Nurse jobs at Rising Medical Solutions - 835 jobs

Job Description: Licensed Nurse, LPN - Sycamore Care Strategies Job Type: Full-time, Day Shift Skills: Licensed Nurse, Nursing Home Sycamore Care in Loogootee is seeking a Licensed Nurse, LPN to join our team. The ideal candidate will have experience working in a nursing home setting and possess a current LPN license. This is a full-time position with 12-hour day shift. We are a licensed dementia facility in southern Indiana. Responsibilities: Administer medications and treatments as prescribed by physicians Assist with daily living activities such as bathing, dressing, and grooming Monitor and record vital signs and medical information Collaborate with physicians and other healthcare professionals to develop and implement care plans Provide emotional support and education to patients and their families Requirements: Current LPN license Experience working in a nursing home setting Excellent communication and interpersonal skills Ability to work independently and as part of a team Flexibility Equal Employment Opportunity Policy People are selected to become members of the Care Strategies family based on skill, merit and mind-boggling talent-not based on race, color, creed, sexual orientation, gender or gender identity, marital status, domestic partnership status, military status, religion, age, national origin, ancestry, alienage, AIDS or AIDS-related complex status, genetic information, predisposition or carrier status, status as a victim of domestic violence, physical or mental disability, or any other characteristic protected by applicable law. If things aren't equal, we all lose.

Sign-On Bonus: $5,000 On Lok PACE We are a non-profit committed to our participants. Dedicated to The Care of Elders: PACE (Program of All-Inclusive Care for the Elderly) was developed to answer the many problems around caring for frail seniors. The PACE model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in their community whenever possible. Seniors, their family members, and caregivers face many issues, including transportation to appointments, management of medications, coordination of medical care from different specialists, lack of social interaction, and ability to stay alone at home. On Lok PACE participants receive in home care services and transportation to a On Lok PACE center for primary medical care, social and recreational activities, and other senior care services. We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare. Join our team of leaders to begin a rewarding career! POSITION SUMMARY: Under the administrative direction and supervision of the Program/Center Manager and the clinical supervision of the Nursing Program Specialist, the Center Nurse offers nursing services, either directly or indirectly to all On Lok participants at the Day Health Center. DUTIES / RESPONSIBILITIES: Assess participant's needs and plans appropriate nursing care upon initial intake as well as upon routine reevaluation of each case. Implements, directs, supervises, and evaluates nursing care for participants at the Day Health Center. Teaches, supervises, and counsels the participant, geriatric aides, and family members regarding nursing care. Acts as nursing consultant to other staff and assists the Medical Physicians and Nurse Practitioners. Participates actively in the interdisciplinary team by offering clinical expertise in team planning, problem solving, and processes. Other related duties as assigned. QUALIFICATIONS (knowledge, skills, abilities): Graduate of an accredited college or university with either an associate or baccalaureate degree in nursing. Possess a current California Registered Nurse license. A California Public Health Nurse certificate is desired. Experience in public health nursing desired. Interest, demonstrated ability and one-year experience working with the elderly or frail population required. Ability to work as part of multidisciplinary team. CPR certificate The above statements are intended to describe the general nature of work performed. They are not considered as an exhaustive list of all job tasks performed. On Lok reserves the right to change job descriptions, work hours or work sites as required by the program. On Lok's Employee Benefits include (eligible for any position for 20 hr/wk or more): Medical, Dental, and Vision coverage Retirement Savings Plan 403(b) and Term Life/AD&D Insurance Flexible Spending Account, Commuter Benefits, Pet Insurance, and Employee Discount Program Mental Wellness Resources and Employee Assistance Program (EAP) Holidays (10 per year), vacation time, sick leave, long-term disability insurance, and additional benefits are available. Pursuant to the San Francisco Fair Chance Ordinance, and state and federal laws (including federal PACE requirements at 42 CFR 460.64(a); 460.68(a), we will consider for employment qualified applicants with arrest and conviction records. On Lok is an equal opportunity employer committed to a diverse and inclusive workforce. All applicants will receive consideration for employment without regard to sex (including pregnancy), race, religion, color, gender, gender identity, gender expression, sexual orientation, national origin, ancestry, disability, medical condition, genetic information, marital status, age, military or veteran status, or any other legally protected status. If you require reasonable accommodation to participate in the job application or interview process, to perform essential job functions and/or to receive other terms, privileges or benefits of employment please contact Talent (**************** ).

Sign-On Bonus: $5,000 On Lok PACE We are a non-profit committed to our participants. Dedicated to The Care of Elders: PACE (Program of All-Inclusive Care for the Elderly) was developed to answer the many problems around caring for frail seniors. The PACE model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in their community whenever possible. Seniors, their family members, and caregivers face many issues, including transportation to appointments, management of medications, coordination of medical care from different specialists, lack of social interaction, and ability to stay alone at home. On Lok PACE participants receive in home care services and transportation to a On Lok PACE center for primary medical care, social and recreational activities, and other senior care services. We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare. Join our team of leaders to begin a rewarding career! POSITION SUMMARY: Under the administrative direction and supervision of the Program/Center Manager and the clinical supervision of the Nursing Program Specialist, the Center Nurse offers nursing services, either directly or indirectly to all On Lok participants at the Day Health Center. DUTIES / RESPONSIBILITIES: Assess participant's needs and plans appropriate nursing care upon initial intake as well as upon routine reevaluation of each case. Implements, directs, supervises, and evaluates nursing care for participants at the Day Health Center. Teaches, supervises, and counsels the participant, geriatric aides, and family members regarding nursing care. Acts as nursing consultant to other staff and assists the Medical Physicians and Nurse Practitioners. Participates actively in the interdisciplinary team by offering clinical expertise in team planning, problem solving, and processes. Other related duties as assigned. QUALIFICATIONS (knowledge, skills, abilities): Graduate of an accredited college or university with either an associate or baccalaureate degree in nursing. Possess a current California Registered Nurse license. A California Public Health Nurse certificate is desired. Experience in public health nursing desired. Interest, demonstrated ability and one-year experience working with the elderly or frail population required. Ability to work as part of multidisciplinary team. CPR certificate The above statements are intended to describe the general nature of work performed. They are not considered as an exhaustive list of all job tasks performed. On Lok reserves the right to change job descriptions, work hours or work sites as required by the program. On Lok's Employee Benefits include (eligible for any position for 20 hr/wk or more): Medical, Dental, and Vision coverage Retirement Savings Plan 403(b) and Term Life/AD&D Insurance Flexible Spending Account, Commuter Benefits, Pet Insurance, and Employee Discount Program Mental Wellness Resources and Employee Assistance Program (EAP) Holidays (10 per year), vacation time, sick leave, long-term disability insurance, and additional benefits are available. Pursuant to the San Francisco Fair Chance Ordinance, and state and federal laws (including federal PACE requirements at 42 CFR 460.64(a); 460.68(a), we will consider for employment qualified applicants with arrest and conviction records. On Lok is an equal opportunity employer committed to a diverse and inclusive workforce. All applicants will receive consideration for employment without regard to sex (including pregnancy), race, religion, color, gender, gender identity, gender expression, sexual orientation, national origin, ancestry, disability, medical condition, genetic information, marital status, age, military or veteran status, or any other legally protected status. If you require reasonable accommodation to participate in the job application or interview process, to perform essential job functions and/or to receive other terms, privileges or benefits of employment please contact Talent (**************** ). Job Posted by ApplicantPro

Sign-On Bonus: $5,000 On Lok PACE We are a non-profit committed to our participants. Dedicated to The Care of Elders: PACE (Program of All-Inclusive Care for the Elderly) was developed to answer the many problems around caring for frail seniors. The PACE model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in their community whenever possible. Seniors, their family members, and caregivers face many issues, including transportation to appointments, management of medications, coordination of medical care from different specialists, lack of social interaction, and ability to stay alone at home. On Lok PACE participants receive in home care services and transportation to a On Lok PACE center for primary medical care, social and recreational activities, and other senior care services. We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare. Join our team of leaders to begin a rewarding career! POSITION SUMMARY: Under the administrative direction and supervision of the Program/Center Manager and the clinical supervision of the Nursing Program Specialist, the Center Nurse offers nursing services, either directly or indirectly to all On Lok participants at the Day Health Center. DUTIES / RESPONSIBILITIES: * Assess participant's needs and plans appropriate nursing care upon initial intake as well as upon routine reevaluation of each case. * Implements, directs, supervises, and evaluates nursing care for participants at the Day Health Center. * Teaches, supervises, and counsels the participant, geriatric aides, and family members regarding nursing care. * Acts as nursing consultant to other staff and assists the Medical Physicians and Nurse Practitioners. * Participates actively in the interdisciplinary team by offering clinical expertise in team planning, problem solving, and processes. * Other related duties as assigned. QUALIFICATIONS (knowledge, skills, abilities): * Graduate of an accredited college or university with either an associate or baccalaureate degree in nursing. * Possess a current California Registered Nurse license. A California Public Health Nurse certificate is desired. * Experience in public health nursing desired. * Interest, demonstrated ability and one-year experience working with the elderly or frail population required. * Ability to work as part of multidisciplinary team. * CPR certificate The above statements are intended to describe the general nature of work performed. They are not considered as an exhaustive list of all job tasks performed. On Lok reserves the right to change job descriptions, work hours or work sites as required by the program. On Lok's Employee Benefits include (eligible for any position for 20 hr/wk or more): * Medical, Dental, and Vision coverage * Retirement Savings Plan 403(b) and Term Life/AD&D Insurance * Flexible Spending Account, Commuter Benefits, Pet Insurance, and Employee Discount Program * Mental Wellness Resources and Employee Assistance Program (EAP) * Holidays (10 per year), vacation time, sick leave, long-term disability insurance, and additional benefits are available. Pursuant to the San Francisco Fair Chance Ordinance, and state and federal laws (including federal PACE requirements at 42 CFR 460.64(a); 460.68(a), we will consider for employment qualified applicants with arrest and conviction records. On Lok is an equal opportunity employer committed to a diverse and inclusive workforce. All applicants will receive consideration for employment without regard to sex (including pregnancy), race, religion, color, gender, gender identity, gender expression, sexual orientation, national origin, ancestry, disability, medical condition, genetic information, marital status, age, military or veteran status, or any other legally protected status. If you require reasonable accommodation to participate in the job application or interview process, to perform essential job functions and/or to receive other terms, privileges or benefits of employment please contact Talent (****************).

is intended to start January 2026. The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in. Work Culture: GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together. GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer). GCHP's focuses on 5 Core Values in the workplace: • Integrity • Accountability • Collaboration • Trust • Respect Disclaimers: • Flexible work schedule is based on job duties, department, organization, or business need. • Gold Coast Health Plan will not sponsor applicants for work visas. POSITION SUMMARY The RN, Quality Improvement (QI) will support the Quality Improvement and Health Services Programs, assisting the health plan to successfully achieve organizational objectives for clinical quality and patient safety. This position will be responsible for core clinical and regulatory compliance functions within the QI and Health Services arena, including Facility Site Review (FSR) Medical Record Review (MRR), Potential Quality Issue (PQI) investigation and reporting, and liaison with the team in designing and implementing clinical quality improvement strategies and interventions to support quality metrics and regulatory requirements. The RN, Quality Improvement I will work closely with the Health Services leadership team and the Chief Medical Officer to assess the Program's outcomes, identify areas of needed improvement, and institute actions to promote the delivery of high-quality care. This employee must be able to interpret the requirements of the Plan's regulatory bodies, and state and federal regulations, NCQA accreditation standards, and institute processes/programs to ensure compliance. Amount of Travel Required: 30-50% Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions. ESSENTIAL FUNCTIONS Job Function & Responsibilities • Work closely with other departments of the Health Plan, Health Services and Ql team, and Chief Medical Officer to achieve the goals of the Quality Improvement and Health Equity Transformation (QIHET) Program by identifying issues and implementing corrective actions to ensure compliance with DHCS regulatory requirements and optimize GCHP quality performance. • Lead the timely investigation, processing, and reporting of identified potential quality issues (PQI following the Plan's procedures and timelines). • Track and trend PQI outcomes for the purpose of reporting and prioritization of improvement actions/interventions. • Annually review and edit relevant policies and procedures per APL updates, regulatory requirements, NCQA standards and/or required process changes. • Conduct facility site reviews (FSR), Medical Record Reviews (MRR), and/or Physical Accessibility Review Surveys (PARS) according to DHCS site survey requirements and maintain the FSR database for ongoing tracking of contracted sites and reporting purposes. • Ensure timely follow up on all FSR/MRR activities, including provider communication and corrective action plan documentation. • Lead and/or participate in quality improvement activities and audits, including but not limited to, focused medical record review (MRR), monitoring of Initial Health Appointment (IHA), blood lead screening in children, and other performance improvement projects. • Participate and/or provide clinical support to regulatory compliance activities, including but not limited to, DHCS Medical Audits, HEDIS compliance audits, and internal/external audits. • Support, as needed, the annual HEDIS project, including medical record abstraction and over-reads to determine compliance with HEDIS measures and optimize performance outcomes. • Utilize clinical expertise to create and/or revise policies and procedures per new APL requirements, regulatory requirements, and/or NCQA standards, establish QIHET work plan metrics and key performance indicators, implement provider training programs, and develop member and provider newsletter and website content. • Lead, facilitate and/or participate in relevant committees and work groups; prepare reports, data, or other materials for committee presentation. • Complete project-related communications, including job aides, member/physician communications, website content, work plans/action plans, graphical analyses, and agendas/minutes, as applicable. • Research best practices, and industry standards to help promulgate quality outcomes for the Plan. • Demonstrate strong critical thinking, collaboration, and work ethic, with the ability to foster teamwork and work effectively with providers and multi-disciplinary teams, and adapt quickly to changing priorities • Perform all other duties as assigned. MINIMUM QUALIFICATIONS Education & Experience: Required Education and Experience • Current CA Registered Nursing License - Unencumbered • Associate or bachelor's degree (two or four-year college or technical school) Required, Field of Study: Nursing • 1-2 years of clinical experience in Quality Improvement, Risk Management, Compliance, and/or Accreditation demonstrating increasing responsibility in clinical quality improvement. KNOWLEDGE, SKILLS & ABILITIES • Analytical and problem-solving acumen. • Critical thinking skills • Excellent verbal and written communication skills and ability to interact in a positive manner within the medical/clinic community. • Team player who builds effective working relationships within and across teams. • Ability to work independently. • Strong organizational skills • Ability to analyze, interpret, apply, and communicate policies, procedures and regulations. • Understanding and ability to perform data analysis, basic statistical skills including intermediate knowledge of Excel. • Proven experience with performance improvement methodologies required. PREFERRED QUALIFICATIONS • Public Health and/or ambulatory care/clinic setting background • Medicaid Health Plan experience • Certified Facility Site Reviewer or FSR experience • Knowledge of quality improvement processes and risk mitigation strategies in a managed care environment. • Knowledge of DHCS requirements, NCQA Accreditation standards, and HEDIS. Technology & Software Skills: • Highly competent in the MS Office products including proficiency in Word, Excel, PowerPoint, and databases. • Working knowledge with electronic health record systems including Cerner, NextGen, and Meditech. Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and Current CA Registered Nurse licensure(s) Competency Statements • Business Acumen - Ability to grasp and understand business concepts and issues. • Decision Making - Ability to make critical decisions while following company procedures. • Goal Oriented - Ability to focus on a goal and obtain a pre-determined result. • Interpersonal - Ability to get along well with a variety of personalities and individuals. • Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type. • Time Management - Ability to utilize the available time to organize and complete work within given deadlines. • Consensus Building - Ability to bring about group solidarity to achieve a goal. • Relationship Building - Ability to effectively build relationships with customers and co-workers. • Presentation Skills - Ability to effectively present information publicly. • Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards. • Judgment - The ability to formulate a sound decision using the available information. • Communication, Oral - Ability to communicate effectively with others using the spoken word. • Communication, Written - Ability to communicate in writing clearly and concisely. • Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

SummaryJob Description We are the makers of possible! BD is one of the largest global medical technology companies in the world. Advancing the world of health™ is our Purpose, and it's no small feat. It takes the imagination and passion of all of us-from design and engineering to the manufacturing and marketing of our billions of MedTech products per year-to look at the impossible and find transformative solutions that turn dreams into possibilities. We believe that the human element, across our global teams, is what allows us to continually evolve. Join us and discover an environment in which you'll be supported to learn, grow, and become your best self. Become a maker of possible with us! The Clinical Specialist is a resource for the execution of the Medication Delivery Solutions value-added clinical business strategy. The role implements clinical programs and initiatives that differentiate the MDS product portfolio based on improved clinical outcomes and process enhancements which may result in a lower cost-in-use. The expertise and credentials of the Clinical Specialist enhances the credibility of recommendations to customers and strengthens customer service and support. This support to customers is achieved through recommending best practice and facilitating education. The Clinical Specialist actively engages in conversion management, product implementation and training of Medication Delivery Solutions products. The Clinical Specialist reports directly to the Clinical Manager. As a Clinical Specialist, you will play a crucial role in providing flawless clinical support and education to our valued customers. Join us and be part of a proven organization that strives for excellence in everything we do. As directed by the Clinical Manager, the Clinical Specialist role will be focused on, but not exclusively limited to, the activities outlined below: Responsibilities: Manage responsibilities within the allotted Travel & Expense budget. Provide monthly updates to the Clinical Manager on regional training activities and support provided in the region. Facilitate customer training classes to support conversion or retention opportunities for key customers. Collaborate with the Regional Team to clinically support customer engagements from pre-sale through post-conversion. Develop strong working relationships with end-users while providing product in-servicing and clinical education. Provide routine follow-up support to customers at end-user locations as needed. Conduct regional training for contractual nursing support as needed. Collaborate with the Clinical Manager and Regional Business Manager to optimize scheduling and activities for maximum results. Conduct Vascular Access Management assessments programs to support both Vascular Care and Vascular Access sales organizations. Requirements: Registered Nurse with a Bachelor's degree required. (BSN is preferred). Minimum of 5 years general nursing experience, with 3 years of Ultrasound guided vascular access device placement experience required (PICC & midline). Good relationship development skills required Strong communicator with effective verbal and written skills required Proven training skills to conduct educational courses. Persuasive and credible; able to influence without authority. Possesses a strong understanding and knowledge of infusion therapy, vascular access, and key disease states served by MDS products. Ability to travel up to 70% of the time required Salary ranges have been implemented to reward associates fairly and competitively, as well as to support recognition of associates' progress, ranging from entry level to experts in their field, and talent mobility. There are many factors, such as location, that contribute to the range displayed. The salary offered to a successful candidate is based on experience, education, skills, and actual work location. Salary ranges may vary for Field-based and Remote roles. $85,537 - $141,135 - Annual Base + Incentive At BD, we prioritize on-site collaboration because we believe it fosters creativity, innovation, and effective problem-solving, which are essential in the fast-paced healthcare industry. For most roles, we require a minimum of 4 days of in-office presence per week to maintain our culture of excellence and ensure smooth operations, while also recognizing the importance of flexibility and work-life balance. Remote or field-based positions will have different workplace arrangements which will be indicated in the job posting. For certain roles at BD, employment is contingent upon the Company's receipt of sufficient proof that you are fully vaccinated against COVID-19. In some locations, testing for COVID-19 may be available and/or required. Consistent with BD's Workplace Accommodations Policy, requests for accommodation will be considered pursuant to applicable law. At BD, we are committed to supporting our associates' well-being, development, and success through a performance-based culture. For this position, BD offers a competitive compensation package along with the following benefits specific to this role: Annual Bonus Potential Discretionary LTI Bonus Potential reimbursement of vehicle use/mileage Potential reimbursement of phone use Health and Well-being Benefits Medical coverage Health Savings Accounts Flexible Spending Accounts Dental coverage Vision coverage Hospital Care Insurance Critical Illness Insurance Accidental Injury Insurance Life and AD&D insurance Short-term disability coverage Long-term disability insurance Long-term care with life insurance Other Well-being Resources Anxiety management program Wellness incentives Sleep improvement program Diabetes management program Virtual physical therapy Emotional/mental health support programs Weight management programs Gastrointestinal health program Substance use management program Musculoskeletal surgery, cancer treatment, and bariatric surgery benefit Retirement and Financial Well-being BD 401(k) Plan BD Deferred Compensation and Restoration Plan 529 College Savings Plan Financial counseling Baxter Credit Union (BCU) Daily Pay College financial aid and application guidance Life Balance Programs Paid time off (PTO), including all required State leaves Educational assistance/tuition reimbursement MetLife Legal Plan Group auto and home insurance Pet insurance Commuter benefits Discounts on products and services Academic Achievement Scholarship Service Recognition Awards Employer matching donation Workplace accommodations Other Life Balance Programs Adoption assistance Backup day care and eldercare Support for neurodivergent adults, children, and caregivers Caregiving assistance for elderly and special needs individuals Employee Assistance Program (EAP) Paid Parental Leave Support for fertility, birthing, postpartum, and age-related hormonal changes Leave Programs Bereavement leaves Military leave Personal leave Family and Medical Leave (FML) Jury and Witness Duty Leave Why Join Us? A career at BD means being part of a team that values your opinions and contributions and that encourages you to bring your authentic self to work. It's also a place where we help each other be great, we do what's right, we hold each other accountable, and learn and improve every day. To find purpose in the possibilities, we need people who can see the bigger picture, who understand the human story that underpins everything we do. We welcome people with the imagination and drive to help us reinvent the future of health. At BD, you'll discover a culture in which you can learn, grow, and thrive. And find satisfaction in doing your part to make the world a better place. To learn more about BD visit ********************** Becton, Dickinson, and Company is an Equal Opportunity Employer. We evaluate applicants without regard to race, color, religion, age, sex, creed, national origin, ancestry, citizenship status, marital or domestic or civil union status, familial status, affectional or sexual orientation, gender identity or expression, genetics, disability, military eligibility or veteran status, and other legally-protected characteristics. Required Skills Optional Skills . Primary Work LocationUSA NJ - Franklin LakesAdditional LocationsWork ShiftNA (United States of America)

About us: Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! Competitive compensation Healthcare benefits package that begins on first day of employment 401K retirement plan with company match Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays Up to 6 weeks of parental and bonding leave Hybrid work schedule (3 days in the office, 2 days from home) Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) Tuition reimbursement after 6 months of employment Numerous opportunities for continued training and career advancement And much more! Responsibilities The Utilization Review Nurse's duties will include, but are not limited to: Support internal claims adjusting staff in the review of workers' compensation claims Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone Meet required decision-making timeframes Clearly document all communication and decision-making within our insurance software system Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys Utilize good clinical judgment, careful listening, and critical thinking and assessment skills Track ongoing status of all UR activity so that appropriate turn-around times are met Maintain organized files containing clinical documentation of interactions with all parties of every claim Send appropriate letters on each completed UR Salary Range $65,000.00 - $100,000.00 USD The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. Qualifications Active Licensed Practical Nurse and/or Registered Nurse License 1+ years of utilization review experience at a managed care plan or provider organization 2 + years' clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review Excellent oral and written communication skills, including outstanding phone presence Strong interpersonal and conflict resolution skills Experience in a fast-paced, multi-faceted environment The ability to set priorities and work both autonomously and as a team member Well-developed time-management and organization skills Excellent analytical skills Working knowledge of: Microsoft Word, Excel, and Outlook

Discover an exhilarating opportunity as a Per Diem RN at John Knox Village of Florida, located in the beautiful Pompano Beach. This onsite role allows you to immerse yourself in a community that values compassion and excellence in home health care. As part of a dedicated team, you'll engage directly with residents, delivering empathetic care that truly makes a difference in their lives. With a culture that thrives on trust, forward-thinking, and high performance, you'll collaborate with like-minded professionals who are committed to innovative solutions in health care. Take pride in your work, knowing that every day presents a chance to positively impact the lives of others. As a team member you'll be able to enjoy benefits such as Medical, Dental, Vision, 401(k), Life Insurance, Health Savings Account, Flexible Spending Account, Competitive Salary, Paid Time Off, Unlimited Paid Time Off, John Knox Village is proud to be a SAFE PLACE TO WORK! Come work at a Great Place to Work, and as well as a Beacon and Pinnacle Lifestyle Award winning organization that puts the health of our residents and employees first. John Knox Village is a Drug-free and Tobacco-Free workplace. EOE. Join us in fostering a vibrant and supportive environment where your skills and dedication to care will be recognized and celebrated. A little about us John Knox Village is a not-for-profit Life Care Retirement Community offering a full range of independent living, assisted living and skilled nursing care options for more than 1,000 senior residents on our 70-acre campus, located in Pompano Beach, convenient to major highways and transportation options. Your day to day as a Woodlands RN As a Full-Time RN at John Knox Village of Florida, you will play a vital role in enhancing the quality of life for the elders residing at The Woodlands. By building strong personal relationships and exercising thoughtful decision-making in a home-like environment, you will empower residents to lead meaningful lives. Your expertise and empathy will guide you in identifying individual needs, fostering connections, and implementing personalized care plans that resonate with each elder's unique journey. Join us in creating a nurturing atmosphere that celebrates the wisdom and experiences of our residents while ensuring they feel valued and engaged in their daily lives. Requirements for this Woodlands RN job To thrive as a Full-Time RN at John Knox Village of Florida, you'll need a deep-seated passion for working with elders, demonstrating empathy and understanding in every interaction. Being a collaborative team player is essential, as you'll engage with a diverse group of healthcare professionals dedicated to providing exceptional care. Previous experience in long-term care, short-term rehab, skilled nursing, or assisted living facilities will greatly enhance your effectiveness in this role. A valid Florida RN license and current CPR certification are crucial, ensuring you meet the standards of excellence we uphold. Additionally, IV certification is preferred, equipping you with the skills necessary to provide comprehensive care. Your commitment to quality and teamwork will make a significant impact on the lives of the residents you serve. Knowledge and skills required for the position are: * Have a passion for working with elders * Someone who likes being part of a team * Has previous experience in long-term care * short-term rehab * skilled nursing * assisting living or healthcare facilities. * You must have a valid Florida RN license * Have current CPR certification. * IV certification preferred! Are you ready for an exciting opportunity? If you think this job is a fit for what you are looking for, great! We're excited to meet you! John Knox Village is proud to be a SAFE PLACE TO WORK! Come work at a Great Place to Work, as well as a Beacon and Pinnacle Lifestyle Award winning organization that puts the health of our residents and employees first. John Knox Village is a Drug-free and Tobacco-Free workplace. EOE

Cypress Creek is a max security residential program for at-risk male youth. Through our trained programming for staff, we promote a normalized high school experience, offers a safe environment and provides opportunities for positive change, as well as providing the unlimited potential for achievement and growth for students and staff. We welcome ALL who are passionate about making a difference! So, come as you are and grow with us. SHIFTS: Hours 6:00am Through 6:pm schedules vary. Pay: $36.00 per hour Perks & Benefits: Medical, Dental, Vision and Company paid Life Insurance within 90 days, 401k match of up to 6% after 1 year of employment, Paid Time Off that can be used as soon as it accrues and more! ROP-benefits-and-perks-2 What you will do: As a Registered Nurse, You will be responsible for the health care of students in our care as well as maintaining all student files. You will also provide education for staff and students on health issues, first aid, infectious controls and emergency procedures. To be considered you should: Possess a Bachelor's degree in related health care field, possess a current Florida Registered Nursing License and two years of medical service. Be at least 21 years of age ~ Be able to pass a criminal background check, drug, physical, and TB test ~ Must meet the requirements to become an ROP eligible driver, including having a valid Driver's License Apply today and Make a Difference in the Lives of Youth! After 40 years of improving the lives of youth, we are looking for passionate advocates to continue the legacy of helping young people become successful adults. As a Registered Nurse, you will have the unique opportunity to create a positive, safe and supportive environment for the youth we serve while building a career rich in growth opportunities and self-fulfillment. Follow us on Social! Instagram / Facebook / Linkedin / Tik Tok / YouTube

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: Assesses disability status, makes recommendations and identifies appropriate resources. Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. Consults on case management issues in area of specialty and applies effective case management interventions. Collaborates with medical and other providers to ensure appropriate treatment and return to work. Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. Addresses causality and refers to appropriate medical expertise. Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. Strong interpersonal skills with the ability to effectively interact with internal and external business partners. Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. Knowledge of Microsoft Office Suite as well as other business related software. Ability to work independently. Education and Experience RN with BSN preferred. Eligible to sit for national case management certifications. Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: * Assesses disability status, makes recommendations and identifies appropriate resources. * Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. * Consults on case management issues in area of specialty and applies effective case management interventions. * Collaborates with medical and other providers to ensure appropriate treatment and return to work. * Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. * Addresses causality and refers to appropriate medical expertise. * Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities * Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. * Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. * Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. * Strong interpersonal skills with the ability to effectively interact with internal and external business partners. * Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. * Knowledge of Microsoft Office Suite as well as other business related software. * Ability to work independently. Education and Experience * RN with BSN preferred. Eligible to sit for national case management certifications. * Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: * Assesses disability status, makes recommendations and identifies appropriate resources. * Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. * Consults on case management issues in area of specialty and applies effective case management interventions. * Collaborates with medical and other providers to ensure appropriate treatment and return to work. * Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. * Addresses causality and refers to appropriate medical expertise. * Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities * Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. * Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. * Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. * Strong interpersonal skills with the ability to effectively interact with internal and external business partners. * Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. * Knowledge of Microsoft Office Suite as well as other business related software. * Ability to work independently. Education and Experience * RN with BSN preferred. Eligible to sit for national case management certifications. * Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare regulations and policies. The Appeals RN works in collaboration with the Appeals Examiners and Reps to ensure redeterminations are medically reviewed as needed and completed timely. Salary Range $66,000 - $68,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin How do I know this opportunity is right for me? If you: Have moved away from direct patient care and want to continue using your nursing knowledge in a new and different way. Excel at analyzing information and critical thinking to make sound medical decisions. A highly organized and adept at researching and finding answers independently using all available resources. Thrive in a production environment where quality and production metrics are critical to individual and team success. Have strength in technical writing. Desire day hours with no on-call work and holidays off. Are technically strong on computers including MS Outlook, Teams, OneNote, Word, and Excel. Are self-motivated and work with a great degree of independence. Are looking for a full-time, permanent position. What will I gain from this role? Collaborating with a team of clinicians and non-clinicians. Learning a variety of systems, including but not limited to, the Medicare Appeal System (MAS) which is a content management system for Part A appeals and our Hyland OnBase tool which is our content management system used for Part B appeals. Experience working in an environment that serves our nation's military, veterans, Guard and Reserves, and Medicare beneficiaries. Working in a continuous performance feedback environment. Minimum Qualifications Associate's Degree in Nursing (ASN) or Bachelor's Degree in Nursing (BSN). Active RN license, applicable to state of practice in good standing. 1 or more years of clinical experience in a healthcare setting (hospital/bedside, case management, MDS/Skilled Nursing, etc.). Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely. Strong attention to detail and organizational skills to manage multiple cases simultaneously. Basic knowledge and understanding of medical/clinical review processes (i.e., Appeals/Utilization Review). Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel. Preferred Qualifications Experience working for a Medicare Administrative Contractor (MAC). 1 or more years of experience working in Medical Management (e.g., MDS role), Medical Review, Utilization Management/Review, or Appeals. Basic Medicare knowledge and/or experience. Remote Work Requirements Wired (ethernet cable) internet connection from your router to your computer High speed cable or fiber internet Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at ********************** Please review Remote Worker FAQs for additional information Benefits Remote and hybrid work options available Performance bonus and/or merit increase opportunities 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately) Competitive paid time off Health insurance, dental insurance, and telehealth services start DAY 1 Employee Resource Groups Professional and Leadership Development Programs Review additional benefits: (******************************************************************* Who We Are WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready. Culture Drives Our Success WPS' Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition. Sign up for Job Alerts FOLLOW US! Instagram LinkedIn Facebook WPS Health Blog This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.

✨Join a group of passionate advocates on our mission to improve the lives of youth! Rite of Passage Team is hiring Registered Nurses at Norris Academy in Andersonville, TN✨ Are you ready to make an IMPACT from day one? Nestled just outside the Great Smoky Mountains, around 30 miles North of Knoxville, in a small, quaint, beautiful town, called Andersonville, sits Norris Academy, a residential treatment facility that offers comprehensive, holistic services to youth with autism spectrum disorders, and/or other neurodevelopmental diagnosis. Compensation: Day Shift starting at $39 per hour. Night Shift starting at $41 per hour. Perks & Benefits: There are SO many benefits that come with working at ROP! Free meals on shift Opportunities for career growth, nationwide Earn PTO from day one of employment Be sure to check out all the benefits ROP has to offer here: ROP-benefits-and-perks-2 What you will do: A day in the life of a Registered Nurse (RN) at Norris Academy is rarely the same, HARD WORK, EXCITING, IMPACTFUL, and very REWARDING. As an RN at Norris, you will be primarily responsible for coordinating the daily activities of the medical department, ensuring adherence to the healthcare guidelines, and implementing safety standards for our youth. This is a 100% onsite position. Duties include but are not limited to: Manage student healthcare according to their needs Assist medical, psychiatric, and dental providers on-site and/or via telehealth Maintain resident medical files Enforce facility rules, policies, and routines To be considered you should: Be at least 21 years of age Have a High School diploma or equivalent, bachelor's degree preferred Have a current RN license in the state of TN Be able to pass a background screening, drug test, and physical Have at least 1 year of experience working with autistic youth Have a passion to work with and help children Schedule/hours/shifts: 12-hour shifts, days and nights available. Apply today and Make a Difference in the Lives of Youth! After 40 years of improving the lives of youth, we are looking for passionate advocates to continue the legacy of helping young people become successful adults. As a Registered Nurse (RN) you will have the unique opportunity to create a positive, safe and supportive environment for the youth we serve while building a career rich in growth opportunities and self-fulfillment. Follow us on Social! Instagram / Facebook / Linkedin / Tik Tok / YouTube

Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Hours: 8am - 5pm in your local time zone Call rotation - 1 weekend every 16 weeks You will report into the Associate Medical Director, Utilization Management. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $211,200 - $ 277,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses. Responsibilities: Provide timely medical reviews that meet Oscar's stringent quality parameters. Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen. Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level). Use correct templates for documenting decisions during case review. Meet the appropriate turn-around times for clinical reviews. Receive and review escalated reviews. Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research. Compliance with all applicable laws and regulations Other duties as assigned Requirements: Board certification as an MD or DO Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC. 6+ years of clinical practice 1+ years of utilization review experience in a managed care plan (health care industry) Bonus points: Licensure in multiple Oscar states BC in Cardiology, Radiation/Oncology, or Neurology Experience with care management within the health insurance industry. Willing and able to obtain additional state licensure as needed, with Oscar's support This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our .

Paramount Home Health Care is seeking a reliable Licensed Nurse (LPN/RN) or Certified Phlebotomist to draw blood and transport specimens to the laboratory twice per week. This is a flexible, part-time opportunity ideal for professionals looking to supplement their schedule. Responsibilities: Perform blood draws on assigned patients Properly label, handle, and store specimens Transport blood samples to the designated laboratory in a timely manner Follow all safety, infection control, and HIPAA guidelines Maintain accurate documentation Requirements: Valid Florida license (LPN/RN) or Phlebotomy certification Experience with venipuncture Reliable transportation Professional, dependable, and detail-oriented Ability to work independently Schedule: Twice weekly (flexible days) Compensation: Competitive pay (based on experience) How to Apply: Please contact Paramount Home Health Care to apply or submit your resume.

The Clinical Risk Manager RN is responsible for providing high quality case management and claims management consulting, including identification, assessment and projections of high-cost cases to assist in the underwriting process. ESSENTIAL EDUCATION AND EXPERIENCE: ASN or BSN in nursing licensed in the State of Residence; at least two (2) years of clinical experience, and at least two (2) years of stop loss or health payer experience. SKILLS/COMPETENCIES REQUIREMENTS: Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers recommendations. Use established guidelines when conducting stop-loss case reviews. Works with underwriting team to identify potential high-risk claimants in new business and renewal groups. Elicits support from sales and account management, and underwriting. Use reporting and risk identification tools on medical and pharmacy claims to assess risk. Assists in responding to inquiries from underwriting and sales for additional information on large claimants. Review of monthly TPA reporting on current business for reserving. Understanding of health and prescription costs. Understanding of health delivery systems and professionals. Understanding of disease life cycle, disease progression, expected health outcomes based on standard, accepted care management principles. Understanding of stop loss reporting tools and requirements preferred. Understanding of risk mitigation, high claimant detection, engagement and management preferred. Requires strong interpersonal skills with a demonstrated ability to work across divisions and with external stakeholders. Requires proficiency in the use of MS Office, AMS product suite, and ESL Office. TRAVEL: Occasional travel may be required for meetings, conferences, or client visits. This includes compliance with all of the requirements of the localities and destinations, as well as transportation carrier requirements.

FUNCTION OF THE JOB: The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position KNOWLEDGE AND SKILLS: Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. Strong interpersonal and relationship building skills. Knowledge of traumatic injuries and the resultant disabilities and medical complications. Knowledge of Worker's Compensation Acts and working knowledge of the medical providers in the assigned territory. Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines. Experience using Microsoft Office products and ability to learn other technology tools. Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines MAJOR DUTIES/RESPONSIBILITIES OF THE JOB: Complete timely initial assessment report, case management plan, and establish disability duration timeframes. Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan. Active participation with claims team to review, establish, and execute action plan. Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines. Work collaboratively with all stakeholders to effectively manage recovery and return to work process. Meet productivity requirements. Effectively manage inventory based on guidelines. EDUCATION AND EXPERIENCE: Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed. BSN preferred. Certified Case Manager (CCM) certification, CDMS and/or CRRN preferred. Compact license preferred. 3-year experience in Workers Compensation Case Management preferred. Proficiency with MS Office products Bi-lingual in Spanish a plus The pay range for the role is $65,900 to $111,900. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

FUNCTION OF THE JOB: The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position KNOWLEDGE AND SKILLS: * Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. * Strong interpersonal and relationship building skills. * Knowledge of traumatic injuries and the resultant disabilities and medical complications. * Knowledge of Worker's Compensation Acts and working knowledge of the medical providers in the assigned territory. * Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines. * Experience using Microsoft Office products and ability to learn other technology tools. * Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines MAJOR DUTIES/RESPONSIBILITIES OF THE JOB: * Complete timely initial assessment report, case management plan, and establish disability duration timeframes. * Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan. * Active participation with claims team to review, establish, and execute action plan. * Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines. * Work collaboratively with all stakeholders to effectively manage recovery and return to work process. * Meet productivity requirements. * Effectively manage inventory based on guidelines. EDUCATION AND EXPERIENCE: * Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed. BSN preferred. * Certified Case Manager (CCM) certification, CDMS and/or CRRN preferred. * Compact license preferred. * 3-year experience in Workers Compensation Case Management preferred. * Proficiency with MS Office products * Bi-lingual in Spanish a plus The pay range for the role is $65,900 to $111,900. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.