Director, Behavioral Health Transfer Center | 100% Remote | RN or LCSW
Remote job
Job Description
Director, Behavioral Health Transfer Center
$90,000 to $140,000 Base compensation based on experience
Must be a licensed clinician such as Registered Nurse. Would possibly consider a Licensed Clinical Social Worker or Licensed Professional Counselor depending on experience
Must hold a multi-state license (e.g., RN Compact or equivalent)
Position Overview
The Director of the Behavioral Health (BH) Transfer Center provides senior-level leadership for a centralized, 24/7 behavioral health access and admissions operation supporting multiple facilities across several states. This role is accountable for operational performance, clinical integrity, regulatory compliance, and relationship management across a multi-state healthcare system.
The ideal candidate is an experienced Behavioral Health leader at the Director level, highly operationally focused, data-driven, and comfortable leading remote clinical and non-clinical teams. This leader serves as the subject matter expert for BH transfer operations and works closely with executive leadership, hospital CEOs, and clinical teams to ensure safe, timely, and compliant patient transfers.
Company Overview
The Behavioral Health Transfer Center functions as a centralized, 24/7 hub responsible for the timely and appropriate placement of patients requiring acute behavioral health care. The center streamlines the transfer process by conducting clinical assessments, confirming bed availability, and coordinating transportation to ensure patients are placed in the appropriate level of care without delay across 18 facilities.
Staffed by a multidisciplinary team of 31 experienced behavioral health professionals-including licensed clinicians, nurses, EMTs, and case managers-the Transfer Center serves as the primary liaison for referring facilities and manages more than 6,000 patient transfers each month. The mission is to reduce wait times, eliminate gaps in care, and ensure safe, seamless transitions for individuals experiencing mental health or substance use crises. This role offers the opportunity to work remotely within a high-volume, fast-paced, and purpose-driven environment focused on clinical excellence and operational efficiency.
Key Responsibilities
Provide overall leadership and accountability for Behavioral Health Transfer Center operations, including remote clinical (RNs/licensed clinicians) and non-clinical staff.
Drive operational excellence through metrics, KPIs, service-level management, and continuous process improvement.
Ensure appropriate clinical decision-making and level-of-care recommendations for behavioral health patients across all age populations.
Partner with hospital CEOs, Directors of Nursing, Directors of Assessment, and executive leadership to ensure consistent admissions and transfer processes across all facilities.
Maintain full compliance with EMTALA, CMS, TJC, HIPAA, and applicable multi-state regulatory requirements; lead regular audits and corrective actions.
Collaborate with Workforce Management and Finance to ensure appropriate staffing models and resource allocation.
Build and maintain strong relationships with physicians, referral sources, internal stakeholders, and external partners.
Work closely with Training and Quality teams to audit calls, referral packets, and documentation to ensure quality and consistency.
Identify and resolve operational gaps, service failures, and process breakdowns in a timely manner.
Lead performance management, coaching, and development of staff; conduct annual and real-time performance evaluations.
Support recruiting, hiring, onboarding, and retention of clinical and non-clinical transfer center staff.
10% travel requirement
Must-Have Qualifications
Director-level leadership experience in Behavioral Health (required).
Strong operational mindset, with demonstrated success managing metrics, workflows, and scalable processes.
Active clinical license required, preferably Registered Nurse (RN).
Must hold a multi-state license (e.g., RN Compact or equivalent).
Candidates with LCSW or LPC licensure may be considered if they hold appropriate multi-state licensure and possess significant leadership experience.
Proven ability to communicate effectively and build relationships across all levels of the organization, including executive leadership and frontline clinical teams.
Experience supporting or leading 24/7 healthcare operations.
Preferred Qualifications
Experience leading a Behavioral Health Transfer Center, Access Center, or centralized admissions function.
Background managing remote or distributed clinical teams.
Direct experience supporting a multi-facility, multi-state behavioral health system.
Master's degree in Nursing, Social Work, Psychology, or Healthcare Administration.
Registered Nurse II-Health
Remote job
Registered Nurses for MAGNET facilities. Provides nursing care to patients using the nursing process (assessment, planning, implementation, and evaluation). Directs and leads other assigned team members and collaborates with multidisciplinary team members to provide age/developmentally appropriate care in accordance with nursing standards of care and practice. Provide patient/family centered care using the nursing process and focusing on the physical, emotional, spiritual, cultural, religious, and environmental needs. This includes providing for the assessment, development of nursing diagnoses, outcome identification, planning, implementation of interventions, coordination of care, health teaching and promotion and evaluation of goals and interventions consistent with the policies of MUSC. Maintains a safe, therapeutic, and healing environment through ensuring patient privacy and responsive, respectful, accepting, and professional behavior. Demonstrates the ability to function in a professional setting through active participation in a professional practice model. This includes participating in shared governance, adherence to standards of care, participation in peer review and professional development promoting leadership and clinical excellence, effective team skills, autonomous practice and acknowledgment of accountability for actions and critical thinking. Coordinates the effective and efficient delivery of patient care services through the application of care management principles. Identifies clinical priorities and initiates action to improve patient outcomes. Demonstrates ability to function in a professional practice model through active participation in shared governance, promotion of a healthy work environment and acceptance of personal responsibility for professional growth.
Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC004226 CHSCorp - Telemedicine Administration
Pay Rate Type
Hourly
Pay Grade
Health-28
Scheduled Weekly Hours
40
Work Shift
Registered Nurses for MAGNET facilities. Provides nursing care to patients using the nursing process (assessment, planning, implementation, and evaluation). Directs and leads other assigned team members and collaborates with multidisciplinary team members to provide age/developmentally appropriate care in accordance with nursing standards of care and practice. Provide patient/family centered care using the nursing process and focusing on the physical, emotional, spiritual, cultural, religious, and environmental needs. This includes providing for the assessment, development of nursing diagnoses, outcome identification, planning, implementation of interventions, coordination of care, health teaching and promotion and evaluation of goals and interventions consistent with the policies of MUSC. Maintains a safe, therapeutic, and healing environment through ensuring patient privacy and responsive, respectful, accepting, and professional behavior. Demonstrates the ability to function in a professional setting through active participation in a professional practice model. This includes participating in shared governance, adherence to standards of care, participation in peer review and professional development promoting leadership and clinical excellence, effective team skills, autonomous practice and acknowledgment of accountability for actions and critical thinking. Coordinates the effective and efficient delivery of patient care services through the application of care management principles. Identifies clinical priorities and initiates action to improve patient outcomes. Demonstrates ability to function in a professional practice model through active participation in shared governance, promotion of a healthy work environment and acceptance of personal responsibility for professional growth.
Additional Job Description
Minimum Requirements: Bachelor of Nursing degree preferred. RN staff hired on or after July 1, 2013 with an Associate or Diploma degree in nursing are required to be enrolled in an accredited BSN program within two years and successfully obtain a BSN degree within four years of the RN hire or reclassification date. Refer to policy A141 for more details. A minimum of one year of work experience as a registered nurse required. Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state. Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required.
Physical Requirements:
1. Ability to stand or sit for extended periods of time.
2. Proficiency in manual dexterity and fine motor skills for tasks such as taking patient vitals, administering injections, or conducting physical exams.
3. Capacity to lift and move patients or medical equipment as needed.
4. Visual acuity and color perception to accurately read medical charts, documents, and monitors.
5. Auditory ability to effectively communicate with patients and colleagues, as well as to perceive important sounds such as alarms or patient instructions.
6. Stamina and resilience to handle the physical and emotional demands of providing patient care, including long shifts and potentially stressful situations.
7. Mobility to navigate clinical environments, including moving between patient rooms, offices, and other areas of the facility.
8. Compliance with infection control protocols and proper use of personal protective equipment to maintain a safe and healthy work environment.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: ***************************************
Auto-ApplyRemote Registered Nurse, Home Health Per Diem
Remote job
Become a part of our caring community and help us put health first As a Home Health Registered Nurse, you will: * Provide admission, case management, and follow-up skilled nursing visits for home health patients. * Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
* Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
* Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers).
* Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
* Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
* Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
* Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
* Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care.
Use your skills to make an impact
Required Experience/Skills:
* Diploma, Associate or Bachelor Degree in Nursing
* Minimum of one year nursing experience preferred
* Strong med surg, ICU, ER, acute experience
* Home Health experience a plus
* Current and unrestricted Registered Nurse licensure
* Current CPR certification
* Strong organizational and communication skills
* Valid driver's license, auto insurance and reliable transportation.
Scheduled Weekly Hours
1
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$69,800 - $96,200 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Registered Nurse - Women's Health
Remote job
Registered Nurse (RN) - Clinical Triage & Inbox Management
Employment Type: Full-Time, 40 hours / week Compensation: $80,000 per year (exempt from overtime) Reports To: Clinical Manager, Practice Administration
Work Schedule (Required)
Monday-Friday
Three fixed shifts available:
6:00 AM PST - 2:30PM PST
7:00AM PST - 3:30PM PST
8:00 AM PST - 4:30 PM PST
Ability to consistently work one of the above shifts is required
Role Summary
The Registered Nurse (RN) will provide clinical triage, EHR inbox management, patient education, and care coordination in a high-volume virtual women's health practice. This role requires independent clinical judgment, strong protocol adherence, and deep experience in women's health, particularly care for women in midlife.
Core Responsibilities
Manage and triage the EHR inbox for a high-volume patient population
Perform clinical triage to assess patient symptoms, concerns, and urgency
Apply clinical protocols and practice guidelines to patient questions and care decisions
Create and implement clinical practice guidelines in support of RN scope of practice
Provide patient education related to medication administration, treatment plans, and general clinical questions
Assess clinical concerns and determine whether resolution is appropriate via protocol or requires provider evaluation
Review laboratory results and diagnostic imaging and identify abnormal findings requiring provider review, including coverage providers when the ordering provider is unavailable
Coordinate care with external partners, including pharmacies and referral sites (e.g., attaching documentation, following up on prescriptions)
Escalate cases to RN visits or MD/NP visits when clinically indicated
Document all patient interactions and clinical decisions accurately and thoroughly in the electronic health record (EHR)
Maintain current knowledge of all Midi/IWC clinical protocols, policies, and workflows relevant to the RN role
Deliver timely, high-quality, patient-centered care in a virtual clinical environment
Perform other duties as assigned
Maintain active, unrestricted, and unencumbered Registered Nurse licensure in all U.S. states
Required Qualifications (Applicants Must Meet All)
Active Registered Nurse (RN) license in good standing, with licensure in at least one (1) of the following states - CA, IL, MN, NY)
and
an active multi-state RN license through the Nurse Licensure Compact (NLC)
Bachelor of Science in Nursing (BSN)
Minimum of 5+ years of triage nursing experience
Minimum of 5+ years of women's health clinical experience, with a focus on care for women in midlife
Examples: Gynecology, Primary Care, Internal Medicine
Minimum of 5+ years managing high-volume patient care, defined as 100+ case escalations per week
Preferred experience as a Family Practice phone triage nurse, Urgent Care or Emergency department triage nurse, or Gynecology office phone triage nurse
Ability to work full-time during one of the required shifts listed above
Strongly Preferred Qualifications
50-state RN licensure
Experience developing clinical practice guidelines and protocols
Emergency Department or Urgent Care experience
Telemedicine or virtual care experience
Strong proficiency with EHR systems and asynchronous patient messaging
About Midi Health
Midi Health is the only comprehensive virtual care clinic dedicated to women in midlife navigating perimenopause, menopause, and other common midlife health challenges. Our care is designed by experts, scaled by technology, and delivered by compassionate, highly trained clinicians.
We accept most major PPO insurance plans and provide access to care through telehealth visits, 24/7 messaging, and evidence-based prescribing. We are focused on correcting the widespread underdiagnosis and undertreatment of women's midlife hormone-related conditions.
Work Location
Midi Health is a remote organization. Employees may reside anywhere within the United States.
Please note that all official communication from Midi Health will come from **************** email address. We will never ask for payment of any kind during the application or hiring process. If you receive any suspicious communication claiming to be from Midi Health, please report it immediately by emailing us at ********************.
Midi Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Please find our CCPA Privacy Notice for California Candidates here.
Auto-ApplyHEDIS Over Reader Nurse - Remote - Contract
Remote job
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.
BILH Pharmacy Services - Field Based - In Home Nurse - Infusion RN Part Time 24 hrs. Days.
Remote job
When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.
The Registered Nurse creates & develops patient care plans to direct the safe and appropriate administration of medication in the home or alternate site setting. Working with Home Infusion staff the Registered Nurse helps identify patients capable of successful self-administration, educates patients & caregivers on proper administration techniques & methods, coordinates discharge activities, administers or supervises administration of medication, provides IV site dressing care and phlebotomy services as ordered.
Job Description:
Primary Responsibilities:
1. Practices in accordance with the state and federal laws, rules, and regulations, including but not limited to Massachusetts Board of Registration in Nursing, Department of Public Health, the Food and Drug Administration, the Drug Enforcement Administration, and the United States Pharmacopeia.
2. Assesses patient needs and capabilities for acceptance onto services for ordered therapies through physical assessment, chart review, patient interview.
3. Provides education with patient & caregiver as a condition of acceptance onto home infusion services (in person, via prerecorded videos or teleconference).
4. Collects necessary authorizations, paperwork, signatures when needed to support patient billing functions.
5. Effectively communicates with all members of patient discharge team (hospital based & pharmacy based).
6. Able to effectively manage patient census & demonstrate flexibility in scheduling to meet time sensitive patient needs.
7. Adheres to policies & procedures for medication handling, preparation, administration, disposal.
8. Advocates patient needs to prescribers or other clinicians through written or verbal communication.
9. Create patient specific care plan, documents patient progress towards goals.
10. Maintains accurate listing of all medications, supplements & diagnoses patient has.
11. Create discharge plan for patient upon completions of therapy as ordered, or if abrupt discontinuation is required.
13. Participates in continuous quality control exercises, policy & procedure review, performance improvement tasks.
14. Take part in clinical on-call rotation for after-hours patient support.
Required Qualifications:
1. Current licensure from the Massachusetts Board of Registration in Nursing.
2. Flexibility with hours worked to provide support evenings/weekends/holidays.
3. Current BLS certification
4. 2 years of Infusion related experience required.
5. Valid Driver's license & auto insurance
Preferred Qualifications:
1. CRNI certification
2. Current ACLS certification
Competencies:
Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
Oral Communications: Ability to comprehend and converse in English to communicate effectively with staff, patients, families and external customers.
Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Adaptability: Ability to work in a fast paced environment and adapt to acute change.
Social/Environmental Requirements:
Health Care Status: HCW 3: Regular provision of service in a patient care area.
Sensory Requirements:
Close work (paperwork, visual examination), Color vision/perception, Visual monotony, Visual clarity feet, Conversation, Monitoring Equipment, Telephone, and Background Noise.
Physical Requirements:
Medium work: Exerting up to 50 pounds of force occasionally and or up to 20 pounds of force frequently. Job is physical in nature and employee needs to stand and/or move around through the majority of their shift.
This job requires constant walking, Endurance-working up to 4-6 hours without a break, frequent sitting, standing, twisting neck, twisting waist, Keyboard use, Reaching-above shoulder height, Reaching-below shoulder height, Lifting and carrying items weighing up to 10 lbs, pushing items weighing up to 10 lbs. There may be occasional bending neck, bending waist, Fine Manipulation using both hands, Pushing/Pulling using both hands.
Pay Range:
$37.00 - $66.70
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.Equal Opportunity Employer/Veterans/Disabled
Auto-ApplyClinical Facilitator, RN or SW
Remote job
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.
Auto-ApplyField Nurse - Palliative/Home-Based Supportive Care **Nassau County; Palliative/Hospice Experience Highly Preferred**
Remote job
NYU Langone Hospital-Long Island is a 591-bed university-affiliated medical center, which offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. We are a major regional healthcare resource with a deep commitment to medical education and research, offering a full complement of inpatient and outpatient services. At NYU Langone Health, equity and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace inclusion and individual skills, ideas, and knowledge.
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NYU Langone Hospital-Long Island
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Position Summary:
We have an exciting opportunity to join our team as a Field Nurse - Eastern Long Island - Home Care Division - SIGN ON BONUS - $5,000.
In this role, the successful candidate Provides safe, quality, therapeutic age appropriate nursing care using evidence based practice. Uses clinical expertise in assessment, clinical decision making, clinical practice and patient education. The nurse coordinates the care provided with the interdisciplinary team to promote optimum patient outcomes and satisfaction.
Job Responsibilities:
Performs other duties as assigned
Completes a comprehensive nursing assessment including but not limited to physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age related, environmental, spiritual, transpersonal and economic factors in a systematic and ongoing process while honoring the uniqueness of the patient.
Derives the diagnoses and needs from the assessment data, validates the diagnoses, and collaborates with the patient, family, caregivers and physician to develop an individualized plan care to attain expected quality outcomes.
Responsible for the coordination of care by interacting and collaborating with other members of the healthcare team to optimize patient outcomes, patient satisfaction and health care goals.
Delivers direct nursing care, ongoing assessment, teaching and training to patientscaregivers that preserves and protects patient autonomy, dignity, rights, values, and benefits using evidence based nursing practice.
Identifies deficits and barriers to effective knowledgeunderstanding of education provided to patients. Employs strategies to optimize patient engagement. Demonstrates caring behaviors toward patients, family and other caregivers.
Complete and maintain accurate, complete and timely documentation reflecting the assessment, examination, diagnosis, prognosis, plan of care, education intervention and evaluation according to Federal, Department of Health and The Joint Commission requirements.
Assist Agency leadership with achieving corporate goals, improving quality of patient care outcomes and patient satisfaction. Participate in Agency quality assessmentperformance improvement initiatives.
Minimum Qualifications:
To qualify you must have a Current Registered Professional Nurse in New York, Bachelor's degree in Nursing required, Basic Life Support Certification through the American Heart Association, Fluent written and spoken English language skills. 1- 2 years Acute care facility OR Home Health,Hospice, and Long Term Home Health Care Program. Excellent communication (both oral and written), interpersonal, customer service skills. Critical thinking skills. Working knowledge of Computers..
Required Licenses: Registered Nurse License-NYS, Basic Life Support Cert
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Hospital-Long Island provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family.
NYU Langone Hospital-Long Island is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.
Know Your Rights: Workplace discrimination is illegal.
NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $110,966.74 - $160,466.74 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
To view the Pay Transparency Notice, please click here
Clinical Reviewer RN (Remote in TN)
Remote job
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
Easy ApplyRN Clinical Documentation Specialist- REMOTE
Remote job
Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. Perform concurrent and retrospective reviews of medical records to ensure accurate documentation of patient care. Educate healthcare providers on the importance of accurate and complete clinical documentation. Utilize clinical knowledge and expertise to identify opportunities for documentation improvement. Ensure compliance with regulatory requirements and guidelines. Participate in multidisciplinary team meetings to discuss documentation improvement strategies. Provide feedback to healthcare providers on documentation practices and areas for improvement. Maintain up-to-date knowledge of clinical documentation standards and best practices.
Responsibilities
* Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers.
* Perform concurrent and retrospective reviews of medical records to ensure accurate documentation of patient care.
* Educate healthcare providers on the importance of accurate and complete clinical documentation.
* Utilize clinical knowledge and expertise to identify opportunities for documentation improvement.
* Ensure compliance with regulatory requirements and guidelines.
* Participate in multidisciplinary team meetings to discuss documentation improvement strategies.
* Provide feedback to healthcare providers on documentation practices and areas for improvement.
* Maintain up-to-date knowledge of clinical documentation standards and best practices.
Qualifications
* Registered Nurse (RN) with a current license from any state.
* Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) certification.
* Certified Coding Specialist (CCS) certification if they have the CCDS 2 certification.
* Minimum of 3 years of clinical nursing experience.
* Strong knowledge of clinical documentation standards and regulatory requirements.
* Excellent communication and interpersonal skills.
* Ability to work collaboratively with healthcare providers and multidisciplinary teams.
* Proficiency in electronic health record (EHR) systems.
Additional Skills
* Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) certification.
* Certified Coding Specialist (CCS) certification if they have the CCDS 2 certification.
Work Environment
Fully remote role. Schedule: Monday-Friday 9am-5pm with potential for flexibility as long as 40-hour weeks are maintained.
Pay and Benefits
The pay range for this position is $70000.00 - $120000.00/yr.
Health, Vision, Dental, 401k
If we find a local candidate (CT RN license in CT, they will receive Middlesex Health Benefits, If we find someone national w/o CT RN License then they will receive benefits through 3rd party organization- Mindlance (have been told this is very expensive so they prefer local). Have all the benefit info in a PDF when needed
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on May 9, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Registered Nurse / Clinical Editor / Proofer / Remote
Remote job
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
Registered Nurse (RN), Triage, Part-time, Remote
Remote job
Department:
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
32
Schedule Details/Additional Information:
Pay Range
$34.90 - $52.35Schedule: Part-time, either 3 (10 hour) shifts or 4 (8 hour) shifts. Day/pm hours available. Every third weekend and holiday rotation.
**Candidate MUST have 2+ years' acute care experience (ED, Urgent Care, ICU and some Med/Surg will be considered) is required within the last 4 years to be considered.**
Due to complex requirements, remote work is NOT permitted from the following states:
CA, CO, CT, HI, MA, MD, MN, NJ, MY, OR, RI, VT, WA
Schedule:
Part time position (30 or 32 hours)
start times mornings 8a,9a or 10a, PMs 12p, 1p, 2p or later
8 hour or 10 hour shifts are available for different shifts
MUST
be available to work every 4th weekend and holiday rotation
Major Responsibilities:
Uses the nursing process and guidance of established protocols to assess the needs of the patient telephonically including the patient, guardian, or family in the conversation when necessary. Determines most appropriate level of care needed, provides detailed education, establishes a plan of care including interventions, and communicates follow up instructions to the patient. Escalates and collaborates with the appropriate on call provider when additional guidance is needed.
Prioritizes patient interactions by acuity and need considering all available information and resources. Applies evidence-based practice to deliver patient care.
Implements strategies to reduce patient risk and increase patient safety. Assesses patient and family readiness to learn and individualizes the approach as necessary. Works collaboratively to develop strategies to meet the learning needs of the patient and family.
Supports shared governance activities and initiatives to improve processes and patient outcomes.
Participates in department quality/process improvement initiatives aimed at enhancing the patient care experience.
Participates in professional activities which contribute to personal professional development and the development of others. Seeks opportunities to be taught, coached, and mentored. Attends required meetings/educational programs and completes annual competencies in a timely manner.
Demonstrates effective communication, feedback, and conflict resolution skills. Promotes collaboration with clinicians and other healthcare team members to coordinate patient-centered care.
Promotes a culture of safety through identifying threats to patient safety and intervening to prevent patient harm. Reports patient safety events and near misses in a timely manner. Seeks to identify potential safety issues and assists in the implementation of corrective action.
Applies ethical decision making, demonstrates respect and understanding for peers, and other clinical disciplines. Participates as an effective member of the patient care team to formulate an integrated, unbiased, individualized approach to care.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret appropriate information needed to identify each patient's requirements relative to his/her age specific needs and provide the care advice/disposition outlined in the departments policies, procedures, and protocols. Schedules appointments with emphasis on making the appointment in correlation to the recommended end point of the protocol used. Collaborates with other health care team members to coordinate medical and nursing management of patient care, including procedures and medication refills.
Accurately maintains and updates the patient's clinical records according to agency, State and Federal guidelines. Documents all call encounters utilizing the patient's Electronic Medical Record at the time of the call. Communicates information relating to the patient's physical and psychological status to the physician, Advanced Practice Clinician and/or additional members of the interdisciplinary team as appropriate. Provides pertinent and concise reports describing patient's response to medical and nursing plans of care.
Participates in team meetings and works on special projects/tasks as assigned by leadership. Participates in the ongoing development of comprehensive health information resources, system and operational efficiencies and resources. Assists in interpreting department policies and procedures and advises staff on procedural changes.
Licensure, Registration, and/or Certification Required:
Registered Nurse license issued by the state in which the team member practices.
Education Required:
Associate's Degree (or equivalent knowledge) in Nursing.
Experience Required:
Typically requires 2+ years' of acute care experience, preferably within the last 4 years (ED, Urgent Care, ICU and some Med Surg will be considered).
Knowledge, Skills & Abilities Required:
Critical thinking skills necessary to independently determine and prioritize the needs of patients using sound judgment and strong problem-solving skills.
Knowledge of a variety of healthcare specialties, including levels of care, symptom identification and proven treatment recommendations. Ability to incorporate past experience with established protocols.
Excellent verbal communication skills demonstrating empathy, respect, restatement, open-ended questions, active listening and diplomacy with a diverse customer population.
Ability to develop rapport and maintain positive, professional relationships with a variety of patients, staff and physicians.
Proven ability to independently organize and prioritize work, managing multiple priorities and maintaining a flexible schedule in a fast paced, dynamic customer service environment.
Excellent customer service and follow-up skills including the ability to stay calm during stressful situations.
Demonstrated proficiency as a technology user with computers, internet, desktop software packages and multiple-line telephone systems.
Ability to converse with customers/patients while researching and documenting calls on multiple systems. Knowledge of documentation techniques for communication
Physical Requirements and Working Conditions:
Required stable and secure internet connection
Must have functional vision, touch, speech, and hearing.
Required sitting a majority of the workday.
Operates all equipment necessary to perform the job.
Must have quiet space to make and receive phone calls
Ability to lift 15 lbs.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Benefits and more
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
Auto-ApplyRegistered Nurse, Clinical Instructor
Remote job
Raleigh General Hospital
Registered Nurse (RN), Clinical Instructor Job Type: PRN
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
Responsible for planning and presenting education programs as directed and for assisting the in-house patient education programs.
Job Requirements
Minimum Education
Graduate of a Program in Discipline - Required
Registered nurse graduated from a school of nursing.
BSN and/or MSN preferred.
Required SkillsRequires 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.
Certifications:
Basic Life Support (BLS)
Advanced Cardiovascular Life Support (ACLS) - required if teaching course
Pediatric Advanced Life Support (PALS) - required if teaching course - to be obtained within 6 months
Evidence of proficient skills in teaching ability, creativity, communication, and in nursing procedure administration. Demonstrated ability to work with persons of diverse backgrounds and training experience. Demonstrated evidence of effective nurse-patient relationships with emphasis on patient teaching. Basic knowledge of Personal Computer.
Required Licenses
Current licensure by the State Board of Nursing
Essential Functions
Participates in and conducts orientation and education programs for hospital staff and community.
Assists with planning, developing and implementing educational programs for hospital staff.
Provides patient instruction and education.
Assists in coordinating educational activities (conferences, seminars) within the hospital.
Coordinating and/or teaching scheduled Childbirth classes.
Delivers direct patient care appropriate to the age of patient served.
Serves as primary contact between The Training Center and the hospital
Auto-ApplyClinical Review Specialist - RN - Appeals Writing
Remote job
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.
Auto-ApplyCharge Nurse - Medical Critical Care - FT - Night
Remote job
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.
Auto-ApplyClinical Research Nurse - Home Visits (PRN); Birmingham, Alabama
Remote job
Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse - Home Visits (PRN), you'll provide high-quality nursing care directly in patients' homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work.
Key Points to Know: • You'll use your own vehicle to visit patients in their homes, typically within 1-2 hours of your location. • Shifts are PRN / per diem, meaning you'll work only when projects are available in your area; project frequency may vary. • Orientation, training, and project-specific instructions are provided before each assignment. • You will be compensated for all time spent on training, travel, and patient visits, including documentation.
We are posting this role now and will be reviewing applications on a rolling basis between now and Christmas.
Interviews will begin in the New Year
, so you may experience a brief delay in hearing back from us during the holiday period. Thank you in advance for your patience - we look forward to connecting in January.
Position: Clinical Research Nurse - Home Visits (PRN) Job Type: Contract, PRN, Per Diem Hourly Rate: $55/hr onsite and $50/hr travel time Work Location: Birmingham, Alabama; Drive up to 1-2 hours to patient homes in your area (travel time compensated!)
Job Description: As a Clinical Research Nurse - Home Visits (PRN), you will play a crucial role in ensuring the successful execution of research studies in patient homes. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your expertise and caring nature will help us maintain compliance with each study's protocol and safeguard the well-being of study patients. Principal Duties and Responsibilities:
Deliver competent, high-quality nursing care to study patients in their homes.
Accountable for the competent and confident delivery of high-quality clinical care to patients/participants. Ensure compliance with each study's protocol by providing thorough review and documentation at each subject study visit.
Administer investigational medications/products as needed; Perform patient assessments to determine presence of side effects; notify Principal Investigator of findings/issues.
Perform medical tests as outlined in protocol, including, but not limited to: vital signs, specimen collection, electrocardiograms; Process specimens and ship specimens per protocol.
Provide patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment.
Responsible for adherence to clinical research policies to ensure ethical conduct and protect vulnerable populations.
Communicate effectively, promoting open and trusting relationships.
Qualifications:
Relevant Nurse Licensure
CH-GCP Certificate
Graduate from an accredited BSN or Associate Degree in Nursing or Nursing Diploma
program
Minimum 2 years' post qualification acute care experience
Clinical Research experience preferred
BLS certification required
Experience and knowledge of working in clinical research trials with ICH-GCP (Good
Clinical Practice) Certification - (training can be provided)
Good basic IT skills, utilizing mobile devices and Microsoft systems
Trained in Handling and Transport of Hazardous Substances (training can be provided)
A flexible schedule is essential
Unencumbered driver's license, reliable car
Benefits:
Competitive hourly pay rate, including compensation for travel time.
Flexible schedule to maintain work-life balance.
Mileage reimbursement for travel expenses.
Ongoing training and support to growth your clinical research skills
Opportunity to make a meaning impact on patients' lives while contributing to cutting-edge medical research.
Join our team and contribute to groundbreaking medical advancements through clinical research!
Auto-ApplyRN-Clinical Auditor 2
Remote job
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
Auto-ApplyClinical Reviewer - RN (Remote U.S.)
Remote job
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.
Job Summary and Responsibilities
Acentra Health is looking for a Clinical Reviewer - RN (Remote U.S.) to join our growing team.
Job Summary:
* Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews.
Responsibilities:
* Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services.
* Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence.
* Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool.
* Ensure accurate and timely submission of all administrative and review-related documents to the company.
* Perform ongoing reassessment of the review process to identify improvement and/or change opportunities.
* Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process.
* Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review.
* Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies.
* Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines.
* Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs.
* Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary.
Work Hours:
* Monday through Friday, 8:00 AM until 5:00 PM within the Time Zone where you reside, plus:
One day per week is a priority day that would be assigned to complete expedited cases received between 3:00 PM and 6:00 PM Central.
Qualifications
Required Qualifications/Experience:
* Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license.
* Associate's, Bachelor's degree (or Diploma) in Nursing.
* 2+ years of clinical experience in an acute OR med-surgical environment.
* 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization.
* 1+ years of knowledge of medical records, medical terminology, and disease process organization.
* 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG).
Preferred Qualifications/Experience:
* Knowledge of current National Committee for Quality Assurance (NCQA) standards.
* Knowledge of Utilization Review Accreditation Commission (URAC) standards.
* Knowledge of Medicare (CMS) guidelines.
* Experience with Medical Appeals.
* Experience with Medicare Advantage plans.
* Medical Record Abstracting skills.
* Clinical assessment and critical thinking skills.
* Excellent verbal and written communication skills.
* Ability to work in a team environment.
* Flexibility and strong organizational skills.
* Proficient in Microsoft Office and Internet/Web Navigation.
#LI-SD1
Why us?
We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.
We do this through our people.
You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.
Thank You!
We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!
~ The Acentra Health Talent Acquisition Team
Visit us at Acentra Health
EEO AA M/F/Vet/Disability
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.
Benefits
Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.
Compensation
The pay range for this position is listed below.
"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."
Pay Range
USD $28.37 - USD $37.50 /Hr.
Registered Nurse (RN) Clinical Documentation Denials Auditor
Remote job
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
Auto-ApplyRemote Field Resource Nurse (LPN/LVN)
Remote job
Float is hiring a fully remote LPN/LVN to support our SuperNurses in the field and serve as their first line of clinical guidance! About Float
Float is the full-stack platform for Specialty Pharma home infusion. We're on a mission to make healthcare safer, easier, and more efficient by connecting SuperNurses to home medication visits - moving all care that doesn't need a hospital to the home.
Float connects nurses with patients so they can get treatments for their chronic conditions in the home rather than going into the overcrowded hospital. Our model benefits all stakeholders - patients get more convenient care, nurses access flexible work for better pay, pharmacies fill more prescriptions, hospitals reduce low-reimbursement admissions, and payors enjoy 12x reduced costs with home-delivered care.
Having closed our Series A in 2023, we're at an inflection point in our growth. We've successfully demonstrated multi-state expansion, validated strong unit economics, and boast remarkable retention of patients, nurses, and pharmacies. We've facilitated over 65,000 patient visits and are scaling our platform, team, and operations to serve more geographies and patients.
The Role
The Field Resource Nurse (LPN/LVN) is part of Float's centralized Clinical Resource team. This role provides real-time phone support to independent contractor nurses in the field, helping them troubleshoot workflows, documentation, and therapy-related questions during active visits. You'll be the first line of contact for Float's field nurses, ensuring they feel supported, informed, and confident while providing patient care.
In this role, you'll also be reviewing clinical documentation and helping create plans of treatment.
This is a great opportunity for a licensed practical or vocational nurse with experience in infusion or specialty pharmacy who communicates clearly, stays calm under pressure, and enjoys helping other clinicians succeed.
This is a first-of-it's-kind role for Float Health as we scale our Clinical Resource Team. You'll be a part of our inaugural LVN/LPN team. We're looking for flexible, adaptable team members who will help us further define this role for the future.
What you'll do:
Provide real-time phone support for field nurses during patient visits.
Help troubleshoot common issues related to equipment, medication handling, documentation, and pharmacy protocols.
Support nurse adherence to therapy standards and pharmacy protocols.
Document call summaries and flag recurring issues for quality or operational follow-up.
Partner with our Clinical Resource Nurses and internal operations teams to ensure a seamless, consistent field support experience.
Clinical Admin tasks, such as: reviewing nurse charts, completion of Plan of Treatment documents, supporting the clinical education team, and management of pharmacy and medication resources.
Additional duties as needed
What you'll bring:
Active unencumbered LPN/LVN license.
5+ years of nursing experience in home health, infusion, lab draws/lab requisitions, or other patient-facing settings.
Excellent communication skills: calm, clear, and professional with both nurses and pharmacy staff.
Strong clinical judgment and ability to recognize when to escalate issues.
Comfort working in a fast-paced, tech-driven environment with multiple communication platforms.
Exceptional customer service skills, with the ability to digest and explain complex information clearly while communicating professionally, empathetically, and effectively with pharmacies, nurses, and patients
Detail-oriented, organized, and dependable under pressure.
Familiarity with infusion therapies, venous access devices, and specialty pharmacy workflows
You'll thrive in this role if:
You're someone who's comfortable supporting the autonomy of like-minded nurses.
You bring emotional intelligence to all that you do, and remain composed and professional in high-stress or uncertain situations.
You're comfortable handling a high volume of calls while juggling incoming issues at once.
You have an IV Therapy certification (preferred)
Location and Schedule:
Location: This is a fully remote position based in the US.
Employment Type: This is a full time position working 40 hours per week.
Work Hours: Float operates in the PST time zone. Work hours for this position is Tuesday to Saturday from 1pm - 9pm PST (or 4pm - 12am EST)
Pay, perks and such:
Medical, dental, vision
401k matching
Unlimited PTO with minimum days
Paid parental leave
WFH monthly allowance and home office set up
Annual Learning Stipend
HSA & FSA
Voluntary Life, Accident, Hospital, and Critical Illness Insurance
Zero commute. Work wherever you are (on or around US hours)
Compensation for this role consists of a base salary and options grant, with the base salary expected to range from $52,000 to $62,000 per year. Individual compensation will be commensurate with the candidate's experience and location.
Culture:
We're a Series A startup looking for individuals who are willing to grow with the team and adapt to our fast-paced, ever changing work environment.
At Float, we #WorkfortheSuperNurse. We believe that making the
best
nurses the heroes attracts the best talent, and in turn delivers the best patient experience. As our nurses boldly do what's right for our patients, we boldly do what's right for them. If this is a purpose that inspires you, we'd love to talk!
Float Health is an equal opportunity employer. We celebrate the diversity of the team that builds for diverse users. We are committed to creating an inclusive environment for all employees.