Staff nurse work from home jobs - 484 jobs

A healthcare provider group is seeking a Clinical Educator NP/PA & Travel Nurse to enhance patient outcomes through education and clinical coverage. This role requires a strong background in Physiatry, a passion for teaching, and the ability to travel nationwide. The competitive compensation includes a salary of $155,000-$185,000, full benefits, and comprehensive travel support. Located remotely with necessary metropolitan area constraints, candidates must be residing in specified locales. #J-18808-Ljbffr

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. This is a home-office based position with field responsibilities. You will spend approximately 50% to 75% of the time in the field within an assigned coverage area. Candidates must be in Franklin County, OH and willing to commute to surrounding counties. If you reside in Franklin County, OH or surrounding counties, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team 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: Current, unrestricted independent licensure as a Registered Nurse in Ohio 2+ years of clinical experience as an RN 1+ years of experience with MS Office, including Word, Excel, and Outlook Reliable transportation and the ability to travel up to 75% within Franklin County, OH and surrounding counties in OH to meet with members and providers Reside in Franklin County, OH and surrounding counties Preferred Qualifications: BSN, Master's Degree or Higher in Clinical Field CCM certification 1+ years of community case management experience coordinating care for individuals with complex needs Experience working in team-based care Background in Managed Care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ 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.

Registered Nurse - PRN visits Leave Shift Work Behind Consider our per diem opportunity to earn additional income as a Nurse Interviewer visiting clients at their place of residence. Complete questionnaires on their medical, functional and cognitive status. Flexible scheduling - The nurses can schedule visits Monday - Sunday, mornings, afternoons or evenings based on the client's and nurse's schedule. Flexible work - you can cover up to a 75 mile radius and work as little or as much as you want per month based on available cases in your area. Extra income - Work with illumifin whenever you need a little extra money, even if you have another job. No blood draws or specimen collections required. About the Role: As a RN with illumifin, you will utilize your critical thinking and assessment skills to complete the following: Obtain thorough cognitive and health assessment information as required. Comply with all assessment instructions and accurately complete assessments. Communicate promptly with illumifin regarding file status and appointment times. Return the assessment within 24 hours after the appointment. Respond promptly to any follow-up and clarification questions on submitted assessments. With E-Assessments training, you can complete assessments electronically using your cell phone, tablet, iPad or Laptop

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

Reports to: Chief Executive Officer and/or Training Director Scope of work: Provides monitoring and clinical skills training & exposure to nurse practitioner and physician assistant students. Education: M.D. from accredited University or Medical School Completion of a Psychiatric Residency Program Experience: Has experience in mental health services Has medical license within the U.S. Responsibilities: Provide monitors and proctors nurse practitioner and physicians assistant students in psychiatric services Provides feedback and training on clinical skills development with NP and PA students

Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse - Home Visits (PRN), you'll provide high-quality nursing care directly in patients' homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work. Key Points to Know: • You'll use your own vehicle to visit patients in their homes, typically within 1-2 hours of your location. • Shifts are PRN / per diem, meaning you'll work only when projects are available in your area; project frequency may vary. • Orientation, training, and project-specific instructions are provided before each assignment. • You will be compensated for all time spent on training, travel, and patient visits, including documentation. We are posting this role now and will be reviewing applications on a rolling basis between now and Christmas. Interviews will begin in the New Year , so you may experience a brief delay in hearing back from us during the holiday period. Thank you in advance for your patience - we look forward to connecting in January. Position: Clinical Research Nurse - Home Visits (PRN) Job Type: Contract, PRN, Per Diem Hourly Rate: $55/hr onsite and $50/hr travel time Work Location: Denver, Colorado; Drive up to 1-2 hours to patient homes in your area (travel time compensated!) Job Description: As a Clinical Research Nurse - Home Visits (PRN), you will play a crucial role in ensuring the successful execution of research studies in patient homes. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your expertise and caring nature will help us maintain compliance with each study's protocol and safeguard the well-being of study patients. Principal Duties and Responsibilities: Deliver competent, high-quality nursing care to study patients in their homes. Accountable for the competent and confident delivery of high-quality clinical care to patients/participants. Ensure compliance with each study's protocol by providing thorough review and documentation at each subject study visit. Administer investigational medications/products as needed; Perform patient assessments to determine presence of side effects; notify Principal Investigator of findings/issues. Perform medical tests as outlined in protocol, including, but not limited to: vital signs, specimen collection, electrocardiograms; Process specimens and ship specimens per protocol. Provide patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment. Responsible for adherence to clinical research policies to ensure ethical conduct and protect vulnerable populations. Communicate effectively, promoting open and trusting relationships. Qualifications: Relevant Nurse Licensure CH-GCP Certificate Graduate from an accredited BSN or Associate Degree in Nursing or Nursing Diploma program Minimum 2 years' post qualification acute care experience Clinical Research experience preferred BLS certification required Experience and knowledge of working in clinical research trials with ICH-GCP (Good Clinical Practice) Certification - (training can be provided) Good basic IT skills, utilizing mobile devices and Microsoft systems Trained in Handling and Transport of Hazardous Substances (training can be provided) A flexible schedule is essential Unencumbered driver's license, reliable car Benefits: Competitive hourly pay rate, including compensation for travel time. Flexible schedule to maintain work-life balance. Mileage reimbursement for travel expenses. Ongoing training and support to growth your clinical research skills Opportunity to make a meaning impact on patients' lives while contributing to cutting-edge medical research. Join our team and contribute to groundbreaking medical advancements through clinical research!

Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, we bring world-class research and health services directly to communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. With programs like Future of Medicine , which makes advanced health screenings and research opportunities accessible to communities worldwide, and Difference Makers , which supports local leaders to expand their community health and wellbeing efforts, we put people at the heart of medical progress. Through partnerships, technology, and perseverance, we are reimagining how clinical research and health services reach the world. Together, we are building a future of health that is better and more accessible for all. To learn more about Care Access, visit ******************* How This Role Makes A Difference The Registered Nurse, Clinical Delivery (RN) in this role will manage the communication of critical and abnormal lab results to patients, ensuring compliance with state licensure requirements. This includes contacting patients, documenting communications, following up on lab escalations, and collaborating with providers to ensure all patient interactions are appropriately managed and documented. This role is also responsible for patient education, ensuring patients understand their lab results and any necessary next steps in their care, as well as providing study specific information that is tailored to the patient. Furthermore, they serve as a point of escalation for the Member Services team, addressing complex inquiries related to lab results and assisting in the resolution of patient concerns by providing clinical insights and ensuring patients receive accurate information and appropriate follow-up. The RN will liaise with the Clinical Conduct Team to investigate and resolve issues related to duplicate lab results or other concerning findings, as advised by the Medical Director. Lastly, they will assist in training and educating the Member Services team to improve patient interactions and enhance service quality. This role is critical in ensuring timely patient communication and maintaining compliance with clinical and legal standards. How You'll Make An Impact Receive and Review Lab Results from Pre-screening Program: Autonomously evaluate flagged abnormal, urgent, or critical lab findings to prepare them for patient communication, ensuring accuracy and timeliness. Patient Communication: Proactively contact patients to discuss abnormal and critical lab outcomes. Ensure focused and uninterrupted communication, adhering to protocols while delivering only legally permissible information within the RN scope of practice. Use communication techniques to convey complex medical information clearly in a way non-medical patients will understand. Understand that the results shared with the patients may have serious health implications for them and relay them in a compassionate manner. Patient Education: Develop and implement patient education initiatives to enhance understanding of lab result significance and promote informed decision-making. Ensure patients understand their lab results and any necessary next steps in their care. Critical Thinking: Independently utilize critical thinking to assess the urgency and implications of abnormal and critical lab results, prioritizing patient communication based on clinical significance. Documentation: Maintain comprehensive and precise documentation of communications in patient progress notes. Record abnormal and critical results, patient concerns, and subsequent actions. Ensure compliance with regulatory signature requirements. Time Management: Exhibit exceptional time management skills to efficiently manage multiple lab results and patient communications, prioritizing urgent cases promptly. Problem Solving Expertise: Apply advanced problem-solving abilities using medical training and experience to troubleshoot issues related to lab result discrepancies or data integrity. Data-Driven Decision Making: Leverage data analytics to identify patterns and trends in lab results, contributing to evidence-based practice and enhanced patient outcomes. Regulatory Knowledge: Maintain up-to-date knowledge of healthcare regulations and compliance standards to ensure all communications adhere to legal and ethical guidelines. Escalation to Providers: For questions beyond the RN's medical scope, escalate to a licensed, on call provider (NP/PA/MD/DO) and manage the completion of result delivery and accompanying required documentation. Member Services Team Escalations: Address lab-related escalations from the Member Services Team, such as result clarifications, data discrepancies, or additional test requests, and communicate resolutions back to the patient, documenting the outcome. The Expertise Required Strong analytical capabilities, exceptional communication skills, and a commitment to fostering a patient centered environment. Strong attention to detail and ability to manage multiple patients efficiently. Ability to work independently while collaborating with a larger clinical team. This role is pivotal in upholding clinical and legal standards through meticulous communication and patient care management. Precision in data analysis and documentation to ensure accuracy in lab results and reporting. Certifications/Licenses, Education, and Experience: Education: Active RN licensure with a commitment to compliance and regulatory standards. Compact Licensure required. Additional licenses may be required in addition. BSN or equivalent degree preferred. Experience: Minimum of 3 years of experience as a working nurse, clinical research, medical communications, and/or related field. Proficiency in Salesforce or other EMR systems for documenting patient interactions. Licensure Requirement: Compact licensure required, non-compact state license preferred. Willingness to maintain and obtain additional state licenses as needed. Must hold all licenses in good standing. Compact States [42]: RNs with compact licenses can practice in all 42 states in the compact, including Alabama, Arizona, Arkansas, Colorado, Florida, Texas, and more. Non-Compact States [8]: California, Nevada, Illinois, Hawaii, Alaska, Oregon, Minnesota, New York. How We Work Together Location: Remote within the United States. This role requires 100% of work to be performed in a remote office environment. Travel: This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role. Physical demands associated with this position Include: The ability to use keyboards and other computer equipment. PTO and On-Call Coordination: Work within a structured on-call system to ensure coverage when team members are on leave. The expected salary range for this role is $70,000 - $100,000 USD per year for full time team members. Benefits & Perks (US Full Time Employees) Paid Time Off (PTO) and Company Paid Holidays 100% Employer paid medical, dental, and vision insurance plan options Health Savings Account and Flexible Spending Accounts Bi-weekly HSA employer contribution Company paid Short-Term Disability and Long-Term Disability 401(k) Retirement Plan, with Company Match Diversity & Inclusion We work with and serve people from diverse cultures and communities around the world. We are stronger and better when we build a team representing the communities we support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Care Access is unable to sponsor work visas at this time. If you need an accommodation to apply for a role with Care Access, please reach out to: ********************************

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

Gateway Rehab Center (GRC) has an outstanding opportunity for a Nurse Liaison Gateway Rehab who will be responsible for the pre-admission case management, ASAM level of care assessment, and coordination of admission to care for substance use disordered patients referred from a hospital setting. To be considered for the position, you must live within the Pittsburgh, PA area or surrounding counties. Responsibilities Assesses admission candidates' medical and psychiatric appropriateness for treatment. Determines level of care placement based on ASAM criteria. Pre-certifies admissions as required. Discusses treatment options with referral sources. Acts as liaison between Gateway and outside referral sources. Coordinates patient transfers from other facilities to Gateway Aliquippa/Westmoreland. Responds to needs of referral sources and managed care representatives. Interacts with the physician through coordination of patient assessments. Attends GRC mandatory training and in-services. Other duties as required. Knowledge, Skills, and Abilities Strong communication skills required. Able to work independently with minimal oversight. Knowledge of skilled nursing Requirements Pennsylvania RN or LPN licensure 3+ years nursing experience preferred. Experience identifying/treating drug and alcohol addictions. Experience in conducting assessments and evaluations. Additional Requirements Pass PA Criminal Background Check Obtain PA Child Abuse and FBI Fingerprinting Clearances. Pass Drug Screen TB Test Access to reliable and dependable internet connection. Work Conditions Favorable working conditions. Minimal physical demands Significant mental demands include those associated with working with patients with addictive disorders and managing multiple tasks. GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.

The structure of Aurora Central High School's Health Office includes a full-time nurse and a full-time health para. This nurse position will work together with the para to meet the health needs of students within our building. Click to view the full job description This position is designated as Hard to Fill and is eligible for an annual stipend of $5000. Stipends are paid in two equal installments of $2,500 in January and June of the school year, contingent upon working the entirety of each semester. To be eligible for the Hard to Fill stipend, staff must: Be licensed by the Colorado Department of Education (CDE) and appropriately endorsed to provide services to students. Serve students in the identified area at least 50% of the assignment.

Remote - PFS Denial Nurse Auditor PFS Billing-Follow Up-Denials Full Time Status Day Shift Pay: $60,382.40 - $96,616.00 / year Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time. The Denials Nurse Auditor works under the supervision of the manager of PFS Denials. The Denials Nurse Auditor is responsible for completing, appealing, tracking, and reporting clinical denial reviews to determine the appropriate actions for post-billing denials. This Individual will combine clinical, financial, and regulatory knowledge and skill to reduce financial risk and exposure caused by payer denials for rendered services. The Denials Nurse Auditor has highly developed knowledge and skills in areas of: Medical Necessity, Authorizations, Experimental/Investigational denials, payer audits and filing appeals as well as Government and Non-Government payor requirements with Denial Management. This position is employed by Mosaic Life Care. Completes clinical review of appropriate post-claim denials; prepares clinical discussion and appeal letters for denied accounts. Consults clinical and hospital appeal guidelines; provides appeal direction using payer guidelines to appropriate departments via monthly denials meetings. Ensures compliance with all federal, state, and local regulations governing rendered patient services and reimbursement. Reviews and analyzes specific audit information and provides education to other caregivers both internal and external to the PFS Denial Management team. Identifies, and initiates clinical and hospital quality improvement initiatives focused on improving both quality indicators and outcomes. Other duties as assigned. Bachelor's Degree - Graduate of school of nursing, BSN is required. Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure Registered Nurse license by the State of Missouri required. 5 Years of experience in health care as a registered nurse, preferably in revenue cycle is required. Excellent understanding of financial and health care strategies is required.

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

Telephonic Case Manager - Rare Opportunity! EK Health is now hiring for a Telephonic Nurse Case Manager (RN) for our Case Management Team! This role includes assessing, planning, implementing, coordinating, and evaluation of service options. The goal of the Case Manager is to assist the injured worker in receiving appropriate, cost-effective medical care for their injury in a timely manner, and to expedite their return to work. Position Logistics: Monday - Friday, 8:30am -5:30pm local time, Full-time Remote. NOTE: Requires a Compact RN license in good standing. Workers Compensation experience is preferred but not required. Wage is based on experience, education, certifications and location (may be either hourly or salary based on individual state requirements). Benefits & Perks: Base pay $35-42/hr ($72,800 - $87,360 annually). Wage is based on experience, education, certifications and location (may be either hourly or salary based on individual state requirements). Medical, Dental and Vision Insurance 401K Paid Time Off Paid holidays Equipment is provided Monthly internet stipend Here's a snapshot of what you'll be doing (not all-inclusive): Communicate with medical providers, employers and with injured workers Perform a complete nursing evaluation to determine needs of patient Review and evaluate all medical correspondence, provider reports, & treatment plan history Evaluate clinical status of claimant and research for alternative options to treatment as warranted Communicate with the claims examiners regarding directives, and provide updates on file status Arranging transportation services when necessary and authorized Evaluating therapy facilities and their progress on specific cases Prepare comprehensive notes following any discussions had with injured worker, medical providers, claims examiners, and employers in the case file Discuss the analyzed data and the comprehensive plan of care with the insurance representative prior to implementation Upon authorization, implement this plan of care with patient, physician and health care providers Arrange for care/services as needed (home care, procedures, medication, equipment or supplies) Monitor the plan of care with modifications or changes suggested to the patient and physician as the need arises Coordinate information between all parties (injured worker, physicians, employer, other providers, such as therapists, and attorney, if any is involved) Requirements Graduate of an accredited school of nursing 3-5 years clinical experience as an RN outside of school Valid Compact RN license in good standing with no restrictions Valid state-appropriate RN license in good standing with no restrictions Possesses and can demonstrate the professional and technical skills of a Registered Nurse Experience in Case Management, Workers' Compensation experience preferred, but not required Experience in Home Health Care, Occupational Health considered a plus Excellent Written and Oral Communication Skills Excellent Interpersonal & Organizational Skills High comfort level with computers and computer programs (MS Word, MS Excel, Email)

Company Details Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker's successful and speedy return to work is good for people and good for Berkley's insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley's operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers' compensation cases. To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley's operating units with reliable results, and reduced time and expenses associated with case management. Responsibilities As a Telephonic Nurse Case Manager, you will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers. Coordinate and implement medical case management to facilitate case closure Timely and comprehensive communication with with employers, adjusters and the injured workers. Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction Acquire and maintain nursing licensure for all jurisdictions as business needs require Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services Document activities and case progress using appropriate methods and tools following best practices for quality improvement Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work. Engage and participate in special projects as assigned by case management leadership team Occasionally attend on site meetings and professional programs Foster a teamwork environment Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status. Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed. Obtain case management professional certification (CCM) within 2 years of hire Qualifications Minimum 2 years of experience in workers compensation insurance and medical case management preferred Minimum of 4 years medical/surgical clinical experience required Ability to work standard business hours in the either Central Standard Time, Mountain Standard Time or Pacific Time Zone (Monday through Friday, 8:00 AM to 5:00 PM CST/MST/PST). Exhibit strong communication skills, professionalism, flexibility and adaptability Possess working knowledge of medical and vocational resources available to the Workers' Compensation industry Demonstrate evidence of self-motivation and the ability to perform case management duties independently Demonstrate evidence of computer and technology skills Oral and written fluency in both Spanish and English a plus Education Graduate of an accredited school of nursing and possess a current RN license. A Compact Nursing License is strongly preferred. A California license is ideal but not mandatory. Candidates must be willing and able to obtain a California license within 90 days of their start date. Additional Company Details ****************** The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees • Base Salary Range: $80,000 - $88,000 • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Additional Requirements • Domestic U.S. travel required (up to 10% of time) Sponsorship Details Sponsorship not Offered for this Role

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

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

Private Health Management (PHM) supports people with serious and complex medical conditions, helping them obtain the best possible medical care. We guide individuals and families to top specialists, advanced diagnostics, and personalized care. Trusted by healthcare providers and businesses, PHM offers independent, science-backed insights to help clients make informed decisions and access the best care. About the Role As a Nurse Advisor at PHM, you'll serve as the first clinical point of contact for new members: discussing their health concerns, assessing their needs, and introducing them to PHM's services. You'll explain how we support members, set expectations, and connect them to the right clinical teams. For existing members, you'll triage evolving concerns and coordinate timely, effective care. You'll also manage a portfolio of low to moderate acuity Health Advisory clients-supporting them as they navigate the healthcare system and access high-quality care. You advocate, educate, and guide using your clinical expertise and a compassionate consultative approach. This role is ideal for a mission-driven nurse who thrives in a dynamic, evolving, and high growth environment. You'll be solving problems, building relationships, and helping others make informed decisions with your curiosity, flexibility, and desire to grow with your team. How You'll Spend Your Days Lead or participate in clinical intake meetings; triage calls and inquiries from members. • Explain PHM's services to new members, setting expectations and supporting their care journey. • Manage a caseload of low to moderate acuity clients-facilitating care coordination and access. • Prepare clinical summaries for and collaborate cross functionally with various internal teams to ensure smooth transitions for our clients. • Recommend providers and facilities; manage logistics to ensure seamless care delivery. What You Bring to the Table Active Registered Nurse license in your home state with 5+ years of healthcare experience. • Experience triaging patients in urgent care or emergency settings; bonus points for experience in case management or business. • Confidence and empathy when engaging with PHM clients • Clear, compassionate communication with both clinical and non-clinical audiences. • Self-starter with strong time management and a collaborative spirit. • Tech-savvy and quick to adapt to new systems. Compensation The target base salary for this role is $85,000-$100,000 annually. This base salary is only a part of a total compensation package that also includes: health/dental/vision benefits, annual cash incentive program, 401k with match, flexible PTO, PHM for PHM (our services for you and your dependents) and other benefits. Individual pay may vary from the target range as a number of factors including market forces, experience, location, disparities in market data and other relevant business considerations may all factor into final compensation. This role may be physically located anywhere in the United States, but priority will be given to candidates with Mountain and /or Pacific time zone availability. Anticipated Pay Range$85,000-$100,000 USD

firsthand supports individuals living with SMI (serious mental illness). Our holistic approach includes a team of peer recovery specialists, benefits specialists and clinicians. Our teams focus on meeting each individual where they are and walking with them side by side as a trusted guide and partner on their journey to better health. firsthand's team members use their lived experience to build trust with these individuals and support them in reconnecting to the healthcare they need, while minimizing inappropriate healthcare utilization. Together with our health plan partners, we are changing the way our society supports those most impacted by SMI. We are cultivating a team of deeply passionate problem-solvers to tackle significant and complex healthcare challenges with us. This is more than a job-it's a calling. Every day, you will engage in work that resonates with purpose, gain wisdom from motivated colleagues, and thrive in an environment that celebrates continuous learning, creativity, and fun. The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. This is primarily a day-shift role (8 hours/day, 8:30-4:30 PST or 8:30-4:30 PST), with occasional potential for nights or weekends. When not managing acute issues, Triage Nurses focus on care coordination, training, and related administrative tasks. Responsibilities of a Triage Nurse include: Triage and Escalation: Manage inbound clinical issues from firsthand staff and patients via phone; triage appropriately and escalate emergencies immediately. Collaboration: Work closely with peer mental health workers, social workers, and APPs to address acute issues comprehensively. Coordination: Coordinate care with patients' other providers to ensure seamless health management. Training: Develop and deliver training on basic medical topics for peer mental health workers and social workers Triage Nurses should have: Strong triage and prioritization skills, with the ability to rapidly assess and determine the appropriate level of care. Problem-solving expertise with a creative, patient-centered approach. Ability to provide condition-specific patient education and self-management guidance. Adaptability to varying team cultures and processes. Empathy, compassion, and approachability in patient and team interactions. Required experience includes: Active RN license through a Nurse Licensure Compact (NLC) state and willingness to obtain licensure in non-compact states. Bachelor of Science in Nursing (BSN). At least 3 (three) years of clinical care experience in an Emergency Department. Experience working with populations facing challenges such as behavioral health and/or substance use disorders. Care management and coordination experience. Bilingual in Spanish Bonus Points for: Certification in Psychiatric-Mental Health Nursing (PMH-BC) Washington state RN license Base salary range:$75,000-$75,000 USD We firmly believe that great candidates for this role may not meet 100% of the criteria listed in this posting. We encourage you to apply anyway - we look forward to begin getting to know you. Benefits For full-time employees, our compensation package includes base, equity (or a special incentive program for clinical roles) and performance bonus potential. Our benefits include physical and mental health, dental, vision, 401(k) with a match, 16 weeks parental leave for either parent, 15 days/year vacation in your first year (this increases to 20 days/year in your second year and beyond), and a supportive and inclusive culture. Vaccination Policy Employment with firsthand is contingent upon attesting to medical clearance requirements, which include, but may not be limited to: evidence of vaccination for/immunity to COVID-19, Hepatitis B, Influenza, MMR, Chickenpox, Tetanus and Diphtheria. All employees of firsthand are required to receive these vaccinations on a cadence/frequency as advised by the CDC, whereas not otherwise prohibited by state law. New hires may submit for consideration a request to be exempted from these requirements (based on a valid religious or medical reason) via forms provided by firsthand. Such requests will be subject to review and approval by the Company, and exemptions will be granted only if the Company can provide a reasonable accommodation in relation to the requested exemption. Note that approvals for reasonable accommodations are reviewed and approved on a case-by-case basis and availability of a reasonable accommodation is not guaranteed. Unfortunately, we are not able to offer sponsorship at this time.

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