Oncology Nurse jobs at Tenet Healthcare

The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and patterns to the CRC leadership. Provides expert application of evidence based medical necessity review criteria tool. Works collaboratively to review, evaluate and improve the denial appeal process. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines and coding guidelines, evidence-based medicine, community and national medical management and coding standards and protocols. * Performs reviews of accounts denied for DRG validation and DRG downgrades. * Documents in appropriate denial tracking tool (ACE). Maintains and distributes reports as needed to leadership. * Identifies payment methodology of accounts including Managed Care contract rates, Medicare and State Funded rates, Per-Diems, DRG's, Outlier Payments, and Stop Loss calculations. * Collaborates with Physician Advisors and CRC leadership when documentation-specific areas of concern are identified. * Maintains expertise in clinical areas and current trends in healthcare, inpatient coding and reimbursement methodologies and utilization management specialty areas. 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. * Effectively organizes work priorities * Demonstrates compliance with departmental safety and security policies and practices * Demonstrates critical thinking, analytical skills, and ability to resolve problems * Demonstrates ability to handle multiple assignments and carry out work independently with minimal supervision * Demonstrates quality proficiency by maintaining accuracy at unit standard key performance indicator goals * Possesses excellent written and verbal communication skills * Detail oriented and ability to work independently and in a team setting * Moderate skills in MS Excel and PowerPoint, MS Office * Ability to research difficult coding and documentation issues and follow through to resolution * Ability to work in a virtual setting under minimal supervision * Ability to conduct research regarding state/federal guidelines and applicable regulatory guidelines related to government audit processes 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 Includes minimum education, technical training, and/or experience required to perform the job. Education * Minimum Required: * Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment * RN License in the State of Practice * Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Preferred/Desired: * Completion of BSN Degree Program * CCDS certification or inpatient coding certification Experience * Minimum Required: * Three to Five years Clinical RN Experience * Three to Five years of Clinical Documentation Integrity experience * Must have expertise with Interqual and/or MCG Disease Management Ideologies * Strong communication (verbal/written) and interpersonal skills * Knowledge of CMS regulations * Knowledge of inpatient coding guidelines * 1-2 years of current experience with reimbursement methodologies * Preferred/Desired: * Experience preparing appeals for clinical denials related to DRG assignment. * Strong understanding of rules and guidelines, including AHA's Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS CERTIFICATES, LICENSES, REGISTRATIONS * Required: * RN, * CCDS or other related clinical documentation specialist certification, and/or AHIMA or AAPC Coding Credential CCS, CCA, CIC, CPC or CPMA * Preferred: BSN 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 lift 15-30lbs * Ability to travel approximately 10% of the time; either to client sites, National Insurance Center (NIC) sites, Headquarters, or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical record quality reviews 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. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * Interaction with facility HIM and / or physician advisors * Must meet the requirements of the Conifer Telecommuting Policy and Procedure As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $56,784.00 - $85,176.00 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. **********

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), 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-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/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 coding or management certification. 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), 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-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/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 coding or management certification. 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), 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-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/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 coding or management certification. 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** - Performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. - Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. - Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). - Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. - Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. - Identifies and reports quality of care issues. - Prepares and presents cases in conjunction with the chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. - Represents Molina and presents cases effectively to judicial fair hearing officer during fair hearings as may be required. - Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. - Provides training, leadership and mentoring for less experienced appeals nurses and administrative team members. **Required Qualifications** - At least 3 years clinical nursing experience, with at least 1 year of managed care experience in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed (such as specialties in: surgical, ob/gyn, home health, pharmacy, etc.), 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-9, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). - Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. - Critical-thinking skills. - Ability to interact effectively with clinical leaders and peers across the organization. - Strong verbal and written communication skills. - Microsoft Office suite/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 coding or management certification. 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Licensed Vocational Nurse/LVN - Heart & Vascular Specialists Clinic - Full-Time, Days - (25011364) Description Licensed Vocational Nurse/LVN - Heart & Vascular Specialists Clinic - Full-Time, DaysBring your passion to Texas Health so we are Better + Together Work location: Alliance - 10840 Texas Health Trail, Alliance/Keller, TX 76244Work hours: Full-time, 40 hours weekly, Monday thru Friday, 8:00am - 5:00pmTravel: 25% to surrounding clinics as needed (mileage reimbursement provided) Heart & Vascular Specialists Clinic Highlights:Strong teamwork and collaboration Fast-paced, high volume inbound/outbound calls Compassion and empathy to our patients and the TeamJoin an innovative team working towards making healthcare more accessible, integrated, and reliable Qualifications Here's What You NeedLVN - Licensed Vocational Nurse Upon Hire (required) Accredited School of Practical Nursing Program (required)6 months LVN experience (strongly preferred)1 year LVN experience (preferred) Proficient IV insertion and ECG rhythms experience (strongly preferred) ACLS or BCLS (required upon hire) Knowledge of basic nursing processes and understanding of healthcare technology, equipment, and supplies Knowledge of state law on nursing care, nurse practice guidelines, and clinic policies and procedures Ability to effectively communicate to staff and patients Demonstrate sound judgment and composure Ability to take appropriate action in questionable or emergency situations Maintain a positive, caring attitude towards staff and patients Possess a strong work ethic and a high level of professionalism Efficient time management skills What You Will DoDelivers care to patients utilizing the LVN ProcessPerforms basic nursing care for patients by following established standards and procedures. May perform specific nursing care as it relates to specialty of the practice. Collects patient data such as vital signs, notes how the patient looks and acts or responds to stimuli and reports this information accordingly. Prepares and administers injections, performs routine tests, treats wounds and changes bandages. 10%Prepares patient records and files using established medical record forms/automated systems and documentation practices. Administers certain prescribed medications and monitors and documents treatment progress and patient response. Participates in the implementation and evaluation of patient care based on practice guidelines, standards of care, and federal/state laws and regulations. Monitors and documents treatment progress and patient response. Conveys information to patients and families about health status, health maintenance, and management of acute and chronic conditions. Participates in teams to improve patient care processes and outcomes. Performs other duties as assigned. Additional perks of being a Texas Health employee Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits. Delivery of high quality of patient care through nursing education, nursing research and innovations in nursing practice. Strong Unit Based Council (UBC). A supportive, team environment with outstanding opportunities for growth. Learn more about our culture, benefits, and recent awards. Entity Highlights:Texas Health Physicians Group includes more than 1,000 physicians, nurse practitioners and physician assistants dedicated to providing quality, patient-safe care at more than 240 offices located throughout the DFW Metroplex. THPG members are active in group governance and serve on multiple committees and councils. Ongoing Texas Health initiatives, like the Diversity Action Council and Living the Promise, have helped to create an inclusive, supportive, people-first, excellence-driven culture and workplace, making THPG a great place to work. If you're ready to join us in our mission to improve the health of our community, then let's show the world how we're even better together! Do you still have questions or concerns? Feel free to email your questions to recruitment@texashealth. org. #LI-CT1 Primary Location: AllianceOther Locations: Pecan Acres, Decatur, Dish, Northlake, Highland Village, Krum, Newark, Argyle, Haslet, Saginaw, Copper Canyon, Blue Mound, Rhome, Denton, Corral City, Flower Mound, Justin, Trophy Club, Roanoke, Westlake, Watauga, KellerJob: LVNOrganization: Texas Health Physicians Group 9250 Amberton Parkway TX 75243Travel: Yes, 25 % of the TimeJob Posting: Nov 3, 2025, 5:43:32 AMShift: Day JobEmployee Status: RegularJob Type: StandardSchedule: Full-time

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Senior Clinical Admin Nurse will be responsible for providing individualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help individuals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams. Candidate must be willing to work Monday - Friday 8:00 am - 5:00 pm. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently * Educate and guide members regarding BHSUD * Assist members with adverse determinations, including the appeal process * Teach members how to navigate UMR internet-based wellness tools and resources * Outreach to membership providing pre-admission counseling to membership * Outreach to membership providing discharge planning to membership and caretakers * Track all activities and provide complete documentation to generate customer reporting * Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed * Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases * Contribute to treatment plan discussions * Other duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current and unrestricted RN compact license * 2+ years of acute nursing experience * 2+ years of behavioral health nursing experience * 2+ years of case management experience * Demonstrated basic computer proficiency (i.e. MS Word, Outlook) * Proven ability to function independently and responsibly with minimal supervision Preferred Qualifications: * Bachelor's degree in nursing * CCM * 2+ years of managed care experience * Critical care, pediatric, med-surg and/or telemetry experience * Utilization management experience * Adverse determination experience * Telecommute experience Soft Skills: * Demonstrated excellent verbal and written communication skills * Excellent customer service orientation * Proven team player and team building skills * Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment #UHCPJ * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Seasonal Registered Nurse RN PRN Nights (Job Number: 540389) Description At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Directs, supervises, provides and evaluates nursing care provided to patients. Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated. Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications. Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies. Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team. Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness. Performs patient care responsibilities considering needs specific to the standard of care for patient's age. Receives physician's orders, ensures transcription is accurate and documents completion. Administers medication utilizing the five rights of medication administration reducing the potential for medication errors. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice. Performs treatments and provides services to level of licensure. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care. Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group. Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors. Initiates or assists with emergency measures for sudden adverse developments in patients' condition. Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs. Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off. Communicates appropriately and clearly to management, co-workers, and physicians. Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs. Participates in orientation, instruction/training of new personnel. Manages and operates equipment safely and correctly. Knowledge/Skills/Abilities/Expectations Knowledge of medications and their correct administration based on age of the patient and their clinical condition. Basic computer knowledge. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Approximate percent of time required to travel: 0% Must read, write and speak fluent English. Must have good and regular attendance. Performs other related duties as assigned. Qualifications Education Graduation from an accredited Bachelor of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program. Licenses/Certification Current state licensure as Registered Nurse. BCLS certification required. ACLS certifications preferred. Experience Minimum six months' Medical/Surgical experience in an acute care setting preferred. Job: RNPrimary Location: OH-Lima-Kindred Hospital-LimaOrganization: 4851 - Kindred Hospital-LimaShift: Night

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** **You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This role can either work a M-F schedule (must be able to work until 5:30 in their time zone) OR a 4 day 10 hour work week but one of those work days must be a Saturday.** **Primary Responsibilities:** + Conducts reviews of member and provider appeals + Analyzes claim adjustment and claim history + Reviews history of previous reviews + Reviews denied services in conjunction with policies and procedures, benefit plans, federal and state regulations, and clinical criteria to and renders approval when appropriate + Extrapolates and summarizes medical information for review by Medical Director, as needed + Balances the need to produce high quality work with meeting timeframes and production goals You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Active, unrestricted RN license in state of residence + 5+ years of clinical experience as an RN including in an acute, inpatient hospital setting + Experience applying benefits and criteria to clinical review + Utilization Management, pre-authorization, concurrent review or appeals experience + Solid computer skills including proficiency in Microsoft Office Word, Outlook, and Internet applications + Ability to access multiple computer platforms + Access to install secure high-speed internet (minimum speed 5 download mps & 1 upload mps) via cable/DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement) + Designated quiet workspace in your home (separated from non-workspace areas) and able to be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI) + Ability to work 9am-6pm CST **Preferred Qualifications:** + Bachelor of Science in Nursing + Medical Coding experience/knowledge + Experience using Interqual + Experience with the following systems: UNET, iCUE/HSR, ATS, ETS or Cirrus + Experience analyzing medical records, benefit plans, medical policies and other various criteria + Demonstrated ability to work independently with solid self-discipline and time management skills + Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Applicants for this role have the flexibility to work remotely from their home anywhere in the United States. This position does require an Oregon RN or LPN license. The work schedule for the position is Monday - Friday, 8am - 5pm Pacific, with occasional weekends and holidays.** Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care Assists with service authorization requests for a member's transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collects, documents, and maintains all member's clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience. Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Registered Nurse RN Weekend Night Option Program (Job Number: 540377) Description $20,000 Sign-on-Bonus!At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and EvaluationDevelops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate Participates in discharge planning process Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department Directs, supervises, provides and evaluates nursing care provided to patients Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness Performs patient care responsibilities considering needs specific to the standard of care for patient's age Receives physician's orders, ensures transcription is accurate and documents completion Administers medication utilizing the five rights of medication administration reducing the potential for medication errors Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice Performs treatments and provides services to level of licensure Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families Functions as liaison between administration, patients, physicians, and other healthcare providers Interacts professionally with patient/family and involves patient/family in the formation of the plan of care Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors Initiates or assists with emergency measures for sudden adverse developments in patients' condition Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off Communicates appropriately and clearly to management, co-workers, and physicians Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs Participates in orientation, instruction/training of new personnel Manages and operates equipment safely and correctly Knowledge/Skills/Abilities/ExpectationsKnowledge of medications and their correct administration based on age of the patient and their clinical condition Basic computer knowledge Able to organize tasks, develop action plans, set priorities and function under stressful situations Ability to maintain a good working relationship both within the department and with other departments Approximate percent of time required to travel: 0%Must read, write and speak fluent EnglishMust have good and regular attendance Performs other related duties as assigned Qualifications Education Graduation from an accredited Bachelor of Science in Nursing Associate Degree in Nursing or Nursing Diploma program Licenses/Certification Current state licensure as Registered Nurse BCLS certification required ACLS certifications preferred Experience Minimum six months' Medical/Surgical experience in an acute care setting preferred Job: RNPrimary Location: OH-Lima-Kindred Hospital-LimaOrganization: 4851 - Kindred Hospital-LimaShift: Night

Registered Nurse/FT/Days (Job Number: 548658) Description $20,000 SIGN ON BONUS THROUGH JANUARY 2026. At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department Directs, supervises, provides and evaluates nursing care provided to patients Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies Performs assessment on all patients on admission and reassessments as per policy Makes referrals to other disciplines based on assessment Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team Assesses and reassesses pain Utilizes appropriate pain management techniques Educates the patient and family regarding pain management Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness Performs patient care responsibilities considering needs specific to the standard of care for patient's age Receives physician's orders, ensures transcription is accurate and documents completion Administers medication utilizing the five rights of medication administration reducing the potential for medication errors Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice Performs treatments and provides services to level of licensure Treats patients and their families with respect and dignity Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families Functions as liaison between administration, patients, physicians, and other healthcare providers Interacts professionally with patient/family and involves patient/family in the formation of the plan of care Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors Initiates or assists with emergency measures for sudden adverse developments in patients' condition Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off Communicates appropriately and clearly to management, co-workers, and physicians Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs Participates in orientation, instruction/training of new personnel Manages and operates equipment safely and correctly Knowledge/Skills/Abilities/ExpectationsKnowledge of medications and their correct administration based on age of the patient and their clinical condition Basic computer knowledge Able to organize tasks, develop action plans, set priorities and function under stressful situations Ability to maintain a good working relationship both within the department and with other departments Approximate percent of time required to travel: 0%Must read, write and speak fluent EnglishMust have good and regular attendance Performs other related duties as assigned Qualifications EducationGraduation from an accredited Bachelor of Science in NursingAssociate Degree in Nursing or Nursing Diploma program Licenses/CertificationCurrent state licensure as Registered NurseBCLS certification required ACLS certifications preferred ExperienceMinimum six months' Medical/Surgical experience in an acute care setting preferred Job: RNPrimary Location: OH-Lima-Kindred Hospital-LimaOrganization: 4851 - Kindred Hospital-LimaShift: Day

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification). You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Review medical records and verify if the requested service meets criteria * Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits * Review and interpret Plan language * Coordinate reviews with the Medical Director * Utilize clinical guidelines and criteria * Accurately documenting determinations * Adherence to all confidentiality regulations and agreements * Hours M-F 8a-5p with alternating Saturdays * Comfortable working mandatory overtime You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Active, unrestricted RN license in state of residence * 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting * Proficiency in Microsoft Office, Word, Outlook, and Internet applications * Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday) Preferred Qualifications: * Bachelor of Science in Nursing * 1+ years of experience using MCG and/or Medicare criteria * 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience * Appeals experience * Proven excellent communication, interpersonal, problem-solving, and analytical skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. Primary Responsibilities: * Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid * Identify if additional information is required to process an appeal * Ability to adapt to changes that require cross training on appeal types as they are identified * Ability to work independently * Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases * Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current, valid, and unrestricted RN licensure in your state of residence * 2+ years of clinical experience in an acute care or an outpatient setting * 1+ years of direct experience within one (or more) of the following areas: * Utilization Review * Medicaid and/or Medicare appeals experience * LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC * Proven experience/understanding of billable services and claims in a managed care environment * Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills * Access to high-speed internet * Ability to work 8-5 within EST (Eastern standard time zone) Preferred Qualifications: * 5+ years of Medical Appeal experience working with Medicare and Medicaid * Solid coding experience or Certified Coder (CPC) * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims. Primary Responsibilities: * Review provider post-service appeals for Medicare and Retirement * Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines * Discuss cases with medical directors when applicable * Ability to communicate and collaborate with other teams in order to gather medical information to process cases * Communicate effectively in both verbal and written documentation * Must meet quality and productivity metrics * Ability to work independently and prioritize * Attend mandatory trainings and scheduled staff meetings * Engage in respectful and courteous team dialog via email, IM and in staff meeting You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Undergraduate degree or equivalent experience * Unrestricted, active RN license * 2+ years of RN experience in acute setting * Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual * Proven proficiency in basic computer skills * Demonstrated ability to have high speed internet installed in home for Secure Job use only * Proven designated HIPPA compliant home workspace Preferred Qualifications: * Undergraduate degree (BSN) * Proven utilization management, prior authorization, case management or prior appeals experience * Proven claims and coding experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims. **Primary Responsibilities:** + Review provider post-service appeals for Medicare and Retirement + Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines + Discuss cases with medical directors when applicable + Ability to communicate and collaborate with other teams in order to gather medical information to process cases + Communicate effectively in both verbal and written documentation + Must meet quality and productivity metrics + Ability to work independently and prioritize + Attend mandatory trainings and scheduled staff meetings + Engage in respectful and courteous team dialog via email, IM and in staff meeting You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Undergraduate degree or equivalent experience + Unrestricted, active RN license + 2+ years of RN experience in acute setting + Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual + Proven proficiency in basic computer skills + Demonstrated ability to have high speed internet installed in home for Secure Job use only + Proven designated HIPPA compliant home workspace **Preferred Qualifications:** + Undergraduate degree (BSN) + Proven utilization management, prior authorization, case management or prior appeals experience + Proven claims and coding experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification). You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Review medical records and verify if the requested service meets criteria + Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits + Review and interpret Plan language + Coordinate reviews with the Medical Director + Utilize clinical guidelines and criteria + Accurately documenting determinations + Adherence to all confidentiality regulations and agreements + Hours M-F 8a-5p with alternating Saturdays + Comfortable working mandatory overtime You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Active, unrestricted RN license in state of residence + 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting + Proficiency in Microsoft Office, Word, Outlook, and Internet applications + **Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a weekday off when working a Saturday)** **Preferred Qualifications:** + Bachelor of Science in Nursing + 1+ years of experience using MCG and/or Medicare criteria + 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience + Appeals experience + Proven excellent communication, interpersonal, problem-solving, and analytical skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. **Primary Responsibilities:** + Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid + Identify if additional information is required to process an appeal + Ability to adapt to changes that require cross training on appeal types as they are identified + Ability to work independently + Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases + Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current, valid, and unrestricted RN licensure in your state of residence + 2+ years of clinical experience in an acute care or an outpatient setting + 1+ years of direct experience within one (or more) of the following areas: + Utilization Review + Medicaid and/or Medicare appeals experience + LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC + Proven experience/understanding of billable services and claims in a managed care environment + Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills + Access to high-speed internet + Ability to work 8-5 within EST (Eastern standard time zone) **Preferred Qualifications:** + 5+ years of Medical Appeal experience working with Medicare and Medicaid + Solid coding experience or Certified Coder (CPC) *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Licensed Practical/Vocational Nurse (LPN/LVN) - Part-Time, Night Shift (Job Number: 526663) Description ScionHealth is committed to a culture of service excellence as demonstrated by our employees' adherence to the service excellence principles of Pride, Teamwork, Compassion, Integrity, Respect, Fun, Professionalism, and Responsibility. As our most acute level of care, our specialty hospitals offer the same critical care patients receive in a traditional hospital or intensive care unit, but for an extended recovery period. Our clinicians play a vital role in the recovery process for chronic, critically ill and medically complex patients. SummaryPart-time, 36 hours a week, 12 hour shifts. Night shift. Under direct supervision of Registered Nurse, the Licensed Practical Vocational Nurse/LPN/LVN job provides nursing care within the scope of licensure for assigned patients according to established nursing standards and hospital policies and procedures. Essential FunctionsUnder direct supervision of a Registered Nurse, the Licensed Practical Vocational Nurse/LPN/LVN administers medication, performs treatments and patient care responsibilities as prescribed. The Licensed Practical Vocational Nurse / LPN / LVN consults with and keeps Registered Nurse informed of activities, symptoms, reactions, and changes in the patient's condition with regard to assigned patients. The Licensed Practical Vocational Nurse / LPN / LVN provides appropriate pain management techniques and educates the patient and family regarding pain management. The Licensed Practical Vocational Nurse / LPN / LVN administers medication following the five rights of medication administration within scope of practice. The Licensed Practical Vocational Nurse / LPN / LVN assists with the rehabilitation and treatment of patients in accordance with the medical plan of care, updates, and revises plan of care under the supervision of Registered Nurse. The Licensed Practical Vocational Nurse / LPN / LVN assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills as directed by the Registered Nurse. The Licensed Practical Vocational Nurse / LPN / LVN treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families. The Licensed Practical Vocational Nurse / LPN / LVN interacts professionally with patient/family and involves patient/family in the formation of the plan of care. The Licensed Practical Vocational Nurse / LPN / LVN assists with admitting, discharging and transferring of patients. The Licensed Practical Vocational Nurse / LPN / LVN identifies and addresses psychosocial needs of patients and family; communicates with Social Services/Discharge Planner regarding both in-hospital and post discharge needs. Qualifications Education:Graduate of an accredited program for Licensed Vocational/Practical Nurses. Licenses/Certification:Licensed Practical/Vocational Nurse License. BCLS Certification. Intravenous Blood Certification preferred. Experience:Minimum six months prior experience in an acute care setting preferred. Job: LPN/LVNPrimary Location: OH-Dayton-Kindred Hospital - DaytonOrganization: 4500 - Kindred Hospital - DaytonShift: Night