audits, to develop educational materials, and to develop strategic plans. * Interpersonal skills required to interact with case managers, administration, and communicate standards to department Directors and medical staff. * Self-Starter with the ability to ask questions and escalate to resolve barriers. Preferred: * Multi-site acute-care Case Management leadership experience preferred. * Advanced degrees in Business, Nursing and/or Health Care Administration are preferred. * Accredited Case Manager (ACM) preferred. * Experience with Cerner ACM and InterQual preferred. * Change and Project management experience; strong analytical skills including use of Excel and PowerPoint, and the ability to manipulate and analyze data preferred. Compensation: * Pay: $120,016 - $191,568 annually. Compensation depends on location, qualifications, and experience. * Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits: The following benefits are available, subject to employment status: * Medical, dental, vision, disability, life, AD&D and business travel insurance * Manager Time Off - 20 days per year * Discretionary 401k match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. * For Colorado employees, paid leave in accordance with Colorado's Healthy Families and Workplaces Act. #LI-JR2

At Viridian, we are focused on developing best-in-class medicines for people living with autoimmune and rare diseases. Leveraging our team's expertise in antibody discovery and engineering, we have created a robust pipeline of differentiated investigational therapeutic candidates for well-validated targets. Reporting to the Senior Director, PV Operations, the Director, PV Case Management will be responsible for the operational management and oversight of case processing activities performed internally and also externally by Pharmacovigilance's vendors, in both the post-marketing and clinical trials settings. The Director ensures compliance with regulatory requirements, corporate and departmental procedures and data handling conventions. This role may be based in Waltham, MA, which would be a hybrid role, or it can also be fully remote. Our office-based employees are required to work in the office three (3) days a week. If remote, travel to headquarters for meetings would be required at the discretion of management. Responsibilities (including, but not limited to): * Oversee ICSR workflow to ensure prioritization and high quality of cases, working closely within PV with PV Scientist, Safety MDs, and cross-functional colleagues in addition to vendor staff to ensure compliance with timelines and requirements * Ensure compliance in AE case processing, in both the Post-Marketing and Clinical Trial settings * Act as a subject matter expert on operations and oversight of AE case processing partners during audits and inspections as necessary * Lead PV vendor management including business requirements knowledge, vendor selection, contract details, vendor oversight, and safety management plans as needed * Lead vendor onboarding and ongoing management of partner and vendor needs (e.g., access, training, etc.) * Set case handling standards and perform relevant case handling activities as needed, e.g. retrospective QC and approving logical deletions * Complete late case investigations and owning case management related CAPAs * Act as the business lead for the safety database needs * Lead safety CT operational activities, including SAE data reporting and reconciliation between the safety and clinical databases * Review Study level documents including Study Management Plans, Study Safety Summaries and SAE Reconciliation Plans * Represent PV Operations on program study teams Qualifications: * Requires 12 years prior experience in pharmacovigilance * Advanced degree in a scientific discipline (e.g., PharmD, MD, PhD) preferred * Demonstrated knowledge of relevant FDA, EMA, International Conference on Harmonization (ICH) guidelines, initiatives, and regulations governing both Safety reporting and processing for clinical trial environments * Knowledge of MedDRA and WHO Drug Dictionary terminology and its application as well as experience with common safety database systems (Argus/ArisG/Veeva Safety) * Development and review of SOPs and Work Instructions * Vendor Management oversight responsibilities required. Experience with setting up a post-marketing PV vendor and global safety database preferred * Excellent organizational skills and demonstrated ability to navigate in a fast-paced environment with changing priorities * Excellent verbal and written communication skills including the ability to present to both internal and external partners * Strong analytical and problem-solving skills * Ability to work effectively in a fast-paced, dynamic environment * High integrity and commitment to patient safety * Strong commitment to ethical standards * Proficient with Microsoft Office suite (i.e., Word, PowerPoint, Excel, Outlook, SharePoint, etc.) * Ability to travel up to 10-15% * The salary range for this position is commensurate with experience Viridian offers a comprehensive benefits package including: * Competitive pay and stock options for all employees * Medical, dental, and vision coverage with 100% of premiums paid by Viridian for employees and their eligible dependents * Fertility and mental health programs * Short- and long-term disability coverage * Life, Travel and AD&D * 401(k) Company Match with immediate company vest * Employee Stock Purchase plan * Generous vacation plan and paid company holiday shutdowns * Various mental, financial, and proactive physical health programs covered by Viridian Viridian Therapeutics, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination, harassment, or retaliation of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by Federal, State, and Local laws. Viridian will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation. Viridian Therapeutics, Inc participates in E-Verify, the federal program for electronic verification of employment eligibility.

SYNERGY HEALTHCARE: Nurse Case Manager/Advocate - LOUISVILLE, KY (Remote) Job Summary: We are seeking an experienced Case Manager to join our growing team and serve as a Nurse Advocate for our new client and their employees. The ideal candidate will be located in the greater Louisville area, have a thorough understanding of the healthcare system, and will be responsible for providing guidance and support to members in navigating the complex healthcare landscape. As the dedicated Nurse Advocate, you will be responsible for resolving a myriad of issues for their members and allow you the flexibility to “think outside the box”. With your clinical experience and background, you will help members better understand their health status, and will play a pivotal role in promoting patient wellness, managing chronic conditions, and enhancing overall health outcomes through personalized coaching and education. This position requires a blend of clinical expertise, strong communication skills, and a passion for helping others achieve their health goals. While this specific client has a a couple primary offices in KY, this opportunity allows for remote work so can be flexible on location. Minimal travel within the State for periodic client visits may be required. Most if not all work will be done virtually out of the convenience of your own home office. The key to your success will rely on your ability to cultivate trusted relationships with stakeholders, members, and their families. Our growing Synergy team is passionate about delivering an exceptional healthcare experience that is personal, data driven, and value based to help every person live their healthiest life. Key Responsibilities: Serve as the primary point of contact for members seeking assistance with navigating the healthcare system. Work with members to identify their healthcare needs and provide clinical support. Liaison with TPAs and insurance companies to resolve claim and billing issues. Educate members on healthier lifestyle, member benefits and how to effectively utilize them. Advocate for members so they can receive improved healthcare outcomes, including referrals to specialists and timely access to care. Collaborate with other healthcare professionals, including physicians and nurses to ensure seamless coordination of care. Monitor member health status and progress towards achieving their healthcare goals. Maintain accurate and up-to-date records of member interactions and healthcare interventions. Client facing reporting with the potential for limited travel to client worksites. Health Risk Assessment review to encourage lifestyle modification and improve overall wellness. Qualifications: Active nursing license with a Bachelor of Science in Nursing (BSN) degree preferred. Minimum of 3 years of experience as a nurse case manager or in a related healthcare field. CCM certification or CCM eligible. Commit to CCM exam within the first year. In-depth knowledge of the healthcare and insurance systems. Strong analytical and problem-solving skills with the ability to identify and resolve complex healthcare issues. Excellent communication and interpersonal skills with the ability to interact effectively with employees and healthcare professionals. Ability to work remotely, independently, and as part of a team in a fast-paced, dynamic environment. Strong organizational skills with the ability to manage multiple tasks and priorities simultaneously. Proficient in the use of electronic health records (EHRs), Outlook, Excel, and other healthcare-related software. If you are passionate about helping others and have a solid understanding of the healthcare system, we encourage you to apply for this exciting opportunity as a Case Manager Nurse Advocate with our growing organization. Questions... Please reach out to *************************** today!

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.

Job Description Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan in San Francisco. It is a hybrid position with 1-2 days per week on-site required. Collaborates with the physician, nurse case manager, social worker, and other members of the health care team to meet individualized patient outcomes. Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly. Education Valid RN license in State of California Bachelor's degree in Nursing Experience Clinical experience in acute care setting Required Experience with interqual and millimen Preferred Licenses and Certifications CPR - Cardiac Pulmonary Resuscitation CPR/BLS Preferred and CCM - Certified Case Manager CCM Preferred and ACMA Preferred Knowledge, Skills, and Abilities Verbal and written communication skills. Basic computer skills. Diagnostic and problem-solving skills. Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. Actively participates in ongoing professional enrichment and educational opportunities. Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high quality, cost effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient, LOS insurance and discharge needs. Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement, risk management, safety, infection control, and other departments as appropriate. Confers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care. Evaluates concurrent and retrospective denials for appeal opportunities. May generate appeal letters based on knowledge of clinical severity and intensity. Identifies insurance information, obtains authorization, communicates with financial counseling and assigns appropriate length of stay for admission. Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to case management team. Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources. Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services, staff meetings, orientation and formal educational offerings. Demonstrates knowledge of the dynamics of abuse/neglect, including identification and reporting laws. Coordinates with investigating law enforcement, protection agencies, hospital security, risk management, and healthcare team. Demonstrates knowledge of community resources serving the high social risk populations. Performs other duties as assigned.

As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and documenting prior authorization and concurrent stay requests. You will also manage member case history in compliance with established policies and procedures, applying clinical criteria and member coverage. This role involves interfacing with members, providers, facilities, medical directors, intake staff, case managers, and other internal departments. Your attention to detail and clinical judgment will be crucial in determining the medical necessity of post-acute stays, including skilled nursing facilities, acute inpatient rehabilitation, and long-term acute care hospitals. Responsibilities + Review and document prior authorization and concurrent stay requests. + Manage and evaluate member case history in line with policies and procedures. + Interface with members, providers, facilities, medical directors, and various internal departments. + Apply clinical judgment to assess the medical necessity of post-acute stays. Essential Skills + Expertise in utilization management and utilization review. + Experience in acute care and nursing. + Proficiency in prior authorization processes. + Active, unrestricted RN license in the state of MN or WI. + Associate or bachelor's degree in nursing. + 3-5+ years of clinical experience. + Previous utilization management experience required. Additional Skills & Qualifications + Demonstrated clinical assessment skills with critical thinking and evidence-based decision-making. + Self-motivated and able to work independently and collaboratively. + Detail-oriented with strong organizational skills. + Technology-savvy with the ability to navigate multiple computer applications. Work Environment This position is remote, requiring 40 hours per week. Candidates must have a primary home address in Wisconsin or Minnesota. Internet speed tests are required, with minimum upload speeds of 5+ Mbps, download speeds of 25+ Mbps, and a ping less than 100MS. Internet speed test results must be submitted with the application. This is a 6-month contract position with the potential for extension or conversion. Job Type & Location This is a Contract position based out of Minnetonka, MN. Pay and Benefits The pay range for this position is $38.00 - $45.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 22, 2025. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.

Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities Ready to Make Critical Decisions That Ensure Appropriate Patient Care? We're seeking a full time skilled RN who understands that utilization review is about ensuring patients receive the right care at the right time. As our Utilization Review Nurse, you'll use clinical expertise to assess medical necessity, support appropriate care transitions, and serve as an advocate for both quality care and cost-effective treatment options while working collaboratively with medical directors and care teams. What makes this role different ✓ Clinical decision-making: Your assessments directly impact patient care and treatment authorization decisions across multiple service lines ✓ Comprehensive scope: Review outpatient/ancillary pre-certifications, inpatient stays including mental health and substance abuse, skilled nursing, rehabilitation, and post-service reviews ✓ Care coordination focus: Work with hospital staff to ensure smooth patient transitions and optimal discharge planning to appropriate next-level care ✓ Professional autonomy: Make independent clinical judgments using MCG guidelines, internal medical policies, and NCCN while collaborating with medical directors What You'll Actually Do Assess medical necessity: Conduct professional reviews of treatment requests and plans for medical appropriateness using established clinical guidelines and evidence-based criteria. Coordinate care transitions: Partner with hospital staff to prepare patients for discharge while ensuring smooth transitions to appropriate next-level care arrangements. Navigate complex cases: Review outpatient pre-certifications, inpatient hospital stays including mental health and substance abuse treatments, skilled nursing, and rehabilitation requirements with clinical expertise. Ensure appropriate referrals: Work to top of RN license while ensuring proper referral to medical director for denial authorizations through independent review organizations (IRO). Support member wellness: Identify and refer appropriate cases to case management, wellness, chronic disease, and Nurturing Together programs while maintaining thorough documentation. Process appeals: Handle appeals for non-certification of services and complete non-certification letters when appropriate while reviewing plan documents for benefit determinations. Maintain compliance excellence: Meet productivity, quality, and turnaround time requirements while maintaining HIPAA compliance and passing external URAC and NCQA audits. Utilize clinical guidelines: Apply guidelines in appropriate hierarchy including MCG guidelines, internal medical policies, group-specific policies, and NCCN for consistent decision-making. Qualifications What You Bring to Our Mission The clinical foundation: Current RN license in United States or U.S. territory Associate's degree or diploma (Nursing program) required 1+ year clinical experience required The professional competencies: Ability to meet productivity, quality, and turnaround time requirements daily Capability to pass external audits including URAC and NCQA Commitment to maintaining HIPAA compliance per company policies and procedures Ability to complete and pass all annual testing including IRRA at 90% or higher Willingness to cross-train and provide cross-coverage as needed The clinical expertise: Strong clinical judgment for assessing medical necessity across multiple service lines Knowledge of MCG guidelines, internal medical policies, and clinical decision-making tools Ability to review plan documents and attempt to redirect providers and patients to PPO providers when beneficial Proficiency with documentation software and electronic health systems The professional qualities: Excellent communication skills with ability to explain complex medical information clearly Independent judgment combined with collaborative team approach Commitment to maintaining confidentiality and minimum requirement rules Ability to complete all required yearly training per company's expected time period Comfort navigating fast-paced, high-volume review environment while maintaining quality standards Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary that rewards your success PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world while building the career you want? We're ready for you. No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you. Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $30 to $38 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for benefits. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site.

OUR MISSION We exist to create a more connected, compassionate, and confident experience for people with cancer and those who care for them. We make it easier to get answers, access high-quality care quickly, and feel supported throughout treatment and beyond. Today, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. Our model combines high-touch human support with powerful technology and AI to bring together everyone involved in a person's cancer journey: caregivers, oncologists, health plans, and employers. As a tech-native organization, we believe technology should strengthen the human connection at the center of care. Through data science, automation, and AI, we simplify complexity, improve collaboration, and help care teams focus on what matters most: supporting people through cancer. Looking ahead, our vision is bold: to become a household name in cancer care, where every person diagnosed asks for Thyme Care by name. If you're inspired to make cancer care more human and to help reimagine what's possible, we'd love to meet you. Together, we can build a future where every person with cancer feels truly cared for, in every moment that matters. YOUR ROLE Thyme Care Inc., the management company to Thyme Care Medical PLLC, is the employing entity with your duties to be performed for Thyme Care Medical PLLC, a medical practice, and its patients. As a Thyme Care Oncology Nurse Navigator, you'll be a vital clinical resource for our members and their care network, offering triage, support, and education during their cancer journey via phone, email, and video communication. Under the guidance of our Nurse Team Lead, you'll conduct comprehensive clinical assessments, oversee member health, and facilitate end-of-life care discussions. Your main objective will involve actively engaging with members, addressing clinical issues, and efficiently managing any escalations that arise. The shift for this position is 11:30AM - 8:00PM EST. Within your first three months, you will: Familiarize yourself with Thyme Care systems, tools, technology, and partners, conducting a minimum of 20 member calls per day. Collaborate closely with Nurse leaders and Medical Directors to ensure alignment with clinical protocols and best practices. Establish trusting relationships with members and their care network, prioritizing empathy and active listening in every interaction. Adhere to Care Team policies, procedures, and documentation standards, contributing to efficient operations and maintaining quality standards. Support members throughout the oncology care continuum, from screening to survivorship or end-of-life care, coordinating care and providing clinical support as needed. Identify and address member needs promptly, offering assistance with care coordination, symptom management, nutritional support, discharge planning, and provider referrals. Participate in case conferences to monitor member progress, provide updates, and collaborate on targeted support plans with the healthcare team. Foster strong partnerships with payers and providers to optimize care delivery and minimize readmissions. Collaborate with non-clinical Care Team members to address social determinants of health needs, such as food resources and transportation access. Be available for urgent clinical escalations and provide clinical consult support as required. Performs other projects and duties as assigned and as related to department business needs and objectives. WHAT LEADS TO SUCCESS Member-Centric Approach: You prioritize the member experience and demonstrate a deep commitment to Thyme Care's mission. Action-Oriented: You proactively identify and prioritize initiatives, taking prompt action to address urgent needs. Organizational Skills: You excel at multitasking and thrive in fast-paced environments while maintaining meticulous organization in communications and documentation. Communication Skills: You are an effective listener and communicator, skilled at building rapport and fostering strong working relationships with members and colleagues. Adaptability: You are comfortable with change and ambiguity and have a proven track record of success in dynamic environments. Qualifications: A Bachelor of Science Degree in Nursing and a compact unrestricted registered nurse (RN) license are required. Additionally, you have at least 5 years of nursing experience, including 3 years in solid tumor oncology nursing. Certifications: Oncology-related certifications such as Oncology Certified Nurse (OCN), Advanced Oncology Certified Nurse (AOCN), Advanced Oncology Certified Nurse Specialist (AOCNS), or Certified Case Manager (CCM) are required or obtained within 2 years of hire. This job description is intended to provide a general overview of the position, its responsibilities, and the required qualifications. Thyme Care reserves the right to modify, add, or remove duties as necessary to meet business needs and organizational objectives. OUR VALUES At Thyme Care, our core values guide us in everything we do: Act with our members in mind, Move with purpose, and Seek diverse perspectives. They anchor our business decisions, including how we grow, the products we make, and the paths we choose-or don't choose. This is a non-exempt, full time position. The pay rate for this role is $39.90/hour. To perform this role you must be located within the lower 48 United States due to contractual limitations with accessing PHIs. We offer a choice of great medical, dental, and vision insurance plans as well as a generous vacation policy for full-time employees, so you can prioritize the most important parts of your life. To ensure sufficient clinical coverage, we ask that our Care Team be prepared to work up to 2 holidays per year, compensated at a 1x hourly rate and a 1.5x holiday rate. Additionally, we recognize a history of inequality in health care. We're here to challenge these systems with a culture of inclusion through the care we give and the company we build. We embrace and celebrate a diversity of perspectives in reflection of our members and the patients our products serve. We are an equal-opportunity employer. Be cautious of recruitment fraud , and always confirm that communications are coming from an official Thyme Care email.

We are seeking a dedicated and compassionate Wound Care Nurse, Telehealth Coordinator within the skilled nursing environment. The Wound Care Nurse, Telehealth Coordinator is the link between healthcare providers and patients while providing dressing changes to wounds, under direct supervision, utilizing real-time, imaging technologies. If you are passionate about excellent wound care and recognize the role telehealth has for consistent, convenient attention to patients in need, we encourage you to apply for the Telehealth Coordinator position and join our dedicated team. Responsibilities: Act as the in-person, hands on assistant to conduct weekly virtual wound rounds using technology under the guidance of wound care specialists, nurses, or healthcare providers. Photograph wounds using designated telehealth technology and ensure accurate documentation of images for clinical review. Aid patients in navigating telehealth platforms, troubleshoot technical issues, and ensure a seamless virtual connection for appointments. Facilitate patient telehealth scheduling, provide education on virtual visits to patients and staff as needed. Administer all aspects of wound care as per evidence based practice and facility policies, including dressing changes and rounds. Maintain strict adherence to patient confidentiality and privacy regulations, including HIPAA compliance, during all telehealth interactions and documentation processes. Submit orders for wound care products. Qualifications: Graduate of an accredited school of nursing required. Must possess current CPR certifications. Minimum of one (1) year of Wound Care experience required, (2) years preferred. Wound care certification is preferred. Must possess a current, unencumbered, active license to practice as a RN or LPN in state of practice. Excellent communication skills with the ability to convey medical information clearly to physicians, staff, patients and family Empathy, patience, and a genuine desire to provide quality healthcare services to patients at the bedside as well as through telehealth technology. Commitment to maintaining patient confidentiality, privacy, and data security in accordance with healthcare regulations (e.g., HIPAA). Ability to multitask, and adapt to changing telehealth workflows, job requirements, and patient populations. Prior experience in SNF, LTC, or Assisted Living preferred. Travel to assigned facilities using your personal car, valid driver's license, and mileage reimbursement offered. Role starts out Part-Time with the opportunity to be Full-Time.

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

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

Hi. We're Hummingbird. We're elevating patient access so patients can get healthcare how, when, and where they need it. We partner with healthcare systems to transform how patients access care, enabling their providers to focus on what matters most - caring for patients. By managing patient access as a technology-enabled service, we help health systems stabilize costs and improve patient experience while creating good jobs that attract and retain talent in the industry. Our team of experts is obsessed with the connection between the people, processes, and technology that make healthcare organizations hum. Join us and help build the healthcare experience we want for our communities, our families, and ourselves. Summary Help patients get the right level of care with calm, clinically sound guidance over the phone. As a Triage Nurse at Hummingbird, you'll be the first clinical voice many patients hear when they're unsure what to do next. You'll provide telephone triage in a remote, centralized contact center - assessing symptoms, determining urgency, and guiding patients to safe next steps using client-specific protocols and Epic's Nurse Triage module. Most of your day will be on the phone managing back-to-back calls, using your nursing judgment and clear guidelines to advise patients, route them appropriately, and support follow-up care. You'll work with a supportive team of nurses and non-clinical colleagues and receive training, coaching, and feedback to grow your skills, handle increasingly complex scenarios, and continuously improve how we deliver care. Responsibilities Note: This posting is for our ongoing Triage Nurse Talent Pool. We interview continuously and anticipate frequent openings, with start dates typically 2-6 months after your application. What You'll Do In this role, you'll combine clinical judgment, technology, and communication skills to guide patients safely and efficiently: Provide telephone triage with Epic's Nurse Triage module, asking focused questions to assess symptoms, rule out red flags, and recommend the right level of care. Verify and update patient information, protect privacy under HIPAA, and coordinate with clinic teams to schedule or adjust appointments and escalate urgent or complex cases. Document calls in real time in the EHR while using Epic and contact center tools to navigate charts, follow protocols, and meet quality and performance expectations. Handle emotionally charged situations with empathy and professionalism, ensuring patients feel heard, informed, and confident about next steps. Take part in ongoing training and continuous improvement, sharing trends and feedback to strengthen workflows, quality, and team culture. The Details Location: Remote (U.S.-based) Schedule: Full-time or part-time, Monday-Friday; shifts vary based on patient access center hours Compensation: Expected range is $30.43 - $35.00 per hour. New hires usually start between $31.00 and $33.00, depending on experience and internal equity. Benefits: Comprehensive medical, dental, and vision coverage; paid time off; 401(k); parental leave; career development support; and more Training: Paid, structured onboarding that includes Epic workflows, client-specific protocols, and ongoing education and coaching. Expectations for Focus & Presence To support patients and each other, this role requires your full attention during scheduled work hours. Our Outside Employment Policy doesn't allow overlapping work or “job stacking,” so any outside work must happen fully outside your Hummingbird schedule. We're a camera-ready team, and you'll need to be on-camera during training and when needed during the workday after training ends. We value connection, teamwork, and being present, which is what keeps our patients safe and our team supported. If that's what you're looking for, you'll feel at home here. If you're hoping to hold another job during the same hours, this job won't be the best match. About our Talent Pool Hummingbird is growing fast, and we interview year-round for our Triage Nurse Talent Pool. While we're not hiring for this specific role right now, we typically add new specialists monthly, so start dates are often 2-6 months after applying. Joining the talent pool means you'll be among the first considered when opportunities open. We receive a lot of applications, so hearing back may take a little time, but we'll keep you updated, usually within a couple of weeks. You may also be invited to complete an assessment or have a brief conversation with a recruiter as part of early screening. Growth at Hummingbird This role is a key part of our clinical support model. You'll build depth in telephone triage, Epic workflows, and patient communication: skills that are valuable across many care settings. As you gain experience, you may have opportunities to: Take on more complex triage protocols and specialty areas. Support quality review, coaching, or training for other nurses. Contribute to workflow and protocol improvements with clinical and operations teams. At Hummingbird, we believe good jobs should lead somewhere. Your experience as a Triage Nurse can open doors to future opportunities in clinical leadership, operations, or specialist roles as our services continue to grow. Why You'll Love Working Here We're on a mission to make healthcare more human. For our Triage Nurses, that means combining evidence-based practice with empathy, clarity, and calm - especially when patients are worried or unwell. You'll receive structured training, clear protocols, and support from leaders who understand remote triage, building confidence and autonomy as you handle a wide range of patient scenarios over the phone. Our nurses often say how meaningful it is to guide patients to the right care quickly, still using their clinical expertise every day in a setting that emphasizes safety, communication, and connection - without the pace of a bedside shift. Required & Desired Skills What You'll Bring Current, unrestricted RN license in North Carolina; willingness to obtain additional licensure if needed. 1+ years outpatient telephone triage experience or 3+ years clinical nursing experience (ideally primary care, emergency, home health, or med-surg). Strong clinical assessment skills and sound judgment, with the ability to follow standardized guidelines and know when to pause and escalate. Excellent communication skills - you translate complex medical information into clear, patient-friendly language and maintain a calm, steady presence when patients are anxious or unsure. Comfort in a remote contact center setting with back-to-back calls, defined performance metrics, and real-time use of multiple systems (EHR and contact center tools) while documenting and typing ~50 WPM. A strong commitment to patient privacy and strict adherence to HIPAA and all relevant policies. Nice to Have Previous telephone triage or contact center experience Experience using Epic Compact nursing license or eligibility for compact licensure, depending on state and client requirements What Helps You Shine Please note that we use both your resume and your written and oral communication throughout the hiring process to understand your fit for this role. Thoughtful, clear responses help us see your attention to detail, your professionalism, and your ability to communicate with care - skills that are essential for success on our team. Please Note: The seniority level of this position may be adjusted during the recruitment process based on candidate skills and experience. The Hummingbird Approach We value a team that brings diverse perspectives and experiences to the work we do. While there are many ways to do this, people who are successful at Hummingbird: Lead with Respect by valuing kindness and working to actively foster an environment of inclusion and respect. Embrace Growth and seek out learning and growth for themselves and support those around them in their growth journey. They bring curiosity and an openness to innovation to all their interactions. Bring a Win Together mentality by approaching conflict directly, listening carefully, and seeking to understand. They problem-solve with the goal of finding successes, not trade-offs, for all involved. Equal Opportunity Statement Hummingbird Healthcare is an equal opportunity employer committed to diversity and inclusion. We do not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected characteristic. We value the talents of individuals from all backgrounds and actively seek a diverse workforce. Our mission is to provide a fair and inclusive recruitment process for everyone, and reasonable accommodations are available to any applicant who may need them. Please reach out to talent@hummingbird.healthcare to request accommodations and we'd be happy to chat.

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.

Flexible Independent Contractor (1099) Opportunity INDIANA State Medical License required Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally recognized Independent Review Organization (IRO) specializing in technology-driven utilization management and clinical medical review solutions. We're a leader in Peer and Utilization Reviews, known for excellence and continuous improvement. THE OPPORTUNITY: We are currently seeking Board-Certified Internal Medicine physicians with a Geriatric Fellowship to conduct independent Utilization Reviews. This is a flexible, fully remote opportunity requiring just 1-2 hours per week-with no minimum commitment. ADDITIONAL INFORMATION: Work remotely from anywhere in the US (Per HIPPA Regulations patient records cannot leave the US). Covered under MRIoA's Errors and Omissions policy. Independent Contractor (1099) opportunity. Workers are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information. California Consumer Privacy Act (CCPA) Information (California Residents Only): Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver's license number, or state identification card number, and passport number. Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at ************. Must have a Medical Degree MD or DO Must have a current INDIANA unencumbered medical license Current Board Certification in Internal Medicine with a Geriatric Fellowship Must have 5 years of clinical experience residency to be included Daytime availability is required for peer-to-peer conversations

At Curana Health, we're on a mission to radically improve the health, happiness, and dignity of older adults-and we're looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we've grown quickly-now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you're looking to make a meaningful impact on the senior healthcare landscape, you're in the right place-and we look forward to working with you. For more information about our company, visit CuranaHealth.com. Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The role includes providing the medical and utilization expertise necessary to evaluate the appropriateness and efficiency of medical services and procedures. This includes providing prior authorizations, concurrent review, proactive discharge/transition planning, and high dollar claims review. There is a heavy emphasis on concurrent review and proactive transition planning, and high dollar claims review. There is a heavy emphasis on concurrent review and proactive transition planning for members in the hospital and skilled nursing facility. This is primarily a remote telephonic position with normal business day hours, with one weekend day per month coverage. This position serves as a liaison to the Plan Medical Director working closely with appeals and medical decisions. Essential Duties & Responsibilities Performs concurrent and retrospective reviews on all facility and appropriate home health services. Monitors level and quality of care. Responsible for the proactive management of acutely and chronically ill patients with the objective of improving quality outcomes and decreasing costs. Evaluates and provides feedback to member's providers regarding a member's discharge plans and available covered services, including identifying alternative levels of care that may be more appropriate. As part of the hospital prior authorization process, responsible for determining “observational” vs “acute inpatient” status. Integral to the concurrent review process, actively and proactively engages with member's providers in proactive discharge/transition planning. Actively participates in the notification processes that result from the clinical utilization reviews with the facilities. Prepares CMS-compliant notification letters of NON-certified and negotiated days within the established time frames. Reviews all NON-certification files for correct documentation. Maintains accurate records of all communications. Monitors utilization reports to assure compliance with reporting and turnaround times. Addresses care issues with Director of Quality and Care Management and Chief Medical Officer/Medical Director as appropriate. Coordinates an interdisciplinary approach to support continuity of care. Provides utilization management, transition coordination, discharge planning and issuance of all appropriate authorizations for covered services as needed for providers and members. Coordinates identification and reporting of potential high dollar/utilization cases for appropriate reserve allocation. Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum. Clarifies health plan medical benefits, policies and procedures for members, physicians, medical office staff, contract providers, and outside agencies. Responsible for the early identification of members for potential inclusion in a Chronic Care Improvement Program. Assists in the identification and reporting of Potential Quality of Care concerns. Responsible for assuring these issues are reported to the Quality Improvement Department. Work as interdisciplinary team member within Medical Management and across all departments. Other duties as assigned. Qualifications Education and Experience: Minimum 2 years clinical experience as RN, LPN/LVN required. Minimum 1-year managed care or equivalent health plan experience preferred. Demonstrated experience in health plan utilization management, facility concurrent review discharge planning, and transfer coordination required. Medicare Advantage experience preferred. Experience with InterQual or MCG authorization criteria preferred. Excellent computer skills and ability to learn new systems required. Strong attention to detail, organizational skills and interpersonal skills required. Demonstrated ability to problem solve and manage professional relationships. Certificates, Licenses and Registrations Active unrestricted Nursing license required. We're thrilled to announce that Curana Health has been named the 147 th fastest growing, privately owned company in the nation on Inc. magazine's prestigious Inc. 5000 list. Curana also ranked 16 th in the “Healthcare & Medical” industry category and 21 st in Texas. This recognition underscores Curana Health's impact in transforming senior housing by supporting operator stability and ensuring seniors receive the high-quality care they deserve.

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