Telephone Triage Nurse remote jobs

**Shift:** Rotating schedule, 4 10-hour shifts per week **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law_ The **Remote Triage - RN** is responsible for serving as a Registered Nurse in the remote triage call center. Monitors members using established disease specific protocols. Provides clinical support for members on program via telephonic outreach and inbound calls. **How you will make an impact:** + Provides information about the RPM Program to members with chronic conditions and explains the benefit of having chronic conditions managed, assessed and treated. + Communicates with program members and their care givers via outbound and inbound calls with respect to RPM clinical interventions. + Responds to member or provider written or inbound telephonic communications or inquires with respect to clinical interventions. + Monitors biometric data using established disease specific protocols. + Reviews members current labs and medications for appropriateness. **Minimum Requirements:** + Requires BA/BS in a related field and minimum of 3 years of Registered Nurse experience; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted RN license in applicable states required. **Preferred skills, capabilities, and experiences:** + BA/BS in Nursing preferred. + Clinical call center experience preferred. **For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $72,080 to $108,120** **Locations: Washington State** In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._ * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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

Hi. We're Hummingbird. We're elevating patient access so patients can get healthcare how, when, and where they need it. We partner with healthcare systems to transform how patients access care, enabling their providers to focus on what matters most - caring for patients. By managing patient access as a technology-enabled service, we help health systems stabilize costs and improve patient experience while creating good jobs that attract and retain talent in the industry. Our team of experts is obsessed with the connection between the people, processes, and technology that make healthcare organizations hum. Join us and help build the healthcare experience we want for our communities, our families, and ourselves. Summary Help patients get the right level of care with calm, clinically sound guidance over the phone. As a Triage Nurse at Hummingbird, you'll be the first clinical voice many patients hear when they're unsure what to do next. You'll provide telephone triage in a remote, centralized contact center - assessing symptoms, determining urgency, and guiding patients to safe next steps using client-specific protocols and Epic's Nurse Triage module. Most of your day will be on the phone managing back-to-back calls, using your nursing judgment and clear guidelines to advise patients, route them appropriately, and support follow-up care. You'll work with a supportive team of nurses and non-clinical colleagues and receive training, coaching, and feedback to grow your skills, handle increasingly complex scenarios, and continuously improve how we deliver care. Responsibilities Note: This posting is for our ongoing Triage Nurse Talent Pool. We interview continuously and anticipate frequent openings, with start dates typically 2-6 months after your application. What You'll Do In this role, you'll combine clinical judgment, technology, and communication skills to guide patients safely and efficiently: Provide telephone triage with Epic's Nurse Triage module, asking focused questions to assess symptoms, rule out red flags, and recommend the right level of care. Verify and update patient information, protect privacy under HIPAA, and coordinate with clinic teams to schedule or adjust appointments and escalate urgent or complex cases. Document calls in real time in the EHR while using Epic and contact center tools to navigate charts, follow protocols, and meet quality and performance expectations. Handle emotionally charged situations with empathy and professionalism, ensuring patients feel heard, informed, and confident about next steps. Take part in ongoing training and continuous improvement, sharing trends and feedback to strengthen workflows, quality, and team culture. The Details Location: Remote (U.S.-based) Schedule: Full-time or part-time, Monday-Friday; shifts vary based on patient access center hours Compensation: Expected range is $30.43 - $35.00 per hour. New hires usually start between $31.00 and $33.00, depending on experience and internal equity. Benefits: Comprehensive medical, dental, and vision coverage; paid time off; 401(k); parental leave; career development support; and more Training: Paid, structured onboarding that includes Epic workflows, client-specific protocols, and ongoing education and coaching. Expectations for Focus & Presence To support patients and each other, this role requires your full attention during scheduled work hours. Our Outside Employment Policy doesn't allow overlapping work or “job stacking,” so any outside work must happen fully outside your Hummingbird schedule. We're a camera-ready team, and you'll need to be on-camera during training and when needed during the workday after training ends. We value connection, teamwork, and being present, which is what keeps our patients safe and our team supported. If that's what you're looking for, you'll feel at home here. If you're hoping to hold another job during the same hours, this job won't be the best match. About our Talent Pool Hummingbird is growing fast, and we interview year-round for our Triage Nurse Talent Pool. While we're not hiring for this specific role right now, we typically add new specialists monthly, so start dates are often 2-6 months after applying. Joining the talent pool means you'll be among the first considered when opportunities open. We receive a lot of applications, so hearing back may take a little time, but we'll keep you updated, usually within a couple of weeks. You may also be invited to complete an assessment or have a brief conversation with a recruiter as part of early screening. Growth at Hummingbird This role is a key part of our clinical support model. You'll build depth in telephone triage, Epic workflows, and patient communication: skills that are valuable across many care settings. As you gain experience, you may have opportunities to: Take on more complex triage protocols and specialty areas. Support quality review, coaching, or training for other nurses. Contribute to workflow and protocol improvements with clinical and operations teams. At Hummingbird, we believe good jobs should lead somewhere. Your experience as a Triage Nurse can open doors to future opportunities in clinical leadership, operations, or specialist roles as our services continue to grow. Why You'll Love Working Here We're on a mission to make healthcare more human. For our Triage Nurses, that means combining evidence-based practice with empathy, clarity, and calm - especially when patients are worried or unwell. You'll receive structured training, clear protocols, and support from leaders who understand remote triage, building confidence and autonomy as you handle a wide range of patient scenarios over the phone. Our nurses often say how meaningful it is to guide patients to the right care quickly, still using their clinical expertise every day in a setting that emphasizes safety, communication, and connection - without the pace of a bedside shift. Required & Desired Skills What You'll Bring Current, unrestricted RN license in North Carolina; willingness to obtain additional licensure if needed. 1+ years outpatient telephone triage experience or 3+ years clinical nursing experience (ideally primary care, emergency, home health, or med-surg). Strong clinical assessment skills and sound judgment, with the ability to follow standardized guidelines and know when to pause and escalate. Excellent communication skills - you translate complex medical information into clear, patient-friendly language and maintain a calm, steady presence when patients are anxious or unsure. Comfort in a remote contact center setting with back-to-back calls, defined performance metrics, and real-time use of multiple systems (EHR and contact center tools) while documenting and typing ~50 WPM. A strong commitment to patient privacy and strict adherence to HIPAA and all relevant policies. Nice to Have Previous telephone triage or contact center experience Experience using Epic Compact nursing license or eligibility for compact licensure, depending on state and client requirements What Helps You Shine Please note that we use both your resume and your written and oral communication throughout the hiring process to understand your fit for this role. Thoughtful, clear responses help us see your attention to detail, your professionalism, and your ability to communicate with care - skills that are essential for success on our team. Please Note: The seniority level of this position may be adjusted during the recruitment process based on candidate skills and experience. The Hummingbird Approach We value a team that brings diverse perspectives and experiences to the work we do. While there are many ways to do this, people who are successful at Hummingbird: Lead with Respect by valuing kindness and working to actively foster an environment of inclusion and respect. Embrace Growth and seek out learning and growth for themselves and support those around them in their growth journey. They bring curiosity and an openness to innovation to all their interactions. Bring a Win Together mentality by approaching conflict directly, listening carefully, and seeking to understand. They problem-solve with the goal of finding successes, not trade-offs, for all involved. Equal Opportunity Statement Hummingbird Healthcare is an equal opportunity employer committed to diversity and inclusion. We do not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected characteristic. We value the talents of individuals from all backgrounds and actively seek a diverse workforce. Our mission is to provide a fair and inclusive recruitment process for everyone, and reasonable accommodations are available to any applicant who may need them. Please reach out to talent@hummingbird.healthcare to request accommodations and we'd be happy to chat.

We're unique. You should be, too. We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great people to join our team. The Registered Nurse, Care Line, is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the incumbent in this role provides remote clinical advice and assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the interdisciplinary care plan team to provide a team approach of care. The schedule for this position is as follows: Monday 1700-2230 Thursday 1700-2200 Friday 1700-2230 Saturday 0800-2000 Sunday 0830-2030 Must reside in the Continental United States and within a compact state. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: * Connects with patients via phone or video call. Interviews and questions patients to collect health history and uses a computer system to record and store comprehensive and focused data relating to the health needs of patients and families. * Provides health assessment and treatment solutions, monitors patient health and at-home care, aids in emergency scenarios and promotes patient wellness. * Based on technology available, monitors a patient's blood oxygen levels, heart rate, respirations, blood pressure and blood glucose as well as other assessment measures. * With the help of video chatting, identifies patient's symptoms and conditions. Analyzes data to determine the appropriate health maintenance and identify appropriate outcomes for patient and family. * Collaborate with on-call providers as needed to support expected clinical outcomes for the patient and family. * Evaluates and documents progress toward the anticipated outcome. Assist in ensuring achievement of optimal patient outcomes using Telemedicine. Documents interventions in a readable, understandable language. * Aids in enhancing the quality and efficacy of the organization's telehealth practices and professional nursing practice through successful utilization and improvement of outcomes that demonstrate program efficacy. * Utilizes appropriate resources to plan and provide services that are safe, effective and fiscally responsible. * Performs other duties as assigned and modified at manager's discretion. EDUCATION AND EXPERIENCE CRITERIA: * Associate Degree in Nursing required, Bachelor's Degree in Nursing preferred * Nurse Licensure Compact required * Michigan and Illinois Nurse Licensure required within 90 days of hire, ability to obtain additional licenses as requested by the organization within 90 days of hire * Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required * Minimum of 3 years acute clinical nursing work experience required * Minimum of 3-5 years experience with Emergency Services as a Nurse with Triage responsibility highly preferred * Minimum of 1 year virtual care experience preferred PAY RANGE: $62,702 - $89,575 Salary EMPLOYEE BENEFITS ****************************************************** We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day. Current Employee apply HERE Current Contingent Worker please see job aid HERE to apply #LI-Remote

Shift: Rotating schedule, 4 10-hour shifts per week Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law The Remote Triage - RN is responsible for serving as a Registered Nurse in the Remote triage call center. Monitors members using established disease specific protocols. Provides clinical support for members on program via telephonic outreach and inbound calls. How you will make an impact: Provides information about the RPM Program to members with chronic conditions and explains the benefit of having chronic conditions managed, assessed and treated. Communicates with program members and their care givers via outbound and inbound calls with respect to RPM clinical interventions. Responds to member or provider written or inbound telephonic communications or inquires with respect to clinical interventions. Monitors biometric data using established disease specific protocols. Reviews members current labs and medications for appropriateness. Minimum requirements: Requires BA/BS in a related field and minimum of 3 years of Registered Nurse experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable states required. Preferred skills, capabilities, and experiences: BA/BS in Nursing preferred. Clinical call center experience preferred. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

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

Graham Healthcare Group is hiring a Hospice Triage Registered Nurse to join our dynamic team. The Hospice Triage Registered Nurses collaborate to provide management and delivery of patient care plans. This position can be remote. Compensation: $70,000.00 - $75,000.00. The base compensation range for this role is fixed, with a maximum cap of $75,000.00. We want to be transparent about this as we continue discussions. Hours: 12A-8A Monday - Friday, every other weekend 8PM-8AM - Fully Remote Medical Benefits - Health, Vision, and Dental Retirement - 401K & Pension w/ 4% Employer Match PTO - 15 days Hospice Triage Registered Nurse Job Responsibilities: Responsible for all triage calls during the assigned business hours Responsible for reporting all information to team at end of shift, as well as syncing back electronic documents in a timely fashion Stay up to date with current memos and updates to system, read emails, and communicate with team Respond to incoming telephone calls from patients and families in a courteous and professional manner with respect for individual, cultural, and spiritual differences Make patient care decisions in response to incoming patient telephone calls, using current patient databases and professional nursing judgement; such responses may include giving advice or direction to the patient/family, contacting the physician, or scheduling a visit Triage after-hours calls with the goal of problem resolution, patient satisfaction, patient safety, symptom management, positive patient outcomes, and reduction of preventable ER/hospital admissions; initiate communication with attending physicians, other team members, and agencies when needed Coordinate/direct after-hours care for the assigned home care and hospice regions, including coordination of referrals; contacting patients/interdisciplinary team members as needed or directed; staffing; and scheduling of after-hours visits, DME /IV, supplies, etc. Review hospice referrals received after hours; assign staff as appropriate; coordinate, update, and communicate any/all changes to all disciplines, regional scheduling personnel, and to customer service center Follow up as needed and appropriately with management staff pertaining to any concerns regarding patient care Document accurately and appropriately each patient call and/or encounter in real time and maintain up-to-date patient records for coordination of care Coordinate and assign visits which you identify as medically necessary or which is requested by hospice patients/caregivers to meet patient needs Hospice Triage Registered Nurse Qualification Requirements: Associate degree or higher from an accredited School of Nursing RN license in the state in which you work A minimum of two (2) years of experience working as a Registered Nurse, including Hospice experience Demonstrated experience with tablets, mobile phones, and EMR software About Graham Healthcare Group: As an innovator in an evolving healthcare world, Graham Healthcare Group has been designing business and technology solutions to drive better care, outcomes, and productivity within its own home health and hospice companies for over 20 years. In the last several years, our solutions have been successfully integrated across the healthcare continuum. Join the Graham Healthcare Group and enjoy the following benefits: Competitive Pay: With opportunity for advancement Health and Welfare Benefits: Various medical, dental, and vision insurance options for you and your family to choose from. Supplemental Benefits: Company paid life insurance and disability benefits. Also, pre-tax FSA and HSA plans are offered. Generous PTO Packages: 15 days PTO that grows with your tenure, 6 paid holidays, 1 personal day. Retirement: Save for your future with our company offered 401k and Company Contribution Plan. Company-Paid Education Programs: Grow your career by taking advantage of discounts on tuition for selected courses offered by Purdue and Kaplan. Benefits may vary based on your employment status. NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana. By supplying your phone number, you agree to receive communication via phone or text. By submitting your application, you are confirming that you are legally authorized to work in the United States. Graham Healthcare Group is an Equal Opportunity Employer

The Leading Provider of Integrated Occupational Medicine Services CORE Health Networks, the recognized leader in Integrated Occupational Medicine Services, provides integrated solutions to your occupational healthcare needs. Our programs are designed to align with each clients' missions, goals, and values to achieve desired outcomes and exceed expectations. As we continue to grow, we are expanding our team of talented professionals. We are currently seeking a full-time Triage Registered Nurse to work from home Monday through Friday from 9:30am to 6:00pm, Central Time. We offer a highly competitive total compensation package which includes Health, Dental, Vision, Life, 401(k), Six Paid Holidays, Vacation and Sick Leave, Long-term disability and short-term disability benefits, and much more. To learn more about this exciting opportunity, review the job specifications below: Position Overview: Under the direction of the Director of Injury Management, the Triage Nurse administers the intake of calls from contracted clients, an injured worker, Worker's Compensation Insurance adjusters, Medical providers, and clinic staff. Provides exceptional service and quality treatment options to the patient and client throughout the injury management life-cycle. Principal Duties and Responsibilities (Essential Functions): * Triage injury/illness calls to determine if emergent/non-emergent * Determine if injury/illness requires immediate treatment or first aid advice * Research/locate the nearest facility to utilize for injury * Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness; Coordination of visit via phone/fax. * Speak with Medical personnel regarding the mechanism of injury/illness and discuss appropriate treatment pathways, obtaining UDS and BAT when applicable, and workplace accommodation availability. * Inform client/injured worker of name/location and contact information of medical facility available. * Notify appropriate contacts via email of injury/illness details with initial information within one hour of notification, unless an extreme situation. * Provide updates of diagnosis, work status, plan of care and follow up appointments to appropriate personnel with injured worker's employer and adjuster. * Provide updates, diagnosis, clinic notes and treatment authorization requests to designated representative for client and Worker's Compensation insurance adjuster. * Log injury/illness details on spreadsheet; Client specific * Bill time for each case according to services rendered. * Generating letters to providers, for clarification of work-relatedness and or treatment plan. * Obtaining and reviewing Medical records and diagnostics with relation to present injury/illness, prior history and/or forwarding to Specialty providers when allocated. * Proper documentation of phone calls made and received, interpretation of medical records from each exam, work status, and all emails transpired with regard to each case. * Assist Upper Management in CM activities as requested. * Answer phones in a professional manner when receptionist is not available. * Attend and participate in staff meetings. * Assists in office related tasks as needed. * Participate in opportunities for learning and skill maintenance/development, including internal and external training and workshops. * Other duties assigned by the supervisors. Licensures/Certification: * Must possess and retain a valid RN license for the state of LA (or compact multistate license). * Obtain a CWCP certification within two (2) years of employment. Experience: * Previous triage experience in ER or Urgent Care preferred; previous Occupational Health experience preferred * Minimum two (2) years practicing as a Registered Nurse Training: * Training for this position will be held primarily remotely, but may require in-office training at our corporate office depending on demands of training. IMPORTANT NOTICE: PLEASE ATTACH (ALL LICENSURES, CERTIFICATIONS, EDUCATION, AND DOCUMENTATION TO THE UPLOAD PORTION OF THE APPLICATION CORE, CHN, and our subsidiaries are Equal Opportunity Employers. EOE/ADAAA/AA. Applicants have rights under Federal Employment Laws. Please review the linked posters for more information: http://www.dol.gov/whd/regs/compliance/posters/fmla.htm https://www.eeoc.gov/employers/eeo-law-poster http://www.dol.gov/whd/regs/compliance/posters/eppa.htm Accessibility: If you need an accommodation as part of the employment process please contact Human Resources at Phone: 225-456-2243 Email: hr@coreoccupational.com Equal Opportunity Employer, including individuals with disabilities and veterans. If you want to view the Know Your Rights: Workplace Discrimination is Illegal poster, please choose your language: English - Spanish English - Spanish If you want to view the Pay Transparency Policy Statement, please click the link: English View Company Information To see other positions, click here.

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.

The Leading Provider of Integrated Occupational Medicine Services CORE Health Networks, the recognized leader in Integrated Occupational Medicine Services, provides integrated solutions to your occupational healthcare needs. Our programs are designed to align with each clients' missions, goals, and values to achieve desired outcomes and exceed expectations. As we continue to grow, we are expanding our team of talented professionals. We are currently seeking a full-time Triage Registered Nurse to work from home Monday through Friday from 9:30am to 6:00pm, Central Time. We offer a highly competitive total compensation package which includes Health, Dental, Vision, Life, 401(k), Six Paid Holidays, Vacation and Sick Leave, Long-term disability and short-term disability benefits, and much more. To learn more about this exciting opportunity, review the job specifications below: Position Overview: Under the direction of the Director of Injury Management, the Triage Nurse administers the intake of calls from contracted clients, an injured worker, Worker's Compensation Insurance adjusters, Medical providers, and clinic staff. Provides exceptional service and quality treatment options to the patient and client throughout the injury management life-cycle. Principal Duties and Responsibilities (Essential Functions): * Triage injury/illness calls to determine if emergent/non-emergent * Determine if injury/illness requires immediate treatment or first aid advice * Research/locate the nearest facility to utilize for injury * Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness; Coordination of visit via phone/fax. * Speak with Medical personnel regarding the mechanism of injury/illness and discuss appropriate treatment pathways, obtaining UDS and BAT when applicable, and workplace accommodation availability. * Inform client/injured worker of name/location and contact information of medical facility available. * Notify appropriate contacts via email of injury/illness details with initial information within one hour of notification, unless an extreme situation. * Provide updates of diagnosis, work status, plan of care and follow up appointments to appropriate personnel with injured worker's employer and adjuster. * Provide updates, diagnosis, clinic notes and treatment authorization requests to designated representative for client and Worker's Compensation insurance adjuster. * Log injury/illness details on spreadsheet; Client specific * Bill time for each case according to services rendered. * Generating letters to providers, for clarification of work-relatedness and or treatment plan. * Obtaining and reviewing Medical records and diagnostics with relation to present injury/illness, prior history and/or forwarding to Specialty providers when allocated. * Proper documentation of phone calls made and received, interpretation of medical records from each exam, work status, and all emails transpired with regard to each case. * Assist Upper Management in CM activities as requested. * Answer phones in a professional manner when receptionist is not available. * Attend and participate in staff meetings. * Assists in office related tasks as needed. * Participate in opportunities for learning and skill maintenance/development, including internal and external training and workshops. * Other duties assigned by the supervisors. Licensures/Certification: * Must possess and retain a valid RN license for the state of LA (or compact multistate license). * Obtain a CWCP certification within two (2) years of employment. Experience: * Previous triage experience in ER or Urgent Care preferred; previous Occupational Health experience preferred * Minimum two (2) years practicing as a Registered Nurse Training: * Training for this position will be held primarily remotely, but may require in-office training at our corporate office depending on demands of training. IMPORTANT NOTICE: PLEASE ATTACH (ALL LICENSURES, CERTIFICATIONS, EDUCATION, AND DOCUMENTATION TO THE UPLOAD PORTION OF THE APPLICATION CORE, CHN, and our subsidiaries are Equal Opportunity Employers. EOE/ADAAA/AA. Applicants have rights under Federal Employment Laws. Please review the linked posters for more information: ******************************************************* ********************************************* ******************************************************* Accessibility: If you need an accommodation as part of the employment process please contact Human Resources at Phone: ************ Email: *********************** Equal Opportunity Employer, including individuals with disabilities and veterans. If you want to view the Know Your Rights: Workplace Discrimination is Illegal poster, please choose your language: English - Spanish English - Spanish If you want to view the Pay Transparency Policy Statement, please click the link: English View Company Information To see other positions, click here.

We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services. Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients' nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients' care team, and they trust us to support them and their patients during their non-core hours. Learn more at ********************** Why Join Us Base pay at $25 an hour with multiple opportunities to increase the hourly rate with a potential to earn up to $28 an hour within your first 6 months of hire 3 weeks of paid remote training Supportive clinical team Work from home allows you to create a comfortable and personalized workspace Shorter shifts that provide a better work-life balance and reduce potential for burnout Working remotely gives you more time to spend with those you love! What do our nurses say? When asked what inspires her, 2024 IntellaTriage Nurse of the Year shared: “Helping people. That's it. And knowing this team has your back-that makes all the difference. People say it takes a special kind of person to do hospice, and I think that's true. You're walking with people and their families through one of the most sacred times in life. It's an honor to support them and guide them through that journey. I'm so grateful to have been chosen for this award.” At IntellaTriage we recognize nurses who go above and beyond to make a meaningful impact on patients' lives. This years' honoree exemplifies what it means to lead with compassion, skill, and dedication. Read more about being a nurse at IntellaTriage, and the reward: **************************************************************************** Requirements Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination Key responsibilities Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls. Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn up to $28 an hour within your fist 6 months of hire. All nurses are eligible for a $1 shift differential for overnights and a $1 shift differential for weekends (Friday evening, Saturday & Sunday). All part-time and full-time nurses accumulate PTO, based on the number of hours worked (per year). All part-time and full-time nurses are eligible to participate in our 401(k) plan. Full-time nurses may also participate in medical, dental, vision, and/or supplemental insurances.

Site: Brigham and Women's Faulkner Hospital, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Schedule: 24 hours - Remote Job Summary The Preoperative Evaluation Registered Nurse is responsible for conducting comprehensive preoperative assessments to ensure patients are medically optimized and fully prepared for their scheduled surgical or procedural care. This role involves patient education, coordination with interdisciplinary teams, and meticulous review of medical histories, diagnostics, and perioperative requirements. The Pre-Op Eval RN promotes patient safety, supports evidence-based practice, and contributes to a positive patient experience throughout the surgical pathway. Key Responsibilities Perform thorough preoperative nursing assessments, including medical history review, medication reconciliation, allergy verification, and evaluation of comorbid conditions. Review and ensure completion of all required preoperative testing (laboratory work, imaging, EKGs, consults) according to established clinical guidelines. Identify potential risk factors and collaborate with anesthesia, surgery, and other providers to address concerns and optimize patient readiness. Provide clear, comprehensive patient education regarding preoperative instructions, medication management, NPO guidelines, and perioperative expectations. Document all assessments, interventions, and communications accurately within the electronic medical record (EMR). Communicate effectively with surgeons' offices, anesthesia teams, and ancillary departments to clarify orders, missing documentation, or patient-specific needs. Triage and respond to patient inquiries related to preoperative preparation and coordinate follow-up as needed. Participate in continuous quality improvement initiatives, ensuring compliance with regulatory standards and institutional policies. Support patient safety initiatives, including infection prevention, accurate patient identification, and confirmation of surgical readiness. Maintain current knowledge of clinical best practices, surgical protocols, and perioperative guidelines. Qualifications Current Registered Nurse (RN) license in good standing. Bachelor of Science in Nursing (BSN) preferred. Minimum of 1-2 years of clinical nursing experience; perioperative, PACU, ambulatory surgery, or critical care experience strongly preferred. Strong critical thinking, assessment, and clinical judgment skills. Excellent communication, patient education, and interdisciplinary collaboration abilities. Proficiency with electronic medical record systems and strong organizational/documentation skills. Adheres to all I.C.A.R.E. standards. The RN must show evidence of the basic analytic thinking necessary to care for a group of patients. Must demonstrate observational skills and the ability to set priorities. Must be able to function under stress with good interpersonal and communication skills. Must demonstrate effective skills in applying hospital standards in area of service, team work, communication, respect for others, and time/priority management. Additional Job Details (if applicable) Remote Type Remote Work Location 1153 Centre Street Scheduled Weekly Hours 24 Employee Type Regular Work Shift Day (United States of America) Pay Range - / Grade RN3500 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: Brigham and Women's Faulkner Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services, monitors consumer treatment through ongoing and continuous review to ensure that services are delivered based on consumer need and established clinical guidelines, and identifies and follows-up on clinical cases of concern and high-risk/special needs consumers to ensure enrollees are linked to appropriate treatment resources. The UM Clinical Specialist RN - PH may represent the unit in cross agency collaborative needs. This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed. Responsibilities & Duties Assesses the medical necessity of services Independently conduct medical necessity reviews of service requests submitted by service providers against developed clinical guidelines within contractually mandated turn-around times Ensure authorized services address appropriate service needs, intensity of service outcomes, and alternatives for consumers Provide a consistent application of medical necessity criteria for physical health services that promotes a holistic review of the member's needs Conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards Notify members of adverse benefit determinations while preserving members' Due Process rights Ensure compliance with performance measures outlined within all accrediting body standards Perform other related duties as required by the immediate supervisor or other designated Alliance Health administrators Compliance Comply with utilization management and quality improvement policies and procedures, utilization review laws and regulations, state standards Comply with Utilization Management Department focus on timeliness, effectiveness, quantity, quality, and cost of services for eligible enrollees Coordinate and Implement UM Processes Participate in the integration of the department and its functions into the organization's primary mission Take part in the Utilization Management Department collaboration to ensure an integrated department with Physical Health and Behavioral Health Collaborate with other departments Monitor for undesirable performance or deviations of practice standards that may have a negative impact on consumers. Respond through additional follow-up with consumer and providers, provider technical assistance and/or referral to other departments within the MCO. Maintain open, timely communication with staff, providers, community agencies and other stakeholders Minimum Requirements Education & Experience Graduation from a State accredited school of nursing or an Associate's Degree in Nursing from an accredited and five years of experience with five (5) years nursing experience OR Bachelor's degree in Nursing from an accredited college/university and three (3) years of nursing experience Special Requirement Current, active, and unrestricted North Carolina clinical license as a Registered Nurse, or a compact license Preferred Experience: Experience in Utilization Management Knowledge, Skills, & Abilities Knowledge of physical health and co-morbid health conditions Knowledge of diagnostic treatment guidelines/protocols, level of care criteria Proficient in the use of computer and multiple software programs. Written and oral communication skills Ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations. Knowledge of Utilization Management managed care principles and strategies Ability to analyze effectiveness of processes and adjust developed processes. Knowledge of and experience in acute clinical utilization review Knowledge of Authorization/re-authorization Utilization Management standards Knowledge of related duties in the delivery of patient care, management of patient care providers, or project management in a healthcare environment Ability to lead, delegate and problem solve Ability to develop and document workflows Ability to assist appeal efforts when medical care is denied by various payor entities in a timely fashion. Knowledge of and experience with NCQA Salary Range $68,227 - $86,990/Annual Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility

Job Description ARC Group is recruiting for CLINICAL REVIEW NURSE REMOTE (GEORGIA RESIDENTS ONLY) ARC Group has multiple openings for Clinical Review Nurses! These are 100% remote, full-time, direct hire positions offering competitive salary, benefits, and excellent career growth opportunities within a dynamic and respected organization. At ARC Group, we value diversity, equity, and inclusion. We believe that diverse perspectives drive better innovation and problem-solving. We encourage candidates from underrepresented groups to apply. Location Requirement: Candidates must reside in Georgia and have permanent U.S. work authorization. We do not consider candidates from outside companies (no C2C or third-party arrangements). Summary The Clinical Review Nurse reviews healthcare claims and makes determinations regarding the validity of claims and levels of payment based on national and local policies and accepted medical standards. Using clinical expertise, the nurse assesses medical necessity, service levels, and appropriateness of care, including prior authorization, complex pre-payment, and post-payment medical review cases. Essential Duties & Responsibilities Clinical Review (90% of time): Review and analyze complex pre- and post-payment healthcare claims from a clinical perspective, including prior authorizations. Conduct reviews of claim data and medical records to determine coverage, medical necessity, utilization, and appropriateness of care per policy and accepted standards. Review provider practices for potential overpayment, corrective action, fraud, or abuse; make recommendations for follow-up actions. Process claims and complete project work in relevant systems. Provider Education & Special Projects (10% of time): Identify providers requiring education and provide one-on-one or group instruction based on medical review findings. Participate in special projects as assigned, collaborating with CMS leaders and provider communities when necessary. Required Qualifications Valid nursing degree Minimum of 2 years clinical experience Strong written and verbal communication skills Experience evaluating medical and healthcare delivery issues (e.g., Inpatient Rehabilitation Facility) Proficient in Microsoft Office Valid, unrestricted Registered Nurse (RN) license Preferred Qualifications Inpatient Rehabilitation Facility experience Bachelor of Science in Nursing (BSN) Insurance industry experience Certified Coder

Job Title: Health Plan Nurse CoordinatorJob Description The Health Plan Nurse Coordinator is a Registered Nurse assigned to various Health Services operational units. These units include Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The role involves performing utilization management activities, including telephonic or onsite clinical reviews, case or disease management, care coordination, transition activities, or population health activities. The position requires working with a specific member population and may require bilingual skills in Spanish for certain roles. Responsibilities * Comply with HIPAA, Privacy, and Confidentiality laws and regulations. * Adhere to Health Plan, Medical Management, and Health Services policies and procedures. * Stay informed about clinical knowledge related to disease processes. * Communicate effectively, both verbally and in writing, with providers, members, vendors, and other healthcare providers. * Function as a collaborative member of the multi-disciplinary medical management team. * Identify and report quality of care concerns to management and appropriate departments. * Support and collaborate with team members in implementing and managing Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities. * Participate in the implementation, assessment, and evaluation of quality improvement activities. * Adhere to mandated reporting requirements and comply with regulatory standards. * Be positive, flexible, and open to operational changes. * Attend and actively participate in department meetings. * Participate in the development and evaluation of department initiatives aimed at improving member quality of care. * Stay updated on healthcare benefits and limitations, regulatory requirements, disease processes, treatment modalities, community standards, and professional nursing standards. Essential Skills * Utilization management and review experience. * Strong multi-tasking, organizational, and time-management skills. * Clinical knowledge of adult or pediatric health conditions and disease processes. * Ability to work both individually and collaboratively in a cross-functional team environment. * Excellent interpersonal and communication skills. * Ability to compose clear, professional correspondence. * Understanding of quality improvement theory and strategy. * Experience with HEDIS medical record abstraction. Additional Skills & Qualifications * Registered Nurse (RN) license. * Bilingual skills in Spanish may be required for certain roles. * Experience in case management and working with health plans and providers. Work Environment The role is based in an office setting where the services team works collaboratively. The team includes Case Management, Pharmacy, UM, and Pediatrics. It is a supportive and helpful environment with a mission-driven company that values its employees, offering catered lunches weekly. Job Type & Location This is a Contract position based out of Santa Barbara, CA. Pay and Benefits The pay range for this position is $47.00 - $47.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 20, 2025. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities Ready to Transform Member Health Through Strategic Care Coordination? We're seeking a skilled RN who can telephonically coordinate wellness and disease management programs focused on chronic conditions such as diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia. As our Disease Management Nurse, you'll use national care guidelines to develop individualized care plans while partnering with members to improve their health outcomes and overall wellbeing. What makes this role different: ✓ Chronic disease focus: Specialize in coordinating care for members with multiple chronic conditions requiring expert clinical guidance ✓ Evidence-based approach: Use national care guidelines and claims data to compare patients' current care with industry standards ✓ Care plan ownership: Create individualized care plans for each patient while providing close follow-up with actively managed members ✓ Population health impact: Track high-risk member groups and interventions to demonstrate overall health improvement within organization What You'll Actually Do Coordinate member outreach: Contact targeted members for health promotion and restoration using national care guidelines to compare current care level with industry standards. Develop clinical insights: Use claims processing tools to review and research paid claim data, developing comprehensive clinical picture of member's health status and needs. Create individualized plans: Design and implement individual care plans for each patient while providing close follow-up with actively managed members to ensure progress. Facilitate care access: Work with patients to ensure they have primary care provider, assist in referrals to specialists, help obtain durable medical equipment, and review pricing for high-cost drugs. Make strategic referrals: Evaluate and refer members for case management, prenatal program, or pharmacology review as clinically indicated for optimal outcomes. Maintain comprehensive documentation: Document interventions and patient contact while maintaining privacy of member records and assisting in quarterly client reporting. Track population outcomes: Monitor groups of high-risk members and interventions to demonstrate overall health improvement within organization through data-driven insights. Meet performance standards: Achieve productivity, quality, and turnaround time requirements on daily, weekly, and monthly basis while maintaining quality care coordination. Qualifications What You Bring to Our Mission The clinical foundation: Graduation from accredited RN program required Possession of current United States RN license (may require additional licensing as business needs change) Prior experience in case management, coordinating wellness programs, or equivalent combination of education and experience The technical competencies: Proficiency in Microsoft Excel, Word, PowerPoint, and Outlook Ability to use claims processing tools to review and research paid claim data Understanding of national care guidelines and industry standards for chronic disease management The professional qualities: Strong written and verbal communication skills for telephonic member interactions Demonstrate ability to work independently with excellent clinical judgment Excellent interpersonal and communication skills including ability to give presentations to groups and individuals Good time management skills with highly organized approach to managing caseloads Capability to develop rapport with members over the phone while providing empathetic, evidence-based guidance Commitment to member privacy and accurate documentation of all interventions and patient contacts Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary that rewards your success PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world? We're ready for you. No candidate will meet every single desired qualification. If your experience looks a little different from what we've identified and you think you can bring value to the role, we'd love to learn more about you! Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $31 to $38. Note that compensation may vary based on location, skills, and experience. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site. Application Deadline: Open until position is filled.

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.

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: Registered Nurse Upon Start Current RN license and eligible to practice in VA or MD 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

Full time Shift: First Shift (Days - Less than 12 hours per shift) (United States of America) Hours per week: 40 Job Information Exemption Status: Non-Exempt Provides professional nursing care for clinic patients following established standard and practices. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson's Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization. Education Qualifications Bachelor's of Science in Nursing (BSN) Preferred Experience Qualifications 1 year Nursing experience. Preferred Skills and Abilities Skill in applying and modifying the principles, methods and techniques of professional nursing to provide on-going patient care. (Required proficiency) Skill in establishing and maintaining effective working relationships with patients, medical staff and the public. (Required proficiency) Ability to maintain quality control standards. (Required proficiency) Ability to react calmly and effectively in emergency situations. (Required proficiency) Licenses and Certifications Registered Nurse - KSBN Required What you will do Triage of all incoming phone calls by evaluating the physical and psychosocial health status of patients. Follows nursing protocols and guidelines for answering and directing calls. Record and reports patient's condition and reaction to drugs and treatments to interdisciplinary team. Provide instruction to patients/family regarding treatment. Maintains and reviews patient records, charts, and other pertinent information. Oversee appointment bookings and ensure preferences are given to patients in emergency situations. Arranges for patient testing and admissions. Refill prescribed medications per standing orders. Clarify medication orders and refills to pharmacies as directed by providers. Perform medication prior authorizations as needed by providing needed clinical information to insurance. Maintain timely flow of patient to include scheduling of follow up appointments if needed. Working of in-basket medication refill requests for providers. Provide education to patient and family on medications, treatments and procedures. Record and report patient's condition and reaction to drugs and treatments to interdisciplinary team, reviewing patient records and other pertinent information. Ensure patients receive appointments that align with triage disposition and that maintain timely flow of patients. Coordinate patient testing, referrals, and admissions Work collaboratively with on-site staff to provider coordinated patient care Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Not Patient Facing Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail's Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually. Remote Work Capability Full-Time Scope No Supervisory Responsibility No Budget Responsibility Physical Demands Balancing: Rarely less than 1 hour Carrying: Rarely less than 1 hour Eye/Hand/Foot Coordination: Occasionally 1-3 Hours Feeling: Rarely less than 1 hour Grasping (Fine Motor): Occasionally 1-3 Hours Grasping (Gross Hand): Rarely less than 1 hour Handling: Rarely less than 1 hour Hearing: Occasionally 1-3 Hours Kneeling: Rarely less than 1 hour Sitting: Frequently 3-5 Hours Standing: Rarely less than 1 hour Stooping: Rarely less than 1 hour Talking: Frequently 3-5 Hours Walking: Rarely less than 1 hour Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment. Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.