Oncology nurse work from home jobs

Join Wilson Homecare's On-Call Float Program - CAREGIVERS WANTED! Up to $1500 Sign On Bonus & Full-Time Benefits & Salary! $Are you an experienced nurse aide or caregiver with a passion for providing exceptional care? Wilson Homecare is expanding its highly sought after on-call float program and is actively seeking skilled and compassionate individuals like you! Dive into a rewarding opportunity to care for a diverse range of clients across different areas of Oahu, offering competitive salaries and outstanding benefits. Nurse Aide (FLOAT) - On-Call Program Lucrative Compensation - Competitive weekly salary ranging from $700 to $1,000, with additional sign on bonuses up to $1,500. Flexible Schedules -Customize your availability with options ranging from 2 to 7 days a week, each featuring varying compensation tiers. Career Advancement - Explore growth opportunities within our organization driven by your dedication and skills. Comprehensive Benefits - Access to medical, dental, and vision insurance, 401K retirement plans, and more. As an On-Call Float Nurse Aide, leverage your skills to provide comprehensive care to a wide ranging spectrum of clients utilizing various home healthcare equipment. Your role will involve addressing various client needs, including bed baths, showers, brief changes, transfers, alzheimers/dementia care, and many other skills. One year experience as a nurse aide or CNA certification. Immediate response to phone calls/text/emails during assigned On-Call shifts. If you possess the skills and passion for delivering exceptional care, contact our Recruiting department at ************** to explore joining our On-Call Float program. Virtual and in-person interviews are available Monday-Friday from 9 am to 4 pm. For more details about our company, visit our website at WilsonCare.com . Start the New Year off right with your new career at Wilson Homecare!

Explore Career Opportunities at Alpha-9 Oncology! At Alpha-9 Oncology, we're always looking for passionate and talented individuals who want to make an impact. If you don't see a current opening that aligns with your skills and experience, we'd still love to hear from you! By submitting your resume, you'll be added to our talent network, and we'll reach out if an opportunity arises that could be a great fit. With offices in Vancouver, Boston, and San Francisco, we're growing and excited to connect with individuals who share our commitment to advancing cancer research. If you're interested in joining our team in the future, we encourage you to share your resume-we look forward to staying in touch! Company Summary Alpha-9 Oncology is a clinical-stage biotechnology company pioneering radiopharmaceutical innovation for solid tumors. Our proprietary scaffolds, composed of optimized binders, linkers, chelators, and radioisotopes, enable targeted radiation delivery to cancer cells, minimizing harm to surrounding healthy tissue. Focusing on innovative targeting moieties, we develop molecules tailored for precise tumor targeting. Our comprehensive platform integrates imaging and therapeutic studies to ensure effective radiation delivery and improved patient outcomes. With a robust pipeline entering clinical trials and strong support from leading healthcare investors, Alpha-9 is positioned for rapid growth and advancement in cancer therapy. More about Alpha-9 Oncology Alpha-9 Oncology is committed to fostering a diverse and inclusive workplace and is proud to be an Equal Opportunity Employer. We provide employment opportunities to all qualified applicants without regard to race, ethnicity, religion, age, sex, gender identity or expression, sexual orientation, disability, marital status, family status, national origin, or any other characteristic protected by applicable federal, provincial, or local laws where we operate. We are dedicated to providing reasonable accommodations to qualified applicants and employees to ensure that everyone can perform their essential job functions in an inclusive environment. For inquiries regarding accommodations in the hiring process or for current employees, please contact a member from our Talent Acquisition team.

Be your own boss! As a member of illumifin's national network of Registered Nurses, you will visit local clients at their place of residence. Using your nursing skills these assessments will help to paint a picture of the client's needs. As an independent contractor, the amount of clients you visit and your schedule is up to you. Responsibilities Utilizing illumifin's proprietary questionnaires obtain thorough cognitive and health assessment information as requested Comply with all assessment instructions and accurately complete assessment paperwork Communicate promptly with illumifin regarding file status and appointment times Return completed assessment within 24 hours after the appointment Respond promptly to any follow-up and clarification questions regarding each submitted assessment With easy E-Assessments you can complete assessments electronically using your cell phone, tablet, iPad, or Laptop

This is a contract assignment that will start right away and end on April 30th 2024 Review Nurse SUMMARY DESCRIPTION: The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for reviewing and accurately performing comprehensive review of medical records to abstract relevant clinical data during HEDIS. HEDIS abstractions are completed in accordance with NCQA guidelines and technical specifications. Additional responsibilities include but not limited to folder and file management, annotating medical records and saving completed documents with correct naming conventions on a shared drive as well as data entry into QSHR. ESSENTIAL FUNCTIONS: Abstract medical records Apply product/plan specific abstraction criteria/requirements during medical record review process Maintain defined productivity volumes Sustain accuracy rate of 95% during abstraction and data entry throughout the HEDIS survey Perform quality reviews of abstracted medical records as assigned Ensure open and honest communication with management/designee regarding development or assistance needed throughout project Escalate work related challenges/issues to Senior Director or designee Attend scheduled daily and ad-hoc meetings with HEDIS Project Manager, and /or Quality Management Specialist/ designee to discuss project status, open issues and productivity Comply with HIPAA, PHI, patient confidentiality, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies Other duties as assigned JOB REQUIREMENTS: Registered Nurse (RN)/ Licensed Practical Nurse ( LPN ) with unrestricted license 2 years' HEDIS abstraction/over-reading experience Data entry proficiency Working knowledge PDF, Word and Excel Excellent written and communication skills Database management Preferred Skills: Experience in Pediatrics, Cardiology, Endocrinology and/or Obstetrics QSHR proficiency

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

Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse Coordinator is a Registered Nurse assigned to various Health Services operational units. These units include Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The role involves performing utilization management activities, including telephonic or onsite clinical reviews, case or disease management, care coordination, transition activities, or population health activities. The position requires working with a specific member population and may require bilingual skills in Spanish for certain roles. Responsibilities * Comply with HIPAA, Privacy, and Confidentiality laws and regulations. * Adhere to Health Plan, Medical Management, and Health Services policies and procedures. * Stay informed about clinical knowledge related to disease processes. * Communicate effectively, both verbally and in writing, with providers, members, vendors, and other healthcare providers. * Function as a collaborative member of the multi-disciplinary medical management team. * Identify and report quality of care concerns to management and appropriate departments. * Support and collaborate with team members in implementing and managing Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities. * Participate in the implementation, assessment, and evaluation of quality improvement activities. * Adhere to mandated reporting requirements and comply with regulatory standards. * Be positive, flexible, and open to operational changes. * Attend and actively participate in department meetings. * Participate in the development and evaluation of department initiatives aimed at improving member quality of care. * Stay updated on healthcare benefits and limitations, regulatory requirements, disease processes, treatment modalities, community standards, and professional nursing standards. Essential Skills * Utilization management and review experience. * Strong multi-tasking, organizational, and time-management skills. * Clinical knowledge of adult or pediatric health conditions and disease processes. * Ability to work both individually and collaboratively in a cross-functional team environment. * Excellent interpersonal and communication skills. * Ability to compose clear, professional correspondence. * Understanding of quality improvement theory and strategy. * Experience with HEDIS medical record abstraction. Additional Skills & Qualifications * Registered Nurse (RN) license. * Bilingual skills in Spanish may be required for certain roles. * Experience in case management and working with health plans and providers. Work Environment The role is based in an office setting where the services team works collaboratively. The team includes Case Management, Pharmacy, UM, and Pediatrics. It is a supportive and helpful environment with a mission-driven company that values its employees, offering catered lunches weekly. Job Type & Location This is a Contract position based out of Santa Barbara, CA. Pay and Benefits The pay range for this position is $47.00 - $47.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 20, 2025. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse - Home Visits (PRN), you'll provide high-quality nursing care directly in patients' homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work. Key Points to Know: • You'll use your own vehicle to visit patients in their homes, typically within 1-2 hours of your location. • Shifts are PRN / per diem, meaning you'll work only when projects are available in your area; project frequency may vary. • Orientation, training, and project-specific instructions are provided before each assignment. • You will be compensated for all time spent on training, travel, and patient visits, including documentation. Position: Clinical Research Nurse - Home Visits (PRN) Job Type: Contract, PRN, Per Diem Hourly Rate: $60/hr onsite and $50/hr travel time Work Location: Boston, Massachusetts; Drive up to 1-2 hours to patient homes in your area (travel time compensated!) Job Description: As a Clinical Research Nurse - Home Visits (PRN), you will play a crucial role in ensuring the successful execution of research studies in patient homes. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your expertise and caring nature will help us maintain compliance with each study's protocol and safeguard the well-being of study patients. Principal Duties and Responsibilities: Deliver competent, high-quality nursing care to study patients in their homes. Accountable for the competent and confident delivery of high-quality clinical care to patients/participants. Ensure compliance with each study's protocol by providing thorough review and documentation at each subject study visit. Administer investigational medications/products as needed; Perform patient assessments to determine presence of side effects; notify Principal Investigator of findings/issues. Perform medical tests as outlined in protocol, including, but not limited to: vital signs, specimen collection, electrocardiograms; Process specimens and ship specimens per protocol. Provide patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment. Responsible for adherence to clinical research policies to ensure ethical conduct and protect vulnerable populations. Communicate effectively, promoting open and trusting relationships. Qualifications: Relevant Nurse Licensure CH-GCP Certificate Graduate from an accredited BSN or Associate Degree in Nursing or Nursing Diploma program Minimum 2 years' post qualification acute care experience Clinical Research experience preferred BLS certification required Experience and knowledge of working in clinical research trials with ICH-GCP (Good Clinical Practice) Certification - (training can be provided) Good basic IT skills, utilizing mobile devices and Microsoft systems Trained in Handling and Transport of Hazardous Substances (training can be provided) A flexible schedule is essential Unencumbered driver's license, reliable car Benefits: Competitive hourly pay rate, including compensation for travel time. Flexible schedule to maintain work-life balance. Mileage reimbursement for travel expenses. Ongoing training and support to growth your clinical research skills Opportunity to make a meaning impact on patients' lives while contributing to cutting-edge medical research. Join our team and contribute to groundbreaking medical advancements through clinical research!

Job Description Nursing Administrator The Center for Wound Healing & Hyperbaric Medicine, LLC (CFWH) provides management and consulting services to healthcare providers in the area of wound care and hyperbaric medicine. By focusing on the needs of the patients as well as the partners we serve, The Center for Wound Healing & Hyperbaric Medicine, LLC is able to bring advanced wound healing strategies to many communities around the country. Our Core Values: Compassion, Excellence, Passionate, Integrity, Dedication, Loyalty, Accountability, Enterprising. Job Overview: The Nursing Administrator assists with all patient care services, including but not limited to, case management, extensive chart reviews, utilization of services reviews and discharge planning. Ensures compliance with patient care quality standards as it relates to the care provided to all wound care and hyperbaric patients. Supports all clinical training initiatives for new and existing staff, which includes both hands-on and virtual training. This position reports to the Chief Nursing Officer (CNO). What You'll be Doing: Understands wound care and hyperbaric nursing protocols; ability to practice as required. Participates in the chart review process to ensure patients qualify for treatment prior to appointment. Communicates charting revisions to appropriate staff in a professional, helpful, and kind manner. Educate, as needed. Partners with the HR & Training department on new hire training to provide educational assistance as needed. Requested clinical training from CA may be remote or in-person. Works with the CNO to identify training needs for current staff. Creates appropriate training material/courses and educational aids. Provides training remotely or in-person. Travels to wound centers across the U.S. to support on-going clinical education, coach and develop nursing staff, and to cover clinical shifts if/when required. Supports new clinic openings as requested by the CNO. Support may be administrative, virtual and/or hands-on. Works closely with clinic leadership to advise on patient scheduling, chart reviews, physician communication, and patient evaluations for HBO qualification. Responsible for staying up to date on the standards of care related to wound care and hyperbaric oxygen therapy (local coverage determinations/LCDs) and education of such. Partners closely with the Revenue Cycle Department on insurance verifications to get authorization in a timely and efficient manner. Creates and/or updates clinical procedures for new and existing staff to adhere to. Communicates and trains on procedures as required. Maintains close coordination with all departments to ensure continuity and collaboration of services. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) by safeguarding patient information and maintaining the highest level of confidentiality standards. Maintains efficient and effective clinical operations while verifying compliance with all local, state and federal regulations, standards and protocols. Consistently adheres to company, hospital, and accrediting body clinical, safety, and compliance standards. Other duties as assigned. Requirements for This Role: Registered Nurse (RN) from an accredited school or college of nursing. Current state licensure; no restrictions to obtain RN license in additional states. Current Basic Life Support (BLS) from approved agency. 2+ years wound care experience required. 2+ years clinical training experience required. Deep understanding of charting, billing and insurance authorizations. Proficient in Microsoft Office or related systems. Proficient in a minimum of one EMR system. Strong verbal and written communication skills. Ability to treat others with compassion and patience. Ability to work in a fast-paced team-oriented environment. Must possess excellent interpersonal skills. All employees are required to comply with HIPAA policies and procedures. Desired Qualifications for This Role: Bachelor's Degree preferred. CWS, WCC, WOCN and/or CHRN certification preferred. Knowledge of Hyperbaric Oxygen Therapy preferred. Experience in outpatient clinic and/or hospital operations preferred. Proficiency with Microsoft 365 tools, particularly SharePoint preferred. Travel: This position requires frequent ground and/or air travel. This may result in travel up to 75% of the employee's time with occasional weekend travel. Physical Demands: The physical demands described are representative of those that must be met by a Nursing Administrator to successfully perform the essential competencies, duties, and requirements of this position. These include standing, walking, driving, lifting up to 50 pounds and sitting for extended periods of time and looking at a computer screen for extended periods of time. In addition, pushing, pulling, stooping, squatting and shifting heavy objects, as well as air travel, may be required. Employees should ask for assistance if needed. Equal Employment Opportunity: The Center for Wound Healing & Hyperbaric Medicine, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. As an organization, we are committed to offering reasonable accommodation to job applicants with disabilities. If you need assistance or an accommodation due to disability, please contact us at *********************************** .

Details ! 4 day RN Clinical Supervisor / Friday - Monday - 10 hours days Home Health experience and OASIS knowledge required Experience with Home Care Home Base is preferred POSITION OVERVIEW The CLINICAL MANAGER is a qualified professional responsible for the planning, coordination, and delivery of quality care services to the client. This individual is accountable for the agency's adherence to federal, state, and local laws, accreditation, company standards, compliance, and reimbursable client care services. A Registered Nurse with a Baccalaureate or higher degree in nursing or other health related field and two years clinical experience within the last three years in a home health agency is preferred; or A Registered Nurse with three years of clinical experience within the last five years in a home health agency, home care setting, or healthfacility is preferred.Essential Functions Complies with accepted ethical conduct and professional Standards of Nursing Practice as set forth by the American Nurses Association. Provides leadership in promoting and maintaining standards and compliance with accreditation and licensure. Supervises professional personnel in all aspects of their delivery of care. Develops work methods and procedures that facilitate the rendering of high quality care. Assists field staff in monitoring changing needs of the client and or family. Functions as a liaison with the community's health-related resources. Evaluates the employees under his/her supervision and submits the results to the Administrator for final approval. Performs and monitors the skill competencies and services of the field employees. Supervises the implementation of the Physician's Plan of Treatment. Coordinates the total Plan of Care with the appropriate resources based on ICD coding, PPS guidelines and input from billing/financial department, including insurance companies and authorizations as required. Responsible for maintenance of current and accurate client records. Participates in the selection and orientation of new employees. Assists with the planning and direction of in-service educational programs. Maintains ongoing communication with office staff and participates in staff conferences. Assures coordination of HHA schedules. Assists with performance improvement activities and serves as a member to the PI/QI Committee to assure total quality management. Interprets nursing policies and procedures to non-nursing personnel. Collaborates with Administration to provide necessary statistical and financial data for reimbursement of provider services. Ensures professional scheduling and assignments as appropriate based on client needs, staff expertise, and geographical locations. Ensures office filing/medical record functions are current, accurate, and effective. Participates in local professional organizations and activities, promoting agency services. Documents all client-related activities in a timely manner. Maintains consistent attendance. Submits all credentials in a timely manner. Performs all responsibilities in a professional manner that follows all agency rules of conduct. Provides oversight of all patient care services and personnel to include: Making patient and personnel assignments Coordinating patient care Coordinating referrals Assuring that patient needs are continually assessed Assuring the development, implementation, and updates of the individualized plan of care Reacts to change productively and performs other job-related tasks and duties as assigned. REQUIREMENTS: At least 1 year of supervisory experience preferred. Must be currently licensed (in good standing) in the state(s). Must meet educational/experience requirements outlined in the laws of licensure states. Knowledge of Medicare and Medicaid regulations and reimbursement principles is desired. While performing responsibilities of the job, the employee is required to talk, hear, sit and use hands. Required to stand, walk, reach with arms and hands, lift 15-20 pounds, climb, and kneel. Close vision is also required. Reasonable accommodations can be made to enable people with disabilities to perform essential functions of the job. While performing the duties of this job, the employee is occasionally exposed to moving mechanical parts, external vehicle fumes, major temperature changes, and various odors. Noise level in the work environment is moderate. WORKING ENVIRONMENT: Works indoors in Agency office and patient homes and travels to/from patient homes. RISK EXPOSURE: High risk LIFTING REQUIREMENTS: Ability to perform the following tasks if necessary: Ability to participate in physical activity. Ability to work for extended period of time while standing and being involved in physical activity. Moderate lifting. Ability to do extensive bending, lifting and standing on a regular basis. As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Registered Nurse / Clinical Editor / Proofer - Remote, New York State (#25297) Employment Type: Full-time Hourly Rate: $45/hr Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: We are seeking a detail-oriented Registered Nurse with strong editorial skills to review NYS Dispute Resolution and External Review determinations. This remote position combines clinical expertise with editorial precision to ensure accurate, compliant, and professionally presented case documents while improving team performance through error tracking and staff training. Why Join Us? Competitive Compensation: Earn $45 per hour Comprehensive Benefits: Vacation Leave 6 Major Paid Holidays per year 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act License Reimbursement after 1 year of employment Health insurance is subject to plan eligibility requirements 401k Matching eligibility after 1 year of employment Benefits from Paychex, such as Payactiv GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc Work Schedule: Full-time, Remote. Sunday to Thursday (9:00 AM - 5:30 PM) Professional Growth: Gain valuable experience in healthcare policy and medical editing Impactful Work: Ensure accuracy and compliance in state healthcare dispute resolutions Qualifications: Education: Baccalaureate degree in Nursing or a graduate of an approved RN program Licensure: Active New York State RN license Experience: Must have a minimum of 2 years of experience in an acute care facility, preferably in medicine/surgery or special care units, and one to 3 years of experience in acute care utilization review. Must have post-graduate studies demonstrating proficiency in writing, editing, and proofing skills. Technical Skills: Must have knowledge and experience with electronic medical records, including coding, quality, and clinical charting. Soft Skills: Must have the ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff. Other requirements: A writing sample or publication is required. Key Responsibilities: This individual will review all NYS Dispute Resolution and External Review determinations for accuracy of decisions, mathematical determinations, content, grammar, punctuation, and state-required conventions. They will utilize their clinical knowledge and editorial skills to produce a final, clean copy for each case determination. They will track errors and retrain clinical and administrative staff to mitigate production errors. Conduct a thorough review of pre-final dispute determinations using checklist tools. Make clinical and mathematical edits to responses using provided case documentation, as necessary. Consult with team members and supervisors as necessary to improve the final product. Complete edits check of content, references, grammar, spelling, and punctuation before release of final product. Maintain tracking and trending of errors and use findings to analyze areas of concern and highlight areas of improvement. Will provide technical assistance and conduct/participate in staff huddles. Other activities as may be deemed necessary How to Apply: If you are an RN with strong editorial skills ready to apply your clinical expertise in a unique remote role, we want to hear from you! Submit your Resume/CV and writing sample to hr@glhstaffing.com or call our office at (800) 608-4025 to learn more about this opportunity. Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives

The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services, monitors consumer treatment through ongoing and continuous review to ensure that services are delivered based on consumer need and established clinical guidelines, and identifies and follows-up on clinical cases of concern and high-risk/special needs consumers to ensure enrollees are linked to appropriate treatment resources. The UM Clinical Specialist RN - PH may represent the unit in cross agency collaborative needs. This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed. Responsibilities & Duties Assesses the medical necessity of services Independently conduct medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times Ensure authorized services address appropriate service needs, intensity of service outcomes, and alternatives for consumers Provide a consistent application of medical necessity criteria for physical health services that promotes a holistic review of the member's needs Conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards Notify members of adverse benefit determinations while preserving members' Due Process rights Ensure compliance with performance measures outlined within all accrediting body standards Perform other related duties as required by the immediate supervisor or other designated Alliance Health administrators Compliance Comply with utilization management and quality improvement policies and procedures, utilization review laws and regulations, state standards Comply with Utilization Management Department focus on timeliness, effectiveness, quantity, quality, and cost of services for eligible enrollees Coordinate and Implement UM Processes Participate in the integration of the department and its functions into the organization's primary mission Take part in the Utilization Management Department collaboration to ensure an integrated department with Physical Health and Behavioral Health Collaborate with other departments Monitor for undesirable performance or deviations of practice standards that may have a negative impact on consumers. Respond through additional follow-up with consumer and providers, provider technical assistance and/or referral to other departments within the MCO. Maintain open, timely communication with staff, providers, community agencies and other stakeholders Minimum Requirements Education & Experience Graduation from a State accredited school of nursing or an Associate's Degree in Nursing from an accredited and five years of experience with five (5) years nursing experience OR Bachelor's degree in Nursing from an accredited college/university and three (3) years of nursing experience Special Requirement Current, active, and unrestricted North Carolina clinical license as a Registered Nurse, or a compact license Preferred Experience: Experience in Utilization Management Knowledge, Skills, & Abilities Knowledge of physical health and co-morbid health conditions Knowledge of diagnostic treatment guidelines/protocols, level of care criteria Proficient in the use of computer and multiple software programs. Written and oral communication skills Ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations. Knowledge of Utilization Management managed care principles and strategies Ability to analyze effectiveness of processes and adjust developed processes. Knowledge of and experience in acute clinical utilization review Knowledge of Authorization/re-authorization Utilization Management standards Knowledge of related duties in the delivery of patient care, management of patient care providers, or project management in a healthcare environment Ability to lead, delegate and problem solve Ability to develop and document workflows Ability to assist appeal efforts when medical care is denied by various payor entities in a timely fashion. Knowledge of and experience with NCQA Salary Range $68,227 - $86,990/Annual Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility

📍 Remote (U.S.) | FT | Reports to: Clinical Manager This role is HOT 🔥 - Help scale the fastest-growing virtual clinic for women in midlife health. About Midi Midi Health is the leading virtual care platform focused exclusively on women's midlife health. We provide compassionate, evidence-based care for women navigating perimenopause, menopause, and beyond - delivered by expert clinicians and supported by cutting-edge technology. We're growing fast, backed by world-class investors, and changing lives by helping women feel like themselves again. Join us and be part of the movement to bring modern midlife care to millions. 🌟 Role Overview As a Clinical Coordinator (CC) at Midi, you'll split your time between direct clinical RN duties and team coordination to support efficient and safe clinical workflows. You'll be the go-to for RN onboarding, coaching, daily staffing flow, clinical escalations, and quality assurance. This is a great fit for a nurse who loves blending patient care with operational leadership in a virtual-first environment. What You'll Do 📬 Daily Clinical & Operational Support (≈50% RN Duties) Work RN inbox tasks and resolve patient clinical questions per scope and protocols Provide real-time clinical guidance for escalations and edge cases Reallocate RN coverage to balance inbox volume across queues 📚 Onboarding, Training & Readiness (RNs & MAs) Own onboarding for new RNs (accounts, access, modules, shadowing, sign-offs) Support MA and RN onboarding with standardized competency check-offs Conduct 90-day MA performance reviews and coaching plans Maintain onboarding toolkit (checklists, SOPs, job aids) with CM and LMAs 🤝 Team Leadership & Workflow Management Meet daily with Lead MAs to review inbox SLAs, tasks, volume, and staffing Partner with Lead MAs to ensure task queues (provider comms, labs, RX, prior auths, Zendesk) are properly supported Approve time and complete administrative tasks in Rippling 🔍 Quality Assurance & Continuous Improvement Audit documentation and adherence to workflows; coach RN and MA teams Identify recurring workflow defects and collaborate with CM on SOP updates Track and socialize key team metrics (SLA, rework, onboarding checkpoint rates) 💬 Communication & Escalation Serve as first-line clinical escalation for Lead MAs Communicate with providers, schedulers, and support teams to resolve handoffs Contribute to monthly performance and enablement dashboards 🎯 What You'll Bring Must-Haves Active, unrestricted RN license (compact required; CA highly preferred) 3+ years of hands-on RN experience (telehealth or ambulatory strongly preferred) Proven ability to train and mentor peers in fast-paced clinical environments Comfort with digital platforms (Athena, Slack, portal comms, Google Workspace) Strong organizational judgment, follow-through, and compliance mindset Nice-to-Haves Experience working in virtual care with task-based Medical Assistant teams Background in QA/audits, workflow mapping, or SOP development Familiarity with Zendesk, CoverMyMeds, or cross-queue workflows 🛠 Tools You'll Use Athenahealth ▪ Zendesk ▪ Slack ▪ Google Workspace ▪ Midi Telehealth Platform ▪ Rippling ✅ Compliance & Licensure Maintain active RN licensure and complete all mandatory trainings Follow all Midi policies and uphold HIPAA/PHI standards Participate in incident reporting and periodic competency assessments Please note that all official communication from Midi Health will come from **************** email address. We will never ask for payment of any kind during the application or hiring process. If you receive any suspicious communication claiming to be from Midi Health, please report it immediately by emailing us at ********************. Midi Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Please find our CCPA Privacy Notice for California Candidates here.

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

Inova Health is looking for a dedicated Registered Nurse (RN) Clinical Documentation Denials Auditor to join the team. This role will be fully-time remote, Monday-Friday, regular business hours 8:00 AM - 4:30 PM (flexible). Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Registered Nurse (RN) Clinical Documentation Denials Auditor Job Responsibilities: Evaluates specificity and completeness of physician documentation to ensure optimal coding (e.g. mortality outcomes using APR-DRG, SOI and ROM, appropriate reduction of complications based on PSI and HAC, revenue assurance outcomes based on reimbursement DRG (MS-DRG), documentation of significant chronic conditions affecting resource utilization based on HCC). Summarizes audit findings for individual records along with specific documentation guidelines to improve expected clinical outcomes for an individual physician, physician practice, or specialty. Conducts follow-up audits (i.e. concurrent or post-discharge) with routine feedback until documentation practice comes into line with expected clinical outcomes. Works with Clinical Documentation Improvement (CDI) Director and Lead Auditor on other work related to physician audits and education programs. Demonstrates proficiency with Cobius to access external audit work, record summary results and upload appeal letters. Demonstrates proficiency with Encompass 360 and HDM audit functions to review electronic medical records with advanced functions (i.e. ex, auto-suggest and search) and record detail coding audit results. Showcases proficiency in reviewing records in Epic electronic medical records - which may be the only option for audits of older records. Demonstrates proficiency in writing effective appeal letters that include appropriate coding guidelines and medical references. Identifies trends in external audit findings related to coding quality and physician documentation. Prepares educational communications related to these findings. Evaluates physicians' documentation, diagnostic reports, and clinical findings for validation of diagnoses. Processes the requests for second opinion reviews when clinical validity is not supported or in question. May perform additional duties as assigned. Minimum Qualifications: Certification: Certified Coding Specialist / Certified Clinical Documentation Specialist; ACDIS/AHIMA certification, CCDS or CDIP Licensure: Registered Nurse Upon Start Current RN license and eligible to practice in VA or MD Experience: Seven years of recent CDI, DRG validation or coding audit experience in an acute hospital setting with clinician training as RN, BSN, NP, PA or MD; Coding certification CCS and CDI certification CCDS or CDIP Education: Associate Degree in Nursing or Medicine. Preferred Qualifications: Experience: Recent coding experience. Clinical background and coding + denials knowledge. Experience writing denials & appeals. Outpatient and/or inpatient experience. Knowledge to identify clinical indicators (example: sepsis). EPIC experience. Certifications: CCDS Skills: presenting Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV

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

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

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Clinical Reviewer - RN (Remote U.S.) to join our growing team. Job Summary: * Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews. Responsibilities: * Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services. * Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence. * Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool. * Ensure accurate and timely submission of all administrative and review-related documents to the company. * Perform ongoing reassessment of the review process to identify improvement and/or change opportunities. * Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process. * Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review. * Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies. * Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines. * Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs. * Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. Work Hours: * Monday through Friday, 8:00 AM until 5:00 PM within the Time Zone where you reside, plus: One day per week is a priority day that would be assigned to complete expedited cases received between 3:00 PM and 6:00 PM Central. Qualifications Required Qualifications/Experience: * Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license. * Associate's, Bachelor's degree (or Diploma) in Nursing. * 2+ years of clinical experience in an acute OR med-surgical environment. * 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. * 1+ years of knowledge of medical records, medical terminology, and disease process organization. * 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG). Preferred Qualifications/Experience: * Knowledge of current National Committee for Quality Assurance (NCQA) standards. * Knowledge of Utilization Review Accreditation Commission (URAC) standards. * Knowledge of Medicare (CMS) guidelines. * Experience with Medical Appeals. * Experience with Medicare Advantage plans. * Medical Record Abstracting skills. * Clinical assessment and critical thinking skills. * Excellent verbal and written communication skills. * Ability to work in a team environment. * Flexibility and strong organizational skills. * Proficient in Microsoft Office and Internet/Web Navigation. #LI-SD1 Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at Acentra Health EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay range for this position is listed below. "Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Pay Range USD $28.37 - USD $37.50 /Hr.

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

Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare. Benefits, with a whole-person approach to wellness - * Lifestyle Engagement * e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support * Access & Affordability * e.g. minimal or zero copays, team member cost sharing premiums, daycare About ThedaCare! Summary : The RN Clinical Nurse (Ambulatory) provides patient-centered, specialized, evidence-based nursing care across the continuum through an interprofessional approach to treatment, research, education, and advocacy. Contributes to the goals of the department by being accountable for the delivery of compassionate and safe care within the scope of practice as defined by the Wisconsin Board of Nursing and ThedaCare policy. Through collaborative practice with members of the care team, is responsible for patient outcomes that meet the high quality of care provided by ThedaCare. Furthers the professional practice of nursing at ThedaCare by promoting a culture of innovation and a commitment to growth and professional development. Job Description: Schedule: * PM shift: 3:00 PM - 11:30 PM * Variable Monday-Friday * Weekend and holiday rotation FTE: Flexible, 0.5 - 1.0 KEY ACCOUNTABILITIES: * Utilizes the nursing process, evidence-based practice, and specific competencies to assess the physical condition and nursing needs of patients, and develops a plan of care in a collaborative practice with the patient and interprofessional team. * Plans for the care needs of the patient in collaboration with the interprofessional team to provide the highest quality of care and clinical outcomes. * Demonstrates clinical expertise in the provision of care in the clinical specialty assigned, and performs all functions of the professional clinical nurse (RN), which are age appropriate, developmentally sensitive, and culturally specific. * Identifies ways to improve the patient's experience of care, streamline care processes, and lower costs while promoting quality to improve patient, family, and team member satisfaction. * Contributes to a professional environment that encourages mentoring, engagement, and development to retain expert clinicians. * Provides consultation and maintains positive relationships with physicians and other interprofessional team members, collaborating to problem solve and improve patient care. * Demonstrates, anticipates, and proactively manages risk to prevent crises. * Performs skillfully in life threatening emergencies, matching demands and resources during crises situations. QUALIFICATIONS: * Bachelor of Science in Nursing (BSN) preferred * Associate's Degree in Nursing (ADN) required * Current Wisconsin RN Licensure * American Heart Association Healthcare Provider Basic Life Support (BLS). PHYSICAL DEMANDS: * Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of Fifty (50) pounds without assistance * Job classification is exposed to blood borne pathogens (blood or bodily fluids) while performing job duties • Manual dexterity and hand-eye coordination to perform patient care procedures WORK ENVIRONMENT: * Frequent exposure to sharp objects and instruments * Occasional exposure to moving mechanical parts, fumes or airborne particles, toxic or caustic chemicals, and risk of electrical shock * Occasional high noise level in work environment * Standing and/or walking for extended periods of time * Transporting, transferring, positioning patients and/or equipment from one location to another; little likelihood for injury if proper body mechanics and procedures are followed * Possible exposure to communicable diseases, hazardous materials, and pharmacological agents * Occasional contact with aggressive and or combative patients. Position requires compliance with department specific competencies. Scheduled Weekly Hours: 16 Scheduled FTE: 0.4 Location: Encircle Health - Appleton,Wisconsin Overtime Exempt: No