Utilization review nurse jobs in Bethesda, MD

*Employment Type:* Full time *Shift:* Rotating Shift *Description:* The Graduate Nurse* *works in a collaborative environment at Holy Cross Health within the Emergency Department to deliver excellent patient care as part of an interdisciplinary team providing evidence-based medicine and individualized patient care. This position is a great opportunity to work in an organization that focuses on treating the whole person physically, emotionally and spiritually. Must be authorized to work in the United States without work visa or sponsorship. *What You Will Do:* * Employment Type/Shift: Rotating Shift * Utilizes knowledge of the principles of growth and development appropriate to the patient's age to ensure that care provided meets the unique, physical and psychosocial needs of the patient. * May perform patient assessments after the initial assessment or after the first assessment of the shift performed by the registered nurse. *Minimum Qualifications:* * Intern/extern nursing student enrolled in a program from an accredited school of nursing or a Trinity Health approved program. * Nurse pending license having graduated from an accredited school of nursing or unlicensed under emergency conditions designation. *Position Highlights and Benefits:* * Comprehensive benefit packages available, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from first day of employment. * Work/Life balance with flexible schedules. * Free onsite parking. * Opportunities for advancement through the Clinical Advancement Program. * Our mission and core values are what drives each member of Holy Cross Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all. *Ministry/Facility Information:* Holy Cross Health is a Catholic, not-for-profit health system that serves the two most populous counties in Maryland, Montgomery and Prince George's, with a commitment to being the most trusted provider of health-care services in the area. Founded in 1963 by the Sisters of the Holy Cross, Holy Cross Health is a member of Trinity Health of Livonia, Michigan. Holy Cross Hospital, in Silver Spring, is one of the largest hospitals in Maryland, and Holy Cross Germantown Hospital is the first hospital in the nation built on a community college campus, enhanced by an educational partnership. The Holy Cross Health Network operates primary-care practices and affordable health centers, and offers a wide range of innovative, community-based health and wellness programs. Specialty care, home care and hospice services round out Holy Cross Health's high-quality and coordinated continuum of care that aims to improve health and let you live life on your own terms. *Our Commitment * Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

About this Job: General Summary of Position The Nurse Coordinator Bloodless Medicine is responsible for the planning development and implementation of the Bloodless Medicine program. Develops and manages the operational the operational budget and patient outcome performance; collaborates with specialty departments and patient care units regarding all aspects of non-blood management; serves as a liaison between MedStar Washington Hospital Center and other facilities physicians and families; and manages all personnel related aspects of the department to include the blood conservation staff. Primary Duties and Responsibilities Clinical Practice: Acts as liaison between patients physicians family and staff. Clinical Practice: Discusses and documents clinical alternatives acceptable to patients. Clinical Practice: Finds and makes appointments with cooperating physicias. Clinical Practice: Monitors patients on an ongoing basis. Clinical Practice: Collects data related to the Bloodless Medicine program using an approved data collection tool. Communication: Communicates clearly accurately and effectively to peers physicians visitors and other departments to facilitate patient care. Communication: Clarifies forms financial arrangements and hospital polices to patients and family. Communication: Acts as information resource for the medical staff. Leadership: Supports unit and organization's goals for the fulfillment of the program. Leadership: Delegates and supervises other nursing staff in rendering patient care in accordance with DC Scope of Practice hospital polices and procedures and the American Association of Critical Care Nurses (AACN) standards. Education and Research: Participates in educational programs to ensure the appropriate implementation of the program. Education and Research: Collaborates with nursing units to mentor and educate staff and promote successful implementation of the program. Education and Research: Incorporates research and provides ongoing revision to the program as needed. Minimal Qualifications Education Bachelor's degree in Nursing required Master's degree preferred Experience 3-4 years of critical care nursing experience required Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia required This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr. d24ad0b8-823f-4e68-a892-2986ccdf7392

Requires Vent Experience Are you a critical thinker, a skilled communicator, and passionate about caring for residents? Are you seeking career advancement? As a Registered Nurse (RN) at The Laurels of Middletown, you have the opportunity to use your nursing skills and become a leader. If you're going to work every day for a living, make it count for yourself and your family by joining a company with one of the leading employee benefits packages in the long term health industry. Career ladder programs Paid Time Off Competitive pay Comprehensive medical, dental, vision insurance What you'll be doing Supervise the care/services provided by the LPNs, Certified Nursing Assistants and other team members who care for the residents Coordinate the nursing care of residents on the unit assuring all residents are assigned staff capable of providing appropriate care to the resident. 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. Education and/or Experience: ADN or BSN Demonstrates knowledge of basic nursing practice with an interest in gerontological nursing. Prefer 2 years' experience in a long term care setting. One year vent experience Certificates, Licenses, Registrations: Must have a current state license to practice as a registered nurse (RN) Current CPR certification Additional certification in nursing specialty desired. IND123

Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at The Laurels of Bedford may be just what you're looking for! Laurel Health Care Company offers one of the leading employee benefit packages in the industry, including health insurance, 401K with matching funds, paid time off and paid holidays. When you work with Laurel Health Care Company, you will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Some responsibilities of the MDS nurse include: Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications: Registered Nurse (RN) or Licensed Practical Nurse (LPN) AANC certification a plus. RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred. Experience as an MDS Nurse or acceptable exemption required About Laurel Health Care Laurel Health Care Company is a national provider of skilled nursing, subacute, rehabilitative, and assisted living services dedicated to achieving the highest standards of care. At The Laurels, caring is more than providing excellent medical and guest services. It's also being a companion, and treating each guest with the utmost dignity, respect and compassion. It's what we call "The Laurel Way of Caring", and it comes from within each one of us. IND123

Sign-On Bonus Available Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Minimum Offer $ 34.84/hr. Maximum Offer $ 43.33/hr. Compensation Disclaimer Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations. Department: Behavioral Svcs at MATS Center FTE: 0.90 Full Time Shift: Days Position Summary: Provide professional nursing care for assigned patients in a mental health/psychiatric environment. Design nursing care plans and assist in the development of overall care plans for psychiatric patients, ensure administration of appropriate overall care in a manner conducive to recovery. Ensure adherence to Hospitals and departmental policies and procedures. Patient care assignment may include pediatric, adolescent, adult and geriatric age groups. Detailed responsibilities: * PATIENT CARE - Interview, examine, and assess the health status of psychiatric patients with various cognitive, emotional, developmental, social, and behavioral disorders * PATIENT CARE - Observe patient behavior, activities, and mental status; perform triage and crisis intervention * PATIENT CARE - Write treatment plans; coordinate patient drug and procedure activities; administer medication and treatment; provide and coordinate nursing care of assigned patients; may facilitate group therapy and/or education sessions * PATIENT CARE - Chart and report observed symptoms, reactions, treatments, and changes in the patients' conditions; collect and document data and information; may perform computerized data entry * PATIENT CARE - Perform nursing intakes, draw blood and other patient specimens; may perform or coordinate laboratory tests * PATIENT CARE - Educate patients and families on treatment regimens, management of side effects, and compliance with the treatment plans; provide emotional support and acts as advocate for patients and families * PATIENT CARE - Provide information and facilitate communication between physicians, medical students, staff, patients, families, and community; coordinate and consult with a milieu of service providers * POLICY & PROCEDURE - Follow established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety, environmental, and/or infection control standards * DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops * ADMINISTRATION - Perform various administrative functions such as monitoring expenditures and preparing reports and correspondence; may participate in a variety of research projects to develop service plans; may propose changes to program policies and procedures * PRECEPTOR - Participate in orientation, and having successfully completed preceptor training, assume precepting and evaluation responsibilities of new personnel * TESTS AND PROCEDURES - Assist with special tests and procedures, ensure proper consent has been obtained * EMERGENCY MEASURES - Assist with or institute emergency measures for sudden, adverse developments in patients * MEDICATION - Administer medication, including IV medication, via the Seven Rights; document and communicate clinical findings * ENVIRONMENT - Maintain a safe, comfortable, and therapeutic environment for patients/families in accordance with Hospitals standards * PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols * PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes * PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk * PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner * PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right" Qualifications Education: Essential: * Program Graduate Nonessential: * Bachelor's Degree Education specialization: Essential: * Nationally Accredited Nursing Graduate Nonessential: * Nursing Experience: Essential: Nonessential: Bilingual English, Spanish, Keres, Tewa, Tiwa, Towa, Zuni, or Navajo 1 year directly related experience Credentials: Essential: * CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days * RN in NM or as allowed by reciprocal agreement by NM Physical Conditions: Heavy Work: Exerting 50 to 100 pounds of force occasionally, and/or 25 to 50 pounds of force frequently, and/or 10 to 20 pounds of force constantly to move objects or people. Physical Demand requirements are in excess of those for Medium Work. Working conditions: Essential: * Sig Haz: Physical risk/injuries due to combative patients * Sig Hazard: Chemicals, Bio Hazardous Materials req PPE * Tuberculosis testing is completed upon hire and additionally as required Department: Registered Nurse

Requires Vent Experience Are you a critical thinker, a skilled communicator, and passionate about caring for residents? Are you seeking career advancement? As a Registered Nurse (RN) at The Laurels of Milford, you have the opportunity to use your nursing skills and become a leader. If you're going to work every day for a living, make it count for yourself and your family by joining a company with one of the leading employee benefits packages in the long term health industry. Career ladder programs Paid Time Off Competitive pay Comprehensive medical, dental, vision insurance What you'll be doing Supervise the care/services provided by the LPNs, Certified Nursing Assistants and other team members who care for the residents Coordinate the nursing care of residents on the unit assuring all residents are assigned staff capable of providing appropriate care to the resident. 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. Education and/or Experience: ADN or BSN Demonstrates knowledge of basic nursing practice with an interest in gerontological nursing. Prefer 2 years' experience in a long term care setting. Certificates, Licenses, Registrations: Must have a current state license to practice as a registered nurse (RN) Current CPR certification Additional certification in nursing specialty desired. IND123

Are you an experienced registered nurse (RN) who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at Royalton Manor may be just what you're looking for! We will train the right person for the job! At Ciena Healthcare, we take care of you too, with an attractive benefit package including: Competitive pay Life Insurance 401K with matching funds Health insurance AFLAC Employee discounts Tuition Reimbursement You will join an experienced, hard-working team that values communication and strong teamwork abilities. Responsibilities The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Some responsibilities of the MDS nurse include: Completes the MDS, CAA's and care plans within regulated time frames. Assesses resident through physical assessment, interview and chart review. Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff. Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning. Coordinates, identifies, and/or initiates significant change MDS' Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements. Qualifications Active Registered Nurse (RN) license with the state of Michigan AANC certification a plus RAC-CT Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred Experience as an MDS Nurse About Ciena Healthcare Ciena Healthcare is Michigan's largest provider of skilled nursing and rehabilitation care services. 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, Ciena is the place for you! IND123

Provides quality patient care for pre-operative and post-operative patients, in accordance with nursing philosophy and approved standards. Essential Responsibilities: Performs within the established standard of pre- and post- anesthesia nursing and critical care nursing. Utilizes the standard of care in the assessment, planning, implementation and evaluation of the surgical patient in the delivery of pre-operative and post-operative nursing care. Formulates care plans based on individual assessment of physiologic functions and problems identified pre-operatively and intra-operatively. Provides nursing care utilizing clinical knowledge and expertise, reacting immediately to adverse physiological changes within seconds, to reverse and revive the patients physiological functions. Renders nursing care following aseptic techniques. Assembles and communicates appropriate information in verbal or written reports in order to maintain continuity of care. Executes proper use of equipment and supplies used in the pre-operative area and the recovery (Stage I and Stage II) area. Participates in the Perioperative Services quality assurance program. Promotes personal and professional growth by actively participating in continuing education programs. Participates in the professionalism of the Perioperative Services by adhering to the standards. May be required to administer conscious sedation after appropriate training and competency requirements are met Assumes other related duties as directed. Basic Qualifications: Experience A minimum of two (2) years current PACU or critical care experience required. Education High School Diploma or GED required. License, Certification, Registration This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire. Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire OR Compact License: Registered Nurse within 6 months of hire Registered Nurse License (District of Columbia) within 6 months of hire Basic Life Support from American Heart Association Pediatric Advanced Life Support Advanced Cardiac Life Support Additional Requirements: Good oral and written communication skills required. Proficiency in the use of applicable computer software required. Preferred Qualifications: Recent PACU experience preferred. BSN preferred.

As a Senior Review Coordinator, you will be responsible for conducting utilization review/medical management for all services, including training/mentoring other team members, and performing preliminary research on requested topics. In addition, you may provide technical assistance, medical record review, and support to provider staff and physician reviewers.Essential Functions You will perform prospective, concurrent, or retrospective utilization review/medical management for all services including appropriateness of quality of care based on contract, state, or URAC requirements. You will screen individual situations according to specific criteria to determine if care is appropriate. You will refer cases that fail to meet screening criteria to peer reviewer. You will coordinate and participate in peer-to-peer review as warranted. With prior management approval, you may deviate from criteria with proper justification to authorize the service. You will serve as liaison between peer reviewer, provider, facility and/or subscriber. You will coordinate and participate in appeal process as directed by management. You will train or serve as a mentor to team members and physician reviewers to ensure reviews and appeals are conducted thoroughly and within specified time frames. You will perform preliminary research on topics such as experimental or cosmetic services, coverage determinations, coding or standards of care. You will document review and special project results in workflow documentation system, ensuring data is accurate and timely. You will assist in compliance reporting. You will perform miscellaneous duties as assigned. Requirements Four-year degree in health care or two or three-year degree in nursing or related field and/or equivalent training and/or experience 3+ years recent experience working in a clinical environment Current MD state RN license Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential. We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories Preferred Skills Oral/Written Communication Professional Image Attention to Detail Teamwork Technical Expertise Judgment Relationship Building Influencing Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and helth shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

**Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Use your skills to make an impact** **Required Qualifications** + Active unrestricted RN license with the ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers **Preferred Qualifications** + Education: BSN or bachelor's degree in a related field + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Alert** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Interview Format - HireVue** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Benefits** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2025 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

Job Title: Clinical Medical Review Nurse Type: Contract Compensation: $41.50 Contractor Work Model: Hybrid The Clinical HEDIS Nurse (Medical Review Specialist) is responsible for supporting the organization's HEDIS and Quality initiatives through medical record retrieval, clinical data abstraction, and quality review processes in alignment with NCQA specifications. This role demands significant expertise in HEDIS measures, EMR navigation, and clinical abstraction. The nurse must maintain strict adherence to HIPAA Privacy and Security standards and demonstrate a strong commitment to data accuracy, quality improvement, and timely execution. Candidates must hold an active RN or LPN license. Work Arrangement This is a hybrid role, with a combination of remote work and potential on-site requirements based on operational needs. Key Responsibilities + Contact provider offices to request or validate facility and provider contact information specifically for HEDIS medical record retrieval. + Retrieve and upload medical records from electronic medical record (EMR) systems in accordance with HIPAA requirements and HEDIS guidelines. + Abstract clinical data from medical charts accurately and efficiently using proprietary abstraction platforms and following company-specific training and NCQA specifications. + Use internal systems to create, track, and research clinical and retrieval pends to support overall HEDIS operations. + Document all communications, record retrieval activities, and chart status updates in designated systems. + Assist with outreach and coordination efforts to maximize medical record collection efficiency and compliance. Additional Responsibilities (assigned based on experience and skill set) Overreading: + Review and validate abstracted charts completed by other team members for accuracy and adherence to HEDIS guidelines. + Correct errors identified during overread and conduct additional chart reviews when similar errors are found. + Collaborate with abstractors to provide feedback and re-education when necessary. Risk Adjustment & Off-Season Support: + Support medical record retrieval activities for risk adjustment, supplemental data validation (PSV), and various other quality and HEDIS-related initiatives outside of the core season. Qualifications Education: + Degree in Nursing (Associate's, Diploma, or Bachelor's) + Credentials such as RHIA, RHIT, or a related field preferred Licensure: + Active RN or LPN license is required Experience: + At least 3 years of clinical nursing experience + Minimum of 5 years of HEDIS experience in a health plan or vendor setting + Strong understanding of NCQA quality metrics + Experience with HEDIS abstraction software or tools (e.g., Reveleer, Cotiviti, Inovalon) preferred Technical Skills: + Proficiency in Microsoft Office applications (Excel, Word, PowerPoint, Outlook, Teams) + Experience with multiple EMR systems, including Epic, eClinicalWorks, Athena, Cerner, AllScripts, and Tebra Core Competencies: + Strong attention to detail and analytical thinking + High degree of accuracy in data interpretation and entry + Excellent time management and organizational skills + Ability to work independently and collaboratively in a fast-paced environment + Professional communication skills, both written and verbal Work Environment + Hybrid work model (remote and occasional in-office work as needed) + Requires prolonged periods of sitting and working on a computer + Frequent phone interaction with provider offices may be required System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan. System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law. #M2 #LI-AJ1 #DI- Ref: #850-Rockville (ALTA IT) System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan. System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

Location: Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Nurse Case Manager Sr will be responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. How you will make an impact: Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups. May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff. Participates in department audit activities. Minimum Requirements: Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: Certification as a Case Manager is preferred. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $89,608- $134,412 Locations: District of Columbia (Washington, DC) In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws . * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Nurse Case Manager I Location: Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: Monday-Friday 8:00AM-5:00PM or 8:30AM-5:30PM EST The Nurse Case Manager I will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. How you will make an impact: * Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. Minimum Requirements: * Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state(s) required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities & Experiences: * Certification as a Case Manager and a BS in a health or human services related field preferred. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $75,440 - $113,160 Locations: District of Columbia (Washington, DC) In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Coast Medical Service is seeking a travel nurse RN Hematology / Oncology for a travel nursing job in Washington, District of Columbia. Job Description & Requirements Specialty: Hematology / Oncology Discipline: RN Start Date: 02/09/2026 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Coast Medical Service is a nationwide travel nursing & allied healthcare staffing agency dedicated to providing an elite traveler experience for the experienced or first-time traveler. Coast is featured on Blue Pipes' 2023 Best Travel Agencies and named a 2022 Top Rated Healthcare Staffing Firm & 2023 First Half Top Rated Healthcare Staffing Firm by Great Recruiters. Please note that pay rate may differ for locally based candidates. Please apply here or contact a recruiter directly to learn more about this position & the facility, and/or explore others that may be of interest to you. We look forward to speaking with you! Coast Medical Services Job ID #35127223. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Bone Marrow,07:00:00-15:30:00 Benefits Holiday Pay Sick pay 401k retirement plan Pet insurance Health Care FSA

About this Job: Job Summary The Nurse Navigator for Colon & Rectal Surgery at MedStar Health serves as a dedicated resource for patients navigating the surgical care continuum. This role provides guidance, education, and advocacy for patients from diagnosis through surgery and postoperative follow-up. The Nurse Navigator coordinates care across surgical teams, gastroenterology, oncology, and support services, helping to ensure timely access to treatments and resources. By addressing patient needs, reducing barriers to care, and promoting engagement, the Colon & Rectal Surgery Nurse Navigator enhances the patient experience, supports adherence to treatment plans, and contributes to improved clinical outcomes. Primary Duties and Responsibilities Guide patients through the entire colon and rectal surgery care continuum, from diagnosis to preoperative preparation, surgery, and postoperative follow-up. Serve as a primary point of contact for patients and families, providing education, answering questions, and supporting decision-making. Conduct patient assessments to identify medical, psychosocial, and logistical needs and develop individualized care plans. Facilitate referrals to surgical teams, gastroenterology, oncology, and supportive services within MedStar Health and the community. Monitor patient progress, follow up on appointments, and address barriers to care to ensure continuity and adherence to treatment plans. Collaborate with multidisciplinary teams including surgeons, nurses, social workers, and other providers to ensure coordinated, patient-centered care. Provide patient education on surgical preparation, postoperative care, disease management, and lifestyle considerations. Maintain accurate documentation in electronic health records (EHR) and track patient outcomes. Support high-risk patients with complex needs, ensuring timely interventions and access to appropriate resources. Participate in quality improvement initiatives, patient satisfaction efforts, and program development to enhance surgical services. Education Bachelor's degree in nursing required Master's degree in nursing preferred Experience Minimum of 2-5 years of clinical nursing experience, in surgical services, oncology, or specialty care required. Experience providing patient education, care coordination, or case management in a healthcare setting required. Familiarity with managing patients undergoing colorectal procedures or complex surgical care. Demonstrated ability to collaborate with multidisciplinary teams, including surgeons, nurses, social workers, and other providers. Experience using electronic health records (EHR) for documentation, care tracking, and outcome monitoring. Prior experience in patient advocacy, navigation, or specialty care coordination is preferred. Licensure & Certifications Active, unencumbered Registered Nurse (RN) license in the state of practice is required. Current Basic Life Support (BLS) certification from the American Heart Association (AHA) is required. Advanced Cardiac Life Support (ACLS) certification preferred but not required. Certification in care coordination, case management (CCM, ACM), or specialty nursing (e.g., Surgical Nursing Certification) is a plus. Experience or certification in patient navigation or specialty care management is desirable. This position has a hiring range of : USD $87,318.00 - USD $157,289.00 /Yr. d24ad0b8-823f-4e68-a892-2986ccdf7392

Sign-On Bonus Available & Relocation Assistance Available Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Full Time Shift: Nights Work within the nursing process to provide direct nursing care to assigned patients. Serve as a role model to promote a positive work environment and quality patient care. Ensures adherence to Hospital and Departmental Policies and Procedures. Patient care assignment may include; Neonate, Pediatric, Adolescent, Adult and Geriatric age groups. PATIENT CARE - Deliver safe direct care to an assigned group of patients as required * POLICIES - Work within Hospitals, Nursing division and departmental policies * CARE PLAN - Work in collaboration with the healthcare team, implement and document individualized care plans incorporating age specific considerations, including discharge planning and patient/family teaching * upon successful completion of preceptor training assume precepting and evaluation responsibilities of new personnel * EMERGENCY MEASURES - Assist with or institute emergency measures for sudden, adverse developments in patients * MEDICAL RECORDS - Ensure that patient medical records contain necessary information * INQUIRIES - Answer telephones and triage calls as per departmental policy * document and communicate clinical findings * PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols * PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes * PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk * PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner * PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right" Program Graduate Bachelor's Degree Nationally Accredited Nursing Graduate Nursing No minimum experience required Bilingual English/Spanish CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days * RN in NM or as allowed by reciprocal agreement by NM Chemicals, Bio Hazardous Materials req PPE Registered Nurse

**Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Use your skills to make an impact** **Required Qualifications** + Active unrestricted RN license with the ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers **Preferred Qualifications** + Education: BSN or bachelor's degree in a related field + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Alert** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Interview Format - HireVue** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Benefits** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2025 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

Shift: Monday - Friday; 8:30am - 5:00pm EST Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state(s) required. * Multi-state licensure is required if this individual is providing services in multiple states. * For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. * Current and active RN license required in applicable state(s). * Multi-state licensure is required if this individual is providing services in multiple states. Preferred skills, capabilities, and requirements: * Certification as a Case Manager and a BS in a health or human services related field preferred. * Previous OB/NICU experience preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

**Telephonic Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. **Hours:** Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. **_***This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. **How you will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. + Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. + Coordinates internal and external resources to meet identified needs. + Monitors and evaluates effectiveness of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. + Negotiates rates of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management policies and procedures. **Minimum requirements:** + Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted RN license in applicable state(s) required. + Multi-state licensure is required if this individual is providing services in multiple states. _For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states._ **Preferred Capabilities, Skills, and Experiences:** + Certification as a Case Manager preferred. + Ability to talk and type at the same time preferred. + Demonstrate critical thinking skills when interacting with members preferred. + Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred. + Ability to manage, review and respond to emails/instant messages in a timely fashion preferred. + Minimum 2 years' experience in acute care setting preferred. + Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred. + Managed Care experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $76,944 to $126,408 Locations: Colorado, Maryland, Massachusetts, New Jersey, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.