Pediatric Nurse remote jobs - 470 jobs

The RN or SW Clinical Facilitator coordinates with Clinical Teams and other internal stakeholders to advance Healthfirst's clinical practice through technical assistance, education, and innovation solutions by applying adult learning theory. The technical assistance solutions will ensure efficient and effective quality of care in accordance to Healthfirst standards and rules/regulations set forth by state, and federal regulatory and compliance agencies. Within the Clinical Division at Healthfirst, the Clinical Technical Assistance Center (CTAC) will assist clinical employees and other internal stakeholders in tactically obtaining or improving the essential knowledge or skills needed to perform their jobs. The CTAC will also serve as the hub for ongoing adult learning and skills acquisition which supports Healthfirst's commitment to ensuring its teams are capable, engaged, and committed to their work.Leverages adult learning principles and clinical practice standards to move towards a culture of continuous technical assistance improvement and clinical capacity building with innovative learning solutions. Develops technical assistance goals that are congruent with the organization and the Clinical Department's mission, vision, and strategic direction. Provides technical assistance, resources and tools that define performance requirements, identify gaps between existing and required performance, analyze root causes that limit performance and recommend and/or implement learning solutions that focus on and deliver business results. Utilizes current literature, research, and evidence-based findings in the design, implementation and evaluation of technical assistance solutions and education programs for staff learning and development. Conducts onboarding, preceptorship, and ongoing professional training to ensure clinical staff are equipped to perform job responsibilities in accordance to Healthfirst standards and rules/regulations set forth by regulatory and compliance agencies. Facilitates with subject matter experts, instructional designers, training agencies and technical assistance facilitators to design and deliver innovative learning solutions for performance enhancements needed to support the clinical department's business objectives. Facilitates updating departmental training manuals, job aids, quick reference guides and the clinical department's policies/procedures. Develop, implement, and evaluate a preceptorship training program curriculum to standardize the quality of preceptorship practices among the clinical teams. Conducts field assessments as needed to evaluate clinical staff and update the preceptorship training program curriculum. Minimum Qualifications: Licensure: Current Registered Professional Nurse or Registered Social Worker (i.e. LMSW or LCSW) in the State of New York. Education: Bachelor's in nursing or social work preferred with previous work experience in education. Three to five years of clinical experience in a specialty area, or combination of staff nurse/leadership experience in the specialty area, i.e. Care Management, Utilization Management, Clinical Eligibility. Excellent skills in the following areas: verbal and written communication, critical thinking, creativity, interpersonal relationships and team building; change management. Demonstrates knowledge base in professional nursing or social work and evidence based practice; participatory leadership, continuous learning environment, current issues and trends in care management and clinical practice, nursing and social work education and development. Ability to travel about 10% of time around downstate New York including Westchester County and Long Island to conduct clinical observations. Preferred Qualifications: Master's degree in Education and understanding of Adult Learning Theory applications to enhance the technical assistance and education of care management and care coordination activities. Ability to assess educational needs and design and develop responsible curricula. Highly developed verbal and written communication skills and the ability to present effectively to small and large groups. Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment. Certification in relevant clinical area and Nursing or Social Work Professional Development preferred. Intermediate Microsoft Word, Excel, Outlook and PowerPoint skills WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470 All Other Locations (within approved locations): $71,600 - $106,505 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Division of Pulmonary, Critical Care, and Sleep Medicine and the Department of Internal Medicine at the University of South Florida Morsani College of Medicine, is seeking a Pulmonary/Critical Care physician for a full-time position at the Assistant, Associate or Full Professor rank. This is a full-time 12-month salaried faculty appointment at the rank of Assistant Professor and carries with it attending staff privileges at Tampa General Hospital (TGH) and affiliated hospitals. Appointment at the rank of Associate Professor requires a minimum of five years of continuing and productive service as an Assistant Professor, or the equivalent. Appointment at the rank of Full Professor requires a minimum of five years of continuing and productive service as an Associate Professor, or the equivalent. Responsible to a Chair or other appropriate higher-level administrator of a State university. Responsible for teaching, research, service, and related administrative activities. Responsible for academic advising and related activities. May represent the university, college/school, or department. Minimum: Medical degree from an accredited institution or the highest degree appropriate in the field of specialization with a demonstrated record of achievement in teaching, academic research, and service. Must meet university criteria for appointment to the rank of Assistant, Associate, or Full Professor. For Associate/Full Professor - Normally will have produced creative work, professional writing or research in refereed and other professional journals, and be a recognized authority in the field of specialization. Preferred: Must hold or be eligible for a full, unrestricted Florida Medical License or foreign equivalent required. To perform this position, the candidate will need to obtain and maintain a full un-restricted FL Medical License, maintain credentials in the USF Health faculty practice plan, and be a medical staff member in good standing at the hospitals he/she is assigned to perform clinical duties. The candidate will participate in the teaching of residents, fellows, and medical students in clinical medicine. USF is especially interested in candidates who can contribute to the diversity and excellence of the academic community through their research, teaching, and/or service. MUST BE BOARD CERTIFIED/ELIGIBLE IN: Critical Care and Pulmonary Disease Clinical-Provides Pulmonary and Critical Care Services at USF, TGH and/or other affiliated hospitals and clinics. Teaching-Provide instruction and supervision for medical students, residents and fellows at USF and its affiliated institutions in the areas of critical care, clinics, consults and lectures. Responsible to a Chair or other appropriate higher-level administrator of a State university. Responsible for teaching, research, service, and related administrative activities. Responsible for academic advising and related activities. May represent the university, college/school, or department.

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

Description & Requirements Maximus is seeking a Clinical Reviewer (Registered Nurse) to support the Tennessee (TN) Appeals area of the contract. In this role, the RN Clinical Reviewer is responsible for reviewing clinical cases, applying nursing judgment and regulatory guidelines, and ensuring each case is accurately assessed and routed to the appropriate department or escalated as needed. This position plays a critical role in maintaining compliance, supporting timely appeal resolutions, and ensuring high-quality, clinically sound decision-making. About the Program:Tennessee Long-Term Services and Supports (TN LTSS) refers to a coordinated system of programs and services designed to assist individuals who have chronic illnesses, disabilities, or functional limitations and need ongoing support to live as independently and safely as possible. TN LTSS includes a range of home- and community-based services (HCBS) and institutional care options that help individuals with activities of daily living, medical needs, and personal care, while prioritizing care in the least restrictive setting. The program supports older adults and individuals with physical, intellectual, or developmental disabilities through person-centered planning that promotes dignity, independence, and quality of life. Why Maximus? - Work/Life Balance Support - Flexibility tailored to your needs! - • Competitive Compensation - Bonuses based on performance included! - • Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance. - • Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching. - •Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage. - • Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP). - • Recognition Platform - Acknowledge and appreciate outstanding employee contributions. - • Tuition Reimbursement - Invest in your ongoing education and development. - • Employee Perks and Discounts - Additional benefits and discounts exclusively for employees. - • Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs. - • Professional Development Opportunities-Participate in training programs, workshops, and conferences. - •Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees. Essential Duties and Responsibilities: - Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. - Issue approvals, denials or recommendations based on contract requirements. - Identify need for additional clinical documentation or consultation. - Complete documentation of activities within contract systems. - Communicate with providers, individuals and their designees, or state workers as required. - Performs other related duties as assigned. Minimum Requirements - Current Registered Nurse (RN) license valid in the state of practice is required - High School Degree or equivalent required - Minimum 2 years of clinical experience required - Minimum of one (1) year of registered nurse experience Preferred Requirements - Knowledge of mental health principles and practices - Experience in physical rehabilitation - Attention to detail Home Office Requirements - Maximus provides company-issued computer equipment and/or cell phone - Reliable high-speed internet service - Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity - Minimum 5 Mpbs upload speeds - Private and secure workspace #ClinicalServices EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 33.00 Maximum Salary $ 37.12

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.

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

This is a contract assignment that will start right away and end on June 28th 2024 Remote in TX Must Live in TX SUMMARY DESCRIPTION: RN or LPN with clinical experience and will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications. JOB REQUIREMENTS: • Degree, Diploma or Certificate from a school of nursing with clinical experience. • Licensed in the State of Illinois • Knowledge of medical terminology • Data entry and/or typing experience. • Clear and concise written and verbal communication skills. • PC proficiency to include Word, Excel and Lotus Notes. • Auditing experience preferred. DUTIES AND RESPONSIBILITIES: • Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines. • Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors. • Identify and report abstraction errors and provide measure re-education with for the abstractor. • Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s). • Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results. • Maintains productivity level as determined by the HEDIS Coordinator/QI Department. • Maintain compliance with all HIPPA and patient confidentiality requirements. • All other duties as assigned.

Raleigh General Hospital Registered Nurse (RN), Clinical Educator Job Type: FT | Days About our Health System Raleigh General is a 300 bed hospital located in Beckley, WV, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters. Your experience matters At Raleigh General Hospital, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you're not just valued as an employee, but as a person. As a registered nurse (RN) joining our team, you're embracing a vital mission dedicated to making communities healthier . Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve. Job Summary The Clinical Educator is responsible for developing, planning, implementing and organizing a variety of education activities including individual, department and hospital wide programs. The Clinical Educator serves as consultant, facilitator, change agent and leader. This position supports clinical department leadership. Reports to: CNO FLSA: Exempt Job Requirements Minimum Education Bachelor of Science degree in Nursing Preferred: Master's degree Required Skills Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Licensed as a Registered Nurse Basic Life Support-Health Care Provider Basic Life Support-Health Care Provider Instructor within 3 years of accepting or transferring into the position. Minimum Work Experience 3-5 years of recent clinical experience with ongoing ability to demonstrate mastery of relevant clinical skills. Sufficient previous experience in adult education. Essential Functions Follows established policies and procedures, objectives, safety standards, and sensitivity to confidential information. Utilizes excellent customer service skills at all time. Complies with Federal and State law and accrediting and licensing agencies at all times, to include but not limited to, the Joint Commission and federal compliance regulations. Develops/coordinates orientation of new employee and transferred employee with active on-going involvement in the orientation process and continuing education materials. Develops, manages, and coordinates education programs and conducts training related to the needs of the organization including State, Federal, and accreditation mandatory programs. Works closely with Patient Safety Officer and responds to identified system changes or other identified needs to promote quality and patient safety. Works closely with Quality Director in developing and maintaining the quality program and the education of staff. Assists in managing data collection to evaluate organizational outcomes and submits accurate data in a timely manner as required by regulatory agencies; or as part of any volunteer/collaborative initiative. Assists in implementation of department quality initiatives and analysis of outcome data. Analysis shares and assists the interpretation of outcome data with appropriate staff, medical staff, and customers. Facilitates any action as indicated for noted undesirable data and/or negative trends. Facilitates teambuilding and leadership development in assigned areas. Responds to change in nursing practice and develops programs to support those changes. Maintains flexibility when managing multiple roles and responsibilities. Leads committees, work groups and/or projects related to the implementation of educational activities. Teaches content as needed and/or assigned within clinical expertise to facilitate orientation, staff development and/or safe practice. Performs managerial duties as needed, to support day to day activities, i.e., Kronos, daily productivity, etc. Responsible for planning, development, implementation, evaluation, and maintenance of continuing education activities as appropriate to various accrediting bodies, as assigned. Complies with continuing education accrediting body requirements. Participates as instructor in specialty courses as assigned. Is a subject matter expert in area of expertise. Develops education programs for clinical and non-clinical staff. Maintains and evaluates these programs on an ongoing basis. Provides consultation to department managers and staff on the education process, job competencies, and accrediting agency requirements. Maintains clinical knowledge in assigned areas and active involvement with orientation, on-going education and quality audits and initiatives. Maintains working knowledge of learning management systems and other data management systems in the department. Promotes collaborative relationships among health care professionals in the region. Assists in department budget preparation; contains expenditure within budget. Assists in the maintenance of employer education records for all disciplines. Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and professional conferences. Maintains confidentiality in accordance with HIPAA regulations. Support the culture of service excellence throughout the organization. Actively seek ways to demonstrate a commitment to continuous improvement and participate in professional development opportunities. Performs other related duties as assigned or requested. Functional Demands Population Served □ Does not treat or care for patients. X Neonate (X Infant (X Early Childhood (1 year and X Late Childhood (5 years and X Adolescent (13 and X Young Adult (17 to X Middle Adult (30 years to X Older Adult (>60 years) Protected Health Information Type of Protected Information Accessed: X Demographic X Clinical X Insurance X Financial X Complete Medical Record Bloodborne Pathogens Exposure: Rarely While performing this job, occupational exposure is present for all employees Physical Requirements - Physical Dexterity and Effort Bending/Stooping □ rarely, □ occasionally, X frequently, □ constantly Climbing □ rarely, X occasionally, □ frequently, □ constantly Keyboard Data Entry □ rarely, □ occasionally, □ frequently, X constantly Kneeling □ rarely, X occasionally, □ frequently, □ constantly Lifting/Moving Patients X rarely, □ occasionally, □ frequently, □ constantly Reaching □ rarely, X occasionally, □ frequently, □ constantly Repetitive Foot/Leg Movements □ rarely, □ occasionally, X frequently, □ constantly Repetitive Hand/Arm Movements □ rarely, □ occasionally, □ frequently, X constantly Running X rarely, □ occasionally, □ frequently, □ constantly Sitting □ rarely, □ occasionally, X frequently, □ constantly Squatting X rarely, □ occasionally, □ frequently, □ constantly Standing □ rarely, X occasionally, □ frequently, □ constantly Walking □ rarely, X occasionally, □ frequently, □ constantly Pushing / Pulling: 0-25 lbs. X rarely, □ occasionally, □ frequently, □ constantly Pushing / Pulling: 26-75 lbs. X rarely, □ occasionally, □ frequently, □ constantly Pushing/Pulling: over 75 lbs. X rarely, □ occasionally, □ frequently, □ constantly Lifting/Carrying (non-patient) : 0-25 lbs. X rarely, □ occasionally, □ frequently, □ constantly Lifting/Carrying (non-patient) : 26-75 lbs. X rarely, □ occasionally, □ frequently, □ constantly Lifting/Carrying (non-patient) : over 75 lbs. X rarely, □ occasionally, □ frequently, □ constantly Visual Acuity, Hearing and Speaking: Rarely Audible Speech □ rarely, □ occasionally, □ frequently, X constantly Hearing Acuity □ rarely, □ occasionally, □ frequently, X constantly Smelling Acuity X rarely, □ occasionally, □ frequently, □ constantly Taste Discrimination X rarely, □ occasionally, □ frequently, □ constantly Vision: Depth Perception □ rarely, □ occasionally, □ frequently, X constantly Vision: Distinguish Color X rarely, □ occasionally, □ frequently, □ constantly Vision: Seeing Far □ rarely, □ occasionally, □ frequently, X constantly Vision: Seeing Near □ rarely, □ occasionally, □ frequently, X constantly Biological: Rarely Biohazardous waste/ hazards X rarely, □ occasionally, □ frequently, □ constantly Blood and/or bodily fluids X rarely, □ occasionally, □ frequently, □ constantly Communicable diseases/pathogens X rarely, □ occasionally, □ frequently, □ constantly Chemical: Rarely Asbestos or lead X rarely, □ occasionally, □ frequently, □ constantly Cytotoxic Chemicals X rarely, □ occasionally, □ frequently, □ constantly Dust X rarely, □ occasionally, □ frequently, □ constantly Hazardous Chemicals X rarely, □ occasionally, □ frequently, □ constantly Gases/Vapors/Fumes X rarely, □ occasionally, □ frequently, □ constantly Hazardous Medication X rarely, □ occasionally, □ frequently, □ constantly Latex X rarely, □ occasionally, □ frequently, □ constantly Working Conditions: Subject to many interruptions Occasionally subjected to irregular hours Occasion exposure to blood borne pathogens. May periodically come into contact with fumes or airborne pathogens. Periodically work around hazardous waste. Works in moderate noise conditions. Nonessential Functions Proficient with computer and/or keyboarding skills required. Ability to work without direct supervision.

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. Location: Remote within the United States ONLY Schedule: Monday - Friday, 8:00 AM - 5:00 PM As a Clinical Review Specialist (RN), you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor. You will perform retrospective clinical case reviews and draft appeals that focus on establishing the Medical Necessity of the services performed, both Inpatient and Outpatient. Essential Duties and Responsibilities: · Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials. · Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. o Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. · Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process. Minimum Qualifications & Competencies: · RN License with strong clinical knowledge - Active unrestricted clinical license in at least one state within the United States. · Minimum of 2-3 years of writing appeals letters and clinical auditing. · Minimum of 2-3 years Utilization Review / Case Management experience within the last 5 years. · Must be familiar with the payer guidelines and EMR systems like Epic, Cerner or Meditech. · Managed care payor experience a plus in either Utilization Review, Case Management or Appeals. · Must have excellent attention to detail, written communication skills and be computer proficient. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed 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 Registered Nurse, Quality Practice Advisor is responsible for coordinating performance improvement activities to engage, educate, and manage activities to improve the health outcomes of Healthmap Solutions members. This position will closely partner with the Care Navigation team to improve the quality of the Kidney Health Management clinical program. Responsibilities * Develop a trusting partnership with clinical providers and practice locations * Identify opportunities to improve health outcomes for Healthmap Solutions members based on provider specific data * Incorporate education and communication on Best Practice sharing for identified areas of provider low performance * Provide assistance in identifying areas for process improvement in provider office workflows * Partner with physicians/physician staff to identify Healthmap Solutions members that would benefit from Care Navigation support * Support operational and clinical stakeholders in the identification, development, and execution of process improvement initiatives * Improve provider performance in areas such as Healthmap Solutions Interventions, Care Gaps, and Chronic Conditions * Educate providers on HEDIS measures and open Care Gaps * Support the development and implementation of quality improvement interventions * Identify opportunities to educate provider offices on topics related to Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, etc. * Build strong cross-functional relationships with internal departments and provider partners and practice staff * Collaborate with the Care Navigation team to provide and receive information to enhance care coordination on Healthmap Solutions members * Maintain thorough documentation of all provider meetings and interactions for consistency and coordination of provider engagement * Maintain documentation in compliance with National Committee for Quality Assurance (NCQA) standards * Ensure timely and successful delivery of reports to internal and external stakeholders * Perform other related duties as assigned Requirements * Bachelor's degree required * Active, unrestricted, RN license required * Basic Life Support (BLS) certification required for all field roles (within 30 days of hire) * 3 years of experience in a health care or managed care setting * 3 years of experience in claims or gap closure campaigns, preferred * 3+ years of progressive experience in healthcare services, clinical operations, quality, or care management * Prior experience building and managing relationships with health care providers preferred * Proof of valid and unrestricted driver's license required and automobile insurance as required by law; this position requires regular travel within assigned region to support practices and or other healthcare/clinical sites as needed * Same state residency required Must comply with organization policies for health screening and immunizations, including but not limited to: * Current Tuberculosis (TB) test or current chest X-ray * Proof of immunizations (e.g., Hepatitis B, MMR, Varicella, COVID-19, Influenza) * Participation in annual health and wellness screenings Skills * Excellent verbal, written and presentation, skills * Interpersonal skills to develop and maintain strong internal and external relationships * Ability to multitask, prioritization, and create solutions in a fast-paced environment * Strong critical thinking and analytical skills * Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint Travel Heavy Travel, over 50%, to support practices in an assigned geographic market. #LI-HYBRID

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 Job Summary: Join Acentra Health as an RN Clinical Reviewer and play a critical role in supporting priority populations while making a meaningful difference in the communities we serve. In this role, you will leverage your clinical expertise to review and assess medical records against established clinical criteria and contract requirements, helping ensure accurate, compliant, and high-quality outcomes. This is a Full-Time remote position offers the flexibility to work from your home office while contributing to work that truly matters. You'll be part of a mission-driven organization dedicated to improving health outcomes.Candidates must be available to work during regular business hours of 9:00 A.M. to 5:30 P.M. Eastern Time, with some flexibility for those located in the Central Time zone. Acentra Health provides the essential technology equipment for your home office, including a company-issued laptop Job Responsibilities * Ensure the accuracy, quality, and timeliness of all assigned case reviews in accordance with contract requirements and regulatory standards. * Effectively manage daily workloads and review queues, adjusting schedules as needed to meet departmental demands and turnaround times. * Collaborate with the Supervisor on quality monitoring and improvement initiatives to support compliance and performance excellence. * Maintain up-to-date knowledge of clinical practices, review criteria, and assessment processes to ensure informed and consistent decision-making. * Serve as a clinical liaison to providers, addressing customer service inquiries and supporting issue resolution in a professional and timely manner. * Perform all applicable review types as required based on workload volume and business needs. * Build and maintain positive, professional relationships with both internal teams and external stakeholders. * Participate in required training sessions and scheduled meetings to stay current on policies, procedures, and process updates. * Cross-train as needed to provide workforce flexibility and support evolving client and customer needs. * Understand and adhere to all corporate policies, including those related to HIPAA and its Privacy and Security Rules. * Maintain compliance with established workflows, regulatory requirements, and best-practice standards. Qualifications Required Qualifications & Experience * Active, unrestricted Registered Nurse (RN) license in good standing, with an Associate's degree (Bachelor's degree preferred) or completion of an accredited professional nursing diploma program. * Strong clinical assessment, analytical, and critical-thinking skills with the ability to make sound, evidence-based decisions. * Working knowledge of medical records review, medical terminology, and disease processes. * Strong written and verbal communication skills, with the ability to clearly document and explain clinical findings. * Detail-oriented with excellent organizational skills and the ability to prioritize and complete tasks efficiently within established timeline. Preferred Qualifications & Experience * Experience working for an Independent Review Organization (IRO) or in a similar clinical review setting. * Familiarity with URAC accreditation standards and regulatory requirements. * Knowledge of public mental health systems and government-sponsored medical programs is preferred. * Prior experience working in a remote or virtual clinical environment. * Proficiency in computer-based applications and the Microsoft Office Suite, including Word, Excel, Outlook, and Teams. 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. 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. 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 ******************************** 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. Compensation The pay 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 $38.00 /Hr.

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE). Job Summary: The Clinical Auditor 2 performs audits of medical records on behalf of hospital clients for denials review, defense audits, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and Milliman (MCG) in addition to criteria established by state Medicaid programs or hospital policy. Audit and analysis must be accurate and consistently ensure a high level of quality, knowledge of laws, rules, regulations and guidelines necessary to ensure compliance and protection of information. Primary / Essential Functions: The Primary/ essential job duties may not be exhaustive. Clinical Staff Responsibilities: Performs audits of medical records to identify and/or defend charges, including: o Defense Audits o Patient Inquiry Audits o Disallowed Charges o Biller Requested Audits Completes analysis of records against established criteria, (e.g., InterQual, MCG, Medicare, Medicaid criteria), to determine if patient condition and/or care meets that criteria, including: o Avoidable day studies o Managed care, Medicare or Medicaid reconsiderations/appeals o Medicare or Medicaid RAC appeals or other specialized Audit Appeals (e.g. CERT, ZPIC, SMRC) Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and patient. Will compose appeal letters addressing and appealing both contract issues and medically related issues Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution. Enter audit findings and/or data into Client's computer based system. Proficiently utilize multiple computer based systems to complete and document work (both Savista and client) Client based billing, Internal based billing, medical record and quality systems Microsoft Outlook, Word and Excel Function in a professional, efficient and positive manner Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession Will help identify issues or challenges in the department, and come up with solutions or ideas to improve Maintain confidentiality of patient information and abide by all HIPAA related guidelines Competencies: · Puts Clients First · Drives for Results · Understands our Business · Thinks Innovatively · Values Differences · Builds Teamwork · Gains Trust · Communicates Effectively · Shows Accountability · Takes Action · Embraces Change · Makes Quality Decisions Physical / Mental Demands, Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to use hands to finger, handle or feel, sit, stand, walk, lift up to 20 pounds, stoop, clean, bend, and reach with hands and arms. Must communicate clearly in English. Requires the ability to speak, read, write, see, and hear to perform essential duties of the job. Effective and positive human relations skills are required, including confidentiality, in order to appropriately interface with staff and clients. Must be able to perform multiple tasks and detailed work, problem solve, reason, and perform basic mathematical calculations. Equipment Used: Telephone, fax, calculator, computer, monitor, printer, hardware and software packages, computer peripheral equipment i.e. mouse and keyboard; and Microsoft software. Minimum Qualifications: Must be RN/Case Management /Utilization Review/Coding clinical certification with a BS/BA preferred otherwise equivalent years of technical experience 3 to 5 years of clinical experience or 3 to 5 years of clinical auditing experience in either case management, Medicare appeals, utilization review or denials management Knowledge of Milliman (MCG) or InterQual criteria preferred Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization Fundamental knowledge of Medicare/Medicaid Guidelines Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling) Skilled with Microsoft Outlook, Word, Excel and EMR Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $28.00 to $38.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills. SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class. California Job Candidate Notice

Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse - Home Visits (PRN), you'll provide high-quality nursing care directly in patients' homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work. Key Points to Know: • You'll use your own vehicle to visit patients in their homes, typically within 1-2 hours of your location. • Shifts are PRN / per diem, meaning you'll work only when projects are available in your area; project frequency may vary. • Orientation, training, and project-specific instructions are provided before each assignment. • You will be compensated for all time spent on training, travel, and patient visits, including documentation. We are posting this role now and will be reviewing applications on a rolling basis between now and Christmas. Interviews will begin in the New Year , so you may experience a brief delay in hearing back from us during the holiday period. Thank you in advance for your patience - we look forward to connecting in January. Position: Clinical Research Nurse - Home Visits (PRN) Job Type: Contract, PRN, Per Diem Hourly Rate: $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!

Full time Shift: 12 Hour Night Shift (United States of America) Hours per week: 36 Job Information Exemption Status: Non-Exempt Responsible for the daily to day operations of the Critical Care department. Promotes a strong team atmosphere through motivation, coaching, and conflict management. Prioritizes communication throughout the system and community to facilitate a multi-disciplinary approach to coordination of throughput and capacity management. Education Qualifications Bachelors of Science: Nursing (BSN) Preferred Experience Qualifications 2 years Current experience in related clinical field in acute care facility. Preferred Supervisor experience. Preferred Skills and Abilities Demonstrates awareness and sensitivity to rights of patient/significant other, as identified within the institution. (Required proficiency) Demonstrates awareness and application of safety issues as identified within the institution. (Required proficiency) Demonstrates awareness of legal issues in all aspects of patient care and departmental functioning. Strives to manage situations in a manner, which minimizes risk to the patient and the institution. (Required proficiency) Demonstrates competency in selected psychomotor skills. (Required proficiency) Ability to communicate effectively using verbal, non-verbal and written methods. (Required proficiency) Ability to perform mathematical calculations related to medication administration and equipment calibration. Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. (Required proficiency) Licenses and Certifications Registered Nurse - KSBN A multistate license with the ability to practice within the State of Kansas is also accepted. Required What you will do Provides strong leadership, able to motivate staff and respond to individual needs on assigned department and shift. Organizes workload effectively and delegates responsibilities appropriately. Acts as leader for Nurse Manager or Director as appropriate. Recruits, interviews, coaches and develops direct reports; applies corrective actions as appropriate. Performs staffing duties within scheduling guidelines. Provides direct patient care as defined within the scope of the state's nurse practice act. Performs assessment/data collection in an ongoing and systematic manner, focusing on physiological and cognitive status. Administers prescribed medications and treatments in accordance with nursing standards. Formulates a prioritized and goal directed plan of care, which is based on patient's presenting problems and projected outcomes. Functions to establish priorities of patient care based on essential patient needs and available unit resources of time, personnel, equipment and supplies. Prepares equipment and aids provider during treatment, examination and testing of patients. Evaluates the effectiveness of the health care process (self, systems, environment, and instrumentation) in meeting outcomes. Observes, records, and reports patient's condition and reaction to drugs and treatments to provider. Provides medication as directed. Documents in patient and department records in a timely, accurate and concise manner according to department standards. Maintains and reviews patient records, charts, and other pertinent information. Compiles tests and examination results. Evaluates the patient's progress towards achieving outcomes. Performs efficiently in emergency patient situations following established standards of care. Practices effective problem identification and resolution as a method of sound decision making. Greets patients and prepares them for provider examination. Collects patient history information. Instruct patients in collection of samples and tests. Triages and refers incoming telephone calls. Instructs patient and family regarding medications and treatment instructions. Participates in system wide/department patient care quality improvement activities as well as standards development. Participates actively in clinical education activities, including orientation of new employees and teaching student nurses. Participates in nursing research activities. Participates in development and attainment of system wide/department hospital goals. Triages and refers incoming telephone calls. Instructs patient and family regarding medications and treatment instructions. Delegates tasks and duties in the direction and coordination of health care team members, patient care and department activities in accordance with the Kansas State Nurse Practice Act. Adheres to staffing and scheduling practices. Seeks validation of knowledge base, skill level and decision making as necessary and assertively seeks guidance in areas of question. Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Patient Facing Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail's Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually. Remote Work Capability On-Site; No Remote Scope Has Supervisory Responsibility No Budget Responsibility No Budget Responsibility Physical Demands Balancing: Occasionally 1-3 Hours Carrying: Occasionally 1-3 Hours Climbing (Ladders): Rarely less than 1 hour Climbing (Stairs): Occasionally 1-3 Hours Crawling: Rarely less than 1 hour Crouching: Occasionally 1-3 Hours Driving (Automatic): Rarely less than 1 hour Driving (Standard): Rarely less than 1 hour Eye/Hand/Foot Coordination: Frequently 3-5 Hours Feeling: Frequently 3-5 Hours Grasping (Fine Motor): Frequently 3-5 Hours Grasping (Gross Hand): Frequently 3-5 Hours Handling: Frequently 3-5 Hours Hearing: Frequently 3-5 Hours Kneeling: Occasionally 1-3 Hours Lifting: Frequently 3-5 Hours up to 50 lbs Operate Foot Controls: Occasionally 1-3 Hours Pulling: Occasionally 1-3 Hours up to 25 lbs Pushing: Occasionally 1-3 Hours up to 25 lbs Reaching (Forward): Occasionally 1-3 Hours up to 25 lbs Reaching (Overhead): Occasionally 1-3 Hours up to 25 lbs Repetitive Motions: Occasionally 1-3 Hours Sitting: Frequently 3-5 Hours Standing: Frequently 3-5 Hours Stooping: Frequently 3-5 Hours Talking: Frequently 3-5 Hours Walking: Frequently 3-5 Hours Working Conditions Burn: Rarely less than 1 hour Chemical: Rarely less than 1 hour Combative Patients: Occasionally 1-3 Hours Dusts: Rarely less than 1 hour Electrical: Occasionally 1-3 Hours Explosive: Rarely less than 1 hour Extreme Temperatures: Rarely less than 1 hour Infectious Diseases: Frequently 3-5 Hours Mechanical: Rarely less than 1 hour Needle Stick: Frequently 3-5 Hours Noise/Sounds: Frequently 3-5 Hours Other Atmospheric Conditions: Occasionally 1-3 Hours Poor Ventilation, Fumes and/or Gases: Occasionally 1-3 Hours Radiant Energy: Occasionally 1-3 Hours Risk of Exposure to Blood and Body Fluids: Frequently 3-5 Hours Risk of Exposure to Hazardous Drugs: Occasionally 1-3 Hours Hazards (other): Occasionally 1-3 Hours Vibration: Rarely less than 1 hour Wet and/or Humid: Rarely less than 1 hour Working Conditions Comments: Majority of work time is spent in pleasant interior, well-lighted, climate controlled environment. Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment. Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.

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: Current RN license and eligible to practice in VA 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

Job DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review. ESSENTIAL DUTIES & RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary. 90% of time will be spent on one or more of the following activities depending on assignments: Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization: Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations. Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care. Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns. May develop recommendations for further corrective action based on medical review findings. May refer for review, or implement, corrective action related to medical review activities. May process claims and complete project work in the appropriate computer system(s). The remaining 10% of time will be spent on the following activities depending on assignments: Identify providers needing education and individually educate providers who are subject to medical review processes: Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal. This may involve discussion with CMS leaders and leaders in the provider community. Participate in special projects as assigned. REQUIRED QUALIFICATIONS * Valid nursing degree * 2 years' clinical experience * Excellent written and oral communication skills * Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility) * Strong computer skills to include Microsoft Office proficiency * Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS * Inpatient Rehabilitation Facility Experience * Bachelor of Science in Nursing (BSN) * Insurance industry experience * Certified Coder ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Compensation: $80,000-$95,000 + equity This salary range reflects multiple experience levels and locations. Actual compensation within the range will be determined based on factors such as experience, skills, qualifications, and geographic location. Schedule: Full-time, 5 days a week, Tuesday-Saturday Location: Remote Role Type: Full-time | Bilingual Spanish preferred but not required About Bariendo Bariendo is on a mission to cure obesity. Founded by Harvard Medical School professors, we are pioneering quick, non-surgical weight loss procedures that are 7x safer than surgery and more effective and affordable than the best medications. Our digital health platform combines telehealth, distributed clinics, and an expert care team in endoscopic weight loss to deliver lasting, affordable results for the 40% of Americans struggling with obesity. We're growing rapidly-now in 8 cities after just 6 quarters of operations-with a vision to become the one-stop shop for obesity management, offering the most comprehensive set of interventions available online and via our distributed partner clinics. Join us to help patients reclaim their lives. About This Role We are looking for a people-centered, professional, and organized Nurse Patient Concierge to join our team and deliver Bariendo's signature 6-star care. You'll be the first point of contact for patients and a crucial part of making their weight loss journey feel smooth, supported, and stress-free. This is a role for someone who thrives in a fast-paced environment, has a concierge mindset, and finds joy in turning complex coordination into calm execution. In this role, you will: Deliver 6-Star Service: Be the warm, welcoming presence patients first encounter. Whether by phone, text, or email, you'll create a calm, organized, and exceptional experience that reflects Bariendo's high standards of care. Be a Trusted Clinical Guide: Act as a primary point of contact for patients on clinical and care-related questions, escalating appropriately to providers and ensuring clear, timely communication so patients feel confident and supported throughout their treatment. Ensure Clinical & Procedural Readiness: Partner closely with Bariendo's procedure centers to confirm accurate bookings, review patient charts for completeness and readiness, and coordinate outstanding requirements so every patient arrives fully prepared for their procedure. Be a Concierge for Every Concern: Monitor incoming communications, answer phone calls, and anticipate patient needs before they arise. You'll be a responsive, empathetic problem-solver who builds trust with every interaction. Drive Administrative Excellence: Maintain accurate records across our systems, ensure compliance with regulations like HIPAA, and support documentation workflows that enable smooth care delivery. What We're Looking For Clinical, Service-Driven Experience: Active RN license with 3+ years of patient-facing clinical experience, including experience delivering care or care coordination virtually (phone, text, telehealth). Ideally in procedural, ambulatory, or concierge-style settings where high-touch, white-glove support is the norm. Experience in Weight Management or Bariatric Care (preferred): Prior exposure to obesity medicine, bariatric surgery, endoscopy, or medical weight-loss clinics is a strong plus, particularly in patient education, pre-procedure readiness, or longitudinal care coordination. Fluent in Spanish (preferred, not required): Able to communicate clearly and professionally with Spanish-speaking patients across phone, email, and text. Detail-Oriented & Reliable: Comfortable juggling complex logistics with accuracy. You stay organized, catch errors before they happen, and keep things moving smoothly under pressure. Warm, Clear Communicator: You build trust quickly, make patients feel at ease, and bring empathy and professionalism to every interaction. Operationally Sharp & Adaptable: Confident discussing pricing and payment options in a direct-pay model, comfortable navigating EHRs and new software, and energized by fast-paced, ever-evolving environments where proactive problem-solving is key. What Makes This Job Amazing Mission: Join a team of Harvard Medical School professors and healthcare innovators transforming thousands of lives. Watch our patient's stories. Hybrid Environment: Work three days a week from our Market Street office and two days remotely, with some (infrequent) Saturday calls -all patient care is delivered virtually via telehealth. Foundational Role in a Growing Startup: Be part of a fast-growing, mission-oriented team. Collaborate closely with teams like Product to help shape and innovate our virtual care experience. Total Rewards Competitive salary with equity in a high growth, seed-stage startup Comprehensive health benefits (medical, dental, vision) 11 paid holidays, 15 personal vacation days, 10 wellness days Hybrid work, 3 days in-office 2 days remote

Our Virtual Urgent Care team is looking for an experienced Physician Assistant or Nurse Practitioner to join their team. In this role, you will be providing virtual medical care to patients of varying type and acuity. This is a full-time night shift position. As we care for patients of all ages, we cannot consider Adult/Gerontology trained Nurse Practitioners. Qualifications Physician Assistant * Required Master's Degree Graduate of an accredited Physician Assistant educational program * LIC-Physician Assistant - STATE_MI State of Michigan Upon Hire required * CRT-Physician Asst Certified (PA-C) - NCCPA National Commission on Certification of Physician Assistants Upon Hire required * CRT-Basic Life Support (BLS) - AHA American Heart Association 90 Days required Or * CRT-Basic Life Support (BLS) - ARC American Red Cross 90 Days required * CRT-Pediatric Adv Life Support (PALS) - AHA American Heart Association 120 Days required * CRT-Adv Cardiovascular Life Support (ACLS) - AHA American Heart Association 120 Days required Nurse Practitioner * Required Master's Degree Nurse Practitioners who obtained their education and certification after 2000 must show evidence of completion of a master's, post-master's or doctorate from a Nurse Practitioner program that is accredited by the Commission on the Collegiate of Nursing Education or the National League for Nursing Accrediting Commission * 3 years of relevant experience current, relevant clinical experience * Previous experience functioning in a collaborative role as a Nurse Practitioner * LIC-Nurse Practitioner (NP) - State of Michigan * CRT-Basic Life Support (BLS) * CRT-Neonatal Resuscitation Program (NRP) * CRT-Pediatric Adv Life Support (PALS) Corewell Health West Medical Group The Corewell Health West Medical Group is part of a not-for-profit health system serving 13 counties in West Michigan. Corewell Health West is a region of Corewell Health, formerly the BHSH System (Beaumont Health and Spectrum Health) that provides care and coverage with an exceptional team of 60,000+ dedicated people-including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving over 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. Corewell Health People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy, and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 65,000+ dedicated people-including more than 12,000 physicians and advanced practice providers and more than 15,500 nurses providing care and services in 21 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving more than 1.3 million members Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. For more information, visit corewellhealth.org. How Corewell Health cares for you * Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. * On-demand pay program powered by Payactiv * Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! * Optional identity theft protection, home and auto insurance, pet insurance * Traditional and Roth retirement options with service contribution and match savings * Eligibility for benefits is determined by employment type and status Primary Location SITE - 515 Michigan St NE - Grand Rapids Department Name Virtual Urgent Care - CHMG West Employment Type Full time Shift Variable (United States of America) Weekly Scheduled Hours 40 Hours of Work Variable Days Worked Variable Weekend Frequency Every third weekend CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling ************.