Utilization review coordinator jobs near me - 634 jobs

We offer a great FULL TIME benefits and perks package! Company Paid Benefits: Short Term Disability (Guardian)-for employee only, benefit percentage 60% of salary! Long Term Disability (Guardian)-for employee only, benefit percentage 60% of salary! Life and AD&D (Guardian) Health Advocate (Employee Assistance Program)-for Employee, Spouse, Dependents, Parents, and Parents in Law. Examples that are available for help: Emotional Support-Stress, Realtionships, Addictions, Mental Illness, Anger, Loss, Depression, Time Management. Work and Life Balance Specialists Employee Optional Benefits: Medical (BCBS)-for Employee, Spouse, and/or Dependents. HSA (Health Savings Account) is optional if Medical is selected. Great tax benefit! Dental (Guardian)-for Employee, Spouse, and/or Dependents. Vision (Guardian VSP)-for Employee, Spouse, and/or Dependents. Additional Voluntary Life (Guardian)-for Employee, Spouse, and/or Dependents. Additional Voluntary AD&D (Guardian) Critical Illness (Guardian)-for Employee, Spouse, and/or Dependents. Hospital Indemnity (Guardian)-for Employee, Spouse, and/or Dependents. Accident (Guardian) Metlife Legal (Legal Shield)-for Employee, Spouse, and/or Dependents. Assistance with Adoption, Lawyers, Wills and Trusts and much more! No waiting periods, no claim forms, no deductibles! Metlife Pet Insurance Wide range of coverages for your fur babies! All dog and cat breeds are covered. Identity Theft (All State) 401(k) with Matching (TransAmerica) Tuition Reimbursement Perks: Vacation from 90th Day of Employment Worked Holidays Paid @ Double Time! On Demand Pay Option Bonuses: Resident Referral Bonus Opportunities Employee Referral Bonus Opportunities Shift Pick Up Bonuses Training Bonuses We offer a great PART TIME perks package too! Perks: Worked Holidays Paid @ Double Time! On Demand Pay Option Opportunity for Advancement within the Company! Benefits: 401(k) with Matching (TransAmerica) Bonuses: Resident Referral Bonus Opportunities Employee Referral Bonus Opportunities Shift Pick Up Bonuses Training Bonuses Danbury does not require employees to be vaccinated. Pay rate for this position is up to $29.00 At Danbury, you don't just clock in at a job. You walk in the door to a work family who wants to make the day count. We truly believe our employees and residents are a family that comes together to enjoy the good things in life, including one another. When our employees feel special, so do our residents. That's the Danbury Difference. We are currently seeking applicants for Licensed Practical Nurse (LPN) positions. This position is also often referred to as Practical Nurse or PN. What do you do as an LPN at Danbury? Our Licensed Practical Nurses provide direct nursing care to residents, prepare and administer medications, perform routine charting and documentation duties, and perform other duties necessary to ensure that our residents' total regimens of care are maintained. What experience or skills do you need to be a Licensed Practical Nurse at Danbury? We are looking for applicants who are licensed by the State of Ohio. Experience in a nursing capacity in a senior living setting is helpful, but not required. We are seeking Licensed Practical Nurses (LPNs) who are outstanding in their profession and would work well with our team. If you're a Licensed Practical Nurse (LPN) and want to make our residents' days better then apply now for immediate consideration! Danbury Senior Living provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. Summary: At OhioHealth, we help registered nurses new to acute care transition to bedside care by building the knowledge, skills, professional presence, and experience needed to be an OhioHealth nurse. Our residents will experience the benefit of centralized recruitment during the application, interview and hiring process. Beginning upon hire, OhioHealth's Nurse Residency Program is customized to meet the needs of the transitioning nurse by incorporating central and track specific learning experiences. Our program is designed to extend beyond clinical orientation to support the nurse residents throughout their first year by facilitating interactions with experienced preceptors, subject matter experts and small peer groups. This position provides general nursing care to patients and families along the health illness continuum in diverse health care settings while collaborating with the health care team. He/She is accountable for the practice of nursing as defined by the Ohio Board of Nursing. Responsibilities And Duties: Assessment/Diagnosis - Performs initial, ongoing, and functional health status assessment as applicable to the population and or individual (30%). Outcomes Identification/Planning - Based on nursing diagnoses and collaborative problems, documents planned nursing interventions to achieve outcomes appropriate to patient needs (30%). Implementation/Evaluation - Evaluates and documents response to nursing interventions and achievement of outcomes at appropriately determined intervals; as part of a multidisciplinary team, revises plan of care based on evaluative data (20%). Leadership - Actively participates in process improvement activities to achieve targeted measures of clinical quality, customer satisfaction, and financial performance (10%). Operations (10%). As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties. The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time. Minimum Qualifications: Associate's Degree (Required) BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing Additional Job Description: RN - Registered Nurse BLS - Basic Life Support CPR - Cardiopulmonary Resuscitation Field of Study: Nursing Years of Experience 0 Work Shift: Variable Scheduled Weekly Hours : 36 Department CC Med Surg Fellowship Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

Join us for our job fair on Tuesday, January 13th from 10am - 4pm! Job offers will be given on the spot! Sign-On Bonuses: $10,000 for full-time hires $5,000 for part-time hires Shift Available (rotating weekends required): Full-time days (7am-7pm) Want to make a difference in someone's life every day? As a nurse with The Laurels of West Columbus, you will work as part of a team providing skilled nursing and short-term rehabilitation care to our valued guests. If you have patience, compassion, and a desire to care for guests in a gentle and empathetic way, you will love this role. Benefits: Comprehensive health insurance - medical, dental, and vision. 401K with matching funds. DailyPay , a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. Paid time off (beginning after six months of employment) and paid holidays. Flexible scheduling. Tuition reimbursement and student loan forgiveness. Zero cost uniforms. Responsibilities: Supervise the care/services provided by State-Tested Nursing Assistants (STNA) and other team members who care for guests. Provide safe and accurate medication-related interventions to guests. Assess the health of guests and notify the physician of status changes. Promptly implement new orders. Select and institute appropriate nursing interventions to stabilize a guest's condition and/or prevent complications. Contribute to the guest's assessment (MDS/CAA's) and the development of a plan of care. Qualifications: 1-3 years of experience in a long-term care setting (preferred, but not required). Current Licensed Practical Nurse (LPN) licensure in the state. CPR certification. Ciena Healthcare: We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way. IND123

$7,500 sign on bonus for full-time! Shift Available: FT - Days (7am-7pm) Want to make a difference in someone's life every day? As an LPN with The Laurels of Walden Park, you will work as part of a team providing skilled nursing and short-term rehabilitation care to our valued guests. If you have patience, compassion and a desire to care for guests in a gentle and empathetic way, you will love this role. Benefits: Comprehensive health insurance - medical, dental and vision. 401K with matching funds. DailyPay, a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. Paid time off (beginning after six months of employment) and paid holidays. Flexible scheduling. Tuition reimbursement and student loan forgiveness. Zero cost uniforms. Responsibilities: Supervise the care/services provided by Certified Nursing Assistants (CNA)/State-Tested Nursing Assistants (STNA) and other team members who care for guests. Provide safe and accurate medication-related interventions to guests. Assess the health of guests and notify the physician of changes in status. Promptly implement new orders. Select and institute appropriate nursing interventions to stabilize a guest's condition and/or prevent complications. Contribute to the guest's assessment (MDS/CAA's) and the development of a plan of care. Qualifications: 1-3 years of experience in a long-term care setting (preferred, but not required). Current Licensed Practical Nurse (LPN) licensure in the state. CPR certification. Ciena Healthcare: We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way. IND123

Shift Available: Full time - Days (7am-7pm) PRN for both shifts Want to make a difference in someone's life every day? As an LPN with The Laurels of Gahanna, you will work as part of a team providing skilled nursing and short-term rehabilitation care to our valued guests. If you have patience, compassion and a desire to care for guests in a gentle and empathetic way, you will love this role. Benefits: Comprehensive health insurance - medical, dental and vision. 401K with matching funds. DailyPay, a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. Paid time off (beginning after six months of employment) and paid holidays. Flexible scheduling. Tuition reimbursement and student loan forgiveness. Zero cost uniforms. Responsibilities: Supervise the care/services provided by Certified Nursing Assistants (CNA)/State-Tested Nursing Assistants (STNA) and other team members who care for guests. Provide nursing care of residents on the unit assuring all residents receive appropriate care. Provide safe and accurate Medication Related interventions to residents. Assess the health of residents and notify the physician of changes in status and promptly implement new orders. Develop a plan of care based on assessment, implementing nursing care. Select and institutes appropriate nursing interventions to stabilize a resident's condition and /or prevent complications. Contribute to the resident's assessment (MDS/CAA's) and the development of a plan of care. Qualifications: 1-3 years of experience in a long-term care setting preferred, but not required. Current Licensed Practical Nurse (LPN) licensure in the state. CPR certification. Ciena Healthcare: We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way. IND123

If you have a passion for helping others... If it is your calling to make someone's day better... If you want to build meaningful relationships with those you work with... Then it's time for you to join the Danbury family! Our residents and team members can't wait to meet you. We are looking for new team members who care like we do. We care for our residents, our co-workers, our families, our vendors... We Care. That's the Danbury Difference. We are currently seeking a LPN for our community. Check with the hiring manager for up to date shifts available. We offer a great FULL TIME benefits and perks package! Company Paid Benefits: Short Term Disability (Guardian)-for employee only, benefit percentage 60% of salary! Long Term Disability (Guardian)-for employee only, benefit percentage 60% of salary! Life and AD&D (Guardian) Health Advocate (Employee Assistance Program)-for Employee, Spouse, Dependents, Parents, and Parents in Law. Examples that are available for help: Emotional Support-Stress, Realtionships, Addictions, Mental Illness, Anger, Loss, Depression, Time Management. Work and Life Balance Specialists Employee Optional Benefits: Medical (BCBS)-for Employee, Spouse, and/or Dependents. HSA (Health Savings Account) is optional if Medical is selected. Great tax benefit! Dental (Guardian)- for Employee, Spouse, and/or Dependents. Vision (Guardian VSP)- for Employee, Spouse, and/or Dependents. Additional Voluntary Life (Guardian)- for Employee, Spouse, and/or Dependents. Additional Voluntary AD&D (Guardian) Critical Illness (Guardian)- for Employee, Spouse, and/or Dependents. Hospital Indemnity (Guardian)- for Employee, Spouse, and/or Dependents. Accident (Guardian) Metlife Legal (Legal Shield)- for Employee, Spouse, and/or Dependents. Assistance with Adoption, Lawyers, Wills and Trusts and much more! No waiting periods, no claim forms, no deductibles! Metlife Pet Insurance Wide range of coverages for your fur babies! All dog and cat breeds are covered. I dentity Theft (All State) 401(k)with Matching (TransAmerica) Tuition Reimbursement Perks : Vacation from 90th Day of Employment Worked Holidays Paid @ Double Time ! On Demand Pay Option Bonuses : Resident Referral Bonus Opportunities Employee Referral Bonus Opportunities Shift Pick Up Bonuses Training Bonuses We offer a great PART TIME perks package too! Perks: Worked H olidays Paid @ D ouble Time ! On Demand Pay Option Opportunity for Advancement within the Company! Benefits: 401(k)with Matching (TransAmerica) Bonuses: Resident Referral Bonus Opportunities Employee Referral Bonus Opportunities Shift Pick Up Bonuses Training Bonuses NEW Graduates Welcome! Our LPN responsibilities include: • Our Licensed Practical Nurses provide direct nursing care to residents, prepare and administer medications, perform routine charting and documentation duties, and perform other duties necessary to ensure that our residents' total regimens of care are maintained. The experience and/or skills required for this position are: We are looking for applicants who are licensed by the State of Ohio. Experience in a nursing capacity in a senior living setting is helpful, but not required. We are seeking Licensed Practical Nurses (LPNs) who are outstanding in their profession and would work well with our team. If you're ready to make a difference in the lives of our residents and our teams, apply now. Danbury does not require employees to be vaccinated. Danbury Senior Living provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Want to make a difference in someone's life every day? As a nurse with The Laurels of Norworth, you will work as part of a team providing skilled nursing and short-term rehabilitation care to our valued guests. If you have patience, compassion and a desire to care for guests in a gentle and empathetic way, you will love this role. Benefits: Comprehensive health insurance - medical, dental and vision. 401K with matching funds. DailyPay , a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. Paid time off (beginning after six months of employment) and paid holidays. Flexible scheduling. Tuition reimbursement and student loan forgiveness. Zero cost uniforms. Responsibilities: Supervise the care/services provided by Certified Nursing Assistants (CNA)/State-Tested Nursing Assistants (STNA) and other team members who care for guests. Provide safe and accurate medication-related interventions to guests. Assess the health of guests and notify the physician of changes in status. Promptly implement new orders. Select and institute appropriate nursing interventions to stabilize a guest's condition and/or prevent complications. Contribute to the guest's assessment (MDS/CAA's) and the development of a plan of care. Qualifications: Current Licensed Practical Nurse (LPN) licensure in the state. CPR certification. Ciena Healthcare: We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way. IND123

RELOCATE TO VIRGINIA OPPORTUNITY Join our esteemed team of healthcare professionals committed to advancing healthcare through cutting-edge research, comprehensive training, and compassionate care. UVA Health is an integrated health system with a world-class academic medical center that includes a level 1 trauma center, a level IV NICU, the first NCI-designated Comprehensive Cancer Center in Virginia, and UVA Health Children's, the #1 pediatric hospital in Virginia. UVA Health also encompasses three community hospitals, a specialty rehabilitation hospital, and an integrated network of primary and specialty care clinics throughout Virginia. UVA Health consists of UVA Health University Medical Center, UVA School of Medicine, UVA School of Nursing, UVA Claude Moore Health Sciences Library, UVA Community Health, and UVA Physicians Group. Through teaching and research, we continue to advance medicine and innovate excellence while providing high-quality care in communities across the state. An Exceptional Place to Call Home Nestled amid the picturesque Blue Ridge Mountains, Charlottesville and Albemarle County offer a welcoming community, rich cultural opportunities, and an enviable lifestyle. Enjoy award-winning culinary experiences, vibrant local music, and historic landmarks, surpassing many larger cities in charm and amenities. Charlottesville Accolades: “#1 City in America” (Frommer's) “Best Place to Live Among Small Cities” (Money magazine) “Top 15 Happiest Places to Live in the U.S.” (Outside Magazine) “Top Ten Cities That Have It All” (A&E TV) “Top 10 Best College Towns” (WalletHub) “#2 Best Small College Town” (WalletHub) “Healthiest Place to Live” (Kiplinger) “Hottest for Fitness” (Newsweek) “Best Place to Raise a Family” (Readers' Digest) “2023 Wine Region of the Year” (Wine Enthusiasts) “Top 10 Greenest Cities” (Streetdirectory.com) “Top 5 Best Digital Cities” (Center for Digital Government) “Top 50 Best Places to Launch a Small Business” (Money Magazine) We offer competitive compensation, generous relocation assistance, an inclusive work environment, and opportunities for professional growth. Do you have the expertise and passion to contribute to our mission? Professional Excellence: Thrive in a collaborative environment with access to state-of-the-art resources. Comprehensive Benefits: Enjoy a robust benefits package designed to support your personal and professional well-being. Career Development: Participate in continuous learning and development opportunities to advance your career. Click Apply Now to learn more about this opportunity at UVA Health.

$7,500 sign-on bonus full-time LPN! Licensed Practical Nurse-LPN Are you a critical thinker, a skilled communicator, and passionate about caring for seniors? Are you seeking career advancement? As an LPN at The Laurels of Mt. Vernon, you have the opportunity to use your nursing skills and become a leader. The Laurels of Mt. Vernon offers one of the leading employee benefits packages in the industry. This includes: Comprehensive health insurance - medical, dental and vision 401K with matching funds DailyPay, a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. Paid time off (beginning after six months of employment) and paid holidays Flexible scheduling Tuition reimbursement and student loan forgiveness Zero cost uniforms Legacy, our new virtual community and rewards & recognitions program When you work with Laurel Health Care Company, you will join an experienced, hard-working team that values communication and collaboration. Why just work when you can help shape a legacy? Responsibilities The Licensed Practical Nurse plans, coordinates, provides and manages nursing care, services and health education to nursing home guests. Supervise the care/services provided by the LPNs, CNAs/STNAs and other team members who care for guests. Provide safe and accurate medication-related interventions to guests. Assess the health of guests and notify the physician of changes in status; promptly implement new orders. Develop a plan of care based on assessment, and implementing nursing care. Select and institute appropriate nursing interventions to stabilize a guest's condition and/or prevent complications. Contribute to guest assessments (MDS/CAA's) and the development of a plan of care. Qualifications 1-3 years of experience in a long-term care setting preferred Current LPN license CPR certification or acceptable exemption required Laurel Health Care Company is a national provider of skilled nursing, sub-acute, rehabilitative, and assisted living services dedicated to achieving the highest standards of care. We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way. #IND123

Sign-On Bonus: $7,500 for full-time hires! Days (7am-7pm) Want to make a difference in someone's life every day? As an Licensed Practical Nurse (LPN) with The Laurels of Heath, you will work as part of a team providing skilled nursing and short-term rehabilitation care to our valued guests. If you have patience, compassion and a desire to care for guests in a gentle and empathetic way, you will love this role. B enefits: Comprehensive health insurance - medical, dental and vision. 401K with matching funds. DailyPay , a voluntary benefit that allows associates at our facilities the ability to access their pay when they need it. Paid time off (beginning after six months of employment) and paid holidays. Flexible scheduling. Tuition reimbursement and student loan forgiveness. Zero cost uniforms. Responsibilities: Supervise the care/services provided by Certified Nursing Assistants (CNA)/State-Tested Nursing Assistants (STNA) and other team members who care for guests. Provide nursing care of residents on the unit assuring all residents receive appropriate care. Provide safe and accurate Medication Related interventions to residents. Assess the health of residents and notify the physician of changes in status and promptly implement new orders. Develop a plan of care based on assessment, implementing nursing care. Select and institutes appropriate nursing interventions to stabilize a resident's condition and /or prevent complications. Contribute to the resident's assessment (MDS/CAA's) and the development of a plan of care. Qualifications: 1-3 years of experience in a long-term care setting preferred, but not required. Current Licensed Practical Nurse (LPN) licensure in the state. CPR certification. Ciena Healthcare: We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way. IND123

JOIN TEAM TRILOGY: At Trilogy, you'll experience a caring, supportive community that values each team member. We prioritize meaningful relationships, genuine teamwork, and continuous growth. With the stability of long-term care, competitive pay, and exceptional benefits, Trilogy offers a work environment where you're supported, appreciated, and empowered to thrive in your career. If you're ready to join a team committed to your success, Trilogy is where you belong and thrive! WHAT WE'RE LOOKING FOR: The Licensed Practical Nurse (LPN) is primarily responsible for providing direct, quality clinical care and the supervision of nursing assistants working with residents assigned to each unit. Key Responsibilities Visit residents on assigned unit daily to observe and evaluate each resident's physical and emotional status and notify the charge nurse, the physician, and/or the Director of Nursing when there is a change in a resident's condition. Identify resident problems and emergency situations and initiate immediate lifesaving measures in the absence of a physician. Provide holistic care for residents within the scope of your LPN license. Assist in monitoring the inventory of medications, medical supplies and equipment to ensure that an adequate supply is on hand and readily available to meet the needs of the residents. Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting, etc. as necessary Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility's policies and procedures governing accidents and incidents. Qualifications Must have and maintain a current, valid state LPN license Current, valid CPR certification required WHERE YOU'LL WORK : Location: US-OH-New Albany LET'S TALK ABOUT BENEFITS: Our comprehensive Thrive benefits program focuses on your well-being, offering support for personal wellness, financial stability, career growth, and meaningful connections. This list includes some of the key benefits, though additional options are available. Medical, Dental, Vision Coverage - Includes free Virtual Doctor Visits, with coverage starting in your first 30 days. Get Paid Weekly + Quarterly Increases - Enjoy weekly pay and regular quarterly wage increases. Spending & Retirement Accounts - HSA with company match, Dependent Care, LSA, and 401(k) with company match. PTO + Paid Parental Leave - Paid time off and fully paid parental leave for new parents. Inclusive Care - No-cost LGBTQIA+ support and gender-affirming care coordination. Tuition & Student Loan Assistance - Financial support for education, certifications, and student loan repayment. GET IN TOUCH: Misty (614) ###-#### APPLY NOW: Since our founding in 1997, Trilogy has been dedicated to making long-term care better for our residents and more rewarding for our team members. We're proud to be recognized as one of Fortune's Best Places to Work in Aging Services, a certified Great Place to Work, and one of Glassdoor's Top 100 Best Companies to Work. At Trilogy, we embrace who you are, help you achieve your full potential, and make working hard feel fulfilling. As an equal opportunity employer, we are committed to diversity and inclusion, and we prohibit discrimination and harassment based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. NOTICE TO ALL APPLICANTS (WI, IN, OH, MI & KY): for this type of employment, state law requires a criminal record check as a condition of employment.

Build your own schedule. Take control of your career. Looking for LPN jobs that fit your life? If you're tired of having no control over your schedule or just want to earn more money, PRN shifts could be what you're looking for! ShiftKey enables independent Licensed Practical Nurses likeyou to bid on per diem LPN shifts posted by a vast network of Healthcare Facilities-all based on criteria you select. Choose the facilities you want, on days you want, and bid the rate you want. Better work/life balance - Don't want to work nights? Need Mondays off? Only want to work once in a while? No problem. Use ShiftKey to work as little or as much as you like. Extra income - Use ShiftKey to pick up shifts whenever you need a little extra money, even if you have another job. Get paid the next day with a PayCard or go with weekly direct deposit. Pick the right environment for you - PRN shifts are a great way to experience a variety of facilities. ShiftKey partners with Stride Health to allow healthcare professionals who use the ShiftKey App to access Stride's portable benefits platform for affordable healthcare options such as: Health Dental Vision Life Insurance Role Requirements: A high school diploma or GED. A valid LPN license in the state of Ohio. About the Role: You know better than anyone that LPNs are essential members of a facility's medical team. Your role is to assist RNs and physicians in keeping patients comfortable and on the road to recovery. Here are a few things you might do: Chart and record the administration of medication and treatment. Patient observation. Perform specific procedures, such as reading and recording vital signs, measuring and recording weight and height, and running other diagnostic tests. Comfort and reassure apprehensive patients. Here's what ShiftKey users have to say about us: "This was one of the best choices I've made as a nurse. I love the freedom I have now!!" - LVN, Dallas, TX "Amazing! You make your own schedule. You get daily pay or weekly. And they always respond when you need them." - CNA, Springfield, TN "I've been using ShiftKey for years. It's a very good way to work. The people and facilities are respectful and helpful." - CNA, Kansas City, MO

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Manager, Utilization Management (UM) Coordination, oversees non-clinical inpatient and pre-service operations under the direction of the Director of Utilization Management. This role provides leadership to UM Supervisors and their coordinator teams to ensure timely, accurate, and compliant processing of authorizations and referrals in accordance with CMS and organizational standards. The Manager drives operational efficiency, staff development, and process improvement while collaborating with internal departments to support continuity of care and overall service quality. Job Responsibilities: Provide operational leadership and direction to two Utilization Management Supervisors overseeing non-clinical coordinator teams supporting both Inpatient and Pre-Service workflows. Lead the teams meet established turnaround times (TATs), quality, and productivity standards for authorization processing, referral routing, and related UM functions. Oversee staffing allocation, scheduling, and workload balancing between inpatient and pre-service units to maintain consistent service levels. Conduct regular one-on-one meetings with supervisors to review performance metrics, workflow barriers, and staff development needs. Own the daily operations to ensure timely and accurate completion of authorizations, correspondence, and documentation in compliance with CMS, NCQA, and organizational standards. Identify process inefficiencies and implement corrective actions to improve turnaround, accuracy, and staff productivity. Lead root-cause analyses for escalated operational issues and coordinate corrective action plans. Responsible for all the accuracy of all UM workflows, systems, and reporting dashboards to support data-driven decision making. Oversee the development and delivery of training materials, competency assessments, and reference guides to promote consistent and compliant practices. Mentor Supervisors to build leadership capacity, coaching them on staff management, delegation, and performance improvement techniques. Drive onboarding, cross-training, and refresher sessions are regularly conducted to support staff versatility across inpatient and pre-service functions. Manage all team activities adhere to CMS and organizational policies related to Utilization Management, confidentiality, and member communication standards. Oversee internal audit reviews and collaborate with the Quality and Compliance teams to address findings and implement improvement plans. Direct that all letters and communications use approved templates and standardized language for UM determinations and continuity-of-care requirements. Participate in internal and external audits, Medical Services Committee meetings, and other regulatory reviews as required. Review and analyze key performance indicators (KPIs), including volume, turnaround time, accuracy, and productivity reports; present trends and improvement strategies to leadership. Support the preparation and submission of monthly UM reports, dashboard summaries, and Medical Services Committee deliverables. Leverage data to identify training needs, process gaps, and operational trends impacting service delivery or compliance. Serve as a liaison between UM, Case Management, Provider Relations, and Claims departments to streamline interdepartmental communication and issue resolution. Collaborate with network providers and internal teams to clarify authorization processes and ensure alignment with benefit and policy criteria. Participate in internal workgroups or initiatives to improve system functionality, workflow automation, and reporting enhancements. Assist with the development, implementation, and monitoring of UM-related initiatives and special projects (e.g., claims review process, continuity-of-care tracking, or performance optimization programs). Evaluate and revise UM policies and procedures to align with evolving regulatory standards and organizational goals. Support readiness activities for CMS audits and other accreditation requirements. Perform other related functions and special assignments as directed by senior leadership. Core Competencies: Leadership & Talent Development - Demonstrates the ability to lead through others by developing and empowering supervisors and staff. Fosters a culture of accountability, engagement, and continuous improvement within the UM department. Operational Management - Applies strong organizational and analytical skills to oversee workflow execution, resource allocation, and performance metrics across inpatient and pre-service teams. Regulatory & Compliance Expertise - Maintains in-depth knowledge of CMS regulatory standards, confidentiality requirements, and UM protocols to ensure full compliance and audit readiness. Analytical Thinking & Decision-Making - Uses data to identify trends, evaluate outcomes, and implement process improvements that enhance accuracy, turnaround times, and service quality. Communication & Collaboration - Communicates clearly across all organizational levels; partners effectively with Clinical Operations, Provider Relations, Case Management, and Claims to resolve issues and align priorities. Process Improvement & Innovation - Continuously evaluates operational workflows and implements efficiency strategies that support organizational goals and member satisfaction. Member & Service Orientation - Demonstrates commitment to delivering high-quality service, ensuring that UM processes support positive member experiences and continuity of care. Change Management - Adapts to evolving regulatory, system, and organizational needs while leading teams through process transitions and new initiatives effectively. Supervisory Responsibilities: Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management. Job Requirements: Experience Required: Minimum (4) years of related experience in a managed care setting and a minimum (3) years of recent and related supervisory experience Education Required: Highschool Diploma or GED Required Preferred: Bachelor's Degree or higher Other: Strong knowledge of Medicare Managed Care Plans Proficient in Microsoft Word, Excel, and Outlook; advanced Excel skills preferred (pivot tables, formulas, data visualization, and reporting functions for performance tracking and analysis). Experience leading and sustaining process improvement initiatives within healthcare operations to enhance efficiency, compliance, and service quality. Communication and Interpersonal Skills - Excellent written and verbal communication skills; able to build and maintain collaborative relationships with diverse teams, including leadership, staff, and external partners. Analytical and Reasoning Skills - Strong analytical thinking with the ability to define problems, collect and interpret data, establish facts, draw valid conclusions, and develop actionable solutions. Problem-Solving and Organizational Skills - Demonstrated ability to prioritize multiple tasks, manage time effectively, and maintain accuracy in a fast-paced, dynamic environment. Data and Report Analysis - Ability to interpret, analyze, and present statistical and operational reports to support decision-making and performance monitoring. Essential Physical Functions: 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. 1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $70,823.00 - $106,234.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.

Flexible Independent Contractor (1099) Opportunity Current Unrestricted State Medical License in Minnesota or Oregon Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally recognized Independent Review Organization (IRO) specializing in technology-driven utilization management and clinical medical review solutions. We're a leader in Peer and Utilization Reviews, known for excellence and continuous improvement. THE OPPORTUNITY We're seeking Board-Certified physicians in PM&R with a Pain Fellowship with a current MINNESOTA to provide expert Utilization Reviews. This is a flexible, remote opportunity requiring just 1-2 hours per week, could be more if you prefer. ADDITIONAL INFORMATION: Work remotely from anywhere in the US (Per HIPPA Regulations patient records cannot leave the US). Covered under MRIoA's Errors and Omissions policy. Independent Contractor (1099) opportunity. Workers are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information. California Consumer Privacy Act (CCPA) Information (California Residents Only): Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver's license number, or state identification card number, and passport number. Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at ************. Must have a Medical Degree MD or DO Must have a current state medical license in MINNESOTA or OREGON Current Board Certification in PM&R and have a Pain Fellowship Must have 5 years of clinical experience residency to be included Daytime availability is required for peer-to-peer conversations

REM Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person has the right to livewell, and everyone deserves to have a fulfilling career. You'll join a mission-driven team and create relationships that motivate us all every day. Join us today, and experience a career well lived. Pay $23.00 per hour! Full-time positions available. SUMMARY Provides prescribed medical treatment and personal care services to individuals receiving services under the direction of an RN or physician. ESSENTIAL JOB FUNCTIONS To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below. • Provides basic care and medical treatment to individuals receiving services. • Completes health assessments and provides input of health diagnosis to RN or physician for the development of nursing care plan. Follows-up on all physician orders and monitors and ensures follow through on individual's medical/dental appointments. • Monitors and records medications in a timely manner; acts as a liaison to pharmacy. Reviews medication error forms, analyzes errors and makes recommendations for procedural changes. Administers medication as required. • Oversees and monitors staffs who administer medication. Conducts quality assurance checks on health care records. • Provides emergency coverage and/or care for individuals receiving services. • Maintains confidentiality, respects human rights and practices universal precautions in accordance with Sevita policy. Upholds policy and procedure development related to health care. • Works with external agencies to coordinate services and ensure consistent treatment of clients. • Administers, tracks, and maintains log for staff and individual's testing. • Provides training for staff including medication administration, universal precautions and infection control. • Provides training for individuals receiving services such as self-medication, prescribed treatments, sex education/STD prevention and smoking cessation. • May be required to coordinate, organize and/or assist with household activities such as light housekeeping and meal preparation; transport individuals receiving services to planned and/or necessary activities, appointments. Participates in on call system as needed. • Performs other related duties and activities as required. SUPERVISORY RESPONSIBILITIES • None Required Minimum Knowledge and Skills required for the Job The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job. Education and Experience: • Associates degree in nursing or related field or state certificate • One year experience working with population served in a nursing capacity Certificates, Licenses, and Registrations: • Current LPN/LVN licensure for state of residence • Other certifications as required by state licensing regulations such as CPR/FA and HIV/AIDS certification, BBP, and ACT training Blood Borne Pathogen Category: • Job requires performance of duties that involve potential for exposure to blood, body fluids, or tissues. Tasks that do involve exposure are an expectation of employment. Other Skills and Abilities: • N/A Other Requirements: • Travel as needed Physical Requirements: • Heavy work. Exerting up to 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects. Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face. We've made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve all over the U.S. As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, citizenship, or any other characteristic protected by law.

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: The Behavioral Health Utilization Manager plays a critical role in ensuring the appropriate and effective delivery of mental health and substance use disorder services. This role serves as a key clinical decision-maker, exercising independent judgment and critical thinking in the evaluation of behavioral health service requests. This position is responsible for managing complex outpatient and non-24-hour diversionary cases, applying clinical expertise to ensure appropriate, timely, and effective care. The role requires a proactive and analytical approach to service delivery, with a focus on clinical quality and compliance. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Responsibilities: · Use advanced clinical judgment and critical thinking to evaluate outpatient and non-24-hour behavioral health services, determining the appropriateness of care based on individual member needs, clinical presentations, and professional standards. · Collaborate with Medical Directors when clinical complexity requires further review, ensuring decisions align with clinical best practices and organizational values. · Identify members who may benefit from enhanced care coordination or specialized interventions and initiate appropriate referrals to internal programs. · Ensure accurate, timely, and well-reasoned documentation of clinical decisions in accordance with operational standards and regulatory expectations. · Provide clear, thoughtful communication to internal and external stakeholders, helping resolve questions or concerns with clinical insight in a timely manner. · Participate in clinical rounds and interdisciplinary case discussions to support collaborative care planning and cross-functional learning. · Represent the organization with external partners, including providers and state agencies, conveying clinical insight and ensuring organizational compliance. · Monitor clinical trends for potential indicators of Fraud, Waste, and Abuse (FWA), and take appropriate action when concerns are identified. · Partner with leadership and the BH Medical Director to evaluate existing processes and support initiatives aimed at improving quality and operational efficiency. · Provide crisis intervention support using clinical judgment to de-escalate situations and assist members in stabilizing their conditions. · Uphold all organizational policies, professional standards, and compliance requirements. · Contribute to special projects and organizational initiatives as assigned by senior leadership, offering insight and subject matter expertise. · In rotation with other BH UM clinicians, provide on-call weekend and holiday support for members that are ED boarding and manage urgent authorization needs. Potential Additional Responsibilities · Providing Network Management in collaboration with other MCEs within Massachusetts for CBHI Providers (may require some travel within Massachusetts) Qualifications: Educational Requirements: · Master's degree in Social Work, Psychology, Counseling, or a related Behavioral Health field. Experience: · 5-7years of experience in a health insurance environment with a focus on behavioral health. · Demonstrated expertise in utilization management and medical necessity determinations. Preferred Qualifications: · Experience working with Child and Adolescent Behavioral Health Services and/or Substance Use Disorder Services. · Familiarity with managed care principles and regulatory compliance requirements. Licensure and Certification: · Active, unrestricted independent licensure in Massachusetts and/or New Hampshire in one of the following: LICSW, LMHC, or LMFT. · For ABA UM Position Only: Must hold an active Board Certified Behavior Analyst (BCBA) credential. Additional independent licensure (LICSW, LMHC, LMFT) is preferred. Core Competencies: · Exceptional verbal and written communication skills, with the ability to collaborate effectively across all organizational levels and with external partners. · Strong organizational and time management abilities, with a focus on meeting deadlines and managing competing priorities. · Capacity to thrive in a fast-paced environment, balancing multiple responsibilities while maintaining accuracy and efficiency. · Proficiency in Microsoft Office applications, particularly Outlook, Word, and Excel, along with experience in data management systems. · Superior analytical and problem-solving skills with a keen attention to detail. Work Environment and Physical Demands: · Primarily remote role with periodic travel to the Charlestown, MA office for team meetings and training sessions. · Additional travel within Massachusetts may be required for individuals with CBHI Network Management expectations. · Dynamic and fast-paced work setting requiring adaptability and resilience. · Minimal physical exertion required; standard office tasks such as typing and phone use. · Consistent and reliable attendance is an essential job requirement. Compensation Range: $69,500 - $100,500 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This range is based on Boston-area data, and is subject to modification based on geographic location. About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

This position is a critical part of utilization management within the emergency department setting. The role ensures that patient admissions meet medical necessity standards and that healthcare resources are used appropriately and efficiently. It combines clinical expertise, analytical skills, and communication abilities to support both patient care and organizational compliance.Responsibilities Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources Participate in telephonic discussions with emergency department physicians relative to documentation and admission status Enter clinical review information into system for transmission to insurance companies for authorization Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required Current and unrestricted RN license At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 2 years utilization management experience in acute admission and concurrent reviews Intermediate level experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) Experience in Microsoft Suite including Office and basic Excel Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-related pre-employment assessment(s) Preferred At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience within the hospital setting Bachelor's of Science in Nursing (BSN) Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC) Expectations Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication Shift Needs & Work Requirements: Must work 4 holidays per year, each for a 4-hour shift. 16 hours of the required 48 hours per month must be worked on the weekend. Work schedules and shift assignments are subject to change based on evolving client needs and operational demands. While we strive to provide consistent scheduling, associates may be required to adjust their availability or work different shifts. Flexibility and adaptability are essential for success in this role. Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate. Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider. If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled. All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position. Netsmart's Job Applicant Privacy Notice may be found here.

Utilization Review Registered Nurse, Case Management, FT, 08A-4:30P Local Remote-155662Description The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments.Qualifications Degrees: Associates. Licenses & Certifications: MCG Care Guidelines Specialist.Registered Nurse. Additional Qualifications: RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN. however, they are required to complete the BSN within 5 years of job entry date. MCG Specialist Certification ISC/HRC required within 12 months of job entry date. 3 years of Nursing experience preferred. Excellent written, interpersonal communication and negotiation skills. Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently. Strong analytical, data management and computer skills. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Current working knowledge of payer and managed care reimbursement preferred. Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. Knowledgeable in local, state, and federal legislation and regulations. Ability to tolerate high volume production standards. Minimum Required Experience: 3 YearsJob Case Management/Home HealthPrimary Location Boca RatonOrganization Boca Raton Regional HospitalSchedule Full-time Job Posting Jan 7, 2026, 5:00:00 AMUnposting Date Ongoing Pay Grade R21EOE, including disability/vets