Traveling Nurse remote jobs - 375 jobs

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

Travel Nurse & Allied Health Recruiter - REMOTE DescriptionTravel RN Recruiter (Independent Contractor - 1099) We're seeking an experienced Travel Nurse Recruiter to join our team. This role requires current (within the last 4 months) hands-on experience recruiting Travel RNs through both VMS platforms and direct client relationships. If you do not have recent, active experience recruiting Travel Nurses, please DO NOT APPLY . Performance Expectations Within your first two weeks, you should consistently submit a minimum of three (3) qualified Travel RN candidates per week Success is based on quality, speed, and consistency of candidate submissions and placements. Compensation & Structure 1099 Independent Contractor (Commission Only). You control your methods, schedule, and approach - we focus solely on results. Recruiters are responsible for their own business expenses (job boards, sourcing tools, networking, etc.). Commissions are paid upon successful candidate placements. Contract Continuation Ongoing partnership depends on meeting or exceeding outlined performance expectations. Failure to maintain consistent results may result in termination of the agreement at the company's discretion. Requirements Available to work full-time or near full-time hours on a commission-only basis as an independent contractor. Must respond to all new job postings within 4 hours. Note: we work across PST to EST so you need to be flexible and able to work across all time zones. Must respond to all candidate / applicants within 4 hours through text, email, call. Note: we work across PST to EST so you need to be flexible and able to work across all time zones. 1+ years of proven success recruiting Travel Registered Nurses (RNs) across the U.S. Current (within last 4 months) experience with VMS/MSP platforms and direct client placements - required. Ability to demonstrate personal performance metrics (submissions, interviews, hires, margins, etc.) during the interview. Self-motivated, organized, and able to manage a high volume of requisitions independently. Available to work full-time or near full-time hours on a commission-only basis as an independent contractor.

This is a contract assignment that will start right away and end on June 28th 2024 Remote in TX Must Live in TX SUMMARY DESCRIPTION: RN or LPN with clinical experience and will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications. JOB REQUIREMENTS: • Degree, Diploma or Certificate from a school of nursing with clinical experience. • Licensed in the State of Illinois • Knowledge of medical terminology • Data entry and/or typing experience. • Clear and concise written and verbal communication skills. • PC proficiency to include Word, Excel and Lotus Notes. • Auditing experience preferred. DUTIES AND RESPONSIBILITIES: • Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines. • Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors. • Identify and report abstraction errors and provide measure re-education with for the abstractor. • Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s). • Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results. • Maintains productivity level as determined by the HEDIS Coordinator/QI Department. • Maintain compliance with all HIPPA and patient confidentiality requirements. • All other duties as assigned.

Part Time/Contract Position -Assess patient health problems over the phone and via secure video -Schedule appointments and refer patients -Advise and monitor simple home treatment interventions -Instruct patients in self evaluation -Use Schmitt/Thompson protocols to assess patients REQUIREMENTS: -At least 3 years experience as a Registered Nurse; preferably in the ICU, ED, Mother/Baby unit, Peds, Home Health & Hospice -Excellent critical thinking skills -Compassionate, caring attitude -Expertise and experience in disease management, coaching, crisis intervention -Excellent communication skills (written and spoken) - Highspeed Internet (DSL or Cable) -Laptop, PC or MAC -Dedicated work space -Flexibility with scheduling i.e. ability to work every other weekend and some holidays Requirements Compact RN license 3-4 Years of experience in Peds, OB, ICU, Med-Surg, Hospice, Home Health, Occupational Health Prefer experience with Schmitt-Thompson Pediatric and Adult protocols Comfortable working with EHR, Word, Excel, and other programs required for position

Job Description Director, Behavioral Health Transfer Center $90,000 to $140,000 Base compensation based on experience Must be a licensed clinician, such as Registered Nurse. Would possibly consider a Licensed Clinical Social Worker or Licensed Professional Counselor depending on experience Must hold a multi-state license (e.g., RN Compact or equivalent) Position Overview The Director of the Behavioral Health (BH) Transfer Center provides senior-level leadership for a centralized, 24/7 behavioral health access and admissions operation supporting multiple facilities across several states. This role is accountable for operational performance, clinical integrity, regulatory compliance, and relationship management across a multi-state healthcare system. The ideal candidate is an experienced Behavioral Health leader at the Director level, highly operationally focused, data-driven, and comfortable leading remote clinical and non-clinical teams. This leader serves as the subject matter expert for BH transfer operations and works closely with executive leadership, hospital CEOs, and clinical teams to ensure safe, timely, and compliant patient transfers. Company Overview The Behavioral Health Transfer Center functions as a centralized, 24/7 hub responsible for the timely and appropriate placement of patients requiring acute behavioral health care. The center streamlines the transfer process by conducting clinical assessments, confirming bed availability, and coordinating transportation to ensure patients are placed in the appropriate level of care without delay across 18 facilities. Staffed by a multidisciplinary team of 31 experienced behavioral health professionals-including licensed clinicians, nurses, EMTs, and case managers-the Transfer Center serves as the primary liaison for referring facilities and manages more than 6,000 patient transfers each month. The mission is to reduce wait times, eliminate gaps in care, and ensure safe, seamless transitions for individuals experiencing mental health or substance use crises. This role offers the opportunity to work remotely within a high-volume, fast-paced, and purpose-driven environment focused on clinical excellence and operational efficiency. Key Responsibilities Provide overall leadership and accountability for Behavioral Health Transfer Center operations, including remote clinical (RNs/licensed clinicians) and non-clinical staff. Drive operational excellence through metrics, KPIs, service-level management, and continuous process improvement. Ensure appropriate clinical decision-making and level-of-care recommendations for behavioral health patients across all age populations. Partner with hospital CEOs, Directors of Nursing, Directors of Assessment, and executive leadership to ensure consistent admissions and transfer processes across all facilities. Maintain full compliance with EMTALA, CMS, TJC, HIPAA, and applicable multi-state regulatory requirements; lead regular audits and corrective actions. Collaborate with Workforce Management and Finance to ensure appropriate staffing models and resource allocation. Build and maintain strong relationships with physicians, referral sources, internal stakeholders, and external partners. Work closely with Training and Quality teams to audit calls, referral packets, and documentation to ensure quality and consistency. Identify and resolve operational gaps, service failures, and process breakdowns in a timely manner. Lead performance management, coaching, and development of staff; conduct annual and real-time performance evaluations. Support recruiting, hiring, onboarding, and retention of clinical and non-clinical transfer center staff. 10% travel requirement Must-Have Qualifications Director-level leadership experience in Behavioral Health (required). Strong operational mindset, with demonstrated success managing metrics, workflows, and scalable processes. Active clinical license required, preferably Registered Nurse (RN). Must hold a multi-state license (e.g., RN Compact or equivalent). Candidates with LCSW or LPC licensure may be considered if they hold appropriate multi-state licensure and possess significant leadership experience. Proven ability to communicate effectively and build relationships across all levels of the organization, including executive leadership and frontline clinical teams. Experience supporting or leading 24/7 healthcare operations. Preferred Qualifications Experience leading a Behavioral Health Transfer Center, Access Center, or centralized admissions function. Background managing remote or distributed clinical teams. Direct experience supporting a multi-facility, multi-state behavioral health system. Master's degree in Nursing, Social Work, Psychology, or Healthcare Administration.

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

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

Nursing Service at Avel requires all nurses to practice at a competent level of nursing care and demonstrate a professional level of behavior in his/her role as an RN. The ANA Standards of Clinical Nursing Practice are exemplified within the service line. The RN is responsible for utilizing the nursing process to provide nursing care through innovative means for rural clinic sites through two way video technology. He/she assumes responsibility and accountability for his/her individual actions and outcomes of patient care delivered on his/her shift. General Hours of Work: Full Time, 40 hours per week Exempt/Nonexempt: Non-Exempt Department/Unit: Specialty Clinic FTE/Hours: 1.0 FTE/40 hours per week Schedule: Monday - Friday between the hours of 7:45am and 6:00pm ESSENTIAL FUNCTIONS 1. Demonstrates professionalism and excellent customer service when conducting assigned patient appointments, to include home phone/video visits and clinic visits. 2. Performs general nursing care as appropriate to virtual care. 3. Prepares the telemedicine equipment and assists provider during virtual clinic visits. 4. Assist site staff, as applicable with examinations, screenings, and assessments. 5. Creates Electronic Health Record (EHR) telemedicine encounters and document required items for each patient appointment. 6. Documents notes in EHR when applicable. 7. Assists site with troubleshooting equipment and technological issues. 8. Answers all inquiry calls in a timely fashion, offer and schedule assessments, complete the database and keep all information up to date. As the point of contact for all of eCare services, provide excellent customer service to all callers. 9. Communicates with nurses, sites, providers, and coordinators regarding patient readiness or patient needs. 10. Performs professionally in communication with patient and site staff via camera. 11. Assists with scheduling and completing patient appointments. 12. Performs camera and equipment checks with sites. 13. Maintain an environment conducive to open communications, cooperation, and staff development through the use of active listening and other effective communications skills. Suggests plans tosolve clinic problems to make improvements in the delivery of care. 14. Collaborate with site staff and patients regarding medications, treatment instructions, diagnostic process, and lab results. 15. Assumes other responsibilities with eCare Specialty Clinic projects, implementations, and activities assigned by the Director. EDUCATION and/or EXPERIENCE: Graduate from a CCNE or NLN accredited nursing program is strongly preferred. Graduate from an approved nursing program is acceptable. Two years of experience required. Bachelor's degree preferred. CERTIFICATION, LICENSURE, and/or REGISTRATIONS: Licensed as a Registered Nurse with one unrestricted state license is required. RN licensure required within the states that Specialty Clinic is providing service within 120 days of hire. ABOUT AVEL eCARE Avel eCare is a nationally recognized leader in telemedicine, operating one of the most extensive virtual healthcare networks in the world. Based in Sioux Falls, South Dakota, Avel partners with more than 650 health systems, rural hospitals, clinics, and facilities to deliver innovative telehealth solutions. Our services span Behavioral Health, Critical Care, Emergency, Hospitalist, Pharmacy, Specialty Clinic, Senior Care, and School Health - impacting nearly two million patients annually. For three decades, Avel has been at the forefront of healthcare innovation, developing telehealth solutions that reduce costs, save time, and remove barriers to quality care. Join our mission-driven team and help reshape the future of healthcare. MISSION “Every person and every community deserves access to high quality care. Avel's experts collaborate with local clinicians through telemedicine, to deliver high quality care when and where it's needed.” VISION “Avel eCare serves as a catalyst for change. We are creating a future of health care without boundaries through Service, Quality, Collaboration, and Innovation.” JOB CODE: 486

Description & Requirements Maximus is seeking a Clinical Reviewer (Registered Nurse) to support the Tennessee (TN) Appeals area of the contract. In this role, the RN Clinical Reviewer is responsible for reviewing clinical cases, applying nursing judgment and regulatory guidelines, and ensuring each case is accurately assessed and routed to the appropriate department or escalated as needed. This position plays a critical role in maintaining compliance, supporting timely appeal resolutions, and ensuring high-quality, clinically sound decision-making. About the Program: Tennessee Long-Term Services and Supports (TN LTSS) refers to a coordinated system of programs and services designed to assist individuals who have chronic illnesses, disabilities, or functional limitations and need ongoing support to live as independently and safely as possible. TN LTSS includes a range of home- and community-based services (HCBS) and institutional care options that help individuals with activities of daily living, medical needs, and personal care, while prioritizing care in the least restrictive setting. The program supports older adults and individuals with physical, intellectual, or developmental disabilities through person-centered planning that promotes dignity, independence, and quality of life. Why Maximus? * Work/Life Balance Support - Flexibility tailored to your needs! * Competitive Compensation - Bonuses based on performance included! * ️ Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance. * Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching. * ️Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage. * Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP). * Recognition Platform - Acknowledge and appreciate outstanding employee contributions. * Tuition Reimbursement - Invest in your ongoing education and development. * Employee Perks and Discounts - Additional benefits and discounts exclusively for employees. * Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs. * Professional Development Opportunities-Participate in training programs, workshops, and conferences. * Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees. Essential Duties and Responsibilities: * Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. * Issue approvals, denials or recommendations based on contract requirements. * Identify need for additional clinical documentation or consultation. * Complete documentation of activities within contract systems. * Communicate with providers, individuals and their designees, or state workers as required. * Performs other related duties as assigned. Minimum Requirements * Current Registered Nurse (RN) license valid in the state of practice is required * High School Degree or equivalent required * Minimum 2 years of clinical experience required * Minimum of one (1) year of registered nurse experience Preferred Requirements * Knowledge of mental health principles and practices * Experience in physical rehabilitation * Attention to detail Home Office Requirements * Maximus provides company-issued computer equipment and/or cell phone * Reliable high-speed internet service * Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity * Minimum 5 Mpbs upload speeds * Private and secure workspace #ClinicalServices EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************.

Caring for San Diegans since 1924, Scripps Clinic is San Diego's first choice for exceptional primary care and highly specialized and coordinated specialty care. Scripps Clinic offers a comprehensive range of medical and surgical services that are nationally recognized for quality, excellence and innovation. From primary to specialty care, our team-based model is designed to provide the best possible care and outcomes for you and your family. More than 900 providers and physicians provide 1.5 million patient visits a year coordinated through an integrated electronic health record. This is a per diem/casual, non-benefited position working 8-hr shifts sometime between 7am-7pm on weekdays and 8am-5pm on weekends. The ideal candidate will be available one day/week with potential for additional shifts. Preferred availability is Saturdays, Fridays and Mondays. Located both on site at Scripps Corporate Offices (4S Ranch, ~1 day/month) and remote. Training is on site at 4S Ranch for ~4 weeks, then another ~1-3 weeks at a clinic site before moving to the hybrid schedule. Why join Scripps Health? At Scripps Health, your ambition is empowered and your abilities are appreciated: * Nearly a quarter of our employees have been with Scripps Health for over 10 years. * Scripps is a Great Place to Work Certified company for 2025. * Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications. * Becker's Healthcare ranked Scripps Health on its 2024 list of 150 top places to work in health care. * We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career. * Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology. Why join this team? * Our team is a newer support team within Scripps Clinic looking to support our patients and providers via the MyScripps portal. * This team is dedicated to message triage, phone triage and collaboration with our provider staff to ensure the best possible care for our patients. * Caring for San Diegans since 1924, Scripps Clinic is San Diego's first choice for exceptional primary care and highly specialized and coordinated specialty care. * We offer a comprehensive range of medical and surgical services that are nationally recognized for quality, excellence, and innovation. What you'll do: * Ensure Scripps patients and their families have an exceptional health care experience. * Provide direct patient care within the scope of practice. Patient care includes compliance with patient assessments and care tasks, triaging, emergency protocols, and medication administration. * Work collaboratively with the other members of the patient care team to ensure optimal patient care. * Assist patients, staff, and physicians as needed to maintain a high level of efficiency of operations and customer service while providing quality care to the designated patient population. * Assist with the leadership of the clinical and clerical staff. * Support all primary care across Scripps Clinic. * Phone triage as well as triaging patients who present to the clinic, assisting with phone calls and portal messages, documentation in EMR (electronic medical record), performing nursing tasks within scope of practice. * Using a care team approach, you will support Primary Care and work a hybrid of onsite and remote shifts to assist the team as needed. * Practice autonomously consistent with ANA Standards of Practice and Professional Performance and be able to delegate tasks appropriately. * Independent judgment is expected to be exercised within the context of interdisciplinary and multidisciplinary approaches to patient care. Required Education/Experience/Specialized Skills: * ADN or Nursing Diploma Required Certification/Registration: * CA RN license * BLS through American Heart Association Preferred Education/Experience/Specialized Skills/Certification: * BSN * One year RN working experience, preferably outpatient experience in Adult Medicine * Pediatrics experience * One year RN triage experience * Epic experience At Scripps Health, you will experience the pride, support and respect of an organization that has been repeatedly recognized as one of the nation's Top 100 Places to Work. You'll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you're open to change, go ahead and unlock your potential. Position Pay Range: $51.66-$74.92/hour

Our Virtual Urgent Care team is looking for a Physician Assistant or Nurse Practitioner to join their team. In this role, you will be providing virtual medical care to patients of varying type and acuity. . As we care for patients of all ages, we cannot consider Adult/Gerontology trained Nurse Practitioners. Qualifications Physician Assistant Required Master's Degree Graduate of an accredited Physician Assistant educational program LIC-Physician Assistant - STATE_MI State of Michigan Upon Hire required CRT-Physician Asst Certified (PA-C) - NCCPA National Commission on Certification of Physician Assistants Upon Hire required CRT-Basic Life Support (BLS) - AHA American Heart Association 90 Days required Or CRT-Basic Life Support (BLS) - ARC American Red Cross 90 Days required CRT-Pediatric Adv Life Support (PALS) - AHA American Heart Association 120 Days required CRT-Adv Cardiovascular Life Support (ACLS) - AHA American Heart Association 120 Days required Nurse Practitioner Required Master's Degree Nurse Practitioners who obtained their education and certification after 2000 must show evidence of completion of a master's, post-master's or doctorate from a Nurse Practitioner program that is accredited by the Commission on the Collegiate of Nursing Education or the National League for Nursing Accrediting Commission 3 years of relevant experience current, relevant clinical experience Previous experience functioning in a collaborative role as a Nurse Practitioner LIC-Nurse Practitioner (NP) - State of Michigan CRT-Basic Life Support (BLS) CRT-Neonatal Resuscitation Program (NRP) CRT-Pediatric Adv Life Support (PALS) Corewell Health West Medical Group The Corewell Health West Medical Group is part of a not-for-profit health system serving 13 counties in West Michigan. Corewell Health West is a region of Corewell Health™, formerly the BHSH System (Beaumont Health and Spectrum Health) that provides care and coverage with an exceptional team of 60,000+ dedicated people-including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving over 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. Corewell Health People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy, and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 65,000+ dedicated people-including more than 12,000 physicians and advanced practice providers and more than 15,500 nurses providing care and services in 21 hospitals, 300+ outpatient locations and several post-acute facilities-and Priority Health, a provider-sponsored health plan serving more than 1.3 million members Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. For more information, visit corewellhealth.org. How Corewell Health cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance, pet insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - 515 Michigan St NE - Grand Rapids Department Name Urgent Care Virtual - Medical Group West Employment Type Part time Shift Variable (United States of America) Weekly Scheduled Hours 0.04 Hours of Work Variable Days Worked Variable Weekend Frequency Variable weekends CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling ************.

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE). Job Summary: The Clinical Auditor 2 performs audits of medical records on behalf of hospital clients for denials review, defense audits, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and Milliman (MCG) in addition to criteria established by state Medicaid programs or hospital policy. Audit and analysis must be accurate and consistently ensure a high level of quality, knowledge of laws, rules, regulations and guidelines necessary to ensure compliance and protection of information. Primary / Essential Functions: The Primary/ essential job duties may not be exhaustive. Clinical Staff Responsibilities: Performs audits of medical records to identify and/or defend charges, including: o Defense Audits o Patient Inquiry Audits o Disallowed Charges o Biller Requested Audits Completes analysis of records against established criteria, (e.g., InterQual, MCG, Medicare, Medicaid criteria), to determine if patient condition and/or care meets that criteria, including: o Avoidable day studies o Managed care, Medicare or Medicaid reconsiderations/appeals o Medicare or Medicaid RAC appeals or other specialized Audit Appeals (e.g. CERT, ZPIC, SMRC) Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and patient. Will compose appeal letters addressing and appealing both contract issues and medically related issues Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution. Enter audit findings and/or data into Client's computer based system. Proficiently utilize multiple computer based systems to complete and document work (both Savista and client) Client based billing, Internal based billing, medical record and quality systems Microsoft Outlook, Word and Excel Function in a professional, efficient and positive manner Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession Will help identify issues or challenges in the department, and come up with solutions or ideas to improve Maintain confidentiality of patient information and abide by all HIPAA related guidelines Competencies: · Puts Clients First · Drives for Results · Understands our Business · Thinks Innovatively · Values Differences · Builds Teamwork · Gains Trust · Communicates Effectively · Shows Accountability · Takes Action · Embraces Change · Makes Quality Decisions Physical / Mental Demands, Environment: 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. Must be able to use hands to finger, handle or feel, sit, stand, walk, lift up to 20 pounds, stoop, clean, bend, and reach with hands and arms. Must communicate clearly in English. Requires the ability to speak, read, write, see, and hear to perform essential duties of the job. Effective and positive human relations skills are required, including confidentiality, in order to appropriately interface with staff and clients. Must be able to perform multiple tasks and detailed work, problem solve, reason, and perform basic mathematical calculations. Equipment Used: Telephone, fax, calculator, computer, monitor, printer, hardware and software packages, computer peripheral equipment i.e. mouse and keyboard; and Microsoft software. Minimum Qualifications: Must be RN/Case Management /Utilization Review/Coding clinical certification with a BS/BA preferred otherwise equivalent years of technical experience 3 to 5 years of clinical experience or 3 to 5 years of clinical auditing experience in either case management, Medicare appeals, utilization review or denials management Knowledge of Milliman (MCG) or InterQual criteria preferred Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization Fundamental knowledge of Medicare/Medicaid Guidelines Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling) Skilled with Microsoft Outlook, Word, Excel and EMR Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $28.00 to $38.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills. SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class. California Job Candidate Notice

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Clinical Reviewer - RN (Remote U.S.) to join our growing team. Job Summary: * Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews. Responsibilities: * Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services. * Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence. * Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool. * Ensure accurate and timely submission of all administrative and review-related documents to the company. * Perform ongoing reassessment of the review process to identify improvement and/or change opportunities. * Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process. * Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review. * Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies. * Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines. * Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs. * Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. Work Hours: * Monday through Friday, 8:00 AM until 5:00 PM within the Time Zone where you reside, plus: One day per week is a priority day that would be assigned to complete expedited cases received between 3:00 PM and 6:00 PM Central. Qualifications Required Qualifications/Experience: * Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license. * Associate's, Bachelor's degree (or Diploma) in Nursing. * 2+ years of clinical experience in an acute OR med-surgical environment. * 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. * 1+ years of knowledge of medical records, medical terminology, and disease process organization. * 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG). Preferred Qualifications/Experience: * Knowledge of current National Committee for Quality Assurance (NCQA) standards. * Knowledge of Utilization Review Accreditation Commission (URAC) standards. * Knowledge of Medicare (CMS) guidelines. * Experience with Medical Appeals. * Experience with Medicare Advantage plans. * Medical Record Abstracting skills. * Clinical assessment and critical thinking skills. * Excellent verbal and written communication skills. * Ability to work in a team environment. * Flexibility and strong organizational skills. * Proficient in Microsoft Office and Internet/Web Navigation. #LI-SD1 Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at Acentra Health EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay range for this position is listed below. "Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Pay Range USD $28.37 - USD $37.50 /Hr.

Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization requests to determine the medical necessity of services and the appropriate level of care. This position ensures compliance with national standards, contractual requirements, and a member's benefit coverage while providing recommendations to the medical team to promote quality and cost-effectiveness of medical care. Responsibilities + Perform medical necessity and clinical reviews of authorization requests to determine the appropriateness of care in accordance with regulatory guidelines and criteria. + Work with healthcare providers and the authorization team to ensure timely review of services and requests, ensuring members receive authorized care. + Coordinate with healthcare providers and interdepartmental teams to assess the medical necessity of member care. + Escalate prior authorization requests to Medical Directors as necessary to determine the appropriateness of care. + Assist with service authorization requests for member transfers or discharge plans to ensure timely discharge between levels of care and facilities. + Collect, document, and maintain all members' clinical information in health management systems to ensure compliance with regulatory guidelines. + Provide education to providers and interdepartmental teams on utilization processes to promote high-quality and cost-effective medical care to members. + Provide feedback on opportunities to improve the authorization review process for members. + Comply with all policies and standards. Essential Skills + Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing. + 2-4 years of related experience. + LPN - Licensed Practical Nurse - State Licensure required. + RN license required for Health Net of California and Superior Health Plan. + Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service. + Knowledge of Medicare and Medicaid regulations. + Familiarity with utilization management processes. Additional Skills & Qualifications + Experience with Medicaid line of business. + Experience reviewing outpatient service requests for medical necessity. + Familiarity with InterQual. + Experience working with medical directors and therapists. Work Environment The position involves working closely with healthcare providers, authorization teams, and interdepartmental teams. The role requires the use of health management systems to maintain compliance with regulatory guidelines. The work environment is collaborative, with a focus on ensuring timely and appropriate medical care for members. Job Type & Location This is a Contract position based out of Baton Rouge, LA. Pay and Benefits The pay range for this position is $34.00 - $38.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 21, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.

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

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

Department: Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Pay Range $34.90 - $52.35 Looking for full time RNs - is 100% remote **Candidate MUST have 2+ years' acute care experience (ED, Urgent Care, ICU and some Med/Surg will be considered) is required within the last 4 years to be considered.** Due to complex requirements, remote work is NOT permitted from the following states: CA, CO, CT, HI, MA, MD, MN, NJ, MY, OR, RI, VT, WA Schedule: Full time position Start times days: 8a-10a or PM 12p-2p (or later) 8 hour or 10 hour shifts are available for different shifts MUST be available to work every 4th weekend and holiday rotation. Major Responsibilities: Uses the nursing process and guidance of established protocols to assess the needs of the patient telephonically including the patient, guardian, or family in the conversation when necessary. Determines most appropriate level of care needed, provides detailed education, establishes a plan of care including interventions, and communicates follow up instructions to the patient. Escalates and collaborates with the appropriate on call provider when additional guidance is needed. Prioritizes patient interactions by acuity and need considering all available information and resources. Applies evidence-based practice to deliver patient care. Implements strategies to reduce patient risk and increase patient safety. Assesses patient and family readiness to learn and individualizes the approach as necessary. Works collaboratively to develop strategies to meet the learning needs of the patient and family. Supports shared governance activities and initiatives to improve processes and patient outcomes. Participates in department quality/process improvement initiatives aimed at enhancing the patient care experience. Participates in professional activities which contribute to personal professional development and the development of others. Seeks opportunities to be taught, coached, and mentored. Attends required meetings/educational programs and completes annual competencies in a timely manner. Demonstrates effective communication, feedback, and conflict resolution skills. Promotes collaboration with clinicians and other healthcare team members to coordinate patient-centered care. Promotes a culture of safety through identifying threats to patient safety and intervening to prevent patient harm. Reports patient safety events and near misses in a timely manner. Seeks to identify potential safety issues and assists in the implementation of corrective action. Applies ethical decision making, demonstrates respect and understanding for peers, and other clinical disciplines. Participates as an effective member of the patient care team to formulate an integrated, unbiased, individualized approach to care. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret appropriate information needed to identify each patient's requirements relative to his/her age specific needs and provide the care advice/disposition outlined in the departments policies, procedures, and protocols. Schedules appointments with emphasis on making the appointment in correlation to the recommended end point of the protocol used. Collaborates with other health care team members to coordinate medical and nursing management of patient care, including procedures and medication refills. Accurately maintains and updates the patient's clinical records according to agency, State and Federal guidelines. Documents all call encounters utilizing the patient's Electronic Medical Record at the time of the call. Communicates information relating to the patient's physical and psychological status to the physician, Advanced Practice Clinician and/or additional members of the interdisciplinary team as appropriate. Provides pertinent and concise reports describing patient's response to medical and nursing plans of care. Participates in team meetings and works on special projects/tasks as assigned by leadership. Participates in the ongoing development of comprehensive health information resources, system and operational efficiencies and resources. Assists in interpreting department policies and procedures and advises staff on procedural changes. Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices. Education Required: Associate's Degree (or equivalent knowledge) in Nursing. Experience Required: Typically requires 2+ years' of acute care experience, preferably within the last 4 years (ED, Urgent Care, ICU and some Med Surg will be considered). Knowledge, Skills & Abilities Required: Critical thinking skills necessary to independently determine and prioritize the needs of patients using sound judgment and strong problem-solving skills. Knowledge of a variety of healthcare specialties, including levels of care, symptom identification and proven treatment recommendations. Ability to incorporate past experience with established protocols. Excellent verbal communication skills demonstrating empathy, respect, restatement, open-ended questions, active listening and diplomacy with a diverse customer population. Ability to develop rapport and maintain positive, professional relationships with a variety of patients, staff and physicians. Proven ability to independently organize and prioritize work, managing multiple priorities and maintaining a flexible schedule in a fast paced, dynamic customer service environment. Excellent customer service and follow-up skills including the ability to stay calm during stressful situations. Demonstrated proficiency as a technology user with computers, internet, desktop software packages and multiple-line telephone systems. Ability to converse with customers/patients while researching and documenting calls on multiple systems. Knowledge of documentation techniques for communication Physical Requirements and Working Conditions: Required stable and secure internet connection Must have functional vision, touch, speech, and hearing. Required sitting a majority of the workday. Operates all equipment necessary to perform the job. Must have quiet space to make and receive phone calls Ability to lift 15 lbs. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

MOBILE PRIMARY CARE - Remote $23.00hr - $27.00hr About us: Mobile Primary Care is a home-based primary care practice that specializes in geriatric healthcare, serving New York State. About the Opportunity: A healthcare organization seeking a licensed LVN, LPN or RN to join their growing staff as a new Care Management Nurse. This role will be providing telephonic Care Management for patients throughout the health system under the direction of a patient's provider. The nurse utilizes nursing process to evaluate patient needs over the telephone and provide guidance and education to patients, adhering to organizational policies, procedures and guidelines. Provides high risk patients with chronic disease management and liaises between the patient, patient's family or caregiver, provider, provider's office, hospital, home care agency etc. This position is telephonic care coordination as directed by the patients provider. Position Responsibilities: Cooperatively develop and integrate patient centered provider care plan and goals with the client/family and other providers Work collaboratively with team members to provide outreach and engagement with the patient Work closely with in-office providers/staff members to: Provide patient education to assist with self-management Identify gaps or barriers in treatment plans Coordinate care enrolled patients including scheduling appointments Coordinate referrals Coordinate community resources as needed (ie: home health, DME etc) Educate members on disease processes Encourage members to make healthy lifestyle changes Actively maintain assigned caseload of patients Make outbound calls to assess members current health status Receive and respond to telephone calls from patients. Collecting health data and providing medical guidance under the direction of the patients provider Document calls according to established guidelines Connects patient's care team together with updated information as received Participation in education and in-service programs Performs on-call for region that you are assigned Additional duties as assigned Required Qualifications: Unrestricted and current license to practice as LVN/LPN/RN with a New York State license. 3 years of experience within Care Management setting or Case Coordinator either in the homecare, inpatient, physician practice or in-home case management setting Strong working knowledge of chronic disease states including chronic kidney disease, diabetes mellitus, chronic obstructive pulmonary disease and congestive heart failure and basic medical management of these states Must be highly motivated, result-oriented with strong skills in presenting, communicating, organizing and time management skills Strong organizational and interpersonal skills Excellent customer service skills demonstrated by positive feedback from patients/team Ability to identify problems and recommend solutions Demonstrates progressive proficiency with the utilization of available computer technology, including typing skills Demonstrates; leadership, communication, interpersonal and problem-solving skills Experience working with Electronic Health Record (EHR) Ability to sit and work at a computer for extended periods of time 60 words per minute typing Preferred Qualifications: Bilingual in Spanish

Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare. Benefits, with a whole-person approach to wellness - Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare About ThedaCare! Summary :The RN Clinical Nurse (Ambulatory) provides patient-centered, specialized, evidence-based nursing care across the continuum through an interprofessional approach to treatment, research, education, and advocacy. Contributes to the goals of the department by being accountable for the delivery of compassionate and safe care within the scope of practice as defined by the Wisconsin Board of Nursing and ThedaCare policy. Through collaborative practice with members of the care team, is responsible for patient outcomes that meet the high quality of care provided by ThedaCare. Furthers the professional practice of nursing at ThedaCare by promoting a culture of innovation and a commitment to growth and professional development.Job Description: Schedule: Night shift: 11:00 PM - 7:30 AM Variable Monday-Friday Weekend and holiday rotation KEY ACCOUNTABILITIES: Utilizes the nursing process, evidence-based practice, and specific competencies to assess the physical condition and nursing needs of patients, and develops a plan of care in a collaborative practice with the patient and interprofessional team. Plans for the care needs of the patient in collaboration with the interprofessional team to provide the highest quality of care and clinical outcomes. Demonstrates clinical expertise in the provision of care in the clinical specialty assigned, and performs all functions of the professional clinical nurse (RN), which are age appropriate, developmentally sensitive, and culturally specific. Identifies ways to improve the patient's experience of care, streamline care processes, and lower costs while promoting quality to improve patient, family, and team member satisfaction. Contributes to a professional environment that encourages mentoring, engagement, and development to retain expert clinicians. Provides consultation and maintains positive relationships with physicians and other interprofessional team members, collaborating to problem solve and improve patient care. Demonstrates, anticipates, and proactively manages risk to prevent crises. Performs skillfully in life threatening emergencies, matching demands and resources during crises situations. QUALIFICATIONS: Bachelor of Science in Nursing (BSN) preferred Associate's Degree in Nursing (ADN) required Current Wisconsin RN Licensure American Heart Association Healthcare Provider Basic Life Support (BLS). PHYSICAL DEMANDS: Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of Fifty (50) pounds without assistance Job classification is exposed to blood borne pathogens (blood or bodily fluids) while performing job duties • Manual dexterity and hand-eye coordination to perform patient care procedures WORK ENVIRONMENT: Frequent exposure to sharp objects and instruments Occasional exposure to moving mechanical parts, fumes or airborne particles, toxic or caustic chemicals, and risk of electrical shock Occasional high noise level in work environment Standing and/or walking for extended periods of time Transporting, transferring, positioning patients and/or equipment from one location to another; little likelihood for injury if proper body mechanics and procedures are followed Possible exposure to communicable diseases, hazardous materials, and pharmacological agents Occasional contact with aggressive and or combative patients. Position requires compliance with department specific competencies. Scheduled Weekly Hours:24Scheduled FTE:0.6Location:CIN 3 Neenah Center - Appleton,WisconsinOvertime Exempt:No