Utilization review nurse jobs in Doylestown, PA

Care Career is seeking a travel nurse RN Case Management for a travel nursing job in Pennington, New Jersey. Job Description & Requirements Specialty: Case Management Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours, days Employment Type: Travel Case managers work to facilitate patient care by assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress. The overall goal for case managers is to improve clinical outcomes, increase patient satisfaction, and promote cost-effectiveness. Care Career Job ID #35176950. Pay package is based on 12 hour shifts and 36.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN Case Manager About Care Career Care Career brings together a portfolio of leading healthcare staffing organizations, each delivering specialized talent solutions across the industry. Wherever you want to go, We Make It Happen. With travel nursing jobs across the country, you can discover the possibilities that create the lifestyle and financial position that you have dreamed of. Care Career is a modern, transparent staffing firm creating the ultimate community of US. Benefits Referral bonus Weekly pay Medical benefits Continuing Education Dental benefits Vision benefits

Prime Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Pennington, New Jersey. Job Description & Requirements Specialty: Case Management Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours Employment Type: Travel About the Position Specialty: RN Case Manager Experience: 1+ year of recent case management or discharge planning experience preferred License: Active State or Compact RN License Certifications: BLS - AHA Must-Have: Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with providers, social workers, and external agencies to ensure timely, efficient, and effective discharge planning and transitions. Supports utilization management and ensures compliance with payer guidelines. Onboarding typically takes 2-4 weeks based on documentation and clearance processes. Requirements Required for Onboarding: Active RN License BLS Prime Staffing Job ID #35176945. Pay package is based on 12 hour shifts and 36.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Case Manager,07:00:00-19:30:00 About Prime Staffing At Prime Staffing, we understand the importance of finding the perfect fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent staffing to our clients, and the most competitive contracts to our workforce. Our experienced team takes the time to get to know both our clients and candidates, their needs, and preferences, to ensure that each placement is a success. We offer a wide range of staffing services including temporary, temp-to-perm, and direct hire placements. Our extensive network of qualified candidates includes nurses, allied healthcare professionals, corporate support professionals and executives.

Full-time Description The Renfrew Center of Philadelphia, offers an unmatched opportunity, in the field of eating disorders, for a Utilization Review Coordinator to work in an environment that changes lives. The Renfrew Center has opportunities for individuals of all backgrounds, that have the desire and passion to foster a positive outcome and impact on our patients' lives. The Renfrew Center's research-based treatment model, for eating disorders, is focused on treating the whole person and helping them lead a rich and fulfilling life. Our commitment to you - We are committed to providing every employee the opportunity for personal and professional development through: 401(k) with company match Healthcare benefits Vacation and sick days Employee referral program Employee discounts to various stores, amusement parks, events, etc. Continuing education (CE) programs and training Advancement opportunities within the organization Position Responsibilities: Complete daily treatment pre-certifications with insurance/managed care companies. Complete daily concurrent reviews with insurance/managed care companies. Understand and present acuity, rationale for continued stay, treatment goals and discharge criteria from a medical record. Be familiar with various managed care companies medical necessity criterion and appropriate application, to guide the concurrent review process. Maintain accurate and complete documentation, including computer documentation. Participate and effectively collaborate with a treatment team as an active team member. Demonstrate an understanding of the functional/developmental age of the individual served. Requirements Education, Competencies and Credentials: Master's degree in Human Services, Psychology, or Social Work required. A minimum of 1-2 years of training/working in a residential or health care facility is required. Previous experience working with eating-disorder patients is highly preferred. Familiarity with psychiatric disorders is required. Hours: 40 hours per week, Monday through Friday. The Renfrew Center provides women with the tools they need to succeed - in recovery and life. Offering a warm, nurturing environment, Renfrew emphasizes respect for the unique psychology of women, the importance of a collaborative, therapeutic relationship, and the belief that every woman needs to actively participate in her growth and recovery. The Renfrew Center - An Equal Employment Opportunity Employer, devoted to diversity, equity, and inclusion.

About us: Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! Competitive compensation Healthcare benefits package that begins on first day of employment 401K retirement plan with company match Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays Up to 6 weeks of parental and bonding leave Hybrid work schedule (3 days in the office, 2 days from home) Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) Tuition reimbursement after 6 months of employment Numerous opportunities for continued training and career advancement And much more! Responsibilities The Utilization Review Nurse's duties will include, but are not limited to: Support internal claims adjusting staff in the review of workers' compensation claims Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone Meet required decision-making timeframes Clearly document all communication and decision-making within our insurance software system Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys Utilize good clinical judgment, careful listening, and critical thinking and assessment skills Track ongoing status of all UR activity so that appropriate turn-around times are met Maintain organized files containing clinical documentation of interactions with all parties of every claim Send appropriate letters on each completed UR Qualifications Active Licensed Practical Nurse and/or Registered Nurse License 1+ years of utilization review experience at a managed care plan or provider organization 2 + years' clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review Excellent oral and written communication skills, including outstanding phone presence Strong interpersonal and conflict resolution skills Experience in a fast-paced, multi-faceted environment The ability to set priorities and work both autonomously and as a team member Well-developed time-management and organization skills Excellent analytical skills Working knowledge of: Microsoft Word, Excel, and Outlook

**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 *************************************************************

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $39.40 - $59.19 Scheduled Weekly Hours: 40 Position Overview Performs chart review of identified patients to identify quality, timeliness and appropriateness of patient care. Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self pay patients, based on appropriate guidelines. Uses these criteria guidelines to screen for appropriateness for inpatient level of care or observation services based on physician certification (physicians H&P, treatment plan, potential risks and basis for expectation of a 2 midnight stay). Refers cases as appropriate, to the UR physician advisor for review and determination. Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis. Performs concurrent and retrospective clinical reviews with various payers, utilizing the appropriate guidelines as demonstrated by compliance with all applicable regulations, policies and timelines. Adheres to CMS guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee. Identifies, develops and implements strategies to reduce length of stay and resource consumption. . Confers proactively with admitting physician to provide coaching on accurate level of care determinations at point of hospital entry. Keeps current on all regulatory changes that affect delivery or reimbursement of acute care services. Uses knowledge of national and local coverage determinations to appropriately advise physicians. Understands and applies federal law regarding the use of Hospital Initiated Notice of Non-Coverage (HINN) and Lifetime Reserve Days letters. Identifies and records consistently any information on any progression of care or patient flow barriers using the Avoidable Days tool in the Utilization software program. Consults with medical staff, care team and case managers as necessary to resolve immediate progression of care barriers through appropriate administrative and medical channels. Engages care team colleagues in collaborative problem solving regarding appropriate utilization of resources. Recognizes and responds appropriately to patient safety and risk factors. Represents Utilization Management at various committees, professional organizations an physician groups as needed. Promotes the use of evidence based protocols and or order sets to influence high quality and cost effective care. Identifies, develops and implements strategies to reduce lengths of stay and resource consumption in the patient population. Participates in performance improvement activities. Promotes medical documentation that accurately reflects findings and interventions, presence of complication or comorbidities, and patient's need for continued stay. Identifies and records episodes of preventable delays or avoidable days due to failure of progression of care processes. Maintains appropriate documentation in the Utilization software system on each patient to include specific information of all resource utilization activities. Participates actively in daily huddles, patient care conferences, and hospitalist or nurse handoff reports to maintain knowledge about intensity of services and the progression of care. Identifies potentially wasteful or misused resources and recommends alternatives if appropriate by analyzing clinical protocols. Maintains related continuing education credits = 15 per calendar year. MINIMUM REQUIREMENTS Education: Minimum of Associate's degree in Nursing. Graduate of an accredited school of nursing. CPHQ, CCM or CPUR preferred. Experience: Three years of clinical nursing or two years quality management, utilization review or discharge planning experience. Other Credentials: Registered Nurse - NJ Knowledge and Skills: Three years of clinical nursing or two years quality management, utilization review or discharge planning experience. CPHQ, CCM or CPUR preferred. Special Training: Basic computer skills including the working knowledge of Microsoft Office, UR software and EMR. Possesses familiarity with MCG guidelines. Mental, Behavioral and Emotional Abilities: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Usual Work Day: 8 Hours PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Sitting , Standing , Walking Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Keyboard use/repetitive motion , Talk or Hear Continuous physical demands include: Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 5 lbs. Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: N/A This position is eligible for the following benefits: Medical Plan Prescription drug coverage & In-House Employee Pharmacy Dental Plan Vision Plan Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA Retirement Savings and Investment Plan Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Supplemental Group Term Life & Accidental Death & Dismemberment Insurance Disability Benefits - Long Term Disability (LTD) Disability Benefits - Short Term Disability (STD) Employee Assistance Program Commuter Transit Commuter Parking Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child Voluntary Legal Services Voluntary Accident, Critical Illness and Hospital Indemnity Insurance Voluntary Identity Theft Insurance Voluntary Pet Insurance Paid Time-Off Program The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description • Evaluate clinical information submitted by providers against plan review criteria and benefit guidelines • Utilize clinical information to determine if criteria for medical necessity and benefit guidelines are met • Document pertinent case information for approvals and denials- refer cases failing to meet Interqual to Medical Director • Act as liaison to ensure services are provided in the least restrictive, most cost effective and clinically appropriate setting • ID and resolve problems that could interfere with provider's continuity and coordination of care of members- refer unresolved problems to the manager Qualifications • Clear and active RN license in state of PA • Minimum AS in nursing • 2 years' experience in acute care hospital AND • 2 years' experience in managed care, quality assurance or utilization review setting Additional Information Hours for this Position: 40 hours a week M-F, daytime hours Advantages of this Opportunity: • Competitive salary, negotiable based on relevant experience • Benefits offered, Medical, Dental, and Vision • Fun and positive work environment • Right to Hire opportunity • Can start as early as next week Interested in being considered? If you are interested in applying to this position, please contact Steph Zymowski at 407-636-7030 ext.220 and click the Green I'm Interested Button to email your resume.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

**his position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. 2. Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided. 3. Coordinates and assists in implementation of plan for members. 4. Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. 5. Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care. 6. Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. 7. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. 8. Encourages member participation and compliance in the case/disease management program efforts. 9. Documents accurately and comprehensively based on the standards of practice and current organization policies. 10. Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care. 11. Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes. 12. Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes. 13. Completes other assigned functions as requested by management. Core Individual Contributor Competencies. Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus, Accountable, Learn, Communicate. **Qualifications:** **Education/Experience** 1. Requires an associate's or bachelor's degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school. 2. Requires a minimum of two (2) years clinical experience. **Additional licensing, certifications, registrations:** 1. Requires an active New Jersey Registered Nurse License. **Knowledge:** - Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications. - Prefers working knowledge of case/care management principles. - Prefers working knowledge of principles of utilization management. - Prefers basic knowledge of health care contracts and benefit eligibility requirements. - Prefers knowledge of hospital structures and payment systems. **Skills and Abilities:** - Analytical - Compassion - Interpersonal & Client Relationship Skills - Judgment - Listening - Planning/Priority Setting - Problem Solving - Team Player - Time Management - Written/Oral Communication & Organizational Skills **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** . US Tech Solutions is 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, or status as a protected veteran.

Job Description Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations. The building B.L.O.C.K.S. of our team's success! Bring the fun Leverage together for better Outperform yourself Care at every touchpoint Keep your word. Keep it real Stay curious & listen well Primary Purpose: We are proud of the quality care we provide members and our team is rapidly expanding to meet the demands of our growing business; we are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at risk populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. This role is 1099 (PRN) and offers tremendous flexibility and opportunity for those who are balancing competing priorities. Learn more about our primary purpose here Follow us on LinkedIn: ****************************************** NP Responsibilities: Perform annual in-home wellness visits and risk adjustment health assessments on a population with chronic conditions; Our thorough evaluations include: a comprehensive assessment, physical examination, body system review, vital signs, review of medication history, review of current prescriptions, review of member functional status, pain management, cognitive assessment, review of the home environment, fall risk screening, social assessment, review of daily living activities, mental health screening, documentation and communication You will play a pivotal role in providing individualized quality care to the elderly population in their homes Deliver patient health education on topics such as pain management, medication, etc. Build relationships of trust with members through exceptional communication and empathy Assist in closing quality care gaps (i.e. screenings and labs) An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Mercer County, NJ Requirements NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in This role requires travel within the assigned job posting county up to a maximum 55-mile radius Previous in-home risk assessment experience preferred Previous 1099 (PRN) experience is preferred but not required 3 years patient care experience preferred (primary care/adult/geriatric, EMR) May be requested to obtain additional NP licensure supported by Advantmed Access to reliable transportation that will enable you to travel to member's homes within a designated area Strong ability to work within our EMR system Ability to work independently Bilingual is a plus Benefits Advantmed offers: Competitive compensation of ~$100 per completed in-home health assessment Paid mileage Flexible work schedule Evening and weekend availability Never on-call Visits ready to be scheduled immediately Appointment confirmation support Dedicated coordinator support Advanced member scheduling coverage State of art technology

HealthPlus Staffing is seeking a Nurse Case Manager in Philadelphia, PA. The Case Manager will provide help to pregnant women and children in getting the health care and social services needed. Job Requirements: Bachelor's degree with major course work in sociology, social work, social welfare, psychology, gerontology, anthropology, other related social sciences, criminal justice, theology, nursing, healthcare administration, counseling, or education or Registered Nurse Licensed Practical Nurse or Certified Nurse Assistant (CNA) or Medical Assistant plus two (2) years of mental health direct care experience. Individuals using these criteria must receive a written waiver from the DBHIDS prior to hire. Must have Active nurse License in the state of Illinois Compensation: Commensurate on experience Benefits: Full Benefits Pediatrics Schedule: Monday to Friday Location: Philadelphia, PA Reliably commute or planning to relocate before starting work (Required) Education: Bachelor's (Preferred) Experience: Nursing: 1 year (Preferred) For more info please reach out to us at Recruitment@HealthPlusStaffing.com or call at 561-291-7787

Job Description Hospice Nurse Case Manager Full-time | Philadelphia, PA | Monday-Friday with occasional on-call rotation We are seeking a compassionate and experienced Hospice Nurse Case Manager to join a dedicated interdisciplinary team providing high-quality end-of-life care to patient's in their residence. The ideal candidate is a skilled clinician who thrives on building strong relationships with patients and families, coordinating care plans, and ensuring that each individual's final journey is met with dignity, comfort, and compassion. You'll be joining a passionate teams of physicians, NPs, chaplains, social workers, and aides. Responsibilities: Manage a caseload of hospice patients, conducting comprehensive assessments and developing individualized care plans. Provide direct skilled nursing care and education to patients and caregivers in the home setting. Coordinate care with physicians, social workers, chaplains, and other members of the hospice team to ensure holistic, patient-centered care. Monitor patient status and adjust care plans as needed to maintain optimal comfort and symptom management. Document assessments, interventions, and communications in accordance with state, federal, and agency guidelines. Serve as a clinical resource and advocate for patients and families, ensuring their physical, emotional, and spiritual needs are met. Participate in regular interdisciplinary team meetings and case conferences. Rotate in after-hours or weekend on-call coverage as assigned. Qualifications: Current Registered Nurse (RN) license in the state of Pennsylvania Minimum of 1-2 years of hospice or home health nursing experience strongly preferred. Strong clinical assessment, communication, and organizational skills. Empathetic, patient-centered approach with the ability to support families during emotionally challenging times. Valid driver's license, reliable transportation Benefits: Competitive salary and mileage reimbursement Comprehensive health, dental, and vision insurance Paid time off and retirement plan options Ongoing training and professional development opportunities Supportive and collaborative work environment

As our community evolves, so does the need for compassionate care. If your position was recently impacted, Greater Philadelphia Health Action, Inc., invites you to continue your mission of service with us. Founded in 1970 as South Philadelphia Health Action and subsequently incorporated as Greater Philadelphia Health Action, GPHA is a non-profit healthcare organization with a commitment to provide compassionate and affordable healthcare services regardless of an individual's ability to pay. Since 1970, GPHA has expanded to become one of the premier providers of primary and behavioral healthcare in the Greater Philadelphia area. GPHA offers GREAT PAY, Performance BONUSES, Comprehensive Medical, Dental, Vision, Life, and LTD Insurance. We also offer 401k with a very lucrative company match, Employee Assistance and Self-Care, and Professional Activity, Educational, and Tuition Reimbursements, Paid Vacation, Paid Sick, Paid Personal Days, Paid Educational Days, Holiday Pay, Loan Forgiveness, and Free Malpractice Insurance. We are presently seeking full-time Registered Nurses (RN's) in our Medical Division. These positions offer potential for clinical and managerial professional growth. Qualified candidates have: Graduated from an accredited program in nursing; Active, licenses as an RNs in the Commonwealth of Pennsylvania; At least two (2) years clinical experience in an ambulatory setting preferred, OB/GYN experience a plus; Current CPR certification; Creativity; Experience in working with diverse populations; Good oral and written skills; Foreign language skills (Chinese, French, Spanish skills a plus). GPHA RNs: Utilize clinical judgment to increase access to care and maximize clinical outcomes; Coordinate patient flow and service provision so that clinical and productivity objectives are met and/or exceeded; Perform timely and accurate assessment and assignment of “walk-in” and appointment patients according to policy document; Provide direct clinical services in accordance with Nursing Protocols, Clinical Policies and Procedures and other departmental/ corporate policy, procedure and protocol manuals; Obtain complete age/gender-appropriate patient histories; Coordinate office visit preparation for patients with complex needs; Provide counseling and health education to patients and their families according to need, provider orders or patient request, including but not limited to pre- and post-HIV antibody test counseling and HIV related medication adherence assessment/counseling, prenatal education and smoking cessation; Assess completeness of care; Work collaboratively with providers, allied health and support staff to ensure treatment plans are implemented Join a network that values dedication, balance, and purpose. At Greater Philadelphia Health Action, Inc. (GPHA), we respect diversity and promote equity through action, advocacy, and policy through a dedicated team of representatives committed to listening, learning, and enacting systemic change. We create different channels, outlets, and programs to enhance safe spaces within GPHA, creating a shared understanding and language around justice, diversity, equity, and inclusion. GPHA is an Equal Opportunity Employer. GPHA does not and will not discriminate in employment and personnel practices to include hiring, transferring and promotion practices on the basis of race, color, sex, age, handicap, disability, religion, religious creed, ancestry, national origin, or any other basis prohibited by applicable law.

Job Description Pay: $80,000.00 - $115,000.00 per year Accela Post Acute Care at Hamilton is currently seeking a dedicated and experienced MDS Nurse to join our team on a full-time, onsite basis. Located on a hospital campus, our 55-bed facility specializes exclusively in short-term rehabilitation and skilled nursing care. We offer a supportive and collaborative work environment, led by a committed management team focused on clinical excellence and staff well-being. Position Highlights: No floor nursing responsibilities Manager-on-duty rotation only once every 6-8 weeks Supportive interdisciplinary team Competitive work environment focused on quality outcomes Previous experience is required Key Responsibilities: Complete and submit MDS assessments timely and accurately under the PDPM reimbursement model Collaborate with interdisciplinary team members to improve coding accuracy, documentation quality, and workflow efficiency Identify barriers to performance improvement affecting quality measures, Five-Star ratings, and reimbursement Provide staff education on RAI process best practices and compliance Analyze clinical data and KPIs to monitor success and address areas needing improvement Conduct audits of assessments and documentation to ensure regulatory compliance Support the facility in maintaining excellence in care outcomes and survey readiness Qualifications: Current New Jersey RN or LPN license (required) MDS experience under the PDPM model (required) RAC-CT certification (preferred) Strong understanding of Medicare and Medicaid reimbursement systems Proficiency with Microsoft Office and electronic medical records Exceptional attention to detail and organizational skills Strong communication and collaboration skills Ability to work independently and as part of a team in a fast-paced environment Why Join Us? Supportive leadership and team culture Opportunities for professional growth and continuing education Competitive salary and benefits package If you're an experienced MDS nurse passionate about clinical documentation, reimbursement integrity, and quality resident care - we'd love to hear from you! Apply today to join our dedicated team at Accela Post Acute Care at Hamilton. #IND1

Clinical Nurse Review Coordinator is remote. REQUIRED - active nursing license; Resides in a PST location National Medical Reviews, Inc. (NMR) is looking for a licensed RN for a full-time salaried position Monday-Friday for medical record review. National Medical Reviews, Inc. (NMR) is an URAC accredited Independent Review Organization. NMR's mission is to provide high-quality, objective, independent and expedient medical review services. The core business of NMR is providing independent medical reviews for all types of benefit disputes and quality of care issues in both the medical management and workers' compensation settings. NMR provides expedient, unbiased, and expert opinions in a full range of utilization review services for both medical/surgical and behavioral health coverage addressing adverse determinations at the first, second and third level of review, as well as initial determinations. These reviews include issues pertaining to medical necessity, experimental / investigational, administrative and quality of care concerns (for fraud, waste and abuse). The role of the Nurse Review Coordinator (RC) is to coordinate the case review process. The RC will work with our administrative staff and panel of physician peer reviewers to answer the questions posed by our clients. The RC is responsible for the quality review of the physician's report. We need your clinical knowledge - do not worry about the process. We will teach you that! This position is hybrid. 1 hybrid position available now. Responsibilities: Collaborate telephonically and electronically with industry professionals (case managers, appeals coordinators, physician reviewers etc.) Summarize and produce well-written reports Interact with clients and resources throughout the United States Coordinate with non clinical administrative support staff to ensure quality and strict timelines are maintained Requirements: Utilization Review / Utilization Management experience Resides in a PST location Broad clinical background Excellent written and verbal communication skills Computer proficiency using Microsoft Office (Word, Excel, Access) Highly organized Sharp attention to detail Education & Background Current Registered Nurse (RN) license A minimum of five (5) years of clinical experience involving direct patient care NMR provides a supportive, team-oriented work environment with an ongoing mentoring process. Training on medical records review and appeals procedures is provided.' ' Benefits: Health insurance Dental insurance Vision insurance Retirement plan Paid time off This Company Describes Its Culture as: People-oriented -- supportive and fairness-focused Team-oriented -- cooperative and collaborative Relocation Assistance Provided: No Schedule: Monday to Friday This Job Is Ideal for Someone Who Is: Dependable -- more reliable than spontaneous Detail-oriented -- would rather focus on the details of work than the bigger picture High stress tolerance -- thrives in a high-pressure environment Job Type: Full-time Salary: $60-65,000.00 per year Benefits: 401(k) Dental insurance Disability insurance Employee assistance program Health insurance Life insurance Paid time off Vision insurance Schedule: 8 hour shift Day shift Monday to Friday License/Certification: RN or LPN license (Required) Work Location: Remote in Warminster, PA 18974

At International SOS, we are in the business of protecting and saving lives. For 40 years, we have delivered customised security risk management, health, and wellbeing solutions to organisations worldwide. With a presence in 90 countries and a team of nearly 13,000 experts, we provide 24/7 support to help organisations fulfil their Duty of Care responsibilities. Now, we're looking for talented individuals to join our team and make a difference. Description: The Coordinating Nurse (CN) will be responsible for the delivery of high professional standards, best practice standards and effective medical assistance services for all clients of International SOS. The CN provides nursing support to the 24 hour Assistance Centre (AC) combined with coordinating medical evacuations working collaboratively with the operations, security and other medical team members throughout the world. SHIFT: 3x13 hour or 4x10 hour NO OVERNIGHT SHIFT Onsite: Office in Blue Bell, PA Essential Job Duties and Responsibilities: Provide professional telephonic nursing consultations and referrals to patients. Monitor the appropriateness of medical treatment and care provided. Understand and manage different case types confidently. Obtain medical reports from treating doctors to coordinate patient needs. Monitor medical aspects of evacuations and repatriations, including assessing the necessity and means of evacuation. Complete medical documentation accurately and timely. Assess cases based on medical elements, acuity, and geographical location to facilitate appropriate medical assistance. Maintain open communication with medical and operational team members. Document patient case notes and details in the electronic case management system. Update medical actions on cases and ensure proper handover to the next shift. Understand clients' contractual agreements and assist non-medical staff with relevant referrals. Adhere to International SOS internal policies and procedures. Required Skills and Knowledge Proficiency in Microsoft Word, typing, computer and communication skills Good global geographical knowledge preferred Required Competencies US Registered Nursing License (current) BLS certification (current) - Required ACLS certification (current) - Required PALS (current) - Preferred Required Work Experience Three years of recent inpatient clinical experience By joining International SOS, you will contribute to a global network dedicated to protecting people and organisations. We offer a dynamic and respectful workplace where expertise, innovation, and collaboration drive our success. 13,000 experts | 1,200+ locations | 90 countries | 110+ languages Start your journey with us today. Apply now!

Company DescriptionJobs for Humanity is partnering with Cooper University Health Care to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located. Company Name: Cooper University Health Care Job Description About us At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to its employees by providing competitive rates and compensation, a comprehensive employee benefits programs, attractive working conditions, and the chance to build and explore a career opportunity by offering professional development. Discover why Cooper University Health Care is the employer of choice in South Jersey. Short Description Clinical application of the knowledge and skill in the following areas: Pharmacology, principals and application of chemotherapy administration, side effects and appropriate nursing intervention, chemotherapy, liaison for patients/families receiving treatment. Evaluates patients in need of intravenous treatment or medication and plans, implements and documents nursing care. Determines appropriate venipuncture site and administers intravenous therapeutic treatments, which includes chemotherapy/biotherapy, blood components, fluid and electrolyte replacements, and other oncology treatments as prescribed. Provides information and education to patients and families regarding intravenous treatment and/or side effect management. Experience Required 3 years of oncology experience preferred. Education Requirements BSN; Graduate of NLN accredited School of Nursing. License/Certification Requirements Current NJ-RN License (Registered Nurse); Curretn NJ-BLS Certification (Basic Life Support) Oncology Nursing Society Chemotherapy/Biotherapy certification (ONS ONCC) within 8 weeks of hire.

Job Description NP (Ortho Focus) - $103K-$153K in the Philadelphia Suburbs Join a leading orthopedic team in Chester County where clinical excellence and lifestyle meet. This full-time Nurse Practitioner role features a weekday schedule, income potential near $150K, and the freedom to enjoy evenings and weekends off. You'll become part of a physician-led practice that values collaboration, patient education, and quality outcomes. With high pay, comprehensive insurance coverage, and a 401(k) match, this role provides both financial and professional rewards. Experience a setting that prioritizes your success while giving you time to enjoy the community you serve. Please apply here to be considered by the hiring manager. Kindly respond with a resume. For further details and next steps, please contact Sean at ************** or email ************************. You may also reach Van Kalman at ************** ext. 102 or email ******************************. We will be happy to assist you.

$50 per hour and a wonderful work environment. Please send resume, and letter of application via email to ***************