Utilization Review Nurse- Remote
Remote job
American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.
If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!
Benefits and Perks include:
* Affordable Medical/Dental/Vision insurance options
* Generous paid time-off program and paid holidays for full time staff
* TeleDoc 24/7/365 access to doctors
* Optional short- and long-term disability plans
* Employee Assistance Plan (EAP)
* 401K retirement accounts with company match
* Employee Referral Bonus Program
JOB SUMMARY:
The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services by conducting pre-service, concurrent, and retrospective utilization management reviews. The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate medical services in compliance with medical and regulatory guidelines.
ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
* Assess the medical necessity, quality of care, level of care and appropriateness of health care services for plan members
* Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity
* Conduct outreach to requesting providers which can include specialty physicians, ancillary providers and institutions to gather the appropriate/necessary clinical data
* Apply clinical review criteria, guidelines, and screens in determining the medical necessity of health care services against the clinical data provided
* Certify cases that meet clinical review criteria, guidelines and/or screens
* Consult with physician when reviews do not meet clinical review criteria, guidelines, and screens
* Refer cases to other professionals internally, including case management and medical consultation when indicated
* Adhere to accreditation, contractual and regulatory timeframes in performing all utilization management review processes
* Ensure that the Director of Medical Management or designee is made aware of any potential risk management issues in a timely manner
* Other duties as assigned
JOB REQUIREMENTS:
* Maintain privacy and confidentiality of records, conditions, and other information relating to residents, employees and facility
* Encourage an atmosphere of optimism, warmth and interest in patients' personal and health care needs
* Develop and maintain collaborative relationships with providers and educate on levels of care
* Ensure the integrity and high quality of utilization management services
* Self-motivated
* Ability to work independently and as part of a team
* Able to work congenially with a wide variety of individuals
* Maintain the highest level of confidentiality and professionalism at all times
* Strong oral and written communications skills, including active listening
* Proficient in navigating through multiple computer applications
* Positive, engaging customer service skills
* Critical thinking and decision-making skills
* Successful completion of required training
* Handle multiple priorities effectively
* Independent discretion/decision making
* Make decisions under pressure
REQUIRED QUALIFICATIONS:
* Experience:
o At least 1 year experience in utilization management with a health plan or hospital-based UM department with use of Interqual or MCG
o Prefer clinical experience
o Broad knowledge of Medicare regulations and guidance
o Trained in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures
o Excellent customer service experience
o Strong knowledge of medical terminology and CPT, ICD-10, and HCPCS codes
o Proven ability to problem-solve and make solid decisions
* License/Certification:
o Current Certified Case Manager (CCM) credential is a plus
o Current, active and unrestricted Registered Nurse (RN) license
EQUAL OPPORTUNITY EMPLOYER
This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.
Wound Care Nurse - Telehealth Coordinator
Remote job
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.
Auto-ApplyRemote Psychiatric Preceptors (04232021Avenia)
Remote job
Reports to: Chief Executive Officer and/or Training Director
Scope of work: Provides monitoring and clinical skills training & exposure to nurse practitioner and physician assistant students.
Education: M.D. from accredited University or Medical School
Completion of a Psychiatric Residency Program
Experience:
Has experience in mental health services
Has medical license within the U.S.
Responsibilities:
Provide monitors and proctors nurse practitioner and physicians assistant students in psychiatric services
Provides feedback and training on clinical skills development with NP and PA students
Clinical Research Nurse - Home Visits (PRN); Birmingham, Alabama
Remote job
Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse - Home Visits (PRN), you'll provide high-quality nursing care directly in patients' homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work.
Key Points to Know: • You'll use your own vehicle to visit patients in their homes, typically within 1-2 hours of your location. • Shifts are PRN / per diem, meaning you'll work only when projects are available in your area; project frequency may vary. • Orientation, training, and project-specific instructions are provided before each assignment. • You will be compensated for all time spent on training, travel, and patient visits, including documentation.
We are posting this role now and will be reviewing applications on a rolling basis between now and Christmas.
Interviews will begin in the New Year
, so you may experience a brief delay in hearing back from us during the holiday period. Thank you in advance for your patience - we look forward to connecting in January.
Position: Clinical Research Nurse - Home Visits (PRN) Job Type: Contract, PRN, Per Diem Hourly Rate: $55/hr onsite and $50/hr travel time Work Location: Birmingham, Alabama; Drive up to 1-2 hours to patient homes in your area (travel time compensated!)
Job Description: As a Clinical Research Nurse - Home Visits (PRN), you will play a crucial role in ensuring the successful execution of research studies in patient homes. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your expertise and caring nature will help us maintain compliance with each study's protocol and safeguard the well-being of study patients. Principal Duties and Responsibilities:
Deliver competent, high-quality nursing care to study patients in their homes.
Accountable for the competent and confident delivery of high-quality clinical care to patients/participants. Ensure compliance with each study's protocol by providing thorough review and documentation at each subject study visit.
Administer investigational medications/products as needed; Perform patient assessments to determine presence of side effects; notify Principal Investigator of findings/issues.
Perform medical tests as outlined in protocol, including, but not limited to: vital signs, specimen collection, electrocardiograms; Process specimens and ship specimens per protocol.
Provide patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment.
Responsible for adherence to clinical research policies to ensure ethical conduct and protect vulnerable populations.
Communicate effectively, promoting open and trusting relationships.
Qualifications:
Relevant Nurse Licensure
CH-GCP Certificate
Graduate from an accredited BSN or Associate Degree in Nursing or Nursing Diploma
program
Minimum 2 years' post qualification acute care experience
Clinical Research experience preferred
BLS certification required
Experience and knowledge of working in clinical research trials with ICH-GCP (Good
Clinical Practice) Certification - (training can be provided)
Good basic IT skills, utilizing mobile devices and Microsoft systems
Trained in Handling and Transport of Hazardous Substances (training can be provided)
A flexible schedule is essential
Unencumbered driver's license, reliable car
Benefits:
Competitive hourly pay rate, including compensation for travel time.
Flexible schedule to maintain work-life balance.
Mileage reimbursement for travel expenses.
Ongoing training and support to growth your clinical research skills
Opportunity to make a meaning impact on patients' lives while contributing to cutting-edge medical research.
Join our team and contribute to groundbreaking medical advancements through clinical research!
Auto-ApplyRemote - PFS Denial Nurse Auditor
Remote job
Remote - PFS Denial Nurse Auditor
PFS Billing-Follow Up-Denials
Full Time Status
Day Shift
Pay: $60,382.40 - $96,616.00 / year
Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time.
The Denials Nurse Auditor works under the supervision of the manager of PFS Denials. The Denials Nurse Auditor is responsible for completing, appealing, tracking, and reporting clinical denial reviews to determine the appropriate actions for post-billing denials. This Individual will combine clinical, financial, and regulatory knowledge and skill to reduce financial risk and exposure caused by payer denials for rendered services. The Denials Nurse Auditor has highly developed knowledge and skills in areas of: Medical Necessity, Authorizations, Experimental/Investigational denials, payer audits and filing appeals as well as Government and Non-Government payor requirements with Denial Management. This position is employed by Mosaic Life Care.
Completes clinical review of appropriate post-claim denials; prepares clinical discussion and appeal letters for denied accounts.
Consults clinical and hospital appeal guidelines; provides appeal direction using payer guidelines to appropriate departments via monthly denials meetings.
Ensures compliance with all federal, state, and local regulations governing rendered patient services and reimbursement.
Reviews and analyzes specific audit information and provides education to other caregivers both internal and external to the PFS Denial Management team. Identifies, and initiates clinical and hospital quality improvement initiatives focused on improving both quality indicators and outcomes.
Other duties as assigned.
Bachelor's Degree - Graduate of school of nursing, BSN is required.
Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure Registered Nurse license by the State of Missouri required.
5 Years of experience in health care as a registered nurse, preferably in revenue cycle is required. Excellent understanding of financial and health care strategies is required.
Nurse Liaison - Remote
Remote job
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.
PA/NP - Virtual Urgent Care - Remote (Night Shift)
Remote job
Our Virtual Urgent Care team is looking for an experienced Physician Assistant or Nurse Practitioner to join their team. In this role, you will be providing virtual medical care to patients of varying type and acuity. This is a full-time night shift position.
As we care for patients of all ages, we cannot consider Adult/Gerontology trained Nurse Practitioners.
Qualifications
Physician Assistant
* Required Master's Degree Graduate of an accredited Physician Assistant educational program
* LIC-Physician Assistant - STATE_MI State of Michigan Upon Hire required
* CRT-Physician Asst Certified (PA-C) - NCCPA National Commission on Certification of Physician Assistants Upon Hire required
* CRT-Basic Life Support (BLS) - AHA American Heart Association 90 Days required Or
* CRT-Basic Life Support (BLS) - ARC American Red Cross 90 Days required
* CRT-Pediatric Adv Life Support (PALS) - AHA American Heart Association 120 Days required
* CRT-Adv Cardiovascular Life Support (ACLS) - AHA American Heart Association 120 Days required
Nurse Practitioner
* Required Master's Degree Nurse Practitioners who obtained their education and certification after 2000 must show evidence of completion of a master's, post-master's or doctorate from a Nurse Practitioner program that is accredited by the Commission on the Collegiate of Nursing Education or the National League for Nursing Accrediting Commission
* 3 years of relevant experience current, relevant clinical experience
* Previous experience functioning in a collaborative role as a Nurse Practitioner
* LIC-Nurse Practitioner (NP) - State of Michigan
* CRT-Basic Life Support (BLS)
* CRT-Neonatal Resuscitation Program (NRP)
* CRT-Pediatric Adv Life Support (PALS)
Corewell Health West Medical Group
The Corewell Health West Medical Group is part of a not-for-profit health system serving 13 counties in West Michigan. Corewell Health West is a region of Corewell Health, formerly the BHSH System (Beaumont Health and Spectrum Health) that provides care and coverage with an exceptional team of 60,000+ dedicated people-including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving over 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.
Corewell Health
People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy, and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 65,000+ dedicated people-including more than 12,000 physicians and advanced practice providers and more than 15,500 nurses providing care and services in 21 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving more than 1.3 million members Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. For more information, visit corewellhealth.org.
How Corewell Health cares for you
* Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
* On-demand pay program powered by Payactiv
* Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
* Optional identity theft protection, home and auto insurance, pet insurance
* Traditional and Roth retirement options with service contribution and match savings
* Eligibility for benefits is determined by employment type and status
Primary Location
SITE - 515 Michigan St NE - Grand Rapids
Department Name
Virtual Urgent Care - CHMG West
Employment Type
Full time
Shift
Variable (United States of America)
Weekly Scheduled Hours
40
Hours of Work
Variable
Days Worked
Variable
Weekend Frequency
Every third weekend
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling ************.
25-26 Aurora Central HS: Nurse
Remote job
The structure of Aurora Central High School's Health Office includes a full-time nurse and a full-time health para. This nurse position will work together with the para to meet the health needs of students within our building.
Click to view the full job description
This position is designated as Hard to Fill and is eligible for an annual stipend of $5000. Stipends are paid in two equal installments of $2,500 in January and June of the school year, contingent upon working the entirety of each semester.
To be eligible for the Hard to Fill stipend, staff must:
Be licensed by the Colorado Department of Education (CDE) and appropriately endorsed to provide services to students.
Serve students in the identified area at least 50% of the assignment.
Auto-ApplyUtilization Review Nurse - Remote
Remote job
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: *****************************
Auto-Apply
At Hologic, we value professionals who combine clinical expertise with empathy, advocacy, and educational excellence. We are seeking a Nurse Advocate as a part of our Market Development team who can deliver outstanding support and guidance to our patients and providers, acting as a trusted advisor and resource.
Role Responsibilities:
Respond to patient inquiries via inbound and outbound communication, providing information and facilitating referrals to physicians.
Educate prospective patients about Hologic products featured in awareness campaigns and help them prepare for conversations with their healthcare providers.
Accurately record all interactions and referral activities in Salesforce.com.
Mentor and assist new team members to uphold exceptional patient care standards.
Travel as required to deliver onsite education, training, and support.
Who You Are
Knowledge & Experience
Comprehensive understanding of nursing principles and patient care, with a focus on women's health and Sonata and Acessa treatments.
Clinical knowledge of RFA products Acessa and Sonata preferred.
Familiarity with healthcare compliance guidelines and business rules.
Knowledge of effective patient education strategies and referral processes.
Skills
Strategic thinker with exceptional planning and organizational skills.
Strong verbal and written communication, tailored to diverse audiences.
Active listening and information gathering to understand patient needs.
Exceptional organizational and multitasking skills, ensuring accurate documentation and follow-up.
Proficient use of Microsoft Word and Excel for reporting and communication.
Proficiency in CRM systems (Salesforce.com) and telecommunications.
Advanced problem-solving and issue resolution abilities.
Competency in mentoring and training new team members.
Behaviors
Demonstrates empathy and builds rapport quickly with patients and stakeholders.
Maintains professionalism and exemplary phone etiquette at all times.
Proactively facilitates communication between patients, physicians, and staff.
Manages time effectively, prioritizing tasks and following through on commitments.
Adheres strictly to compliance, safety, and emergency protocols.
Actively seeks continuous professional development and training.
Required Experience:
Active RN license in good standing.
Bachelor's Degree in Nursing (BSN) or equivalent.
Minimum of 5 years' experience in patient care and education.
Experience working in a healthcare or patient support environment.
Proven ability to build and maintain strong relationships with stakeholders.
Why Hologic?
At Hologic, we're driven by a passion for innovation and a commitment to improving patient outcomes. As part of our team, you'll play a pivotal role in bringing breakthrough RFA technology to healthcare facilities, empowering clinicians, enhancing patient care, and transforming the standard of women's health. Here, your leadership will be valued, your ideas heard, and your growth supported
The annualized base salary range for this role is $116,600-165,100 and is bonus eligible. Final compensation packages will ultimately depend on factors including relevant experience, skillset, knowledge, geography, education, business needs and market demand.
Agency And Third Party Recruiter Notice
Agencies that submit a resume to Hologic must have a current executed Hologic Agency Agreement executed by a member of the Human Resource Department. In addition, Agencies may only submit candidates to positions for which they have been invited to do so by a Hologic Recruiter. All resumes must be sent to the Hologic Recruiter under these terms or they will not be considered.
Hologic's employees are subject to third-party COVID-19 vaccination requirements, including from customers and governmental entities. Hologic is an equal opportunity employer and consistent with federal, state, and local requirements, will consider requests for reasonable accommodation based on disability or sincerely-held religious beliefs where it is able to do so without undue hardship to the company.
Hologic, Inc. is proud to be an Equal Opportunity Employer inclusive of disability and veterans.
#LI-LB2
Auto-ApplyNurse Coordinator (Remote, Digital Weight Loss)
Remote job
Compensation: $80,000-$95,000 + equity
This salary range reflects multiple experience levels and locations. Actual compensation within the range will be determined based on factors such as experience, skills, qualifications, and geographic location.
Schedule: Full-time, 5 days a week, Tuesday-Saturday
Location: Remote
Role Type: Full-time | Bilingual Spanish preferred but not required
About Bariendo
Bariendo is on a mission to cure obesity. Founded by Harvard Medical School professors, we are pioneering quick, non-surgical weight loss procedures that are 7x safer than surgery and more effective and affordable than the best medications. Our digital health platform combines telehealth, distributed clinics, and an expert care team in endoscopic weight loss to deliver lasting, affordable results for the 40% of Americans struggling with obesity.
We're growing rapidly-now in 8 cities after just 6 quarters of operations-with a vision to become the one-stop shop for obesity management, offering the most comprehensive set of interventions available online and via our distributed partner clinics. Join us to help patients reclaim their lives.
About This Role
We are looking for a people-centered, professional, and organized Nurse Patient Concierge to join our team and deliver Bariendo's signature 6-star care. You'll be the first point of contact for patients and a crucial part of making their weight loss journey feel smooth, supported, and stress-free. This is a role for someone who thrives in a fast-paced environment, has a concierge mindset, and finds joy in turning complex coordination into calm execution.
In this role, you will:
Deliver 6-Star Service: Be the warm, welcoming presence patients first encounter. Whether by phone, text, or email, you'll create a calm, organized, and exceptional experience that reflects Bariendo's high standards of care.
Be a Trusted Clinical Guide: Act as a primary point of contact for patients on clinical and care-related questions, escalating appropriately to providers and ensuring clear, timely communication so patients feel confident and supported throughout their treatment.
Ensure Clinical & Procedural Readiness: Partner closely with Bariendo's procedure centers to confirm accurate bookings, review patient charts for completeness and readiness, and coordinate outstanding requirements so every patient arrives fully prepared for their procedure.
Be a Concierge for Every Concern: Monitor incoming communications, answer phone calls, and anticipate patient needs before they arise. You'll be a responsive, empathetic problem-solver who builds trust with every interaction.
Drive Administrative Excellence: Maintain accurate records across our systems, ensure compliance with regulations like HIPAA, and support documentation workflows that enable smooth care delivery.
What We're Looking For
Clinical, Service-Driven Experience: Active RN license with 3+ years of patient-facing clinical experience, including experience delivering care or care coordination virtually (phone, text, telehealth). Ideally in procedural, ambulatory, or concierge-style settings where high-touch, white-glove support is the norm.
Experience in Weight Management or Bariatric Care (preferred): Prior exposure to obesity medicine, bariatric surgery, endoscopy, or medical weight-loss clinics is a strong plus, particularly in patient education, pre-procedure readiness, or longitudinal care coordination.
Fluent in Spanish (preferred, not required): Able to communicate clearly and professionally with Spanish-speaking patients across phone, email, and text.
Detail-Oriented & Reliable: Comfortable juggling complex logistics with accuracy. You stay organized, catch errors before they happen, and keep things moving smoothly under pressure.
Warm, Clear Communicator: You build trust quickly, make patients feel at ease, and bring empathy and professionalism to every interaction.
Operationally Sharp & Adaptable: Confident discussing pricing and payment options in a direct-pay model, comfortable navigating EHRs and new software, and energized by fast-paced, ever-evolving environments where proactive problem-solving is key.
What Makes This Job Amazing
Mission: Join a team of Harvard Medical School professors and healthcare innovators transforming thousands of lives. Watch our patient's stories.
Hybrid Environment: Work three days a week from our Market Street office and two days remotely, with some (infrequent) Saturday calls -all patient care is delivered virtually via telehealth.
Foundational Role in a Growing Startup: Be part of a fast-growing, mission-oriented team. Collaborate closely with teams like Product to help shape and innovate our virtual care experience.
Total Rewards
Competitive salary with equity in a high growth, seed-stage startup
Comprehensive health benefits (medical, dental, vision)
11 paid holidays, 15 personal vacation days, 10 wellness days
Hybrid work, 3 days in-office 2 days remote
Auto-ApplyNursing Administrator (RN), Full-time, Remote
Remote job
Job Description
Nursing Administrator
The Center for Wound Healing & Hyperbaric Medicine, LLC (CFWH) provides management and consulting services to healthcare providers in the area of wound care and hyperbaric medicine. By focusing on the needs of the patients as well as the partners we serve, The Center for Wound Healing & Hyperbaric Medicine, LLC is able to bring advanced wound healing strategies to many communities around the country.
Our Core Values:
Compassion, Excellence, Passionate, Integrity, Dedication, Loyalty, Accountability, Enterprising.
Job Overview:
The Nursing Administrator assists with all patient care services, including but not limited to, case management, extensive chart reviews, utilization of services reviews and discharge planning. Ensures compliance with patient care quality standards as it relates to the care provided to all wound care and hyperbaric patients. Supports all clinical training initiatives for new and existing staff, which includes both hands-on and virtual training. This position reports to the Chief Nursing Officer (CNO).
What You'll be Doing:
Understands wound care and hyperbaric nursing protocols; ability to practice as required.
Participates in the chart review process to ensure patients qualify for treatment prior to appointment.
Communicates charting revisions to appropriate staff in a professional, helpful, and kind manner. Educate, as needed.
Partners with the HR & Training department on new hire training to provide educational assistance as needed. Requested clinical training from CA may be remote or in-person.
Works with the CNO to identify training needs for current staff. Creates appropriate training material/courses and educational aids. Provides training remotely or in-person.
Travels to wound centers across the U.S. to support on-going clinical education, coach and develop nursing staff, and to cover clinical shifts if/when required.
Supports new clinic openings as requested by the CNO. Support may be administrative, virtual and/or hands-on.
Works closely with clinic leadership to advise on patient scheduling, chart reviews, physician communication, and patient evaluations for HBO qualification.
Responsible for staying up to date on the standards of care related to wound care and hyperbaric oxygen therapy (local coverage determinations/LCDs) and education of such.
Partners closely with the Revenue Cycle Department on insurance verifications to get authorization in a timely and efficient manner.
Creates and/or updates clinical procedures for new and existing staff to adhere to. Communicates and trains on procedures as required.
Maintains close coordination with all departments to ensure continuity and collaboration of services.
Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) by safeguarding patient information and maintaining the highest level of confidentiality standards.
Maintains efficient and effective clinical operations while verifying compliance with all local, state and federal regulations, standards and protocols.
Consistently adheres to company, hospital, and accrediting body clinical, safety, and compliance standards.
Other duties as assigned.
Requirements for This Role:
Registered Nurse (RN) from an accredited school or college of nursing.
Current state licensure; no restrictions to obtain RN license in additional states.
Current Basic Life Support (BLS) from approved agency.
2+ years wound care experience required.
2+ years clinical training experience required.
Deep understanding of charting, billing and insurance authorizations.
Proficient in Microsoft Office or related systems.
Proficient in a minimum of one EMR system.
Strong verbal and written communication skills.
Ability to treat others with compassion and patience.
Ability to work in a fast-paced team-oriented environment.
Must possess excellent interpersonal skills.
All employees are required to comply with HIPAA policies and procedures.
Desired Qualifications for This Role:
Bachelor's Degree preferred.
CWS, WCC, WOCN and/or CHRN certification preferred.
Knowledge of Hyperbaric Oxygen Therapy preferred.
Experience in outpatient clinic and/or hospital operations preferred.
Proficiency with Microsoft 365 tools, particularly SharePoint preferred.
Travel:
This position requires frequent ground and/or air travel. This may result in travel up to 75% of the employee's time with occasional weekend travel.
Physical Demands:
The physical demands described are representative of those that must be met by a Nursing Administrator to successfully perform the essential competencies, duties, and requirements of this position. These include standing, walking, driving, lifting up to 50 pounds and sitting for extended periods of time and looking at a computer screen for extended periods of time. In addition, pushing, pulling, stooping, squatting and shifting heavy objects, as well as air travel, may be required. Employees should ask for assistance if needed.
Equal Employment Opportunity:
The Center for Wound Healing & Hyperbaric Medicine, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment 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 or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
As an organization, we are committed to offering reasonable accommodation to job applicants with disabilities. If you need assistance or an accommodation due to disability, please contact us at
***********************************
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Nursing Administrator (RN), Full-time, Remote
Remote job
Nursing Administrator
The Center for Wound Healing & Hyperbaric Medicine, LLC (CFWH) provides management and consulting services to healthcare providers in the area of wound care and hyperbaric medicine. By focusing on the needs of the patients as well as the partners we serve, The Center for Wound Healing & Hyperbaric Medicine, LLC is able to bring advanced wound healing strategies to many communities around the country.
Our Core Values:
Compassion, Excellence, Passionate, Integrity, Dedication, Loyalty, Accountability, Enterprising.
Job Overview:
The Nursing Administrator assists with all patient care services, including but not limited to, case management, extensive chart reviews, utilization of services reviews and discharge planning. Ensures compliance with patient care quality standards as it relates to the care provided to all wound care and hyperbaric patients. Supports all clinical training initiatives for new and existing staff, which includes both hands-on and virtual training. This position reports to the Chief Nursing Officer (CNO).
What You'll be Doing:
Understands wound care and hyperbaric nursing protocols; ability to practice as required.
Participates in the chart review process to ensure patients qualify for treatment prior to appointment.
Communicates charting revisions to appropriate staff in a professional, helpful, and kind manner. Educate, as needed.
Partners with the HR & Training department on new hire training to provide educational assistance as needed. Requested clinical training from CA may be remote or in-person.
Works with the CNO to identify training needs for current staff. Creates appropriate training material/courses and educational aids. Provides training remotely or in-person.
Travels to wound centers across the U.S. to support on-going clinical education, coach and develop nursing staff, and to cover clinical shifts if/when required.
Supports new clinic openings as requested by the CNO. Support may be administrative, virtual and/or hands-on.
Works closely with clinic leadership to advise on patient scheduling, chart reviews, physician communication, and patient evaluations for HBO qualification.
Responsible for staying up to date on the standards of care related to wound care and hyperbaric oxygen therapy (local coverage determinations/LCDs) and education of such.
Partners closely with the Revenue Cycle Department on insurance verifications to get authorization in a timely and efficient manner.
Creates and/or updates clinical procedures for new and existing staff to adhere to. Communicates and trains on procedures as required.
Maintains close coordination with all departments to ensure continuity and collaboration of services.
Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) by safeguarding patient information and maintaining the highest level of confidentiality standards.
Maintains efficient and effective clinical operations while verifying compliance with all local, state and federal regulations, standards and protocols.
Consistently adheres to company, hospital, and accrediting body clinical, safety, and compliance standards.
Other duties as assigned.
Requirements for This Role:
Registered Nurse (RN) from an accredited school or college of nursing.
Current state licensure; no restrictions to obtain RN license in additional states.
Current Basic Life Support (BLS) from approved agency.
2+ years wound care experience required.
2+ years clinical training experience required.
Deep understanding of charting, billing and insurance authorizations.
Proficient in Microsoft Office or related systems.
Proficient in a minimum of one EMR system.
Strong verbal and written communication skills.
Ability to treat others with compassion and patience.
Ability to work in a fast-paced team-oriented environment.
Must possess excellent interpersonal skills.
All employees are required to comply with HIPAA policies and procedures.
Desired Qualifications for This Role:
Bachelor's Degree preferred.
CWS, WCC, WOCN and/or CHRN certification preferred.
Knowledge of Hyperbaric Oxygen Therapy preferred.
Experience in outpatient clinic and/or hospital operations preferred.
Proficiency with Microsoft 365 tools, particularly SharePoint preferred.
Travel:
This position requires frequent ground and/or air travel. This may result in travel up to 75% of the employee's time with occasional weekend travel.
Physical Demands:
The physical demands described are representative of those that must be met by a Nursing Administrator to successfully perform the essential competencies, duties, and requirements of this position. These include standing, walking, driving, lifting up to 50 pounds and sitting for extended periods of time and looking at a computer screen for extended periods of time. In addition, pushing, pulling, stooping, squatting and shifting heavy objects, as well as air travel, may be required. Employees should ask for assistance if needed.
Equal Employment Opportunity:
The Center for Wound Healing & Hyperbaric Medicine, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment 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 or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
As an organization, we are committed to offering reasonable accommodation to job applicants with disabilities. If you need assistance or an accommodation due to disability, please contact us at ***********************************.
Auto-ApplyRemote HEDIS Nurse Consultant
Remote job
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.
Utilization Review Nurse - Remote - Contract
Remote job
, 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.
Utilization Review Nurse (PRN) - All Shifts Avaliable (Morning, Evenings and Weekends) (Working 4 or 8 hours shifts)
Remote job
This position is a critical part of utilization management within the emergency department setting. The role ensures that patient admissions meet medical necessity standards and that healthcare resources are used appropriately and efficiently. It combines clinical expertise, analytical skills, and communication abilities to support both patient care and organizational compliance.Responsibilities
Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria
Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources
Participate in telephonic discussions with emergency department physicians relative to documentation and admission status
Enter clinical review information into system for transmission to insurance companies for authorization
Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources
Qualifications
Required
Current and unrestricted RN license
At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
At least 2 years utilization management experience in acute admission and concurrent reviews
Intermediate level experience with InterQual and/or MCG criteria within the last two years
Proficiency in medical record review in an electronic medical record (EMR)
Experience in Microsoft Suite including Office and basic Excel
Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
Passing score(s) on job-related pre-employment assessment(s)
Preferred
At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
At least 3 years utilization management experience within the hospital setting
Bachelor's of Science in Nursing (BSN)
Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC)
Expectations
Comfortable with remote work arrangements and virtual collaboration tools
Physical demands include extended periods of sitting, computer use, and telephone communication
Shift Needs & Work Requirements:
Must work 4 holidays per year, each for a 4-hour shift.
16 hours of the required 48 hours per month must be worked on the weekend.
Work schedules and shift assignments are subject to change
based on evolving client needs and operational demands. While we strive to provide consistent scheduling, associates may be required to adjust their availability or work different shifts. Flexibility and adaptability are essential for success in this role.
Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.
Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider.
If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.
All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.
Netsmart's Job Applicant Privacy Notice may be found here.
Auto-ApplyMedical Review Nurse (USACE)
Remote job
Our vision aims to empower our clients by actively leveraging our broad range of services. With our global presence, we have career opportunities all across the world which can lead to a unique, exciting and fulfilling career path. Pick your path today! To see what career opportunities we have available, explore below to find your next career!
Please be aware of employment scams where hackers pose as legitimate companies and recruiters to obtain personal information from job seekers. Please be vigilant and verify the authenticity of any job offers or communications. We will never request sensitive information such as Social Security numbers or bank details during the initial stages of the recruitment process. If you suspect fraudulent activity, contact us directly through our official channels. Stay safe and protect your personal information.
Job Summary:
Under general supervision of the Program Manager (PM) and reporting to the PM, the Medical Review Nurse (MRN) is responsible for the initial chart review and chart case management for medical exam/screening programs to verify that all medical information and exam components are accurate. The RN works directly with Physicians and Examinees to ensure all medical information is gathered and performs medical Quality Assurance on all charts in various process stages leading to a final determination.
Salary is $66,560-$70,000.
Duties and Responsibilities:
• Performs medical review of incoming charts to determine if additional medical information is needed.
• Collaborates with Physician(s) and other internal nursing staff members for chart review.
• Performs medical Quality Assurance (QA) on all charts in various process stages.
• Interfaces with Client's Medical Department as well as the on-site provider.
• Contacts Examinee via telephone or email to clarify information necessary to complete the chart.
• Develops a very good understanding of the specific contract's guidelines and addendums as required.
• Masters the various software programs specific to the functioning of the exam program.
• Implements and follows up on requests for further evaluation from the Examinee when required.
• Works closely with other departments to provide accurate and quality outcomes.
• Thoroughly cognizant of metrics and organizes workload to meet them.
• Consistently learns and applies codified state and federal regulations specific to particular contract(s).
• Serve as backup to other nurses for daily duties and assists with follow-up calls to facilities and Examinees as needed as well as other duties as assigned.
• Opportunity to travel and assist on medical mobile events as either a site lead and/or RN as work or personal schedule permit.
• May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain a specific level of knowledge pertaining to new developments, new task efforts, contract awards, and new policy requirements.
• Supports marketing and sales objectives and efforts as requested.
• Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training, and goals. Ensures safe operating conditions within an area of responsibility. Encourages co-workers to work safely. Identifies “close calls” and/or safety concerns to supervisory personnel. Maintains a clean and orderly work area.
• Assists in the active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, and other mandated regulations/standards.
• May serve on the OSHA VPP, Safety, and Wellness Committees.
Qualifications:
• 5-7 years of relevant experience.
• Fully unencumbered nursing license required.
• Proficiency with computer and common office equipment, as well as with MS Office products.
• Must be able to multitask, be flexible, be organized, and have excellent oral and written communication skills as well as exceptional attention to detail.
Preferred Qualifications:
• COHN-S and/or CAOHC certifications
• Bachelor's Degree with 5 years of relevant experience
• Flexibility and availability to travel and assist to support medical mobile events as either site lead and/or RN
Physical Requirements and Work Conditions:
• Work is normally performed in a typical interior/office work environment.
• Work involves sitting and standing for prolonged periods of time.
• May require bending and lifting up to 15 lbs.
• Constant use of computer and common office equipment required.
Acuity International is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, national origin, age, protected veteran status, or disability status.
For OFCCP compliance, the taxable entity associated with this job posting is:
Acuity-CHS, LLC
Auto-ApplyBilingual Remote Triage Nurse (Full-Time)
Remote job
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
Auto-ApplyMaster of Science in Adult Gerontology and Acute Care Nurse Practitioner Adjunct Faculty- Remote
Remote job
Job DescriptionDescription:
Master of Science in Adult Gerontology and Acute Care Nurse Practitioner Adjunct Faculty
South College -
We are one of the nation's fastest growing institutions of higher learning … come grow your career with us.?
In order to fully meet our Mission to our students, we require a diverse combination of perspectives, backgrounds, life experiences, and ideas from our faculty and staff and will provide them with an equitable and inclusive work environment -where respect and open interchange of ideas are at the heart of that culture.
Almost 20,000 Students
10 Campuses?
Competency Based Education
Online
Master of Science in Adult Gerontology and Acute Care Nurse Practitioner Adjunct Faculty Description
South College Online seeks candidates for an adjunct Adult Gerontology and Acute Care Nurse Practitioner (AGACNP) faculty member. The position is online remote and will report directly to the Program Coordinator of the AGACNP program.
Responsibilities
Provide quality instruction in each assigned course within the approved academic program curriculum.
Respond, in a timely manner, to specific and general information requests from the institution and administrative officials, prospective employers, professional organizations, public agencies, civic organizations, private foundations, general public, and students, as appropriate.
Promote appropriate standards of linguistic expression in both written and oral communications.
Ensure that all academic program requirements and forms of documentation (e.g., clinical evaluations, competency documentation) are completed as required for each student and submitted per established deadlines.
Ensure all faculty expectations are met on a weekly basis.
Appropriately manage all classroom activities.
Be reasonably accessible to students for questions and assistance.
Monitor educational and professional literature for the best practices in areas related to courses taught.
Requirements:
Education
Applicants must have a minimum of a doctorate degree in nursing practice with a certification in AGACNP and successful completion of at least 18 hours of directly related graduate coursework.
Experience
Preference will be given to applicants with prior successful online teaching.
Licensure
Must have PA, LA, TN, and GA APRN License.
Remote Triage Nurse
Remote job
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