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Registered nurse case manager jobs in Carolina, PR

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  • Case Management Core 2 Manager

    Alivia Health

    Registered nurse case manager job in Guaynabo, PR

    Under the leadership of the Operations Director the main objective of this role is to provide ongoing oversight of the Case Management Core 2 Team which includes Inflammatory, Osteoporosis /Osteoarthritis, Floater and Zero refill resources. This team is accountable for initial interview and following up with patient or MD office to obtain additional information/documentation to be able to process claim. This team will also be responsible for working medication refills. The Manager will manage all aspects of the department functions, including personnel, systems, initial and on going training and employee development. Responsibilities include but are not limited to: Holds self and others accountable for measurable high quality and timely . Develops/refines processes and procedures and ensures they are consistently applied across the Case Management Core 2 Team. Leads Change - acts as a catalyst for organizational change and employee engagement. Makes decisions that produce high quality results by applying technical knowledge, analyzing problems and calculating risks. Partners with other Operations teams to ensure quick turnaround of referral Assesses and analyses team performance, identifies performance gaps and provides feedback and coaching Responsible for leading a team through teaching, coaching and inspiring by fostering a sense of energy, ownership and a responsibility for the flawless execution of commercial excellence; engage in the selection and hiring process as needed. Administers company personnel policies and follows company staffing standards Enforcing policies and procedures to include business standards, maintaining customer satisfaction levels and improving quality of service. Collaborates with key business partners on process and or operational improvements to enhance efficiency and effectiveness of Case Management Core 2 team. Monitoring and assessing staff's compliance with the Company's rules and procedures related to behavior with Patients and Co-workers, attendance, dress code, productivity standards and any other applicable instruction provided by Company's management. Performs other duties as assigned. Minimum Requirements: 2 years of leadership/people management experience is required Demonstrated track record of meeting/exceeding goals Prior experience working in Specialty Pharmacy preferred Pharmacy Technician Associate Degree -Pharmacy license and registration Bachelor's degree in healthcare or business-related field (preferred) EEOC F/M/V/D
    $45k-54k yearly est. Auto-Apply 14d ago
  • Paralegal Case Manager

    Ingroup International LLC

    Registered nurse case manager job in Guaynabo, PR

    Job DescriptionSalary: The Paralegal Case Manager supports the Legal Department by managing legal cases from intake through resolution, ensuring timely follow-up, accurate documentation, and compliance with applicable laws and internal policies. This role will work closely with legal director, compliance teams, external counsel, and internal stakeholders to organize case files, track deadlines, prepare legal documents, and support litigation, regulatory, and compliance matters across multiple jurisdictions. Essential Functions: Case Management & Legal Support Manage and track legal cases, claims, and regulatory matters from initiation to closure. Maintain organized and up-to-date case files, including correspondence, pleadings, contracts, and evidence. Monitor deadlines, hearings, filings, and follow-ups to ensure timely compliance with legal requirements. Prepare draft legal documents, reports, summaries, and correspondence for attorney review. Assist with discovery, document production, and responses to subpoenas or regulatory requests. Compliance & Risk Support Support compliance initiatives by assisting with internal reviews, audits, and investigations. Monitor documentation related to member, partner, and customer issues to ensure consistency with company policies and applicable laws. Assist in reviewing marketing, social media, and promotional materials for legal and compliance concerns. Help maintain standard operating procedures and legal templates in compliance with regulatory standards. Contract & Documentation Management Assist with drafting, reviewing, and organizing contracts, agreements, and amendments. Track contract execution, renewals, and expirations. Maintain contract databases and ensure accurate recordkeeping. Litigation & Dispute Resolution Support Coordinate with external legal counsel by organizing case materials and facilitating information exchange. Compile factual timelines, case summaries, and evidence logs. Cross-Functional Collaboration Act as a liaison between the Legal Department and internal teams such as HR, Compliance, Operations, Finance, and Marketing. Respond to internal legal inquiries by gathering relevant documentation and escalating issues as needed. Support legal training initiatives by preparing materials and tracking participation. Knowledge and Skills: Strong organizational and case management skills with exceptional attention to detail. Excellent written and verbal communication skills. Ability to manage multiple cases and priorities in a fast-paced environment. High level of integrity and discretion in handling confidential information. Strong Computer Skills: (Microsoft Word and Excel or Google Docs and Sheets) File organization and electronic record management Accurate data tracking Proficiency with legal research tools, case management systems. Preparing documents, managing spreadsheets, organizing records, and using office software efficiently. Familiarity with compliance, regulatory processes, and litigation support. Ability to work independently and collaboratively in a remote, multinational environment. Education and Experience: Associates or Bachelors degree in Paralegal Studies, Legal Studies, or a related field (required). Paralegal certification (preferred). 37 years of experience as a paralegal, legal assistant, or case manager. Experience supporting litigation, compliance, or regulatory matters. Familiarity with multi-jurisdictional legal environments and corporate or compliance-driven organizations (preferred).
    $45k-54k yearly est. 7d ago
  • Care Manager, Telephonic Nurse

    Centerwell

    Registered nurse case manager job in San Juan, PR

    **Become a part of our caring community and help us put health first** **Shift/availability details:** + **Full time 40 hours a week.** + **The schedule is 10 hour shifts between the hours of 10:30am-9pm EST, scheduled 4 days a week. The 4 scheduled days a week will vary between Monday-Friday based on business needs.** + **Required weekend coverage every other weekend. Schedule during the weekend days is from** **7am-5:30pm EST** **. When working weekends, it will allow for off days during the week.** + **Required to work every other holiday.** The **Care Manager, Telephonic Nurse** helps to ensure optimal continuity of care for patients transitioning into and out of our services. They are responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. The Clinical Care Coordinator is expected to communicate with the CenterWell Home Health clinical team and help facilitate timely patient follow-up for patients in need of (additional) services when appropriate. The Clinical Care Coordinator is under the general supervision of the Manager of Care Coordination and under established performance criteria. This is a work-from-home telephonic nurse position. **Essential Functions:** + Act as CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services. Able to navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, as well as accessing healthcare resources. + Utilize a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Appropriately handle a variety of customer issues including location lookup, directions, and complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to a service site location or, if not available, look up and provide alternative services. Act as customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Follow-up and track referral and admission outcomes. + Maintains awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met. + Assists in the admissions process by acting as an ambassador for patients who meet the admissions requirements. + Focus on placing the right patient to the right care setting at the right time + Adheres to and participates in Company's mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures. + Reviews and adheres to all Company policies and procedures. + Provide education regarding Home Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services + Participates in special projects and performs other duties as assigned. **Use your skills to make an impact** **Required Experience/Skills:** + Associates Degree required. BSN preferred. + RN license in a compact state is required. May be required to obtain licensure in additional states as dictated by business needs. + At least 3 years post-acute experience. Home Care or hospice experience preferred. + Nursing background working across multiple areas of post-acute care. + Extensive nursing experience in post-acute care. + Current CPR certification. + Good working knowledge of home health, hospice, and palliative care services. + Good time management skills. + Ability to learn and master information related to locations and services of clients. + Excellent analytical and problem-solving skills. + Excellent verbal and interpersonal skills. + Able to communicate effectively with empathy over the phone and while interacting with others. + Must read, write and speak fluent English. **To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:** + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **CenterWell Home Health offers a variety of benefits to promote the best health and well-being of our employees and their families. Our competitive and flexible benefits surround you with support the same way you do for our patients and members, including:** + Health benefits effective day 1 + Paid time off, holidays, and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-24-2025 **About us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
    $71.1k-97.8k yearly 5d ago
  • RN Clinical Manager

    Centers Home

    Registered nurse case manager job in San Juan, PR

    Clinical Manager Responsible for assuring the delivery of quality health care services to the patient. The Clinical Manager represents the agency by facilitating its mission and agency objectives. Duties and Responsibilities Utilizes current nursing concepts and principles as well as understanding of coverage criteria to direct, supervise, and ensure the quality of care provided by the Coordinators of Care (COC) and other Clinical staff Assures the periodic reassessment of and appropriate revisions to the plan of care and ensures full recert packages are submitted timely Evaluates the skills and services provided by the clinical staff through record review, field visits, and case conferencing? Maintains effective communication with staff and patients Serves as a patient advocate in communications with third-party payers. Identifies staffing and service needs Performs duties necessary in the Emergency Disaster Plan Assures that all care and staff interactions uphold the non-discrimination policy and are sensitive to the Americans with Disabilities Act Provide direction to COCs regarding difficult patient issues Assesses the educational needs of the COCs relative to the patient's care and ensures their needs are met? Participates in the agency's orientation, education, and performance improvement activities?? Participates in hiring, training, and disciplining clinical staff Participates in an on-call coverage rotation Coordinates and ensures the accuracy of conversion packets Performs other related duties as needed
    $45k-53k yearly est. 26d ago
  • Care Manager, Telephonic Nurse

    Humana 4.8company rating

    Registered nurse case manager job in San Juan, PR

    **Become a part of our caring community and help us put health first** The Care Manager, Telephonic Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. Work schedule can be between 8am-6:30pm EST. The Care Manager Telephonic Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures The Care Manager Telephonic Nurse employs a variety of strategies, approaches and techniques to assess, intervene, and resolve Access to Care (ATC) barriers related to immediate medical services. The nurse will facilitate verified eligible Humana benefits to a provider and/or member while effectively documenting through assessments and/or evaluations while maintaining compliance with CMS regulations. The Care Manager Telephonic Nurse must also assess for member physical, environmental, and psycho-social health issues and intervene appropriately. **Use your skills to make an impact** **Required Qualifications** + Minimum of an Associate's degree in Nursing + Licensed Registered Nurse (RN) with no disciplinary action + Must have a valid Compact RN license in the state where they reside. **Candidates must reside in a Compact state (excluding CA, IL, MI, NY, OR, AK, DC (District of Columbia), HI, NV, MA, MN, and PR).** + 3 years or more of clinical acute care experience + Comprehensive knowledge of all Microsoft programs including but not limited to Word, Outlook, PowerPoint, SharePoint, OneNote and Excel **Preferred Qualifications** + Bachelor's degree - BSN + Experience with case management, discharge planning, and patient education for adult acute care + Managed care experience + Previous Medicare/Medicaid experience + Bilingual English/Spanish **Additional Information** + Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. + Work schedule can be between 8am-6:30pm EST. **Work At Home / Internet Statement:** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **SSN Alert Statement:** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-04-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $71.1k-97.8k yearly Easy Apply 8d ago
  • Supervisor-Nurse RN

    Acadia External 3.7company rating

    Registered nurse case manager job in San Juan, PR

    PURPOSE STATEMENT: Responsible for day-to-day operations of the unit and ensure staffing is adequate to provide care. ESSENTIAL FUNCTIONS: Provide, delegate, coordinate and evaluate care of patient through the collaborative efforts of team members and in accordance with the nursing process and standards of care and practice. Provide general nursing care in a facility. Function as the lead nurse on assigned shift. Responsible for staff assignments and/or direction of duties, tasks or projects. Provide professional and administrative leadership to staff. Accountable for the oversight of staffing performance. Coordinate nursing, medical and/or behavioral health care activities with all staff to ensure smooth and complete coordination of efforts during shared shift. Supervisory responsibility for assigning staff according to education and ability. Provide mentoring and training as needed. Coordinate all care rendered to patients, including physician orders and diagnostic information, and ensure consultations are ordered. Document medical, behavioral health information and nursing care. Administer medications and maintain records in accordance with company policies and procedures. Assist in developing a plan of care with specific and measurable goals, objectives and interventions defining actions unique to each patient's needs. Assist in updating and revising the plan of care as goals/objectives are met or when the patient's condition changes. Provide structure and maintain a therapeutic environment in collaboration with the patients and other care providers. Consistently utilize universal precautions, environmental safety guidelines and applicable level system as applicable. OTHER FUNCTIONS: Perform other functions and tasks as assigned. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: Graduation from an accredited school of nursing required. Three or more years' experience in nursing practice required. Two or more years' experience in behavioral health preferred. One or more years' experience in a hospital supervisory or charge position preferred. LICENSES/DESIGNATIONS/CERTIFICATIONS: Current RN license as required by state. CPR certification required (training available upon hire and offered by facility). De-escalation/restraint certification required (training available upon hire and offered by facility). First aid may be required based on state or facility.
    $46k-52k yearly est. 30d ago
  • RN SIU Appeals Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR

    Unitedhealth Group 4.6company rating

    Registered nurse case manager job in San Juan, PR

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together** . Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. **Primary Responsibilities:** + Clinical Case Reviews -75% + Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported + Maintain standards for productivity and accuracy. Standards are defined by the department + Provide clear and concise clinical logic to the providers when necessary + Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization + Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities + Investigate and pursue recoveries + Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance + Use pertinent data and facts to identify and solve a range of problems within area of expertise + Other internal customer correspondence and team needs - 15% + Attend and provide feedback during monthly meetings with assigned internal customer department + Provide continuous feedback on how to improve the department relationships with internal team members and departments + Continuing education - 10% + Keep up required Coding Certificate and/or Nursing Licensure + Complete compliance hours as required by the department *****ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***** You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Registered Nurse (RN), Coding Certificate or Nursing Licensure, for example: + Puerto Rico Registered Nurse + Certified Professional Coder (CPC) + CPC A + Certified Inpatient Coder (CIC) + Certified Outpatient Auditor (COC) + Certified Professional Medical Auditor (CPMA) + Certified Coding Specialist (CCS) + Experience in a hospital/inpatient setting, surgical or clinic + Demonstrated proficiency with computers, including Microsoft Suite of products + Willing or able to work from Monday to Friday, 40 hours per week during our business operating hours of 8am - 7pm ATL + Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for this position) **Preferred Qualifications:** + Experience working with medical claims platforms + Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting + Presentation or policy documentation experience + Knowledge of CMS and AMA coding rules specific to CPT, HCPCS + Knowledge of CMS Coverage, Federal and State Statues, Rules and Regulations + Knowledge of Medicaid/Medicare Reimbursement methodologies + Working knowledge of the healthcare insurance/managed care industry + Working knowledge of medical terminology and claim coding _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
    $41k-46k yearly est. 6d ago
  • Registered Nurse (RN) - Clinical Research

    Headlands Research

    Registered nurse case manager job in San Juan, PR

    At Headlands Research, we are dedicated to enhancing clinical trial delivery within our communities. As a leading network of advanced clinical trial sites, we leverage cutting-edge technology and exceptional support services to broaden outreach and participation. Founded in 2018, our rapidly growing company currently operates 20+ sites across the US and Canada, with plans for further expansion. About Us: CMRC Headlands is a premier clinical research site in San Juan, Puerto Rico. We conduct cutting-edge clinical trials in collaboration with global pharmaceutical sponsors, bringing medical innovation to our local communities. Our mission is to advance science while centering the patient experience at every stage of research. Position Summary: CMRC is seeking a seasoned, full-time Registered Nurse (RN) with strong clinical acumen and hands-on experience in both adult and pediatric settings. The ideal candidate has a background in hospital or private clinical practice, is passionate about patient-centered care, and thrives in a fast-paced, ambiguous, research-driven environment. This role requires a proactive self-starter who can navigate complex protocols with clinical judgment, independence, and attention to detail. Bilingual fluency in English and Spanish is essential. Responsibilities: Perform and document pediatric and adult phlebotomy procedures Administer and document vital signs and clinical assessments Support all phases of patient interaction including screening, enrollment, dosing, and follow-ups Act as clinical support during study visits-monitor, document, and report on patient status and adverse events Manage specimen handling, labeling, storage, and timely shipment according to protocol Provide clinical oversight for study-related procedures to ensure safety and compliance Coordinate and schedule research visits and procedures with precision and patient sensitivity Review and interpret study protocols through a clinical lens to anticipate patient care needs Communicate effectively with investigators, monitors, sponsors, and internal teams Support study recruitment and patient outreach strategies Maintain and organize source documentation and regulatory binders Prepare for monitoring visits and assist during sponsor or regulatory audits Other duties as needed to support study execution Required Qualifications: Active and unrestricted Registered Nurse license in Puerto Rico Minimum of 6 years of experience in a clinical setting (hospital or private practice) Minimum of 4 years drawing blood from both pediatric and adult patients Solid understanding of Good Clinical Practice (GCP) and/or willingness to undergo training Comfort working within protocol-driven environments with shifting timelines Demonstrated ability to operate autonomously and take initiative within a small, agile team Proficient with electronic medical records, clinical data entry, and laboratory documentation Exceptional organizational and multitasking skills Strong interpersonal skills and compassionate bedside manner Fluent in English and Spanish (written and verbal) Preferred Qualifications: Prior experience in clinical research or investigational trials is a plus Familiarity with FDA, ICH-GCP, and HIPAA compliance standards Experience preparing for and interacting with clinical trial monitors
    $47k-57k yearly est. Auto-Apply 38d ago
  • RN Clinical Consultation

    Sedgwick 4.4company rating

    Registered nurse case manager job in San Juan, PR

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance RN Clinical Consultation **We are looking to add 1 part time nurse to our team: If you can work any of these shifts, please apply right away!** + **8:30am-6:30pm CST Friday and Saturdays OR 8:30am-6:30pm CST Saturday and Sundays** **PRIMARY PURPOSE OF THE ROLE:** To triage calls to assess needs, giving appropriate care advice and disposition to appropriate level of care treatment while promoting cost-effective outcomes and safely facilitate return to work. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. + Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. + Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. + Enjoy flexibility in your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. + Enable our Caring counts mission supporting injured employees from some of the world's best brands and organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Applies all phases of the nursing process, i.e. assessment, planning, implementation and evaluation when triaging calls. + Identifies the needs of caller by triaging, obtaining general health information and/or physician services referral. + Evaluates need for alternative treatment through telephonic contact and assessment with service provider. + Triages patient using defined triage protocols to obtain pertinent data; and enters data into computer system. + Identifies life-threatening emergencies and recommends appropriate interventions. + Refers issues requiring physician interventions to physician in a timely manner; directs patients to appropriate level of care including but not limited to the nearest emergency room, urgent care facility, primary treating physician or selfcare. Demonstrates effective verbal communications skills. + Adheres to quality assurance standards. + Serves as resource to triage team members. **EDUCATION AND LICENSING** Bachelor's degree in nursing (BSN) preferred. Active unrestricted RN compact licensure required along with two year (2) years of recent clinical practice experience. Should be proficient in multiple screens and multiple computer applications,. **TAKING CARE OF YOU BY** + Seeks innovative customer solutions . + Craves cutting edge opportunities. + Wants dynamic company culture. + Passion about creativity. + Seeks ongoing learning as a person and professional. + Thrives when solving challenging problems. + Wants achievements to be celebrated. + We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day. **NEXT STEPS** If your application is selected to advance to the next round , a recruiter will be in touch. \#NURSE _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $35.00-$36.00/hr . A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ _"Always accepting applications"._ Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
    $35-36 hourly 60d+ ago
  • Inpatient Registered Nurse - RN

    Fresenius Medical Care 3.2company rating

    Registered nurse case manager job in San Juan, PR

    PURPOSE AND SCOPE: The Inpatient RN provides direct patient care in accordance to company policies and procedures which includes FMCNA compliance programs and contracted hospitals' policies and procedures. Areas of practice are diverse, including, but not limited to, hemodialysis, peritoneal dialysis, continuous renal replacement therapies, apheresis, and ultrafiltration. The Inpatient RN will partner with the hospital to provide quality care to the patient and deliver care that provides a positive patient experience. PRINCIPAL DUTIES AND RESPONSIBILITIES: Under limited supervision, applies considerable knowledge to perform a broad range of tasks which include but are not limited to direct patient care in multiple modalities not limited to hemodialysis, peritoneal dialysis, ultrafiltration, continuous renal replacement therapy, and Apheresis. Provides supervision and direction of Patient Care Technicians and clerical staff; provides direction and education to ICU staff for CRRT. Responsible for direct patient care of assigned patients in the Inpatient Renal Replacement and Apheresis Services setting and providing the appropriate treatment technique for assigned patients as prescribed in all modality procedures, as appropriately defined - hemodialysis, peritoneal, continuous renal replacement therapies, ultrafiltration, and Apheresis. Assesses patients' responses to treatment therapy making appropriate adjustments and modifications to the treatment plan as indicated by the appropriately credentialed physician. Communicate problems or concerns to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. Delivers safe, effective care in a timely an efficient manner. Gives organized, concise shift reports for patients on assigned shifts. Apply high level thinking skills to shift patient schedules to meet needs of more critical patients due to labs, MD order, or patient assessment. Responsible for the implementation, administration, monitoring, and documentation of patient's response to prescribed intradialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier. Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust, and coordinate daily patient care plan to ensure continuity of care. Initiates and communicates to FMS facility nursing staff and appropriate hospital personnel as needed. Accurately documents all treatment information in the individual patient record (ACES) and the hospital record, as needed. Cleans and disinfects dialysis machine surface, chair, equipment, and surrounding areas between treatments according to inpatient renal services policies and procedures. Conducts all tasks necessary for preparation for dialysis treatment and documents where appropriate. Performs all required pre-treatment dialysis machine alarm testing. If applicable, initiates Solution Delivery System. Operates all related equipment appropriately and safely and provides minor trouble shooting when necessary; efficiently utilizes supplies to prevent waste. Understands, conducts, and documents appropriately Dialysis/Apheresis machine safety tests/alarm tests, equipment calibration, dialysate testing, machine safety tests, functional testing, and internal and external disinfection on all water & dialysis machines, and complies with the documentation/notification standards per FMS policies. Completes and documents ongoing participation in QAI activities. Participates in staff meetings as scheduled. Participates in staff training and orientation as assigned. Acts as a subject matter expert to hospital staff for dialysis related patient/equipment complications. Responsible for reporting all new or unusual incidents, information, complaints, or problems to the inpatient manager and other parties per the Adverse Event Report requirements. May be assigned to in-center patient care on an as needed basis Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. Assist with various projects as assigned by direct supervisor. Other duties as assigned. PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodations can be made. Direct patient care, interaction with patients, outpatient clinicians, hospital staff, and physicians. The position requires travel between assigned hospitals and facilities; as well as travel to regional meetings/educational events. Position requires on call rotation including night, day, weekend, and holidays. There is potential for exposure to potentially infectious material and contagious diseases/material. Position provides direct patient care which regularly involves heavy lifting, moving of patient and/or equipment > 200lbs (with assistance); and may lift chemical and water solutions of up to 30lbs up as high as 5 feet. SUPERVISION: Provides supervision and direction of Patient Care Technicians (Certified Clinical Hemodialysis Technicians (CCHT)) and clerical staff; provides direction and education to ICU staff for CRRT. EDUCATION: Current appropriate state licensure. Maintains acquired knowledge and remains current in advancements in nephrology, in particular, relative to inpatient care (hospitalized patients requiring varied treatment modalities, not limited to Renal Replacement, Apheresis, and Ultrafiltration services). Must meet the practice requirements in the state in which employed. Certification in Nephrology Nursing, Apheresis Nursing, or both is highly encouraged. EXPERIENCE AND REQUIRED SKILLS: One year RN experience required and required nursing skills. Minimum 6 months nephrology experience required before working independently with no other Dialysis RNs to provide dialysis and ultrafiltration services. Minimum 6 months Nephrology experience required before working independently with no other Apheresis RNs to provide Apheresis services. Demonstrated strong assessment skills related to the critically ill patient. ICU experience preferred but not required. Successful completion of training course in the theory and practice of care of the ESRD patient - Progressive Renal Education Preparation. BLS CPR Recognition. ACLS CPR Recognition preferred, but not required. Demonstrates organizational and time management skills, and a competency toward completing continuing and ongoing Renal/Nephrology education. Displays leadership skills and ability to direct and supervise others (such as PCTs, CCHTs, clerical staff). Successful completion of Nurses Technical Training. Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws. EOE, disability/veterans
    $39k-71k yearly est. Auto-Apply 60d+ ago
  • Supervisor-Nurse RN

    Acadia Healthcare Inc. 4.0company rating

    Registered nurse case manager job in San Juan, PR

    San Juan Capestrano Hospital is an Acadia facility that takes pride in giving quality patient care. We offer competitive benefits and pay. Please join our team and help change the future of Puerto Rico. PURPOSE STATEMENT: Responsible for day-to-day operations of the unit and ensure staffing is adequate to provide care. ESSENTIAL FUNCTIONS: * Provide, delegate, coordinate and evaluate care of patient through the collaborative efforts of team members and in accordance with the nursing process and standards of care and practice. Provide general nursing care in a facility. * Function as the lead nurse on assigned shift. * Responsible for staff assignments and/or direction of duties, tasks or projects. * Provide professional and administrative leadership to staff. * Accountable for the oversight of staffing performance. * Coordinate nursing, medical and/or behavioral health care activities with all staff to ensure smooth and complete coordination of efforts during shared shift. * Supervisory responsibility for assigning staff according to education and ability. * Provide mentoring and training as needed. * Coordinate all care rendered to patients, including physician orders and diagnostic information, and ensure consultations are ordered. * Document medical, behavioral health information and nursing care. * Administer medications and maintain records in accordance with company policies and procedures. * Assist in developing a plan of care with specific and measurable goals, objectives and interventions defining actions unique to each patient's needs. Assist in updating and revising the plan of care as goals/objectives are met or when the patient's condition changes. * Provide structure and maintain a therapeutic environment in collaboration with the patients and other care providers. * Consistently utilize universal precautions, environmental safety guidelines and applicable level system as applicable. OTHER FUNCTIONS: * Perform other functions and tasks as assigned. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: * Graduation from an accredited school of nursing required. * Three or more years' experience in nursing practice required. * Two or more years' experience in behavioral health preferred. * One or more years' experience in a hospital supervisory or charge position preferred. LICENSES/DESIGNATIONS/CERTIFICATIONS: * Current RN license as required by state. * CPR certification required (training available upon hire and offered by facility). * De-escalation/restraint certification required (training available upon hire and offered by facility). * First aid may be required based on state or facility. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. null
    $49k-56k yearly est. 30d ago
  • Registered Nurse I PR

    Encompass Health Corp 4.1company rating

    Registered nurse case manager job in San Juan, PR

    The Registered Nurse provides direct patient care to inpatients. This position assesses patients and creates a plan of care that is individualized and is reflective of each patient's needs and goals. The Registered Nurse supervises activities of care, treatment and services of patient provided by LPN/LVNs, RNTs/CNAs, and other staff on assigned unit and shift. This position communicates information with the interdisciplinary team and reports patient concerns and changes in condition to supervisor and/or physician in a timely manner.
    $41k-70k yearly est. 39d ago
  • Inpatient Registered Nurse - RN

    Fresenius Medical Care North America 4.3company rating

    Registered nurse case manager job in San Juan, PR

    **PURPOSE AND SCOPE:** The Inpatient RN provides direct patient care in accordance to company policies and procedures which includes FMCNA compliance programs and contracted hospitals' policies and procedures. Areas of practice are diverse, including, but not limited to, hemodialysis, peritoneal dialysis, continuous renal replacement therapies, apheresis, and ultrafiltration. The Inpatient RN will partner with the hospital to provide quality care to the patient and deliver care that provides a positive patient experience. **PRINCIPAL DUTIES AND RESPONSIBILITIES:** + Under limited supervision, applies considerable knowledge to perform a broad range of tasks which include but are not limited to direct patient care in multiple modalities not limited to hemodialysis, peritoneal dialysis, ultrafiltration, continuous renal replacement therapy, and Apheresis. + Provides supervision and direction of Patient Care Technicians and clerical staff; provides direction and education to ICU staff for CRRT. + Responsible for direct patient care of assigned patients in the Inpatient Renal Replacement and Apheresis Services setting and providing the appropriate treatment technique for assigned patients as prescribed in all modality procedures, as appropriately defined - hemodialysis, peritoneal, continuous renal replacement therapies, ultrafiltration, and Apheresis. + Assesses patients' responses to treatment therapy making appropriate adjustments and modifications to the treatment plan as indicated by the appropriately credentialed physician. Communicate problems or concerns to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. + Delivers safe, effective care in a timely an efficient manner. + Gives organized, concise shift reports for patients on assigned shifts. Apply high level thinking skills to shift patient schedules to meet needs of more critical patients due to labs, MD order, or patient assessment. + Responsible for the implementation, administration, monitoring, and documentation of patient's response to prescribed intradialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier. + Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust, and coordinate daily patient care plan to ensure continuity of care. + Initiates and communicates to FMS facility nursing staff and appropriate hospital personnel as needed. + Accurately documents all treatment information in the individual patient record (ACES) and the hospital record, as needed. + Cleans and disinfects dialysis machine surface, chair, equipment, and surrounding areas between treatments according to inpatient renal services policies and procedures. + Conducts all tasks necessary for preparation for dialysis treatment and documents where appropriate. + Performs all required pre-treatment dialysis machine alarm testing. + If applicable, initiates Solution Delivery System. + Operates all related equipment appropriately and safely and provides minor trouble shooting when necessary; efficiently utilizes supplies to prevent waste. + Understands, conducts, and documents appropriately Dialysis/Apheresis machine safety tests/alarm tests, equipment calibration, dialysate testing, machine safety tests, functional testing, and internal and external disinfection on all water & dialysis machines, and complies with the documentation/notification standards per FMS policies. + Completes and documents ongoing participation in QAI activities. + Participates in staff meetings as scheduled. + Participates in staff training and orientation as assigned. + Acts as a subject matter expert to hospital staff for dialysis related patient/equipment complications. + Responsible for reporting all new or unusual incidents, information, complaints, or problems to the inpatient manager and other parties per the Adverse Event Report requirements. May be assigned to in-center patient care on an as needed basis + Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. + Assist with various projects as assigned by direct supervisor. + Other duties as assigned. **PHYSICAL DEMANDS AND WORKING CONDITIONS** **:** + The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. + Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodations can be made. + Direct patient care, interaction with patients, outpatient clinicians, hospital staff, and physicians. The position requires travel between assigned hospitals and facilities; as well as travel to regional meetings/educational events. + Position requires on call rotation including night, day, weekend, and holidays. + There is potential for exposure to potentially infectious material and contagious diseases/material. + Position provides direct patient care which regularly involves heavy lifting, moving of patient and/or equipment > 200lbs (with assistance); and may lift chemical and water solutions of up to 30lbs up as high as 5 feet. **SUPERVISION:** + Provides supervision and direction of Patient Care Technicians (Certified Clinical Hemodialysis Technicians (CCHT)) and clerical staff; provides direction and education to ICU staff for CRRT. **EDUCATION:** + Current appropriate state licensure. + Maintains acquired knowledge and remains current in advancements in nephrology, in particular, relative to inpatient care (hospitalized patients requiring varied treatment modalities, not limited to Renal Replacement, Apheresis, and Ultrafiltration services). + Must meet the practice requirements in the state in which employed. + Certification in Nephrology Nursing, Apheresis Nursing, or both is highly encouraged. **EXPERIENCE AND REQUIRED SKILLS** **:** + One year RN experience required and required nursing skills. + Minimum 6 months nephrology experience required before working independently with no other Dialysis RNs to provide dialysis and ultrafiltration services. + Minimum 6 months Nephrology experience required before working independently with no other Apheresis RNs to provide Apheresis services. + Demonstrated strong assessment skills related to the critically ill patient. + ICU experience preferred but not required. + Successful completion of training course in the theory and practice of care of the ESRD patient - Progressive Renal Education Preparation. + BLS CPR Recognition. + ACLS CPR Recognition preferred, but not required. + Demonstrates organizational and time management skills, and a competency toward completing continuing and ongoing Renal/Nephrology education. + Displays leadership skills and ability to direct and supervise others (such as PCTs, CCHTs, clerical staff). + Successful completion of Nurses Technical Training. **Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.** **EOE, disability/veterans**
    $41k-64k yearly est. 60d+ ago
  • Case Management Core 2 Manager

    Alivia Health

    Registered nurse case manager job in Guaynabo, PR

    Under the leadership of the Operations Director the main objective of this role is to provide ongoing oversight of the Case Management Core 2 Team which includes Inflammatory, Osteoporosis /Osteoarthritis, Floater and Zero refill resources. This team is accountable for initial interview and following up with patient or MD office to obtain additional information/documentation to be able to process claim. This team will also be responsible for working medication refills. The Manager will manage all aspects of the department functions, including personnel, systems, initial and on going training and employee development. Responsibilities include but are not limited to: Holds self and others accountable for measurable high quality and timely . Develops/refines processes and procedures and ensures they are consistently applied across the Case Management Core 2 Team. Leads Change - acts as a catalyst for organizational change and employee engagement. Makes decisions that produce high quality results by applying technical knowledge, analyzing problems and calculating risks. Partners with other Operations teams to ensure quick turnaround of referral Assesses and analyses team performance, identifies performance gaps and provides feedback and coaching Responsible for leading a team through teaching, coaching and inspiring by fostering a sense of energy, ownership and a responsibility for the flawless execution of commercial excellence; engage in the selection and hiring process as needed. Administers company personnel policies and follows company staffing standards Enforcing policies and procedures to include business standards, maintaining customer satisfaction levels and improving quality of service. Collaborates with key business partners on process and or operational improvements to enhance efficiency and effectiveness of Case Management Core 2 team. Monitoring and assessing staff's compliance with the Company's rules and procedures related to behavior with Patients and Co-workers, attendance, dress code, productivity standards and any other applicable instruction provided by Company's management. Performs other duties as assigned. Minimum Requirements: 2 years of leadership/people management experience is required Demonstrated track record of meeting/exceeding goals Prior experience working in Specialty Pharmacy preferred Pharmacy Technician Associate Degree -Pharmacy license and registration Bachelor's degree in healthcare or business-related field (preferred) EEOC F/M/V/D
    $45k-54k yearly est. Auto-Apply 13d ago
  • RN Branch Director, Home Health

    Centerwell

    Registered nurse case manager job in San Juan, PR

    **Become a part of our caring community and help us put health first** Reports To: Market Executive - Director, Area Home Health Branch Administration FLSA: Exempt **Work Schedule** : Full-time/40 Hours Type** : On-site **Branch Location** : Stockbridge, GA **** $15,000 Associated Sign-on Bonus **** **** This position is eligible for relocation assistance. The specific package offered will vary based on individual circumstances and company policy. **** **This is not a remote or work-from-home position. This position requires you to sit on-site at our Stockbridge, GA branch location.** The **Branch Director** is accountable for managing the day-to-day branch operations to ensure the following: operational efficiencies, quality of patient care, regulatory compliance, support of business development & patient base growth, achievement of key performance indicators, and people management/development. The Branch Director supervises the branch/clinical staff. Direct responsibility of ensuring the branch meets applicable Federal, State, and local laws regarding the certification and licensure process at all times. Responsible for long-range planning, fiscal viability, and quality of care provided by the branch. Recruits, interviews, and hires staff and monitors quality care and organizational performance. Assist other disciplines in coordinating activities when necessary, assuming responsibility for continuity, appropriateness, and quality of services delivered. **Essential Functions:** + Develops, plans, implements, analyzes and organizes operations for the Branch. + Responsible for the delivery of care for all patients served by the Branch by providing supervision and support to the Clinical Manager(s). + Works in conjunction with the Area Director of Operations or the AVP of Operations and Finance Department to establish Branch's revenue and budget goals. + Recognizes the clinical leadership and provides support and supervision to the Clinical Manager(s) to promote more effective performance and delivery of quality home care services. + Maintains office operations in an efficient, productive, effective, and organized manner, which provides a safe working environment for employees, meeting local ordinances and fire and safety regulations in compliance with the company policies. + Conducts continuous quality improvement quarterly committee meetings, reviews all patient satisfaction data, and follows up on negative patient satisfaction surveys and follow-up visits with referral sources. + Communicate with the Area Director of Operations or the AVP of Operations for direction, problem-solving, and implementation of programs and protocols. + Partners with Sales Directors and Account Manager(s) to meet budgeted admission goals. Participates in sales and marketing initiatives. **Use your skills to make an impact** **License/Certifications:** + Active and unrestricted Registered Nurse (RN) license with authorization to practice in the state of Georgia. **Required Experience/Skills:** + Valid driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse (RN) with at least one-year of management experience in a home care, hospice or equivalent environment. + Home health experience is required. + Management and people leadership experience is required. Outstanding leadership skills with demonstrated experience motivating, educating, supervising, and supporting staff and developing a cohesive team. + OASIS experience is preferred. OASIS certification (HCS-O, COQS, and/or COS-C), preferred. + Homecare Homebase (HCHB) experience is preferred. + CMS PDGM billing knowledge and/or experience is preferred. + Revenue/Fiscal management experience is required. Ability to manage multi-millions in revenue is strongly preferred. + Knowledge of business management, governmental regulations, and accreditation standards. + Experienced with quality improvement monitoring and reporting tools and methods. + Excellent verbal and written communication skills. + Must be proficient with Microsoft Word and Excel. **Additional Information** + Normal Hours of Operation: M-F / 8a-5p (ET) + On-Call Expectation: Yes, rotating on-call shift. + Branch Size: 600+ Census (5.0 STAR rating) + Annual Bonus Eligible: Yes, eligible for the annual incentive bonus. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $93,000 - $128,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-13-2025 **About us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
    $46k-55k yearly est. 16d ago
  • RN SIU Appeals Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR

    Unitedhealth Group Inc. 4.6company rating

    Registered nurse case manager job in San Juan, PR

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. Primary Responsibilities: * Clinical Case Reviews -75% * Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported * Maintain standards for productivity and accuracy. Standards are defined by the department * Provide clear and concise clinical logic to the providers when necessary * Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization * Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities * Investigate and pursue recoveries * Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance * Use pertinent data and facts to identify and solve a range of problems within area of expertise * Other internal customer correspondence and team needs - 15% * Attend and provide feedback during monthly meetings with assigned internal customer department * Provide continuous feedback on how to improve the department relationships with internal team members and departments * Continuing education - 10% * Keep up required Coding Certificate and/or Nursing Licensure * Complete compliance hours as required by the department * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Registered Nurse (RN), Coding Certificate or Nursing Licensure, for example: * Puerto Rico Registered Nurse * Certified Professional Coder (CPC) + CPC A * Certified Inpatient Coder (CIC) * Certified Outpatient Auditor (COC) * Certified Professional Medical Auditor (CPMA) * Certified Coding Specialist (CCS) * Experience in a hospital/inpatient setting, surgical or clinic * Demonstrated proficiency with computers, including Microsoft Suite of products * Willing or able to work from Monday to Friday, 40 hours per week during our business operating hours of 8am - 7pm ATL * Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for this position) Preferred Qualifications: * Experience working with medical claims platforms * Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting * Presentation or policy documentation experience * Knowledge of CMS and AMA coding rules specific to CPT, HCPCS * Knowledge of CMS Coverage, Federal and State Statues, Rules and Regulations * Knowledge of Medicaid/Medicare Reimbursement methodologies * Working knowledge of the healthcare insurance/managed care industry * Working knowledge of medical terminology and claim coding At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
    $41k-46k yearly est. 7d ago
  • Intake RN (San Juan)

    Centers Home

    Registered nurse case manager job in San Juan, PR

    Responsible for assessing patient care needs and planning home health care services. JOB DUTIES /KNOWLEDGE Coordinates, screens and assesses home health care needs of patients referred to Agency Completes intake process within established time parameters Collaborates with physicians, nurses and discharge planners to identify patient care needs and to establish the appropriate level of care for patients referred to the Agency Establishes and completes an individualized Plan of Treatment in accordance with MD orders, patient care needs, insurance guidelines and Agency protocol, including the identification of formal/informal supports in carrying out plan Ensures that the needed DME, medical supplies and ancillary services are ordered and documented Contacts managed care personnel when appropriate to obtain necessary initial authorizations Notifies referring party if patient will require alternative discharge plan Delegates specific tasks to support staff providing clear, timely direction to ensure continuity of care Serves as a resource to all persons contacting the agency for information Treats all referral parties, patients, family members and hospital staff courteously and in a non-discriminatory manner Demonstrates sound knowledge of reimbursement and billing practices for Medicare, Medicaid, managed care, charity care and other third-party payers Demonstrates cultural sensitivity Maintains patient confidentiality at all times Demonstrates working knowledge of State and Federal regulations Participates in Quality and Performance Improvement activities and in the orientation process for agency staff Performs other related duties as required Demonstrates a high degree of commitment to customer relations and quality service Utilizes community resources as appropriate to meet patient care needs JOB PERFORMANCE Demonstrates ability to perform quality and effective services. Demonstrates ability to set and meet objectives, and to find increasingly efficient ways to perform task. Completes work, and documentation with accuracy and within agency time frames. Requires minimal supervision and is self-directed. Understands the delivery of service within home care.
    $47k-59k yearly est. 60d+ ago
  • Outpatient Registered Nurse - RN

    Fresenius Medical Care 3.2company rating

    Registered nurse case manager job in Canvanas, PR

    PURPOSE AND SCOPE: Functions as part of the hemodialysis health care team as a Staff Registered Nurse to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA's mission, vision, values, and customer service philosophy. Supports the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI Activities, including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FMCNA Quality Enhancement Goals (QEP). Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies. PRINCIPAL DUTIES AND RESPONSIBILITIES: * Directs Patient Care Technician's provision of safe and effective delivery of chronic hemodialysis therapy to patients in compliance with standards outlined in the facility policy procedure manuals, as well as regulations set forth by the corporation, state, and federal agencies. * Delegates tasks to all direct patient care staff including but not limited to LVN/LPNs, Patient Care Technicians, and Dialysis Assistants. * Assesses daily patient care needs and develops appropriate patient care assignments. * Routinely monitors patient care staff for appropriate techniques and adherence to facility policy and procedures. * Participates in staff training and orientation of new staff as assigned * Participates in all required staff meetings as scheduled. * Ensures educational needs of patients and family are met regarding End Stage Renal Disease (ESRD). * Provides ongoing education to patients regarding their renal disease, vascular access and dialysis therapy, and other related health conditions. * Discusses with patient, and records education related to diet/fluid and medication compliance. * Provides patient specific detailed education regarding adequacy measures where applicable - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM). * Ensures transplant awareness, modality awareness, and drive catheter reduction. * Educates patients regarding laboratory values and the relationship to adequate dialysis therapy, compliance with treatment schedule, medications, and fluid. * Provides safe and effective delivery of care to patients with ESRD. * Accurately implements treatment prescriptions including Sodium (Na) modeling prescription, and Ultrafiltration modeling (where appropriate) to ensure stable treatment therapy as indicated. * Assesses patients' response to hemodialysis treatment therapy, making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicates problems or concerns to the Team Leader or physician. * Identifies and communicates patient related issues to Team Leader or physician. * Initiates Initial and Annual Nursing Assessment, and ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures. * Actively participates in the pre-evaluation, initiation, monitoring, termination, access homeostasis, and post evaluation of patients receiving hemodialysis treatment therapy according to established FMC procedures. * Takes appropriate intervention for changes in patient adequacy status and troubleshooting access flow issues as identified by OLC/AMP yellow lights. * Provides, supervises (if applicable), and monitors hemodialysis access care according to established procedures. * Implements, administers, monitors, and documents patient's response to prescribed interdialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier. * Ensures accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet. * Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System. * Ensures appropriate preparation of lab requisitions for Spectra or alternate lab. * Ensures correct labs tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples. * Identifies and ensures appropriate follow-through regarding missed labs and specimens reported to be insufficient according to company policies and procedures. * Ensures all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures relating to shipment of blood or body fluid specimens and potentially hazardous material. * Ensures that all labs are directed and delivered to appropriate labs. * Reports alert/panic and abnormal labs results to appropriate physician. * Ensures lab results are forwarded to physicians as requested. * Enforces all company approved policies and procedures, as well as regulations set forth by state and federal agencies and departments. * Maintains overall shift operation in a safe, efficient, and effective manner. * Act as a resource for other staff members. * Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and information. * Collaborate and communicate with physicians and other members of the healthcare team to interpret, adjust, and coordinate care provided to the patient. * Provides assistance as needed to patients regarding prescription refills according to FMCNA Policies. * Ensures all physician orders are transcribed and entered into the Medical Information system in a timely manner. * Oversees all documentation of patient information. * Maintains facility drug list for all required stock medications. * Maintains competency with all emergency operational procedures, and initiates CPR and emergency measures in the event of a cardiac and/or respiratory arrest. * Ensures verification and availability of adequate emergency equipment. * Ensures provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing. * Administers medications as prescribed or in accordance with approved algorithm(s), and documents appropriate medical justification if indicated. * Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness. * Maintains appropriate recording of controlled substances as required by law. * Assists with the coordination of patient transportation if necessary. * Ensures a clean, safe, and sanitary environment in the dialysis facility treatment area. * Ensures competency in the operation of all dialysis-related equipment safely and effectively. * Ensures all patient stations, including machines and chairs, are clean and free of blood and placed appropriately. * Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies. * Ensures all relevant data including physician orders, lab results, vital signs and treatment parameters, and patient status are documented appropriately and entered into Medical Information System. * Ensures all appropriate patient related treatment data is entered into the Medical Information System. * Ensures all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented. * Ensures and verify accuracy of Patient Care Technician documentation. * Reviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff. * Ensures that all appropriate procedures are followed regarding opening and closing procedures, inclusive of monitoring that all staff and patients have safely left the premises. * Initiates, documents, and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports. * Completes monthly nurses' progress note. * Ensures patient medical records are complete with appropriate information, documentation, and identification on each page (Addressograph label is on all chart forms). * Reviews transplant status and follows established procedure regarding appropriate action to be taken. * Completes patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans. * Completes any long-term programs that are due. * Completes initial and annual Nursing History and Assessment physical. * Ensures completion of Annual Standing Order Review with each physician as required. * Performs additional duties as assigned. PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * The position provides direct patient care that regularly involves heavy lifting and moving of patients, and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet. * The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials. * Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodation can be made. SUPERVISION: * None EDUCATION AND REQUIRED CREDENTIALS: * Graduate of an accredited School of Nursing. * Current appropriate state licensure. * Must meet the practice requirements in the state in which he or she is employed. EXPERIENCE AND SKILLS: * Minimum of one-year medical-surgical nursing experience preferred. * Hemodialysis experience preferred. * ICU experience preferred. * Successfully complete a training course in the theory and practice of hemodialysis. * Successfully complete CPR Certification. * Employees have to meet the necessary requirements of Ishihara's Color Blindness test as a condition of employment. * Provide coverage at any or all area facilities as required by management. * Icd-9 coding Training. * Nurses Technical Training. * Must meet appropriate state requirements (if any). Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.
    $39k-71k yearly est. 35d ago
  • Inpatient Registered Nurse - RN

    Fresenius Medical Care North America 4.3company rating

    Registered nurse case manager job in San Juan, PR

    **PURPOSE AND SCOPE:** The Inpatient RN provides direct patient care in accordance to company policies and procedures which includes FMCNA compliance programs and contracted hospitals' policies and procedures. Areas of practice are diverse, including, but not limited to, hemodialysis, peritoneal dialysis, continuous renal replacement therapies, apheresis, and ultrafiltration. The Inpatient RN will partner with the hospital to provide quality care to the patient and deliver care that provides a positive patient experience. **PRINCIPAL DUTIES AND RESPONSIBILITIES:** + Under limited supervision, applies considerable knowledge to perform a broad range of tasks which include but are not limited to direct patient care in multiple modalities not limited to hemodialysis, peritoneal dialysis, ultrafiltration, continuous renal replacement therapy, and Apheresis. + Provides supervision and direction of Patient Care Technicians and clerical staff; provides direction and education to ICU staff for CRRT. + Responsible for direct patient care of assigned patients in the Inpatient Renal Replacement and Apheresis Services setting and providing the appropriate treatment technique for assigned patients as prescribed in all modality procedures, as appropriately defined - hemodialysis, peritoneal, continuous renal replacement therapies, ultrafiltration, and Apheresis. + Assesses patients' responses to treatment therapy making appropriate adjustments and modifications to the treatment plan as indicated by the appropriately credentialed physician. Communicate problems or concerns to the Inpatient Program Manager, appropriately credentialed physician, patient hospital primary nurse and others as indicated. + Delivers safe, effective care in a timely an efficient manner. + Gives organized, concise shift reports for patients on assigned shifts. Apply high level thinking skills to shift patient schedules to meet needs of more critical patients due to labs, MD order, or patient assessment. + Responsible for the implementation, administration, monitoring, and documentation of patient's response to prescribed intradialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier. + Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust, and coordinate daily patient care plan to ensure continuity of care. + Initiates and communicates to FMS facility nursing staff and appropriate hospital personnel as needed. + Accurately documents all treatment information in the individual patient record (ACES) and the hospital record, as needed. + Cleans and disinfects dialysis machine surface, chair, equipment, and surrounding areas between treatments according to inpatient renal services policies and procedures. + Conducts all tasks necessary for preparation for dialysis treatment and documents where appropriate. + Performs all required pre-treatment dialysis machine alarm testing. + If applicable, initiates Solution Delivery System. + Operates all related equipment appropriately and safely and provides minor trouble shooting when necessary; efficiently utilizes supplies to prevent waste. + Understands, conducts, and documents appropriately Dialysis/Apheresis machine safety tests/alarm tests, equipment calibration, dialysate testing, machine safety tests, functional testing, and internal and external disinfection on all water & dialysis machines, and complies with the documentation/notification standards per FMS policies. + Completes and documents ongoing participation in QAI activities. + Participates in staff meetings as scheduled. + Participates in staff training and orientation as assigned. + Acts as a subject matter expert to hospital staff for dialysis related patient/equipment complications. + Responsible for reporting all new or unusual incidents, information, complaints, or problems to the inpatient manager and other parties per the Adverse Event Report requirements. May be assigned to in-center patient care on an as needed basis + Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. + Assist with various projects as assigned by direct supervisor. + Other duties as assigned. **PHYSICAL DEMANDS AND WORKING CONDITIONS** **:** + The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. + Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodations can be made. + Direct patient care, interaction with patients, outpatient clinicians, hospital staff, and physicians. The position requires travel between assigned hospitals and facilities; as well as travel to regional meetings/educational events. + Position requires on call rotation including night, day, weekend, and holidays. + There is potential for exposure to potentially infectious material and contagious diseases/material. + Position provides direct patient care which regularly involves heavy lifting, moving of patient and/or equipment > 200lbs (with assistance); and may lift chemical and water solutions of up to 30lbs up as high as 5 feet. **SUPERVISION:** + Provides supervision and direction of Patient Care Technicians (Certified Clinical Hemodialysis Technicians (CCHT)) and clerical staff; provides direction and education to ICU staff for CRRT. **EDUCATION:** + Current appropriate state licensure. + Maintains acquired knowledge and remains current in advancements in nephrology, in particular, relative to inpatient care (hospitalized patients requiring varied treatment modalities, not limited to Renal Replacement, Apheresis, and Ultrafiltration services). + Must meet the practice requirements in the state in which employed. + Certification in Nephrology Nursing, Apheresis Nursing, or both is highly encouraged. **EXPERIENCE AND REQUIRED SKILLS** **:** + One year RN experience required and required nursing skills. + Minimum 6 months nephrology experience required before working independently with no other Dialysis RNs to provide dialysis and ultrafiltration services. + Minimum 6 months Nephrology experience required before working independently with no other Apheresis RNs to provide Apheresis services. + Demonstrated strong assessment skills related to the critically ill patient. + ICU experience preferred but not required. + Successful completion of training course in the theory and practice of care of the ESRD patient - Progressive Renal Education Preparation. + BLS CPR Recognition. + ACLS CPR Recognition preferred, but not required. + Demonstrates organizational and time management skills, and a competency toward completing continuing and ongoing Renal/Nephrology education. + Displays leadership skills and ability to direct and supervise others (such as PCTs, CCHTs, clerical staff). + Successful completion of Nurses Technical Training. **Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.** **EOE, disability/veterans**
    $41k-64k yearly est. 60d+ ago
  • Bilingual RN- Telephonic Care Management

    Humana 4.8company rating

    Registered nurse case manager job in San Juan, PR

    **Become a part of our caring community and help us put health first** This is a Work-At-Home position located in Puerto Rico. You must live in Puerto Rico for this position. The RN Care Manager works in a telephonic environment. They assess and evaluate members' needs and requirements to achieve and maintain an optimal wellness state. Using clinical knowledge, the Care Manager guides members with chronic conditions toward and facilitates interaction with resources appropriate for their care and wellbeing. The Care Manager, Telephonic Nurse's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. You must be fully bilingual in English/Spanish and will be required to pass a test for both languages - Speaking/Reading/Writing included. ***Please submit resume in English. The Care Manager, Telephonic Nurse employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Responsibilities include the following: + Identifies and resolves barriers that hinder effective care. + Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. + May create member care plans. + Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. + Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree in Nursing (BSN) + Bilingual in English and Spanish (and able to pass language proficiency tests in both languages) + Active RN license without restrictions in Puerto Rico + Active RN license without restrictions in Florida - if you DO NOT have an active FL RN license, you must have already passed the NCLEX exam. + Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico). + Prior clinical experience in adult acute care, skilled nursing, rehabilitation or discharge planning + Knowledge in Chronic Condition management (treatment, pharmacological treatment, signs & symptoms, etc.) Diabetes, Hypertension, COPD, Chronic Kidney Disease, etc. + Ability to work independently under minimum supervision and with a team. + Able to work an 8-hour shift between 8:30 AM - 5:30 PM EST and adjusted for Daylight Savings + (Work schedule can be adjusted according to business hours - necessary overtime and/or weekends) **Preferred Qualifications** + Health Plan experience + Previous Case Management Experience + Call center or triage experience + Previous experience managing Medicare members **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Humana will provide Work-At-Home employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Language Proficiency Testing** Any Humana associate who speaks with a member in a language other than Spanish must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. **Additional Information** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $56,900 - $78,200 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About Us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $56.9k-78.2k yearly 60d+ ago

Learn more about registered nurse case manager jobs

How much does a registered nurse case manager earn in Carolina, PR?

The average registered nurse case manager in Carolina, PR earns between $34,000 and $82,000 annually. This compares to the national average registered nurse case manager range of $46,000 to $112,000.

Average registered nurse case manager salary in Carolina, PR

$53,000
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