Nurse jobs at Tenet Healthcare - 228 jobs

LifePoint is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Mayfield, Kentucky. Job Description & Requirements Specialty: ICU - Intensive Care Unit Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours Employment Type: Travel **URGENT NEED** Jackson Purchase Medical Center 1099 Medical Center Circle Mayfield, KY 42066-1099 **Orientation is weekly, on Mondays - Candidates must be 60 miles or greater to be considered Travel** All Travelers must have REQUIRED certifications prior to start . Client reserves the right to require certifications not listed. Please refer to LPNT checklist for most up to date requirements. A part of LifePoint Health, Jackson Purchase Medical Center is a 107-bed (all private), Joint Commission-accredited facility. The hospital is the sole provider of acute care in Graves County and has been serving patients from the eight counties of the Jackson Purchase since 1993. From emergent to elective, our facility offers a wide variety of inpatient and outpatient services, including those offered at the New Beginnings Birthing Center, the Advanced Healing Wound Care Center and our accredited chest pain center. Lifepoint Job ID #6-981000. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Manages the day-to-day healthcare operations of the community to ensure resident's healthcare needs are met. Ensures residents are treated with respect and dignity and ensures quality care as resident's healthcare needs change. Ensures consistent quality resident care and service delivery throughout all shifts; this may require assuming the role and responsibilities of a Caregiver or Med Tech/Aide in order to meet the residents' needs and staffing requirements. Assists in the supervision of community-based licensed nursing staff, medication technicians/CMA's, and Caregivers and provides training and education to Caregivers on an ongoing basis to include classroom in-services and situation-specific training. In addition, they will also manage the associates schedules. Oversees and manages the continuity and consistency of medication training, pharmacy management and medication supervision and/or administration in the community. Conducts periodic Care Associate medication skills inventory checks, and periodic medication audits per Brookdale Guidelines. Shares on call duties as required. Education as required to obtain state nursing license (LPN/LVN or RN) and a minimum of 1-2 years relevant experience. LPN or LVN license. Brookdale is an equal opportunity employer and a drug-free workplace.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

HIRING FULL TIME FIRST SHIFT NURSE: 6:00AM-2:00PM SECOND SHIFT: 2PM-10PM PRN-THIRD SHIFT: 10PM-6AM UNIFORM TOPS PROVIDED MEALS PROVIDED EVERY OTHER WEEKEND ROTATING HOLIDAYS EXCELLENT BENEFITS Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

Brookdale Wickliffe is hiring PRN LPNs for their team! We are a 47 Bed Assisted Living and a 33 Bed Memory Care. Current Openings: * PRN - All Shifts Recognized by Newsweek in 2024 and 2025 as one of America's Greatest Workplaces for Diversity Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us! You'll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness. Full suite of health insurance, life insurance and retirement plans are available and vary by employment status. Part and Full Time Benefits Eligibility Medical, Dental, Vision insurance 401(k) Associate assistance program Employee discounts Referral program Early access to earned wages for hourly associates (outside of CA) Optional voluntary benefits including ID theft protection and pet insurance Full Time Only Benefits Eligibility Paid Time Off Paid holidays Company provided life insurance Adoption benefit Disability (short and long term) Flexible Spending Accounts Health Savings Account Optional life and dependent life insurance Optional voluntary benefits including accident, critical illness and hospital indemnity Insurance, and legal plan Tuition reimbursement Base pay in range will be determined by applicant's skills and experience. Role is also eligible for team based bonus opportunities. Temporary associates are not benefits eligible but may participate in the company's 401(k) program. Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply. To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year. The application window is anticipated to close within 30 days of the date of the posting. Assist in maintaining a physical, social and psychological environment in the best interest of residents. Monitor care of residents according to treatment plans prescribed by a physician as well as documenting responses to care plans. Nurses also administer medications, ensure cleanliness and security of medicine supply room and adhere to company systems, procedures and processes. LPN or LVN License Required per state regulations. Brookdale is an equal opportunity employer and a drug-free workplace.

For this position we are seeking a (RN) Registered Nurse who must live and have a current active unrestricted RN license in the state of OH Case Manager RN will work in remote and field setting supporting Medicare and Medicaid l health population. This role will be supporting our FIDE-SNP population, completing face to face assessments, care plans, and providing education and support to our members. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Home office with internet connectivity of high speed required. Schedule: Monday thru Friday 8:00AM to 5:00PM Field Travel (Up to 50%) - Union, Delaware, Franklin, Madison, and Pickaway (Columbus OH). (Mileage is reimbursed) JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. ESSENTIAL JOB DUTIES: Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. Identifies and reports quality of care issues. Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. Supplies criteria supporting all recommendations for denial or modification of payment decisions. Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. Provides training and support to clinical peers. Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. REQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). Experience working within applicable state, federal, and third-party regulations. Analytic, problem-solving, and decision-making skills. Organizational and time-management skills. Attention to detail. Critical-thinking and active listening skills. Common look proficiency. Effective verbal and written communication skills. Microsoft Office suite and applicable software program(s) proficiency. PREFERRED QUALIFICATIONS: Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. ESSENTIAL JOB DUTIES: Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. Identifies and reports quality of care issues. Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. Supplies criteria supporting all recommendations for denial or modification of payment decisions. Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. Provides training and support to clinical peers. Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. REQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). Experience working within applicable state, federal, and third-party regulations. Analytic, problem-solving, and decision-making skills. Organizational and time-management skills. Attention to detail. Critical-thinking and active listening skills. Common look proficiency. Effective verbal and written communication skills. Microsoft Office suite and applicable software program(s) proficiency. PREFERRED QUALIFICATIONS: Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. ESSENTIAL JOB DUTIES: Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. Identifies and reports quality of care issues. Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. Supplies criteria supporting all recommendations for denial or modification of payment decisions. Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. Provides training and support to clinical peers. Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. REQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). Experience working within applicable state, federal, and third-party regulations. Analytic, problem-solving, and decision-making skills. Organizational and time-management skills. Attention to detail. Critical-thinking and active listening skills. Common look proficiency. Effective verbal and written communication skills. Microsoft Office suite and applicable software program(s) proficiency. PREFERRED QUALIFICATIONS: Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $29.05 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work hours are Monday-Friday 8:00am- 5:00pm PST. This position included rotating weekends and holidays is required. Remote position Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications *Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications *Behavioral Health nursing experience- inpatient psychiatric, IMD, Residential SUD, IOP, PHP To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26.41 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for reviewing medical records to facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient, by improving the quality of the physicians' clinical documentation. Exhibits a sufficient knowledge of clinical documentation requirements, MS-DRG Assignment, and clinical conditions and/or procedures. Educates members of the patient care team regarding documentation guidelines, including the following: attending physicians, allied health practitioners, nursing, and case management. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. 1. Record Review: * Completes initial medical records reviews of patient records within 24-48 hours of admission for a specified patient population to: (a) evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate MS-DRG assignment, risk of mortality and severity of illness; and (b) record in business partner designated CDI tool and/or host medical record system. * Conducts follow-up reviews of patients every 24-48 hours or as needed up through discharge to support assigned working MS-DRG assignment upon patient discharge, as necessary. * Formulate physician queries regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the health record, as necessary. * Collaborates with providers, case managers, nursing staff and other ancillary staff regarding documentation and to resolve physician queries prior to discharge. 2.CDI * Communicates/Completes Clinical Documentation Integrity (CDI) activities and coding issues (lacking documentation, physician queries, etc.) for appropriate follow-up, provider education and DRG Miss-Match reconciliation. * Assists with Provider education, rounding and communication regarding open queries for resolution. 3. Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD10-CM and PCS coding. Attends CDI Boot camp, CDI/coding trainings annually and quarterly for inpatient coding. Attends monthly education lecture series (MELS) and all CDI/coding assigned learn share modules as well as any additional required CDI education. 4. Assist in training department staff new to CDI 5. Performs other duties as assigned KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * CDI Specialist must display teamwork and commitment while performing daily duties * Must demonstrate initiative and discipline in time management and medical record review. * Travel may be required to meet the needs of the facilities. * Proficient knowledge of disease pathophysiology and drug utilization * Intermediate knowledge of MS-DRG classification and reimbursement structures * Critical thinking, problem solving and deductive reasoning skills. * Effective written and verbal communication skills * Excellent computer skills including MS Word/Excel * Knowledge of coding compliance and regulatory standards * Excellent organizational skills for initiation and maintenance of efficient workflow * Regular and reliable attendance * Capacity to work independently in facility on-site setting. * Capacity to work independently in a virtual office setting if required for specific assignment. * Exhibit flexibility as needed to meet program needs. * Understand and communicate documentation strategies. * Recognize opportunities for documentation improvement. * Formulate clinically, compliant credible queries. * Ability to successfully comply to robust auditing and CDI program monitoring * Ability to apply coding conventions, official guidelines, and Coding Clinic advice to health record documentation. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Preferred: Acute Care nursing and/or Provider relevant experience * Zero (0) to two (2) years CDI experience * Two (2) plus years' nursing experience - Medical/Surgical/Intensive Care and/or Case/Utilization Review * Two (2) plus years' Provider experience - Medical/Surgical/Intensive Care and/or Case/Utilization Review * Graduate from a Nursing program, BSN, or graduate program; OR * Graduate from Medical Doctor and/or Foreign Medical Doctor Program CERTIFICATES, LICENSES, REGISTRATIONS * Active state Registered Nurse license; OR * Graduate MD and/or FMD license * Preferred: CDIP or CCDS PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit for extended periods of time. * Ability to stand for extended periods of time. * Must be able to efficiently use computer keyboard and mouse. * Good visual acuity WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. OTHER * Must be able to travel as needed, not to exceed 10%. Compensation and Benefit Information Compensation * Pay: $72,509- $108,763 annually. Compensation depends on location, qualifications, and experience. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********