Nurse manager jobs in Puerto Rico - 41 jobs

**Become a part of our caring community and help us put health first** Clinical call center. High volume. Fast paced. **Shift/availability details:** + **Part time 20 hours a week, 10 hour shifts.** + **Scheduled to work every Saturday & Sunday from 7am-5:30pm ET.** + **Required to work a rotating holiday schedule.** The **Clinical Care Coordinator** helps to ensure optimal continuity of care for patients transitioning into and out of our services. They are responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. The Clinical Care Coordinator is expected to communicate with the CenterWell Home Health clinical team and help facilitate timely patient follow-up for patients in need of (additional) services when appropriate. The Clinical Care Coordinator is under the general supervision of the Manager of Care Coordination and under established performance criteria. This is a work-from-home telephonic nurse position **Essential Functions:** + Act as CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services. Able to navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, as well as accessing healthcare resources. + Utilize a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Appropriately handle a variety of customer issues including location lookup, directions, and complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to a service site location or, if not available, look up and provide alternative services. Act as customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Follow-up and track referral and admission outcomes. + Maintains awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met. + Assists in the admissions process by acting as an ambassador for patients who meet the admissions requirements. + Focus on placing the right patient to the right care setting at the right time + Adheres to and participates in Company's mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures. + Reviews and adheres to all Company policies and procedures. + Provide education regarding Home Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services + Participates in special projects and performs other duties as assigned. **Use your skills to make an impact** **Required Experience/Skills:** + Associates Degree required. BSN preferred. + RN license in a compact state is required. May be required to obtain licensure in additional states as dictated by business needs. + At least 3 years post-acute experience. Home Care or hospice experience preferred. + Nursing background working across multiple areas of post-acute care. + Extensive nursing experience in post-acute care. + Current CPR certification. + Good working knowledge of home health, hospice, and palliative care services. + Good time management skills. + Ability to learn and master information related to locations and services of clients. + Excellent analytical and problem-solving skills. + Excellent verbal and interpersonal skills. + Able to communicate effectively with empathy over the phone and while interacting with others. + Must read, write and speak fluent English. **To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:** + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 20 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-23-2026 **About us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

**Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed within the **RN/LVN/LPN** scope of practice, under the Medical Director's direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum and working in concert with the health care delivery team to maintain high-quality, cost-effective care delivery. + Perform pre-certification utilization reviews of **Oncology treatment requests** + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review rationales and determinations. + Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director. + Appropriately identifies and refers quality issues to UM Leadership. + Collaborates with physicians and other providers to facilitate the provision of services throughout the health care continuum. + Performs accurate data entry. + Communicates appropriate information to other staff members as necessary/required. + Participates in continuing education initiatives. + Availability on some weekends and holidays may be required. + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license. + High School Diploma or equivalent required + Minimum of three years of direct clinical patient care (acute, inpatient, or critical care setting); strongly prefer direct Oncology experience. + Strong computer skills, including MS Office Suite + Strong interpersonal, oral, and written communication skills. + Availability for weekend holiday rotation. **Finishing Touches (Preferred):** + Experience with clinical decision-making criteria sets (i.e., Milliman, InterQual) + Minimum of one year of experience with medical management activities in a managed care environment + UM/UR experience + Clinical experience in Oncology, ICU, ED, or other critical care environment + Remote work experience To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $32-$37 /hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

Responsibilities The Clinical Manager (CLM) of the Behavioral Health Contact Center is responsible for the depth of the clinical interventions with people that require telephone counseling. CLM is responsible for crisis and emergency management and recommends the alternate care levels leading to a rehabilitation plan. Establish direct communication with leaders and representatives of the Behavioral Health Contact Center, with persons within FHC, mental health clinics, and with the divisions of the integrated system to guarantee the continuity of care. Consults with psychiatrists the more complex cases. Offers support to Case Managers and to all the efforts related to complying with handling the phone calls. The Clinical Manager is responsible for telephonic counseling, managing referrals and providing support in the coordination and notification of appointments scheduled for our members, in accordance with the timeframes established in the organization's policies. This role also ensures accessibility and quality of care for our members. Responsibilities and essential duties: * Upon answering, CLM must identify themselves by name, title, and organization's name following FHC Behavioral Health Contact Center Standards. * Answer incoming calls within the company's established time frame, using a clear, pleasant tone and appropriate language. * Shows appropriate communication skills, effective listening, and case management skills to deal with challenging situations. * Verifies the member eligibility before processing and registering the phone call in FHC's platforms. * Ensures that member consent is obtained and documented. * Provide support to members calling the Behavioral Health Contact Center by conducting needs assessments, brief interventions, facilitating referrals and supportive engagement. * Have immediate access to director or clinical supervisor. * Consult with Behavioral Health Contact Center psychiatrists and/or licensed clinicians whenever necessary. * Offers psychological counseling through the phone to the people who are referred. * Offers intervention for psychiatric crisis or emergency management. * Intervention with emergency services (e.g., 911, mobile crisis units) when immediate action is required and provides follow-up for all emergency calls. * Follow-up call for crisis or emergencies 24 hours after the coordination of services to assure the continuity of care. * Follows internal protocols for mandatory reporting, including cases involving abuse, neglect, or threats to self/others. * Educates the member or authorized representative about our programs and coverage's benefits. * CLM uses the Triage Logic platform to identify the most appropriate level of care and counsels and informs the person about the various options of service available for his or her rehabilitation. * Refers callers to appropriate services, including outpatient therapy, inpatient care, or community-based resources. * Facilitate access to immediate services if an individual reports risk of suicidal or homicidal ideation or threats. * Provide solution-focused interventions such as helping member practice calming/coping skills, facilitating linkage to ongoing support, and explaining the mental health services available. * Refer and analyze with the psychiatrist special situations that require medical or clinical confirmation regarding the correctness of the final decision taken. * Consults with the psychiatrist matters related to the management of medications to make certain and validate the counseling that is going to be provided. * Maintains the confidentiality of the documents and the information received. * Documents according to the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and Law 408. * Present cases to the physical facilities when the psychiatric hospital requests a medical evaluation prior to admission. * Authorizes the services of an ambulance in coordination with the existing criteria guide. * Facilitates the access of the person to the services for his or her rehabilitation and coordinates the necessary visits for the continuation of treatment. * The staff member is responsible for delivering all cases that require follow-up to the next shift, in accordance with established standards. Additionally, they must ensure that all cases from the previous shift are received in a complete and appropriate manner. Key Requirements: * Timely Handover: All pending cases must be transferred before the end of the shift. * Compliance with Standards: Follow organizational protocols for case documentation and communication. * Verification: Confirm that cases received from the previous shift are complete and meet quality requirements. * Validate the registration process of the admissions to mental health services. * Enter the inpatient admission registration to the Registration Hospitalization Module when the facility cannot complete the task. * Assist members and/or providers with the transition of care by identifying resources to support the discharge plan. * Responsible for calling psychiatric inpatient facilities to validate admissions and discharges. * Responsible for entering information related to admissions and/or discharges on the Web Census platform. * CLM is responsible for identifying individuals who experience early or recurrent hospital readmissions to ensure appropriate follow-up care. Additionally, it identifies beneficiaries with high utilization of services and refers them to the Case Management Program for comprehensive support and intervention. * Receives and verify referrals for the coordination of appointments. * For MCS members, logs and generates the authorization of services in the PMHS application within 24 hours. * Escalate issues in a timely manner. * Discuss complex cases with Utilization Review and Case Management Departments. * Interacts with providers, members, and other professionals in charge of member's care to validate continuity of service. * Comply with established quality parameters for abandonment rate, average speed of answer, coordination of services and notifications, calls classification and routing, and first call resolution. * Participates in the mandatory training, such as the Annual Compliance Plan, Human Resources & Departmental, URAC, NCQA and CMS guidelines. * Informs the supervisor or human resources of any sanction or revocation of your license that affects the practice of your profession. * Responsible for meeting daily with the representatives assign to his/her shift to establish the work strategies. * Provides leadership in clinical decisions for the public as well as the private sector. * Offers direct support to Case Managers. * Available for case analysis and for clinical decision-making. * Supports the Behavioral Health Contact Center Case Managers in the management of logistic issues that require more extensive intervention, such as problems with transportation, coordination with facilities, among others. * Complies with the established quality parameters, abandonment rate and average speed of answer, codify the first call resolution and CHRA services. * Carry out delegated duties such as: * Outbound calls for the purpose of requesting information to verify next appointments, attendance at previous appointments, coordinate services and provide service authorizations number, if applicable. * Faxing materials * Mailing/e-mailing already identified materials. * Follow up with referrals. * TTY validation. * Follow up Call Backs. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion, and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state, or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Notice At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: ************************* or **************. Qualifications Minimum qualifications: * Master's in Social Work, Psychology, Psychological Counseling, Mental Health Counseling, or Psychiatric Nursing * Valid and current active license for Social Work, Psychiatric Nursing, Psychological Counseling, Psychology, or Mental Health Counseling * Professional membership certification (colegiación): Valid membership for Social Work and Psychiatric Nursing * Relevant Work Experience: Two or more years of experience in the health field. * Knowledge in Microsoft Office * Preferable fully bilingual

Manage clinical and administrative operations of a nursing unit within the scope of an RN license as defined by the state and Nurse Practice Act. * Accountable for the standard of care at the facility, providing consultations and expertise in the delivery of care to patient. * Serve as a clinical and service resource to nursing staff and other staff as assigned. * Manage the activities of staff, coordinating safe and appropriate care between departments and disciplines. * Manage and evaluate work activities of nursing, technical, clerical, service or maintenance staff for the unit, work group and other facility staff as directed. * Analyze information/situation to choose the best solution(s) to solve problems. * Responsible for recruitment, hiring and training of new staff. * Identify the educational needs of others and develop educational or training programs. * Assist with the development and implementation of organizational policies and procedures for the facility. * Prepare reports to inform management of the status and implementation of programs, services and quality initiatives of the unit. * Perform administrative or managerial functions such as planning budgets and authorizing expenditures. * Provide direct care as needed. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. null

Clinical Manager Responsible for assuring the delivery of quality health care services to the patient. The Clinical Manager represents the agency by facilitating its mission and agency objectives. Duties and Responsibilities Utilizes current nursing concepts and principles as well as understanding of coverage criteria to direct, supervise, and ensure the quality of care provided by the Coordinators of Care (COC) and other Clinical staff Assures the periodic reassessment of and appropriate revisions to the plan of care and ensures full recert packages are submitted timely Evaluates the skills and services provided by the clinical staff through record review, field visits, and case conferencing? Maintains effective communication with staff and patients Serves as a patient advocate in communications with third-party payers. Identifies staffing and service needs Performs duties necessary in the Emergency Disaster Plan Assures that all care and staff interactions uphold the non-discrimination policy and are sensitive to the Americans with Disabilities Act Provide direction to COCs regarding difficult patient issues Assesses the educational needs of the COCs relative to the patient's care and ensures their needs are met? Participates in the agency's orientation, education, and performance improvement activities?? Participates in hiring, training, and disciplining clinical staff Participates in an on-call coverage rotation Coordinates and ensures the accuracy of conversion packets Performs other related duties as needed

PURPOSE AND SCOPE: The Inpatient RN provides direct patient care in accordance to company policies and procedures which includes FMCNA compliance programs and contracted hospitals' policies and procedures. Areas of practice are diverse, including, but not limited to, hemodialysis, peritoneal dialysis, continuous renal replacement therapies, apheresis, and ultrafiltration. The Inpatient RN will partner with the hospital to provide quality care to the patient and deliver care that provides a positive patient experience. PRINCIPAL DUTIES AND RESPONSIBILITIES: Under limited supervision, applies considerable knowledge to perform a broad range of tasks which include but are not limited to direct patient care in multiple modalities not limited to hemodialysis, peritoneal dialysis, ultrafiltration, continuous renal replacement therapy, and Apheresis. Provides supervision and direction of Patient Care Technicians and clerical staff; provides direction and education to ICU staff for CRRT. Responsible for direct patient care of assigned patients in the Inpatient Renal Replacement and Apheresis Services setting and providing the appropriate treatment technique for assigned patients as prescribed in all modality procedures, as appropriately defined - hemodialysis, peritoneal, continuous renal replacement therapies, ultrafiltration, and Apheresis. Assesses patients' responses to treatment therapy making appropriate adjustments and modifications to the treatment plan as indicated by the appropriately credentialed physician. Communicate problems or concerns to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. Delivers safe, effective care in a timely an efficient manner. Gives organized, concise shift reports for patients on assigned shifts. Apply high level thinking skills to shift patient schedules to meet needs of more critical patients due to labs, MD order, or patient assessment. Responsible for the implementation, administration, monitoring, and documentation of patient's response to prescribed intradialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier. Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust, and coordinate daily patient care plan to ensure continuity of care. Initiates and communicates to FMS facility nursing staff and appropriate hospital personnel as needed. Accurately documents all treatment information in the individual patient record (ACES) and the hospital record, as needed. Cleans and disinfects dialysis machine surface, chair, equipment, and surrounding areas between treatments according to inpatient renal services policies and procedures. Conducts all tasks necessary for preparation for dialysis treatment and documents where appropriate. Performs all required pre-treatment dialysis machine alarm testing. If applicable, initiates Solution Delivery System. Operates all related equipment appropriately and safely and provides minor trouble shooting when necessary; efficiently utilizes supplies to prevent waste. Understands, conducts, and documents appropriately Dialysis/Apheresis machine safety tests/alarm tests, equipment calibration, dialysate testing, machine safety tests, functional testing, and internal and external disinfection on all water & dialysis machines, and complies with the documentation/notification standards per FMS policies. Completes and documents ongoing participation in QAI activities. Participates in staff meetings as scheduled. Participates in staff training and orientation as assigned. Acts as a subject matter expert to hospital staff for dialysis related patient/equipment complications. Responsible for reporting all new or unusual incidents, information, complaints, or problems to the inpatient manager and other parties per the Adverse Event Report requirements. May be assigned to in-center patient care on an as needed basis Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. Assist with various projects as assigned by direct supervisor. Other duties as assigned. PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodations can be made. Direct patient care, interaction with patients, outpatient clinicians, hospital staff, and physicians. The position requires travel between assigned hospitals and facilities; as well as travel to regional meetings/educational events. Position requires on call rotation including night, day, weekend, and holidays. There is potential for exposure to potentially infectious material and contagious diseases/material. Position provides direct patient care which regularly involves heavy lifting, moving of patient and/or equipment > 200lbs (with assistance); and may lift chemical and water solutions of up to 30lbs up as high as 5 feet. SUPERVISION: Provides supervision and direction of Patient Care Technicians (Certified Clinical Hemodialysis Technicians (CCHT)) and clerical staff; provides direction and education to ICU staff for CRRT. EDUCATION: Current appropriate state licensure. Maintains acquired knowledge and remains current in advancements in nephrology, in particular, relative to inpatient care (hospitalized patients requiring varied treatment modalities, not limited to Renal Replacement, Apheresis, and Ultrafiltration services). Must meet the practice requirements in the state in which employed. Certification in Nephrology Nursing, Apheresis Nursing, or both is highly encouraged. EXPERIENCE AND REQUIRED SKILLS: One year RN experience required and required nursing skills. Minimum 6 months nephrology experience required before working independently with no other Dialysis RNs to provide dialysis and ultrafiltration services. Minimum 6 months Nephrology experience required before working independently with no other Apheresis RNs to provide Apheresis services. Demonstrated strong assessment skills related to the critically ill patient. ICU experience preferred but not required. Successful completion of training course in the theory and practice of care of the ESRD patient - Progressive Renal Education Preparation. BLS CPR Recognition. ACLS CPR Recognition preferred, but not required. Demonstrates organizational and time management skills, and a competency toward completing continuing and ongoing Renal/Nephrology education. Displays leadership skills and ability to direct and supervise others (such as PCTs, CCHTs, clerical staff). Successful completion of Nurses Technical Training. Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together** . Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. **Primary Responsibilities:** + Clinical Case Reviews -75% + Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported + Maintain standards for productivity and accuracy. Standards are defined by the department + Provide clear and concise clinical logic to the providers when necessary + Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization + Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities + Investigate and pursue recoveries + Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance + Use pertinent data and facts to identify and solve a range of problems within area of expertise + Other internal customer correspondence and team needs - 15% + Attend and provide feedback during monthly meetings with assigned internal customer department + Provide continuous feedback on how to improve the department relationships with internal team members and departments + Continuing education - 10% + Keep up required Coding Certificate and/or Nursing Licensure + Complete compliance hours as required by the department *****ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***** You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Registered Nurse (RN), Coding Certificate or Nursing Licensure, for example: + Puerto Rico Registered Nurse + Certified Professional Coder (CPC) + CPC A + Certified Inpatient Coder (CIC) + Certified Outpatient Auditor (COC) + Certified Professional Medical Auditor (CPMA) + Certified Coding Specialist (CCS) + Experience in a hospital/inpatient setting, surgical or clinic + Demonstrated proficiency with computers, including Microsoft Suite of products + Willing or able to work from Monday to Friday, 40 hours per week during our business operating hours of 8am - 7pm ATL + Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for this position) **Preferred Qualifications:** + Experience working with medical claims platforms + Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting + Presentation or policy documentation experience + Knowledge of CMS and AMA coding rules specific to CPT, HCPCS + Knowledge of CMS Coverage, Federal and State Statues, Rules and Regulations + Knowledge of Medicaid/Medicare Reimbursement methodologies + Working knowledge of the healthcare insurance/managed care industry + Working knowledge of medical terminology and claim coding _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. The Registered Nurse - Wound Specialist, specializes in treating patients with wounds like burns, pressure ulcers, diabetic / arterial ulcers, and more this is performed in accordance with physician orders and plan of care under the direction and supervision of the agency. ________________________________________________________________ About Company: CMS offers an Integrated Home Health System, which includes Durable Medical Equipment (DME), Respiratory Equipment, Home Health Services, Infusion Services, Orthotics and Prosthetics can count on CMS for their immediate, guaranteed. Our service model is recognized by our business partners, positioning us with over three decades of experience as the market leader serving over 800,000 people in Puerto Rico. Come and be part of CMS. Being part of our work team, where we are distinguished by the excellence of the service, we offer our patience. Position Summary: A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the agency Director of Nursing and/or Administrator. Minimum Requirements: Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing. Wound Care Certification required. Al least six (6) months' experience in a Wound Specialist position. Acceptance of philosophy and goals of this Agency. Ability to exercise initiative and independent judgment. Our Benefits: Benefit from our advanced documentation automation app-saving you time and effort so you can dedicate more energy to what matters most: your patients. Health Insurance, (Vision, Dental & Pharmacy) 10 days paid Holidays 12 days of Sick Leave 15 days Vacations Leave 401K with Company Contribution Provide Uniforms Recognition and Incentives Programs Training Program paid by Company “CMS Inc. and CMS Home Care, LLC. is an Equal Employment Opportunity Employer. Affirmative Action for Women, Minorities, Veterans, and People with Disabilities"

A Nursing Success Coordinator who uses Assessment Technologies Institute (ATI) and the simulations of Nursing, resources serves as a dedicated academic support professional within a nursing program, focused on improving student performance, retention, and NCLEX success rates. This role involves acting as a liaison between students, faculty, and ATI, Evolve, Sherpath, vSim and others simulators programs. Essential Duties and Responsibilities: Student Remediation and Support: Establishes plans of action for students who fail exams or struggle academically, providing one-on-one or group tutoring, workshops, and study habit coaching. They guide students through online modules and tutorials, such as the Launch academic readiness program, to build foundational knowledge and essential nursing skills. ATI Integration and Management: Ensures the smooth operation and full integration of ATI, Evolve, Sherpath, vSim and others simulators programs resources across all program levels. This includes scheduling and setting up testing, managing student accounts, and assisting faculty in using ATI, Evolve, Sherpath, vSim and others simulators programs materials in both classroom and clinical settings. Data Analysis and Intervention: Analyzes data from proctored assessments, practice exams, and student time in tutorials to identify individual and cohort weaknesses and trends. This data-driven approach allows for personalized study plans and early intervention strategies. Faculty Liaison and Training: Serves as a campus "ATI champion," Evolve, Sherpath, vSim and others simulators programs. Ensuring faculty training is completed and best practices for using all products are reinforced throughout the program. They also serve as the main point of contact with ATI, Evolve, Sherpath, vSim and others simulators programs. company representatives. NCLEX Preparation: Utilizes ATI's, Evolve, Sherpath, vSim and others simulators programs comprehensive predictor exams and other resources to track student progress and predict NCLEX success, providing targeted support to ensure students are practice-ready upon graduation. Supervisory Responsibilities: This role does not involve supervision of other employees but may provide guidance and support to students and faculty as needed. Qualifications/Education: Master's degree in Nursing (MSN) with Role in Education highly desirable. Current specialist nurse license. Relevant nursing experience, typically several years, is expected. Familiarity and expertise with the ATI, Evolve, Sherpath, vSim and others simulators programs and learning platforms are essential skills for this role. Strong interpersonal, communication, and data management skills are necessary to collaborate with faculty, advise students, and manage program data effectively Proficiency and familiarity with educational platforms and simulation programs such as ATI, Evolve, Sherpath, vSim, and other learning management or simulation tools are essential. Strong interpersonal, communication, and data management skills are required to effectively collaborate with faculty, advice and support students, and manage academic and program-related data. Competencies: Technical Competencies Proficiency in Learning Management Systems (LMS) such as Canvas and their integration with ATI, Evolve, Sherpath, vSim, and other learning management or simulation tools are essential. Competence in digital tools such as Microsoft Teams, Words, Excel, among others. Ability to analyze student performance data and apply findings to continuous improvement initiatives. Knowledge of simulation-based learning methodologies and assessment tools. Core Competencies Strong analytical, organizational, and problem-solving skills. Excellent written and verbal communication abilities. Leadership and teamwork skills with a focus on collaboration and faculty support. Ability to train and mentor faculty and students in the effective use of technological platforms. Commitment to academic excellence, innovation, and quality improvement. High attention to detail, confidentiality, and data integrity. Capacity to manage multiple priorities in a fast-paced academic environment. Language Skills: Ability to express him or herself correctly, precisely, and effectively, orally and in writing. Command of English and Spanish. Mathematical Skills: Ability to make mathematical and deductive reasoning problem solving.+ Technological Skills: Computer skills including practical experience in Microsoft Word, Power Point, Outlook with advance skills in Microsoft Excel. Reasoning Ability: Can identify problems and present solutions. Physical Demands: While performing the duties of the position, physical effort is required (hands and feet). Work Environment: The work environment is dynamic and active. Work will be in an office with different tasks.

Enforce and interpret policies for the delivery of patient and resident care. Ensure proper staffing for each unit, keeping staff ratio, appropriate staffing for patient care needs, covering call-offs and vacation time. Ensure chart checks are completed, seclusion/restraint log is up to date and nursing assessments are completed, as well as MAR's and report sheets are kept accurate and up to date. Rounds are completed at the beginning of shift and perform random audits. Assist DON to make sure all staff are oriented and competent to perform required duties. May include coaching staff. Assist DON by ensuring facility compliance with professional, regulatory and governmental standards. Ensure the effective delivery of competent, compassionate and safe care by monitoring and evaluating patient care processes and outcomes on the patient care units. Prioritize tasks and delegate staff to ensure quality patient care. Leader on shift for all admissions and discharges, as well as informing physician of changes in the patient's conditions. Adjusts staffing accordingly. Utilize administrator-on-call for situations that require additional attention.

Job Description A Nursing Success Coordinator who uses Assessment Technologies Institute (ATI) and the simulations of Nursing, resources serves as a dedicated academic support professional within a nursing program, focused on improving student performance, retention, and NCLEX success rates. This role involves acting as a liaison between students, faculty, and ATI, Evolve, Sherpath, vSim and others simulators programs. Essential Duties and Responsibilities: Student Remediation and Support: Establishes plans of action for students who fail exams or struggle academically, providing one-on-one or group tutoring, workshops, and study habit coaching. They guide students through online modules and tutorials, such as the Launch academic readiness program, to build foundational knowledge and essential nursing skills. ATI Integration and Management: Ensures the smooth operation and full integration of ATI, Evolve, Sherpath, vSim and others simulators programs resources across all program levels. This includes scheduling and setting up testing, managing student accounts, and assisting faculty in using ATI, Evolve, Sherpath, vSim and others simulators programs materials in both classroom and clinical settings. Data Analysis and Intervention: Analyzes data from proctored assessments, practice exams, and student time in tutorials to identify individual and cohort weaknesses and trends. This data-driven approach allows for personalized study plans and early intervention strategies. Faculty Liaison and Training: Serves as a campus "ATI champion," Evolve, Sherpath, vSim and others simulators programs. Ensuring faculty training is completed and best practices for using all products are reinforced throughout the program. They also serve as the main point of contact with ATI, Evolve, Sherpath, vSim and others simulators programs. company representatives. NCLEX Preparation: Utilizes ATI's, Evolve, Sherpath, vSim and others simulators programs comprehensive predictor exams and other resources to track student progress and predict NCLEX success, providing targeted support to ensure students are practice-ready upon graduation. Supervisory Responsibilities: This role does not involve supervision of other employees but may provide guidance and support to students and faculty as needed. Qualifications/Education: Master's degree in Nursing (MSN) with Role in Education highly desirable. Current specialist nurse license. Relevant nursing experience, typically several years, is expected. Familiarity and expertise with the ATI, Evolve, Sherpath, vSim and others simulators programs and learning platforms are essential skills for this role. Strong interpersonal, communication, and data management skills are necessary to collaborate with faculty, advise students, and manage program data effectively Proficiency and familiarity with educational platforms and simulation programs such as ATI, Evolve, Sherpath, vSim, and other learning management or simulation tools are essential. Strong interpersonal, communication, and data management skills are required to effectively collaborate with faculty, advice and support students, and manage academic and program-related data. Competencies: Technical Competencies Proficiency in Learning Management Systems (LMS) such as Canvas and their integration with ATI, Evolve, Sherpath, vSim, and other learning management or simulation tools are essential. Competence in digital tools such as Microsoft Teams, Words, Excel, among others. Ability to analyze student performance data and apply findings to continuous improvement initiatives. Knowledge of simulation-based learning methodologies and assessment tools. Core Competencies Strong analytical, organizational, and problem-solving skills. Excellent written and verbal communication abilities. Leadership and teamwork skills with a focus on collaboration and faculty support. Ability to train and mentor faculty and students in the effective use of technological platforms. Commitment to academic excellence, innovation, and quality improvement. High attention to detail, confidentiality, and data integrity. Capacity to manage multiple priorities in a fast-paced academic environment. Language Skills: Ability to express him or herself correctly, precisely, and effectively, orally and in writing. Command of English and Spanish. Mathematical Skills: Ability to make mathematical and deductive reasoning problem solving.+ Technological Skills: Computer skills including practical experience in Microsoft Word, Power Point, Outlook with advance skills in Microsoft Excel. Reasoning Ability: Can identify problems and present solutions. Physical Demands: While performing the duties of the position, physical effort is required (hands and feet). Work Environment: The work environment is dynamic and active. Work will be in an office with different tasks.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance RN Clinical Consultation **We are looking to add 6 nurses; If you can work any of these shifts, please apply:** **1 nurse 8pm-4am CST, 1 nurse 2pm-10:30pm CST and 4 nurses 12pm -8:30pm CST.** **PRIMARY PURPOSE OF THE ROLE:** To triage calls to assess needs, giving appropriate care advice and disposition to appropriate level of care treatment while promoting cost-effective outcomes and safely facilitate return to work. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. + Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. + Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. + Enjoy flexibility in your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. + Enable our Caring counts mission supporting injured employees from some of the world's best brands and organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Applies all phases of the nursing process, i.e. assessment, planning, implementation and evaluation when triaging calls. + Identifies the needs of caller by triaging, obtaining general health information and/or physician services referral. + Evaluates need for alternative treatment through telephonic contact and assessment with service provider. + Triages patient using defined triage protocols to obtain pertinent data; and enters data into computer system. + Identifies life-threatening emergencies and recommends appropriate interventions. + Refers issues requiring physician interventions to physician in a timely manner; directs patients to appropriate level of care including but not limited to the nearest emergency room, urgent care facility, primary treating physician or selfcare. Demonstrates effective verbal communications skills. + Adheres to quality assurance standards. + Serves as resource to triage team members. **EDUCATION AND LICENSING** Bachelor's degree in nursing (BSN) preferred. Active unrestricted RN compact licensure required along with two year (2) years of recent clinical practice experience. Should be proficient in multiple screens and multiple computer applications,. **TAKING CARE OF YOU BY** + Seeks innovative customer solutions . + Craves cutting edge opportunities. + Wants dynamic company culture. + Passion about creativity. + Seeks ongoing learning as a person and professional. + Thrives when solving challenging problems. + Wants achievements to be celebrated. + We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day. **NEXT STEPS** If your application is selected to advance to the next round , a recruiter will be in touch. \#NURSE _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $68,000-$70,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ Always accepting applications Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

At Headlands Research, we are dedicated to enhancing clinical trial delivery within our communities. As a leading network of advanced clinical trial sites, we leverage cutting-edge technology and exceptional support services to broaden outreach and participation. Founded in 2018, our rapidly growing company currently operates 20+ sites across the US and Canada, with plans for further expansion. About Us: CMRC Headlands is a premier clinical research site in San Juan, Puerto Rico. We conduct cutting-edge clinical trials in collaboration with global pharmaceutical sponsors, bringing medical innovation to our local communities. Our mission is to advance science while centering the patient experience at every stage of research. Position Summary: CMRC is seeking a seasoned, full-time Registered Nurse (RN) with strong clinical acumen and hands-on experience in both adult and pediatric settings. The ideal candidate has a background in hospital or private clinical practice, is passionate about patient-centered care, and thrives in a fast-paced, ambiguous, research-driven environment. This role requires a proactive self-starter who can navigate complex protocols with clinical judgment, independence, and attention to detail. Bilingual fluency in English and Spanish is essential. Responsibilities: Perform and document pediatric and adult phlebotomy procedures Administer and document vital signs and clinical assessments Support all phases of patient interaction including screening, enrollment, dosing, and follow-ups Act as clinical support during study visits-monitor, document, and report on patient status and adverse events Manage specimen handling, labeling, storage, and timely shipment according to protocol Provide clinical oversight for study-related procedures to ensure safety and compliance Coordinate and schedule research visits and procedures with precision and patient sensitivity Review and interpret study protocols through a clinical lens to anticipate patient care needs Communicate effectively with investigators, monitors, sponsors, and internal teams Support study recruitment and patient outreach strategies Maintain and organize source documentation and regulatory binders Prepare for monitoring visits and assist during sponsor or regulatory audits Other duties as needed to support study execution Required Qualifications: Active and unrestricted Registered Nurse license in Puerto Rico Minimum of 6 years of experience in a clinical setting (hospital or private practice) Minimum of 4 years drawing blood from both pediatric and adult patients Solid understanding of Good Clinical Practice (GCP) and/or willingness to undergo training Comfort working within protocol-driven environments with shifting timelines Demonstrated ability to operate autonomously and take initiative within a small, agile team Proficient with electronic medical records, clinical data entry, and laboratory documentation Exceptional organizational and multitasking skills Strong interpersonal skills and compassionate bedside manner Fluent in English and Spanish (written and verbal) Preferred Qualifications: Prior experience in clinical research or investigational trials is a plus Familiarity with FDA, ICH-GCP, and HIPAA compliance standards Experience preparing for and interacting with clinical trial monitors

**Become a part of our caring community and help us put health first** Reports To: Associate Director, Home Health Branch Administrator FLSA: Exempt **Work Schedule** : Full-time/40 Hours Type** : On-site **Branch Location** : Charleston, SC **This branch is commonly referred to as CWHH - North Charleston.** **** $10,000 Associated Sign-on Bonus **** **** This position is eligible for relocation assistance. The specific package offered will vary based on individual circumstances and company policy. **** ***This is an on** **‑** **site position located at our Charleston, SC branch.** ***Remote, work-from-home, and hybrid work arrangements are not supported for this role.** The **RN Clinical Operations Manager** coordinates and oversees all direct care patient services provided by clinical personnel. This role is a focused on both home health clinical quality assurance and home health clinical operations initiatives. + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies. + Manages the assignment of caregivers. + Responsible for and oversees the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission criteria and make the decision to admit patients to service. Assigns appropriate clinicians to a case, as needed. + Instructs and guides clinicians to promote more effective performance and delivery of quality home care services and is available at all times during operating hours to assist clinicians as appropriate. + Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing patient Plan of Care (POC). + Monitors cases to ensure documentation is following compliance with regulatory agencies and requirements of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. + Participates in sales and marketing initiatives. + Supervises all clinical employees assigned to a specific location. Responsible for the overall direction, coordination, and evaluation of the location. Carries out supervisory responsibilities in accordance with Company policies and procedures. + Handles necessary employee corrective action and discipline issues fairly and objectively, in consultation with the Human Resources Department and the Executive Director/Director of Operations. + Participates in the interviewing, hiring, training, and development of direct care clinicians. Evaluates their performance relative to job goals and requirements. Coaches staff and recommends in-service education programs, when needed. Ensures adherence to internal policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts regular staff education as needed. + Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, for appropriateness of care, delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient care on an infrequent basis and only in times of emergency. + Acts as Branch Director in his/her absence. + Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards. **Use your skills to make an impact** **Education:** + Associate degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with authorization to practice in the state of South Carolina. + Proof of current CPR card and/or BLS certification. **Required Experience/Skills:** + Valid driver's license, auto insurance and reliable transportation. + A minimum of 2 years of experience as a Registered Nurse (RN). + Background in home-based care settings, including traditional home health, hospice, or palliative care is strongly preferred. + Management and people leadership experience is preferred. + OASIS experience is preferred. OASIS certification (HCS-O, COQS, and/or COS-C), preferred. + Homecare Homebase (HCHB) experience is preferred. + Foundational knowledge and basic understanding of CMS PDGM is preferred. **Additional Information** + Normal Hours of Operation: M-F / 8a-5p (ET) + On-Call Expectation: Yes, rotating on-call shift. + Branch Size: 700+ Census (5.0 STAR rating) + Annual Bonus Eligible: Yes, eligible for the annual incentive bonus which has pay-outs both quarterly and annually. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $77,200 - $106,200 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

PURPOSE AND SCOPE: The Inpatient RN provides direct patient care in accordance to company policies and procedures which includes FMCNA compliance programs and contracted hospitals' policies and procedures. Areas of practice are diverse, including, but not limited to, hemodialysis, peritoneal dialysis, continuous renal replacement therapies, apheresis, and ultrafiltration. The Inpatient RN will partner with the hospital to provide quality care to the patient and deliver care that provides a positive patient experience. PRINCIPAL DUTIES AND RESPONSIBILITIES: Under limited supervision, applies considerable knowledge to perform a broad range of tasks which include but are not limited to direct patient care in multiple modalities not limited to hemodialysis, peritoneal dialysis, ultrafiltration, continuous renal replacement therapy, and Apheresis. Provides supervision and direction of Patient Care Technicians and clerical staff; provides direction and education to ICU staff for CRRT. Responsible for direct patient care of assigned patients in the Inpatient Renal Replacement and Apheresis Services setting and providing the appropriate treatment technique for assigned patients as prescribed in all modality procedures, as appropriately defined - hemodialysis, peritoneal, continuous renal replacement therapies, ultrafiltration, and Apheresis. Assesses patients' responses to treatment therapy making appropriate adjustments and modifications to the treatment plan as indicated by the appropriately credentialed physician. Communicate problems or concerns to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. Delivers safe, effective care in a timely an efficient manner. Gives organized, concise shift reports for patients on assigned shifts. Apply high level thinking skills to shift patient schedules to meet needs of more critical patients due to labs, MD order, or patient assessment. Responsible for the implementation, administration, monitoring, and documentation of patient's response to prescribed intradialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier. Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust, and coordinate daily patient care plan to ensure continuity of care. Initiates and communicates to FMS facility nursing staff and appropriate hospital personnel as needed. Accurately documents all treatment information in the individual patient record (ACES) and the hospital record, as needed. Cleans and disinfects dialysis machine surface, chair, equipment, and surrounding areas between treatments according to inpatient renal services policies and procedures. Conducts all tasks necessary for preparation for dialysis treatment and documents where appropriate. Performs all required pre-treatment dialysis machine alarm testing. If applicable, initiates Solution Delivery System. Operates all related equipment appropriately and safely and provides minor trouble shooting when necessary; efficiently utilizes supplies to prevent waste. Understands, conducts, and documents appropriately Dialysis/Apheresis machine safety tests/alarm tests, equipment calibration, dialysate testing, machine safety tests, functional testing, and internal and external disinfection on all water & dialysis machines, and complies with the documentation/notification standards per FMS policies. Completes and documents ongoing participation in QAI activities. Participates in staff meetings as scheduled. Participates in staff training and orientation as assigned. Acts as a subject matter expert to hospital staff for dialysis related patient/equipment complications. Responsible for reporting all new or unusual incidents, information, complaints, or problems to the inpatient manager and other parties per the Adverse Event Report requirements. May be assigned to in-center patient care on an as needed basis Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. Assist with various projects as assigned by direct supervisor. Other duties as assigned. PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodations can be made. Direct patient care, interaction with patients, outpatient clinicians, hospital staff, and physicians. The position requires travel between assigned hospitals and facilities; as well as travel to regional meetings/educational events. Position requires on call rotation including night, day, weekend, and holidays. There is potential for exposure to potentially infectious material and contagious diseases/material. Position provides direct patient care which regularly involves heavy lifting, moving of patient and/or equipment > 200lbs (with assistance); and may lift chemical and water solutions of up to 30lbs up as high as 5 feet. SUPERVISION: Provides supervision and direction of Patient Care Technicians (Certified Clinical Hemodialysis Technicians (CCHT)) and clerical staff; provides direction and education to ICU staff for CRRT. EDUCATION: Current appropriate state licensure. Maintains acquired knowledge and remains current in advancements in nephrology, in particular, relative to inpatient care (hospitalized patients requiring varied treatment modalities, not limited to Renal Replacement, Apheresis, and Ultrafiltration services). Must meet the practice requirements in the state in which employed. Certification in Nephrology Nursing, Apheresis Nursing, or both is highly encouraged. EXPERIENCE AND REQUIRED SKILLS: One year RN experience required and required nursing skills. Minimum 6 months nephrology experience required before working independently with no other Dialysis RNs to provide dialysis and ultrafiltration services. Minimum 6 months Nephrology experience required before working independently with no other Apheresis RNs to provide Apheresis services. Demonstrated strong assessment skills related to the critically ill patient. ICU experience preferred but not required. Successful completion of training course in the theory and practice of care of the ESRD patient - Progressive Renal Education Preparation. BLS CPR Recognition. ACLS CPR Recognition preferred, but not required. Demonstrates organizational and time management skills, and a competency toward completing continuing and ongoing Renal/Nephrology education. Displays leadership skills and ability to direct and supervise others (such as PCTs, CCHTs, clerical staff). Successful completion of Nurses Technical Training. Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws. Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors

Responsible for the care of the patient, family and staff members of the healthcare team. This is a leadership role which includes staffing issues, employee concerns, and ensuring required nursing care is be delivered while acting as House Supervisor. Enforce and interpret policies for the delivery of patient and resident care. Ensure proper staffing for each unit, keeping staff ratio, appropriate staffing for patient care needs, covering call-offs and vacation time. Ensure chart checks are completed, seclusion/restraint log is up to date and nursing assessments are completed, as well as MAR's and report sheets are kept accurate and up to date. Rounds are completed at the beginning of shift and perform random audits. Assist DON to make sure all staff are oriented and competent to perform required duties. May include coaching staff. Assist DON by ensuring facility compliance with professional, regulatory and governmental standards. Ensure the effective delivery of competent, compassionate and safe care by monitoring and evaluating patient care processes and outcomes on the patient care units. Prioritize tasks and delegate staff to ensure quality patient care. Leader on shift for all admissions and discharges, as well as informing physician of changes in the patient's conditions. Adjusts staffing accordingly. Utilize administrator-on-call for situations that require additional attention. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. null

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. Primary Responsibilities: * Clinical Case Reviews -75% * Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported * Maintain standards for productivity and accuracy. Standards are defined by the department * Provide clear and concise clinical logic to the providers when necessary * Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization * Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities * Investigate and pursue recoveries * Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance * Use pertinent data and facts to identify and solve a range of problems within area of expertise * Other internal customer correspondence and team needs - 15% * Attend and provide feedback during monthly meetings with assigned internal customer department * Provide continuous feedback on how to improve the department relationships with internal team members and departments * Continuing education - 10% * Keep up required Coding Certificate and/or Nursing Licensure * Complete compliance hours as required by the department * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Registered Nurse (RN), Coding Certificate or Nursing Licensure, for example: * Puerto Rico Registered Nurse * Certified Professional Coder (CPC) + CPC A * Certified Inpatient Coder (CIC) * Certified Outpatient Auditor (COC) * Certified Professional Medical Auditor (CPMA) * Certified Coding Specialist (CCS) * Experience in a hospital/inpatient setting, surgical or clinic * Demonstrated proficiency with computers, including Microsoft Suite of products * Willing or able to work from Monday to Friday, 40 hours per week during our business operating hours of 8am - 7pm ATL * Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for this position) Preferred Qualifications: * Experience working with medical claims platforms * Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting * Presentation or policy documentation experience * Knowledge of CMS and AMA coding rules specific to CPT, HCPCS * Knowledge of CMS Coverage, Federal and State Statues, Rules and Regulations * Knowledge of Medicaid/Medicare Reimbursement methodologies * Working knowledge of the healthcare insurance/managed care industry * Working knowledge of medical terminology and claim coding At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. The Registered Nurse - Wound Specialist, specializes in treating patients with wounds like burns, pressure ulcers, diabetic / arterial ulcers, and more this is performed in accordance with physician orders and plan of care under the direction and supervision of the agency. ________________________________________________________________ About Company: CMS offers an Integrated Home Health System, which includes Durable Medical Equipment (DME), Respiratory Equipment, Home Health Services, Infusion Services, Orthotics and Prosthetics can count on CMS for their immediate, guaranteed. Our service model is recognized by our business partners, positioning us with over three decades of experience as the market leader serving over 800,000 people in Puerto Rico. Come and be part of CMS. Being part of our work team, where we are distinguished by the excellence of the service, we offer our patience. Position Summary: A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the agency Director of Nursing and/or Administrator. Minimum Requirements: Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing. Wound Care Certification required. Al least six (6) months' experience in a Wound Specialist position. Acceptance of philosophy and goals of this Agency. Ability to exercise initiative and independent judgment. “CMS Inc. and CMS Home Care, LLC. is an Equal Employment Opportunity Employer. Affirmative Action for Women, Minorities, Veterans, and People with Disabilities"

**Become a part of our caring community and help us put health first** Reports To: Associate Director, Home Health Branch Administrator FLSA: Exempt **Work Schedule** : Full-time/40 Hours Type** : On-site **Branch Location** : Bluffton, SC **This branch is commonly referred to as CWHH - Beaufort.** **** $10,000 Associated Sign-on Bonus **** **** This position is eligible for relocation assistance. The specific package offered will vary based on individual circumstances and company policy. **** ***This is an on** **‑** **site position located at our Bluffton, SC branch.** ***Remote, work-from-home, and hybrid work arrangements are not supported for this role.** The **RN Clinical Operations Manager** coordinates and oversees all direct care patient services provided by clinical personnel. This role is a focused on both home health clinical quality assurance and home health clinical operations initiatives. + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies. + Manages the assignment of caregivers. + Responsible for and oversees the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission criteria and make the decision to admit patients to service. Assigns appropriate clinicians to a case, as needed. + Instructs and guides clinicians to promote more effective performance and delivery of quality home care services and is available at all times during operating hours to assist clinicians as appropriate. + Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing patient Plan of Care (POC). + Monitors cases to ensure documentation is following compliance with regulatory agencies and requirements of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. + Participates in sales and marketing initiatives. + Supervises all clinical employees assigned to a specific location. Responsible for the overall direction, coordination, and evaluation of the location. Carries out supervisory responsibilities in accordance with Company policies and procedures. + Handles necessary employee corrective action and discipline issues fairly and objectively, in consultation with the Human Resources Department and the Executive Director/Director of Operations. + Participates in the interviewing, hiring, training, and development of direct care clinicians. Evaluates their performance relative to job goals and requirements. Coaches staff and recommends in-service education programs, when needed. Ensures adherence to internal policies and standards. + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts regular staff education as needed. + Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, for appropriateness of care, delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient care on an infrequent basis and only in times of emergency. + Acts as Branch Director in his/her absence. + Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards. **Use your skills to make an impact** **Education:** + Associate degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license or Compact State RN license with authorization to practice in the state of South Carolina. + Proof of current CPR card and/or BLS certification. **Required Experience/Skills:** + Valid driver's license, auto insurance and reliable transportation. + A minimum of 2 years of experience as a Registered Nurse (RN). + Background in home-based care settings, including traditional home health, hospice, or palliative care is strongly preferred. + Management and people leadership experience is required. + OASIS experience is preferred. OASIS certification (HCS-O, COQS, and/or COS-C), preferred. + Homecare Homebase (HCHB) experience is preferred. + Foundational knowledge and basic understanding of CMS PDGM is preferred. **Additional Information** + Normal Hours of Operation: M-F / 8a-5p (ET) + On-Call Expectation: Yes, rotating on-call shift. + Branch Size: 315+ Census (4.5 STAR rating) + Annual Bonus Eligible: Yes, eligible for the annual incentive bonus which has pay-outs both quarterly and annually. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $77,200 - $106,200 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************