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  • Utilization Management Appeals Nurse

    Humana 4.8company rating

    Utilization review nurse job in Jefferson City, MO

    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The Nurse reviews the medical documentation, researching claims, benefits, as well as prior determinations pertinent to the appeal and provides a written summary of findings using a template for each case. The associate will be working and collaborating with Humana CIT teams, Vendors, G&A specialists, and Humana Medical Directors on submitted G&A cases. The G&A Nurse will participate in initiatives which result in improved member outcomes, operational efficiencies, and process improvement opportunities. + Case preparation of Medicare and/or Duals line of businessinvolving expedited, pre-service and post serviceappeals + Apply and implement Medicare, Medicaid,MCG, claims policy and evidence of coverage guidelines for reviews + Perform outreach to providers and/or members + Utilize multiple systems such as MHK, CGX, MRM, SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action + 3 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting or broad clinical nursing experience + Comprehensive knowledge of Microsoft Word, Outlook and Excel + Strong organizational and effective time management skills + Ability to work independently under general instructions and with a team **Preferred Qualifications** + Bachelor's degree (BSN) + Appeal Review Experience + Knowledge of MHK + Previous Medicare/Medicaid Experience + Previous experience in utilization management + Previous claims experience **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 + Associates 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 associates 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 **Additional Information** + Hours are Monday-Friday 9am-6pm EST with a weekend rotation (Your 8-hour shift will fall within this timeframe) + Candidate's must also commit to working on the holidays as needed + This is a remote position, but all candidates must work in the Eastern Standard Time Zone (EST) 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: 01-21-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **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. 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 ***************************************************************************
    $71.1k-97.8k yearly 2d ago
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  • Utilization Management Nurse

    Centerwell

    Utilization review nurse job in Jefferson City, MO

    **Become a part of our caring community and help us put health first** Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. 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. **Preferred Locations:** Daytona, FL, Louisville, KY, San Antonio, TX **Use your skills to make an impact** **Role Essentials** + Active Unrestricted RN license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Valid driver's license and/or dependable transportation necessary + Travel for offsite Orientation 2 to 8 weeks + Travel to offsite meetings up to 6 times a year as requested + 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 + Available for On Call weekend/holiday rotation if needed **Role Desirables** + Education: BSN or bachelor's degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Additional Information** We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, 3 weeks paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more. 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 required; 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. 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: 02-18-2026 **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 *************************************************************
    $71.1k-97.8k yearly 3d ago
  • Nurse Residential (Weekdays)

    Compass Health Network 4.0company rating

    Utilization review nurse job in Jefferson City, MO

    Department Residential Services - Adult Employment Type Full Time Location Jefferson City - Shawn Drive Workplace type Onsite Compensation $36.00 - $44.00 / hour Key Responsibilities Requirements, Skills, Knowledge and Expertise About Compass Health Network About Compass Health Network Compass Health Network is a nonprofit organization dedicated to delivering accessible, high-quality care throughout Missouri. We provide a comprehensive range of integrated services, including behavioral health, substance use treatment, primary care, and dental care. As both a Federally Qualified Health Center (FQHC) and a Community Mental Health Center (CMHC), Compass Health is uniquely positioned to meet the complex and evolving needs of the communities we serve.Our network includes Royal Oaks Hospital and Adapt of Missouri, allowing us to expand our impact and reach across the state. Each part of our organization contributes to our mission: Inspire Hope. Promote Wellness. Adapt of Missouri, a subsidiary of Compass Health Network, has been serving the St. Louis metropolitan area since 1982. While Adapt operates as a for-profit organization, it shares our commitment to providing high-quality, person-centered mental health services. Adapt specializes in community-based support for adults with mental health conditions, focusing on recovery-oriented services such as psychosocial rehabilitation and case management that foster independence and meaningful community engagement. Royal Oaks Hospital serves all acute behavioral health care inpatient needs for children and adolescents 24 hours a day, 7 days a week. Our multi-disciplinary team continually strives to set the standards in patient safety and are committed to providing the highest quality of care. Royal Oaks Hospital believes in the health and wellbeing of our patients and it shows in the care they receive each and every day. Why Join Us?Whether you're joining Compass Health Network or Adapt of Missouri, you'll become part of a dedicated, mission-driven team committed to transforming lives through compassionate, innovative care. We foster a supportive, collaborative environment where your work is valued and your professional growth is encouraged.We offer: Competitive Benefits Opportunities for career advancement Personal and professional development Licensure supervision Tuition reimbursement & scholarships Employee Assistance Program (EAP) Wellness program with Xponential access Generous paid time off and holidays National Health Service Corp loan repayment eligibility* *Please note: While Compass Health Network is eligible for the National Health Service Corps (NHSC) Loan Repayment Program, positions with Adapt of Missouri are not eligible due to its for-profit status. Your Career, Your ImpactWhether you're beginning your career or looking to take the next step, you'll find purpose and opportunity with us. Join a team where your skills and compassion make a meaningful impact-every single day. Ready to make a difference? We'd love to hear from you! Equal Opportunity Statement Compass Health Network is an Equal Opportunity/Affirmative Action Employer and an E-Verify participant.
    $36-44 hourly 12d ago
  • Travel Nurse - Telemetry in Jefferson City, Missouri - $10986/month

    Vetted Health

    Utilization review nurse job in Jefferson City, MO

    This temporary travel nurse position in Jefferson City, Missouri, requires at least two years of telemetry nursing experience and a Missouri RN license. The role involves coordinating patient care, teaching patients and families, and collaborating with healthcare teams in an adult-geriatric setting. The position offers a competitive salary, benefits including travel and housing, and flexible scheduling for a 13-week contract. Job Opportunity: RN - Telemetry Position Details Specialty: RN - Telemetry Location: Jefferson City, Missouri Facility: Atlas MedStaff Employment Type: Temporary Contract Length: 13 weeks Job Description Coordinates total nursing care for patients. Participates in patient and family teaching. Provides leadership by working cooperatively with ancillary nursing and other patient team personnel. Maintains standards for professional nursing practice in the clinical setting. Patient Population: Adult-Geriatric Requirements Experience: 2+ years of RN - Telemetry experience required. Travel healthcare experience preferred. Strong clinical skills and patient care abilities. Licensing: Missouri state license required. Current BLS certification required. Additional certifications may be required based on specialty. Transportation: Candidate must have reliable transportation for travel assignments. Additional Information Scheduling: Work 48 hours per week with 10-hour shifts. Contract start date: December 01, 2025. Competitive monthly compensation: $10986. Benefits: Travel and housing provided. Health insurance and 401(k) matching. Professional development opportunities. Flexible scheduling options. Compliance: All medical/occupational health compliance items must be completed within 5 days of offer acceptance. Background check and drug screening required. Apply now to join our team of travel healthcare professionals! Keywords: travel nurse, telemetry nurse, RN telemetry, Missouri nursing jobs, registered nurse, telemetry patient care, travel healthcare, nursing contract, adult geriatric nursing
    $11k monthly 1d ago
  • Youth Residential Nurse

    Brightli

    Utilization review nurse job in Jefferson City, MO

    Job Title: Youth Residential Nurse Department: Residential Services Employment Type: Full-time The Registered Nurse is responsible for monitoring the safety and well-being of persons served in the IDD (Intellectual and Developmental Disabilities) residential services program. Position Perks & Benefits $1,000 SIGN ON BONUS 29 Days of PTO Eligibility for HRSA Loan Repayment ( subject to requirements ) Comprehensive benefits package: health, dental, vision, retirement, life insurance & more Competitive 401(k) Retirement Savings Plan - up to 5% match Company-paid basic life insurance Emergency Medical Leave Program Flexible Spending Accounts - healthcare and dependent care Health & Wellness Program Employee Assistance Program (EAP) Employee Discount Program Mileage Reimbursement ( if applicable ) Essential Job Functions: Conducts and documents (in Therapy) monthly head to toe assessments of each residential client in their home. Maintains communication with agency management and the client's support team including reporting and documenting all changes in client's health status and needs, consulting with supervisors regarding emergent care and acute medical needs. Ensures needs for staff supervision/delegation or specialized instruction are conducted and documented on the designation form (Delegation of Specialized Nursing Tasks). Accountability and documentation for Activities dedicated to functions of Residential RN each month including: Completion of the Monthly Service Log which details time spent performing Residential RN functions each month. Ensuring annual authorized units are delivered and documented. Completion of Residential RN Orientation Training as provided by local Department of Mental Health (DMH) Regional Offices and ongoing additional training that affects Residential RN program as required by DMH. Completes Abnormal Involuntary Movement Scale (AIMS) every 3 to 6 months (or more often if needed) for clients at risk of developing tardive dyskinesia (TD). If assigned, attends Level 1 Med Aide Instructor's class as provided by the Department of Health and Senior Services and provides Level 1 Med Aide training according to contractual requirements to employees as requested by the Regional Director. If assigned, completes Health Risk Screening Tool (HRST) duties including: completing HRST training through DMH, initial evaluation and completion of Health Risk Screening Tool for each residential client, maintain Electronic Medical Record in DMH database system for all residential clients, attend Individual Support Plan meetings for residential clients, attend transition and discharge meetings from hospitals, rehabilitation facilities, nursing homes, etc. Assists Regional Director (RD) in responding to HIPS (Health Identification and Planning System) Reviews, Mortality Reviews and other Nursing Reviews by the Regional Office in a timely manner that meets contractual guidelines. Adheres to PFH Policy and Procedure. Acts as an advocate for persons served. Completes other duties as assigned. Knowledge, Skills, and Abilities: Ability to operate calmly in a crisis, relate positively to funding sources, employees, those we serve, families and the medical community. Good verbal and written communication skills. Maintain a positive attitude when working with others. Experience and Education Qualifications: Must be a currently registered, licensed registered nurse in the State of Missouri Employment Requirements: Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check. Completion of New Hire Orientation at the beginning of employment. All training requirements including Relias at the beginning of employment and annually thereafter. Current driver's license, acceptable driving record and current auto insurance. Must have and maintain current Missouri license as RN as well as maintain good standing. Must have current certification in CPR and First Aid. Physical Requirements: ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up the 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met. Position Perks & Benefits: Paid time off: full-time employees receive an attractive time off package to balance your work and personal life Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more Top-notch training: initial, ongoing, comprehensive, and supportive Career mobility: advancement opportunities/promoting from within Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness Brightli is on a Mission: A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients. As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace. We are an Equal Employment Opportunity Employer. Preferred Family Health Care is a Smoke and Tobacco Free Workplace.
    $36k-56k yearly est. Auto-Apply 14d ago
  • Appeals Nurse

    Evolent 4.6company rating

    Utilization review nurse job in Jefferson City, MO

    **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures while complying with timeliness guidelines. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes for the Clients and Members we serve. **Collaboration Opportunities:** The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for collaboration include all-team and individual team meetings, Teams chats, and monthly communication on team metrics and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with other departments to satisfactorily resolve issues related to appeals and retrospective reviews. + Provides optimum customer service through professional and accurate communication while maintaining accreditation and health plan's required timeframes. + Refers cases to appropriate internal reviewers according to the business needs of the particular health plan. + Reviews requests for Urgent appeals compared to expedited criteria for downgrade to Standard processing, documenting accordingly. + Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals. + Other duties as assigned. **Qualifications Required and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality improvement environment- **Required** + Able to work in a rotation to work 10:30am to 7pm CST (which includes 30-minute unpaid lunch break) 3 days/week, to meet the business needs of nurses providing coverage until 7:00pm CST. - **Required** + Must be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate through internal and external computer systems. Working knowledge of Microsoft Office Product Suit - **Preferred** + Strong organizational and effective time management skills; demonstrated ability to manage multiple priorities. - **Preferred** + Outstanding interpersonal and negotiation skills to effectively establish positive relationships both internally and externally, including strong written and verbal communication skills. - **Preferred** To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. **Technical Requirements:** We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. **Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ************************** **for further assistance.** The expected base salary/wage range for this position is $37- $42/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!
    $37-42 hourly 60d+ ago
  • Youth Residential Nurse

    Burrell Behavioral Health 4.5company rating

    Utilization review nurse job in Jefferson City, MO

    Job Title: Youth Residential Nurse Department: Residential Services Employment Type: Full-time The Registered Nurse is responsible for monitoring the safety and well-being of persons served in the IDD (Intellectual and Developmental Disabilities) residential services program. Position Perks & Benefits * $1,000 SIGN ON BONUS * 29 Days of PTO * Eligibility for HRSA Loan Repayment (subject to requirements) * Comprehensive benefits package: health, dental, vision, retirement, life insurance & more * Competitive 401(k) Retirement Savings Plan - up to 5% match * Company-paid basic life insurance * Emergency Medical Leave Program * Flexible Spending Accounts - healthcare and dependent care * Health & Wellness Program * Employee Assistance Program (EAP) * Employee Discount Program * Mileage Reimbursement (if applicable) Essential Job Functions: * Conducts and documents (in Therapy) monthly head to toe assessments of each residential client in their home. * Maintains communication with agency management and the client's support team including reporting and documenting all changes in client's health status and needs, consulting with supervisors regarding emergent care and acute medical needs. * Ensures needs for staff supervision/delegation or specialized instruction are conducted and documented on the designation form (Delegation of Specialized Nursing Tasks). * Accountability and documentation for Activities dedicated to functions of Residential RN each month including: * Completion of the Monthly Service Log which details time spent performing Residential RN functions each month. * Ensuring annual authorized units are delivered and documented. * Completion of Residential RN Orientation Training as provided by local Department of Mental Health (DMH) Regional Offices and ongoing additional training that affects Residential RN program as required by DMH. * Completes Abnormal Involuntary Movement Scale (AIMS) every 3 to 6 months (or more often if needed) for clients at risk of developing tardive dyskinesia (TD). * If assigned, attends Level 1 Med Aide Instructor's class as provided by the Department of Health and Senior Services and provides Level 1 Med Aide training according to contractual requirements to employees as requested by the Regional Director. * If assigned, completes Health Risk Screening Tool (HRST) duties including: * completing HRST training through DMH, * initial evaluation and completion of Health Risk Screening Tool for each residential client, * maintain Electronic Medical Record in DMH database system for all residential clients, * attend Individual Support Plan meetings for residential clients, * attend transition and discharge meetings from hospitals, rehabilitation facilities, nursing homes, etc. * Assists Regional Director (RD) in responding to HIPS (Health Identification and Planning System) Reviews, Mortality Reviews and other Nursing Reviews by the Regional Office in a timely manner that meets contractual guidelines. * Adheres to PFH Policy and Procedure. * Acts as an advocate for persons served. * Completes other duties as assigned. Knowledge, Skills, and Abilities: * Ability to operate calmly in a crisis, relate positively to funding sources, employees, those we serve, families and the medical community. * Good verbal and written communication skills. * Maintain a positive attitude when working with others. Experience and Education Qualifications: * Must be a currently registered, licensed registered nurse in the State of Missouri Employment Requirements: * Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check. * Completion of New Hire Orientation at the beginning of employment. * All training requirements including Relias at the beginning of employment and annually thereafter. * Current driver's license, acceptable driving record and current auto insurance. * Must have and maintain current Missouri license as RN as well as maintain good standing. * Must have current certification in CPR and First Aid. Physical Requirements: ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up the 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met. Position Perks & Benefits: Paid time off: full-time employees receive an attractive time off package to balance your work and personal life Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more Top-notch training: initial, ongoing, comprehensive, and supportive Career mobility: advancement opportunities/promoting from within Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness Brightli is on a Mission: A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients. As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace. We are an Equal Employment Opportunity Employer. Preferred Family Health Care is a Smoke and Tobacco Free Workplace.
    $35k-51k yearly est. Auto-Apply 28d ago
  • Graduate Nurse

    SSM Health 4.7company rating

    Utilization review nurse job in Jefferson City, MO

    **It's more than a career, it's a calling** MO-SSM Health St. Mary's Hospital - Jefferson City **Worker Type:** Regular **Job Highlights:** Being a nurse is more than a job, it's a calling. That is why SSM Health wants to invest in your future. As a new graduate nurse hired with SSM Health, you will participate in the SSM Health Nurse Residency Program. This will allow you to connect and learn from other graduate nurses across the system as you work to enhance your confidence, knowledge, and practical skill. The residency program is designed to complement your education and support your continued professional growth. The nurse residency program classes consists of monthly four-hour virtual sessions held over a twelve-month period. **Eligibility:** - Graduate of an accredited nursing program - Eligible to practice as determined by State Board of Nursing - One year experience or less working as an RN **Sign-on Bonus:** $7,500 (paid on the first paycheck) **Schedule Options:** FT **Schedule Time Options:** 7a-7p, 7p-7a **Benefits** : Competitive, affordable health insurance including but not limited to: + Getting paid every day! + Access up to $5,250 in tuition coverage per year + Paid maternity & paternity coverage + Adoption assistance + Various competitive health insurance options & wellness plans + Retirement benefits including employer matching plans + Long & short-term disability + Employee assistance programs (EAP) *Please note, benefits and eligibility can vary by position, exclusions may apply. \#CoreHire **Job Summary:** Pre-licensure graduate of an accredited nursing program who actively participates in SSM Health New Graduate Nurse Residency Program. Under the direction of RN, provides care to patients within scope of role and professional standards. Responsible for the delivery of age appropriate care for assigned patients with a wide variety of medical conditions. Nurse Residents in the state of Oklahoma can perform responsibilities designated below (Oklahoma). Nurse Residents in Wisconsin, Illinois and Missouri can perform all responsibilities listed. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Under the direction of the RN Preceptor: + Performs delegated tasks based on demonstrated competence in performing nursing care activities for population served. Delegated specialized tasks may include anything for which training was received in the approved nursing program. In the state of Oklahoma, this does not include tasks/skills which must be performed by a licensed nurse. + Performs patient assessments including biophysical, psychosocial, spiritual, cultural, and age appropriate needs of the patients, including the assessment of nutrition, pain management, and signs/symptoms of abuse or neglect in order to develop, evaluate and modify patient's plan of care. + Develops a realistic, comprehensive patient family education plan, using appropriate resources and methods of instruction and provides patient/family health education and coaching. + Completes accurate and timely documentation (Oklahoma), including, but not limited to, the processing of physician orders, in accordance with policies and procedures. Monitors and evaluates delivery of nursing care given by team members based on patient needs and professional judgement. + Collaborates with physicians and other health care professionals regarding all aspects of patient care. + Participates in training to understand and perform patient care. (Oklahoma) + Completes competency requirements satisfactorily. (Oklahoma) + Completes training as required; seeks assistance and asks questions as needed to learn and understand role. (Oklahoma) + As part of the SSM Health nursing department, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and care needs of our patients and our patient populations. (Oklahoma) + Works in a constant state of alertness and safe manner. (Oklahoma) + Performs other duties as assigned. (Oklahoma) EDUCATION + Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE + No experience required REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Missouri + Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) + FUTURE Registered Nurses within 3 months of graduation date **Work Shift:** Day Shift (United States of America) **Job Type:** Employee **Department:** **Scheduled Weekly Hours:** 36 **Benefits:** SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. + **Paid Parental Leave** **:** we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). + **Flexible Payment Options:** our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. + **Upfront Tuition Coverage** : we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits (****************************************** _SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,_ _pregnancy, veteran status_ **_,_** _or any other characteristic protected by applicable law._ Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205***********55970.1667***********70506.1667719643)
    $42k-56k yearly est. 60d+ ago
  • staff - Registered Nurse (RN) - Home Health - $70K-95K per year

    Elara Caring

    Utilization review nurse job in Jefferson City, MO

    The position is for a Registered Nurse (RN) specializing in Home Health care, providing personalized nursing services to patients in their homes. The role involves assessing patient needs, planning and implementing care plans, and coordinating with healthcare teams to ensure optimal patient outcomes. The employer offers flexible schedules, competitive compensation, and professional development opportunities in a supportive environment. Elara Caring is seeking a Registered Nurse (RN) Home Health for a nursing job in Jefferson City, Missouri. & Requirements • Specialty: Home Health • Discipline: RN • Duration: Ongoing • Employment Type: Staff At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. : At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there's no place like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their health journey, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Registered Nurse Home Health. Being a part of something this great, starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers. To continue to be an industry pioneer delivering unparalleled care, we need a Registered Nurse Home Health with commitment and compassion. Are you one of them? If so, apply today! Why Join the Elara Caring mission? • Work autonomy and flexible schedules • 1:1 patient care • Supportive and collaborative environment • Competitive compensation package • Tuition reimbursement for full-time staff and continuing education opportunities for all employees • Comprehensive insurance plans for medical, dental, and vision benefits • 401(K) with employer match • Paid time off, paid holidays, family and pet bereavement • Pet insurance As a Registered Nurse Home Health, you'll contribute to our success in the following ways: • Ensures that all activities performed align with the vision of Elara Caring's board of directors, executive team, and the leadership of the Home Health team. • Add key accountabilities here. • Maintains patient and staff privacy and confidentiality pursuant to HIPAA Privacy Final Rule. • Assesses assigned case load of home health care patients and families to identify the physical, psychosocial, and environmental needs of patients as evidenced by documentation, clinical records, Interdisciplinary Team reports, after hours reports, and on-site evaluations. • Assumes primary responsibility for caseload, including assessing, planning, coordinating, implementing, and evaluating the plan of treatment. • Assesses patient needs and obtains data on physical, psychological, social, and spiritual factors that may influence patient/family/caregiver health status and incorporate that data into the plan of care. • Makes the initial evaluation and re-evaluates the patient's nursing needs during each visit. Makes follow up visits according to patient, family, and facility needs. • Communicates significant findings, problems, and changes in health condition, environment, or unsafe facility conditions to the Clinical Supervisor, physician, facility, and/or other personnel involved with patient care. • Revises the plan of care in response to identified patient care issues and notifies the Clinical Supervisor, physician, facility, and other team members. What is Required? • Current, unrestricted state RN licensee • 1+ year experience in a clinical care setting as a nurse • Able and willing to travel within branch/office coverage area. • Must have a dependable vehicle, valid driver's license, and current auto insurance in accordance with state laws. • Must be able and willing to travel 50% • Associates Degree or Bachelor's Degree in Nursing is preferred • Previous Home Health or Hospice Experience is preferred • Previous experience with HomeCare HomeBase is preferred You will report to the Clinical Manager or Clinical Supervisor This is not a comprehensive list of all job responsibilities; a fullwill be provided. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. We value the unique skills of veterans and military spouses. We encourage applications from military veterans and their families. Elara Caring provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age (40 and older), national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, protected veteran status, or any other basis prohibited under applicable federal, state or local law. Elara Caring participates in E-Verify and we will provide the Federal Government with your Form I-9 information to confirm that you are authorized to work in the United States. Employers like Elara Caring can only use E-Verify once you have accepted the job offer and completed the Form I-9. At Elara Caring, pay and compensation are determined by a variety of factors, including education, job-related knowledge, skills, training, and experience. Our compensation structure reflects the cost of labor across different U.S. geographic markets, and may vary based on location. This is not a comprehensive list of all job responsibilities and requirements; upon request, a job description can be provided. If you are an individual with a disability and are unable or limited in your ability to use or access our career site as a result of your disability, you may request reasonable accommodations by reaching out to . Elara Caring Job ID #JR. Posted job title: Registered Nurse RN Home Health About Elara Caring Elara Caring is one of the nation's leading providers of home-based care with a growing footprint of 26,000 caregivers and 60,000 patients in 18 states. Whether you are new to home-based care or a seasoned in-home care professional, Elara Caring will meet you where you are and develop a unique learning plan that recognizes your experience and invests in your clinical professional journey. From our preceptor program to certification prep courses, quality assessments or management training, we care about you and your success. Keywords: Registered Nurse, Home Health Nursing, Patient Care, Nursing Care Plan, Home Health Care, Clinical Assessment, Patient Evaluation, Healthcare, Registered Nurse Jobs, Home Care Nurse
    $38k-66k yearly est. 1d ago
  • Travel Labor & Delivery/Postpartum Nurse - $3,013 per week

    TRS Healthcare

    Utilization review nurse job in Columbia, MO

    This position is for a travel Labor and Delivery Registered Nurse (RN) in Columbia, Missouri, offering a 13-week assignment with 12-hour night shifts. The role involves providing specialized nursing care in labor and delivery at various healthcare facilities. The employer, TRS Healthcare, specializes in placing travel nurses and allied health professionals across diverse healthcare settings nationwide. TRS Healthcare is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Columbia, Missouri. Job Description & Requirements • Specialty: Labor and Delivery • Discipline: RN • Start Date: • Duration: 13 weeks • 48 hours per week • Shift: 12 hours, nights • Employment Type: Travel TRS Healthcare Job ID #. Pay package is based on 12 hour shifts and 48 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: OB - Labor & Delivery Registered Nurse About TRS Healthcare TRS Healthcare has been a leader in the healthcare staffing industry for over 25 years, providing exceptional career opportunities for travel nurses and allied health professionals. An RN-founded, woman-owned company, TRS Healthcare has team members in all 50 states. We recruit and support registered nurses, licensed practical nurses, surgical technicians, respiratory therapists, imaging technologists, laboratory specialists, and other experienced nursing and allied healthcare professionals. We staff hundreds of healthcare facilities across the U.S. in urban, rural, and underserved areas, including multi-state hospital systems, critical access hospitals, rural community hospitals, long-term care facilities, trauma centers, standalone clinics, and more. Learn more about TRS . Keywords: travel nurse, labor and delivery nurse, postpartum nurse, registered nurse, RN travel nursing, night shift nursing, healthcare staffing, maternal health nursing, travel healthcare jobs, nurse assignment
    $63k-115k yearly est. 4d ago
  • Clinical Nursing Staff

    Stephens College 3.8company rating

    Utilization review nurse job in Columbia, MO

    Part-time Description Stephens College is seeking experienced Registered Nurses to join our nursing education team in a part-time clinical staff role. This position supports hospital-based clinical rotations (day and evening shifts), as well as instruction in the Nursing Skills Lab and Simulation Lab. Clinical Nurses will work directly with nursing students, providing supervision, guidance, and evaluation during hands-on learning experiences. Key Responsibilities Supervise nursing students during assigned hospital clinical rotations in areas such as Medical-Surgical, Critical Care, Post-partum, NICU, Pediatrics, and Mental Health. Provide instruction and evaluation in the Nursing Skills Lab and Simulation Lab. Ensure safe, effective learning environments that support course outcomes. Collaborate with the nursing faculty team to align clinical instruction with program standards. Maintain professional role modeling and uphold the values of the Stephens College Nursing Program. Schedule Part-time, flexible scheduling based on program needs. Day shift and evening shift opportunities available for hospital clinicals. Requirements Current, active RN license in Missouri (or privilege to practice in Missouri) without disciplinary action. Minimum of a BSN; MSN preferred. Two or more years of recent clinical nursing experience. Strong communication and collaboration skills. Prior teaching or precepting experience preferred but not required. ***A professional resume, cover letter, transcripts, RN license number, and three references are required to be uploaded when applying for this position.*** Founded in 1833, Stephens College is the second-oldest women's college in the United States, dedicated to providing innovative, experiential, and career-focused education across various disciplines. Located in Columbia, Missouri, Stephens College continues to be a leader in women's education, fostering a community where students are empowered to lead, innovate, and excel. The college also provides flexible, co-educational master's degrees and certificates for working professionals, and is home to the co-educational Conservatory for the Performing Arts at Stephens College. Ranked (over and over again) as one of the best college towns in America, Columbia, Missouri, is home to 36,000+ college students and 118,000 residents. Columbia - conveniently located approximately 100 miles from both Kansas City and St. Louis - has it all: big-time college sports, film, music and arts festivals, a high-energy arts community, amazing recreation, and a great downtown with lots of places to eat, shop, snack and check out the latest bands. The Columbia community offers outstanding health care options, as well as excellent educational opportunities for every level of student (including our own Children's School). Be a part of this amazing community of innovative thinkers, doers and dreamers. Stephens is an Equal Opportunity Employer and will recruit and employ qualified personnel without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, or status as a veteran.
    $51k-63k yearly est. 38d ago
  • vICU Nurse (Non-Exempt)

    Mercy 4.5company rating

    Utilization review nurse job in Jamestown, MO

    Find your calling at Mercy! Provides TeleICU (eICU) nursing care to a diverse population of critically ill ICU patients across multiple hospitals. Collects data and provides tele-nursing care. Assesses, and collaborates with other TeleICU personnel and the bedside team via audio/video connections during patients ICU stay to achieve optimal patient outcomes. Discusses patient care issues with physicians and other health care team members. Maintains professional accountability for provision of patient care for the assigned patients. Maintains patient rights and confidentiality of patient information. Performs duties and responsibilities in a manner consistent our mission, values and Mercy Service Standards. Position Details: Minimum Qualifications: Education: Must have either a current RN Temporary Permit/RN license in the state of practice Licensure: State Licensure in state of practice & Multi-state licensure required within 6 months of hire. Experience: Minimum 2 years recent ICU nursing experience Certifications: CPR required ACLS required. Preferred Qualifications Education: BSN. Experience: Charge nurse experience. Knowledge, Skills, and Abilities: - Requires excellent communication skills and able to collaborate effectively within a team environment. - Must have the ability to independently practice and prioritize demands in an ever-changing, dynamic environment. - Must demonstrate understanding of pathophysiology and common problems and solutions associated with adult ICU patients. Physical Requirements: - The physical demands described here are the representative of the minimums that must be met by an employee to perform all essential functions of the job. Most physical demands are below, plus: - Minimal: push/pull Why Mercy? From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us. By applying, you consent to your information being transmitted by College Recruiter to the Employer, as data controller, through the Employer's data processor SonicJobs. See Mercy Terms & Conditions at about/legal-notices/ and Privacy Policy at about/legal-notices/ and SonicJobs Privacy Policy at us/privacy-policy and Terms of Use at us/terms-conditions
    $29k-52k yearly est. 1d ago
  • Infusion Nurse

    Biomatrix Specialty Pharm

    Utilization review nurse job in Columbia, MO

    INTRODUCTION BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes. At the heart of our Inclusion, Diversity, Equity, & Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone's contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners. Schedule & Location: BioMatrix Specialty Infusion Pharmacy is seeking a Part-Time Per Diem Infusion Nurse to see patients in their homes or infusion suites. It is anticipated that an incumbent in this role will work in one of the metropolitan-area locations noted in the posting. Work location is subject to change based on business needs. Job Description: A Registered Nurse for Home Infusion inserts, monitors and removes an IV used to give medications, blood products and nutrition to a patient. During the IV therapy, the nurse monitors the patient for adverse reactions and ensures that the tubing, bandages and needle stay in place. When a patient needs blood levels checked, an IV nurse performs a veinous phlebotomy. During the entire IV therapy process, the nurse obtains sets of vital signs, completes the physical assessment and review of systems, documents all patient-related activities and records the medications they use. Provides and coordinates all aspects of staffing services to the patient with the assistance of the Company Directors, Nursing Coordinator and the Director of Nursing. Communicates with the patients to determine problems and/or solutions regarding their treatment. The Per Diem RN also conveys collected documentation from patient to all necessary internal and third-party external staff regarding scheduling and other pertinent patient information. Performs a variety of duties both clinical and nursing notes documentation. This position requires skill in planning, organizing, scheduling and coordinating the delivery of patient care by all staff personnel including but not limited to complete documentation of nursing care and submission of nursing notes. QUALIFICATION REQUIREMENTS Nursing Degree from an accredited college or university required IV certification & experience in central line care and management required Current state RN license in location denoted in posting required Minimum of two (2) years of RN experience required Valid state driver's license required CPR certification required Home care, critical care, emergency nursing, AIC or hospital discharge planning experience. Incumbent should have some experience in staffing and should be able to demonstrate the ability to multi-task as well as good communicative and interpersonal skills. Basic level skill in Microsoft Office (including Word, Excel, PowerPoint, etc.). Willing to travel to see patients in the homes, and in other health care facilities. Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction. QUALIFICATIONS PREFERRED Bachelor's degree preferred RN license in other states preferred ESSENTIAL FUNCTIONS AND RESPONSIBILITIES Demonstrates the basic knowledge and judgment to utilize the nursing process to schedule nursing visits in accordance with RX's and established protocols. Coordinates SOC and ongoing nursing visits and confirms scheduled visits with both patient and Nursing Agency/RN. Assures schedule is sent out via email to team members. Responsible for following up on and entering Therapy Admin reports and emailing to team involved. Reviews all nurses notes for content and accuracy and completion without omitting necessary information such as drugs given, drug dosing and time of administration. Continual communication with families, supervisors and field personnel, agencies regarding problems and/or special needs of both the patient. Responsible to communicate all problems and reportable situations to the referring MD and appropriate MD office administrator and to Biomatrix nursing Computer functions including but not limited to input, reports, searches, schedules. Communicates patient/employee information to answering services when necessary. Has read and understands company compliance paperwork and videotapes. Performs all duties in accordance with all applicable federal and state laws and with the highest ethical standards. Coordinates staffing in a timely manner while also adhering to confidentiality and ethics as discussed in the compliance program 100% of the time. Insert intravenous cannulas; administer prescribed intravenous solutions, medications; monitor & maintain infusion sites & system; evaluate responses to prescribed therapy. Teach patients & caregivers to perform & monitor administration of Home Infusion as prescribed. Prepare clinical records, care plans, progress notes for each patient visit. Coordinate schedule of patient visits & phone calls. Works in patients place of residence. Drive as assigned within state. Prior experience in Home Infusion Therapy is preferred. PICC/Port/Midline experience and certification is preferred. NON-ESSENTIAL FUNCTIONS & RESPONSIBILITIES Ability to prioritize and handle multiple tasks and projects concurrently. Must have scheduling flexibility and be able to work extra hours if needed. Careful attention to detail. Performs related duties as requested. Participates in quality assurance activities and audits as directed. KNOWLEDEGE, SKILLS AND ABILITIES REQUIREMENTS Provides professional nursing care within the department Coordinates care planning with other disciplines Provides care that meets the psychosocial, physical general aspects of care Determines priorities of care based on physical psychosocial needs of patients, as well as factors influencing patient flow through the system Communicates regarding changes in patient status, symptomatology results of diagnostic studies Responds quickly accurately to changes in condition or response to treatment Excellent verbal skills and Good written skills Excellent Customer Service skills Must be able to develop caring relationships with their patients and treat them with respect and empathy. Possess medical-surgical experience or knowledge in phlebotomy and venous access, both of which deal with the collection of blood. Must be able to work independently, as well as on a team. Must teach the patient how to properly care for their IV or PICC line and be able to communicate with patients clearly while giving instructions. Ability to work under high levels of stress, know how to handle critical situations in the home. Communication Skills Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information. Computer Skills Become and remain proficient is all programs necessary for execution. PHYSICAL DEMANDS AND WORK ENVIRONMENT This position requires driving to patient homes and other HC facilities, walking, sitting, standing, kneeling or stooping. This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms. This position requires constant talking and hearing. Specific vision abilities required by this job include close vision and the ability to adjust focus. This position must occasionally lift and/or move up to 20 pounds Required to move/lift physical hardware. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If needing a reasonable accommodation within the application process, please contact the BioMatrix People & Culture team at ************************* or ************ x 1425. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. OTHER Will participate in legal and ethical compliance training each year. Will consistently behave in compliance with the BioMatrix, LLC's legal and ethical policies and procedures. Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual. Will not participate in any conduct considered to be unethical or illegal. EXPECTATION FOR ALL EMPLOYEES Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins. GENERAL INFORMATION: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate. Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others). 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.
    $36k-56k yearly est. Easy Apply 21d ago
  • Wound Nurse (LPN/RN)

    Aurora Health and Rehabiliation

    Utilization review nurse job in Rolla, MO

    Job Description The Wound Care Nurse plays a critical role in the healthcare team, specializing in the assessment, treatment, and management of patients with acute and chronic wounds. This position requires a compassionate and skilled nurse who can provide high-quality care while educating patients and their families about wound healing processes. The ideal candidate will possess a strong background in nursing with experience in various healthcare settings, including critical care and urgent care. Job Type: Full-time Employee Benefits Package Comprehensive Health, Dental, and Vision Insurance $100/month company contribution to an HSA account Daily Pay Option 401K Employer paid life insurance 1x annual salary up to $100k Paid Time Off & Flexibility Generous Paid Time Off Personal Day Benefit Guidance and assistance from a dedicated regional team Responsibilities Conduct thorough patient assessments to evaluate wound conditions and overall health status. Develop individualized care plans based on patient needs and evidence-based practices. Administer medications as prescribed and monitor patients for any adverse reactions. Perform wound care procedures, including dressing changes, debridement, and application of topical treatments. Collaborate with interdisciplinary teams to optimize patient outcomes and ensure comprehensive care. Educate patients and families on wound care techniques, health coaching, and preventive measures. Maintain accurate documentation of patient progress, treatments administered, and outcomes achieved. Stay updated on the latest advancements in wound care management and medical terminology. Coordinate facility-wide Infection Prevention Control Program. Ensure compliance with Federal and state regulations Prioritize Infection Prevention goals. Collaborate with Department managers and medical directors in implementing aspects of the Infection Prevention Program when requested or as needed. Skills Proficient in-patient assessment techniques to identify wound types and severity. Strong knowledge of medical imaging processes relevant to wound evaluation. Familiarity with urgent care protocols for treating acute wounds. Ability to administer medications safely and effectively within an ambulatory surgery center setting. Understanding of critical care principles as they relate to complex wound cases. Excellent communication skills for effective patient education and health coaching. Strong organizational skills to manage multiple cases efficiently while ensuring high-quality patient care. Qualifications RN/LPN license required. Current, unencumbered nursing license in the practicing state. Current BLS/CPR certification. Experience in nursing management and infection prevention control. Must have Certification in Infection Prevention and Control. This position is essential for improving patient quality of life through effective wound management strategies. If you are a dedicated nursing professional with a passion for helping others heal, we encourage you to apply. Why Join Us? Be part of a team committed to maintaining high infection control standards. Full PPE is provided for all staff following rigorous sanitation standards by CDC. Engaged Administration and Director of Nursing support. If you are ready to make a significant impact on infection control in various healthcare settings, apply now! We provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
    $100k yearly 8d ago
  • In-Home Visit Nurse

    Phoenix Home Care and Hospice 3.4company rating

    Utilization review nurse job in Columbia, MO

    Job Description In Home Registered Nurse or Licensed Practical Nurse Part Time & Full Time Availability Columbia & Jefferson City, MO and surrounding areas $25 - $35 Per Visit Phoenix Home Care & Hospice is a mission driven company. We are committed to supporting you throughout your journey, assisting you in overcoming the daily obstacles faced in the healthcare industry. We are currently seeking a motivated and compassionate RN or LPN to join our In-Home team. In this nursing role, you will have the opportunity to make a difference in the lives of our clients by providing high-quality care and support in the comfort of their own home. Benefits: Multiple Major Medical Plans to Choose From (Medical, Dental & Vision) Flexibility, competitive pay, paid mileage, benefits package, and 401K! Spousal Insurance PTO Orientation and training tailored to your needs as a new hire. Motivational PHC culture, training, and Supportive In-Home Team Responsibilities: Complete admission assessments and reassessments for In-Home caregiver population. Provide nurse visits for adult and senior population: Taking vitals, medication management, monthly diabetic nails, and labs. May provide supervisory visits for caregiver services Provide instruction/ education on medication Good time management, detail oriented and self-starter Requirements: Active Registered Nurse or Licensed Practical Nurse license in the state of MO Home Care experience preferred but not required Strong organizational and self-management skills Strong and compassionate customer service skills Valid driver's license We're taking the journey with you, creating a New Beginning! Choose Phoenix, Apply today! Our mission is to offer New Beginnings and meaningful opportunities to our caregivers and clinicians while providing home care services to our clients built on innovation, skill, and Christ-like values of compassion, honesty, and patience.
    $30k-46k yearly est. 11d ago
  • IMC Infusion Nurse

    Option Care Health 4.1company rating

    Utilization review nurse job in Columbia, MO

    Extraordinary Careers. Endless Possibilities. With the nation's largest home infusion provider, there is no limit to the growth of your career. Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members. Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you're empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare. Summary: Deliver and monitor specialized infusions or injectable pharmacological treatments in the clinical setting. Monitor patients for infusion related reactions, intervene as required, accurately document the transfusion, and submit transfusion reports in a timely manner. Maintain effective communication with the Physician, Nursing Manager or Director to ensure patient safety and satisfaction. Job Description: RESPONSIBILITIES: Develops and updates treatment plans that are individualized to each patient Conducts patient health assessments and education Obtain IV access through peripheral IV initiation or central line access (PICC. Midline, Port, etc.) Provide PICC/Midline/ Port care and dressing change using sterile technique Prepares and administers a variety of specialized intravenous or injectable pharmacological treatments Provide patient care by utilizing the skills of observations, assessment, nursing diagnosis, counseling, patient education, and reporting any adverse events to medical director and nursing director Perform routine nursing duties in accordance with company policies and procedures Provide patient focused care according to the established care plan or medical directive Perform specialized nursing procedures for which recognized training and current competency have been demonstrated and completed Observe and document patient condition and response during infusion Interpret and implement technical instructions related to patient care Transcribe physician's orders if needed Follow-up communication with patient the day after the infusion for assessment of infusion reactions Demonstrates ability to maintain calm under pressure and cope with changing environment Participates in the orientation of other staff as requested Manage complications from infusion therapies All equipment and chairs used during infusion should be cleaned with approved healthcare disinfectant after each use Ensure the infusion center is appropriately stocked/restocked with equipment and supplies at the end of each day Assess for continuation of orders and obtain if needed for nursing services. For continuation of medication orders, notify IMC support coordinator. Properly document coordination and patient event activities in patient EMR as directed Call Bell pre-assessments and assessment Assist in the management of patient paperwork. Properly tracks all receipt of vital patient paperwork Audit EMR for proper placement in patient records Perform care plan updates for each patient's appointment Participates in ongoing internal and/or external continuing education Participates in quality activities and continuous improvement initiatives in keeping with the company's Quality Management System Participates in proactive Health and Safety activities while performing duties Notifies immediate supervisor of any health and safety risks or concerns Participate in the review of patient satisfaction surveys Presents to work as expected/when expected Maintains a professional appearance and consistently performs in a manner that is consistent with the policies and procedures of Intramed Plus Works collaboratively with IP medical director, pharmacists, and all other team members in a professional manner Completes assigned work in a timely manner based on established schedules Complies with departmental and organizational policies during the completion of all job-related duties/assignments Maintains confidentiality of client and corporate information Completes other tasks as requested Maintains relationships with exceptional interpersonal skills and customer service JOB REQUIREMENTS: A graduate of an accredited nursing program and current licensure as a Registered Nurse Current Basic Cardiac Life Support (BLS) certification At least two years of recent IV experience; excellent IV skills is REQUIRED Experience in acute care and/or with transfusions/ Neurology Infusion experience highly preferred Experience with central lines (CVAD, PICC, etc.) is REQUIRED Excellent interpersonal and communication skills; must be able to communicate with family regarding patient care Advanced computer skills Self-directed, flexible, and comfortable working independently Meets ADA requirements for position Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $35.31-$58.84 Benefits: -Medical, Dental, & Vision Insurance -Paid Time off -Bonding Time Off -401K Retirement Savings Plan with Company Match -HSA Company Match -Flexible Spending Accounts -Tuition Reimbursement -my FlexPay -Family Support -Mental Health Services -Company Paid Life Insurance -Award/Recognition Programs Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.
    $42k-52k yearly est. Auto-Apply 11d ago
  • Nurse Residential (Weekdays)

    Compass Health Network 4.0company rating

    Utilization review nurse job in Jefferson City, MO

    Job DescriptionDescriptionTo support the continued delivery of quality and compassionate care in our communities, we are offering a retention bonus of $4,000.* Your commitment helps us meet critical service needs, and we're excited to have you be a part of our mission! Make a Difference Every Day as a Residential Nurse Schedule: M-F Days As a Residential Nurse, you'll play a key role in supporting the health and wellness of residents in our Transitional Services program. You'll provide compassionate nursing care, coordinate with interdisciplinary teams, and help create a safe, supportive environment that fosters hope, stability, and growth. This is a great opportunity for someone who is dedicated to providing high-quality care, enjoys collaborating with a multidisciplinary team, and values making a meaningful impact in the lives of individuals navigating challenging transitions. Key Responsibilities Provide direct nursing care, including assessments, medication administration, and monitoring residents' physical and mental health Manage medications safely and accurately, including documentation, controlled substances, and patient education Coordinate care with staff, families, physicians, and other healthcare providers Observe and report changes in resident condition and respond appropriately to emergencies Assist with diagnostic and treatment procedures and provide guidance to new staff on protocols Participate in team and leadership meetings, and support a positive, mission-driven care environment Engage with residents through individual or group activities to promote wellness and skill development Perform other duties as assigned, including lifting equipment or residents when needed Requirements, Skills, Knowledge and ExpertiseHigh School/GED required • Practical Nursing certificate or Associate/Bachelor's degree in Nursing required QUALIFICATION(S): LICENSURE/CERTIFICATION • LPN, RN, or GPN/GN - must pass the MO NCLEX exam within 90 days of graduation You'll Be a Great Fit for This Role if You: Approach care with empathy, patience, and professionalism Thrive in a collaborative team environment where communication and reliability are key Are attentive to detail and committed to maintaining safe, high-quality nursing standards Enjoy building supportive relationships with residents and helping them achieve wellness and independence Embrace flexibility and adaptability in a dynamic care environment *Retention bonuses paid as per bonus policy; exclusions may apply. IND2
    $35k-50k yearly est. 14d ago
  • Graduate Nurse- Surgery

    SSM Health 4.7company rating

    Utilization review nurse job in Jefferson City, MO

    It's more than a career, it's a calling MO-SSM Health St. Mary's Hospital - Jefferson City Worker Type: Regular Job Highlights: We are currently hiring Graduate Nurses in our Surgery Department! Being a nurse is more than a job, it's a calling. That is why SSM Health wants to invest in your future. As a new graduate nurse hired with SSM Health, you will participate in the SSM Health Nurse Residency Program. This will allow you to connect and learn from other graduate nurses across the system as you work to enhance your confidence, knowledge, and practical skill. The residency program is designed to complement your education and support your continued professional growth. The nurse residency program classes consists of monthly four-hour virtual sessions held over a twelve-month period. Sign-on Bonus: $7,500 (paid on the first paycheck) Schedule Options: FT Benefits: Competitive, affordable health insurance including but not limited to: Getting paid every day! Access up to $5,250 in tuition coverage per year Paid maternity & paternity coverage Adoption assistance Various competitive health insurance options & wellness plans Retirement benefits including employer matching plans Long & short-term disability Employee assistance programs (EAP) *Please note, benefits and eligibility can vary by position, exclusions may apply. #CoreHire Job Summary: Pre-licensure graduate of an accredited nursing program who actively participates in SSM Health New Graduate Nurse Residency Program. Under the direction of RN, provides care to patients within scope of role and professional standards. Responsible for the delivery of age appropriate care for assigned patients with a wide variety of medical conditions. Nurse Residents in the state of Oklahoma can perform responsibilities designated below (Oklahoma). Nurse Residents in Wisconsin, Illinois and Missouri can perform all responsibilities listed. Job Responsibilities and Requirements: PRIMARY RESPONSIBILITIES Under the direction of the RN Preceptor: Performs delegated tasks based on demonstrated competence in performing nursing care activities for population served. Delegated specialized tasks may include anything for which training was received in the approved nursing program. In the state of Oklahoma, this does not include tasks/skills which must be performed by a licensed nurse. Performs patient assessments including biophysical, psychosocial, spiritual, cultural, and age appropriate needs of the patients, including the assessment of nutrition, pain management, and signs/symptoms of abuse or neglect in order to develop, evaluate and modify patient's plan of care. Develops a realistic, comprehensive patient family education plan, using appropriate resources and methods of instruction and provides patient/family health education and coaching. Completes accurate and timely documentation (Oklahoma), including, but not limited to, the processing of physician orders, in accordance with policies and procedures. Monitors and evaluates delivery of nursing care given by team members based on patient needs and professional judgement. Collaborates with physicians and other health care professionals regarding all aspects of patient care. Participates in training to understand and perform patient care. (Oklahoma) Completes competency requirements satisfactorily. (Oklahoma) Completes training as required; seeks assistance and asks questions as needed to learn and understand role. (Oklahoma) As part of the SSM Health nursing department, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and care needs of our patients and our patient populations. (Oklahoma) Works in a constant state of alertness and safe manner. (Oklahoma) Performs other duties as assigned. (Oklahoma) EDUCATION Graduate of accredited school of nursing or education equivalency for licensing For Illinois: an official passing score on NCLEX results EXPERIENCE No experience required REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Oklahoma • Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) • Or • FUTURE - Basic Life Support Healthcare Provider (BLS HCP) within 90 days - American Heart Association (AHA) • And • FUTURE - Status of Fail on The National Council Licensure Examination for Registered Nurses within 6 months of graduation date - Pearson VUE - Pearson VUE • And • FUTURE - Status of Fail on The National Council Licensure Examination for Registered Nurses within 3 months of graduation date - Pearson VUE • And • FUTURE - NCLEX test date within 30 days - Pearson VUE Work Shift: Day Shift (United States of America) Job Type: Employee Department: ********** Operating RoomScheduled Weekly Hours:40 Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.
    $42k-56k yearly est. Auto-Apply 60d+ ago
  • Pre-Authorization Nurse 2

    Humana 4.8company rating

    Utilization review nurse job in Jefferson City, MO

    **Become a part of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse 2 completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical information in various medical management systems. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + 2+ years Utilization Management experience + Active RN license in the state(s) in which the nurse is required to practice + Ability to be licensed in multiple states without restrictions + A minimum of three years varied nursing experience + Previous experience in utilization management, case management, discharge planning and/or home health or rehab + Proficient with MS Office products including Word, Excel and Outlook + Ability to work independently under general instructions and with a team + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Bachelor's degree + Health Plan experience working with large carriers + Previous Medicare/Medicaid experience a plus + Outpatient or home health experience in Utilization Management + Experience working with MCG or Interqual guidelines **Additional Information** + **Schedule** : Monday through Friday, 8:00 AM - 5:00 PM with flexibility to work overtime/weekend as needed. + **Work Location:** US Nationwide + **Work Style:** Remote + **Travel Requirements** **: Less than 1%** **Work-at-Home (WAH) Internet Statement** 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 required; 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. **Interview Format** 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. 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: 01-19-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **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. 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 ***************************************************************************
    $71.1k-97.8k yearly 2d ago
  • Infusion Nurse

    Biomatrix Specialty Pharmacy

    Utilization review nurse job in Columbia, MO

    INTRODUCTION BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes. At the heart of our Inclusion, Diversity, Equity, & Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone's contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners. Schedule & Location: BioMatrix Specialty Infusion Pharmacy is seeking a Part-Time Per Diem Infusion Nurse to see patients in their homes or infusion suites. It is anticipated that an incumbent in this role will work in one of the metropolitan-area locations noted in the posting. Work location is subject to change based on business needs. Job Description: A Registered Nurse for Home Infusion inserts, monitors and removes an IV used to give medications, blood products and nutrition to a patient. During the IV therapy, the nurse monitors the patient for adverse reactions and ensures that the tubing, bandages and needle stay in place. When a patient needs blood levels checked, an IV nurse performs a veinous phlebotomy. During the entire IV therapy process, the nurse obtains sets of vital signs, completes the physical assessment and review of systems, documents all patient-related activities and records the medications they use. Provides and coordinates all aspects of staffing services to the patient with the assistance of the Company Directors, Nursing Coordinator and the Director of Nursing. Communicates with the patients to determine problems and/or solutions regarding their treatment. The Per Diem RN also conveys collected documentation from patient to all necessary internal and third-party external staff regarding scheduling and other pertinent patient information. Performs a variety of duties both clinical and nursing notes documentation. This position requires skill in planning, organizing, scheduling and coordinating the delivery of patient care by all staff personnel including but not limited to complete documentation of nursing care and submission of nursing notes. QUALIFICATION REQUIREMENTS * Nursing Degree from an accredited college or university required * IV certification & experience in central line care and management required * Current state RN license in location denoted in posting required * Minimum of two (2) years of RN experience required * Valid state driver's license required * CPR certification required * Home care, critical care, emergency nursing, AIC or hospital discharge planning experience. * Incumbent should have some experience in staffing and should be able to demonstrate the ability to multi-task as well as good communicative and interpersonal skills. * Basic level skill in Microsoft Office (including Word, Excel, PowerPoint, etc.). * Willing to travel to see patients in the homes, and in other health care facilities. * Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction. QUALIFICATIONS PREFERRED * Bachelor's degree preferred * RN license in other states preferred ESSENTIAL FUNCTIONS AND RESPONSIBILITIES * Demonstrates the basic knowledge and judgment to utilize the nursing process to schedule nursing visits in accordance with RX's and established protocols. * Coordinates SOC and ongoing nursing visits and confirms scheduled visits with both patient and Nursing Agency/RN. * Assures schedule is sent out via email to team members. * Responsible for following up on and entering Therapy Admin reports and emailing to team involved. * Reviews all nurses notes for content and accuracy and completion without omitting necessary information such as drugs given, drug dosing and time of administration. * Continual communication with families, supervisors and field personnel, agencies regarding problems and/or special needs of both the patient. * Responsible to communicate all problems and reportable situations to the referring MD and appropriate MD office administrator and to Biomatrix nursing * Computer functions including but not limited to input, reports, searches, schedules. * Communicates patient/employee information to answering services when necessary. * Has read and understands company compliance paperwork and videotapes. * Performs all duties in accordance with all applicable federal and state laws and with the highest ethical standards. * Coordinates staffing in a timely manner while also adhering to confidentiality and ethics as discussed in the compliance program 100% of the time. * Insert intravenous cannulas; administer prescribed intravenous solutions, medications; monitor & maintain infusion sites & system; evaluate responses to prescribed therapy. * Teach patients & caregivers to perform & monitor administration of Home Infusion as prescribed. * Prepare clinical records, care plans, progress notes for each patient visit. * Coordinate schedule of patient visits & phone calls. * Works in patients place of residence. * Drive as assigned within state. * Prior experience in Home Infusion Therapy is preferred. PICC/Port/Midline experience and certification is preferred. NON-ESSENTIAL FUNCTIONS & RESPONSIBILITIES * Ability to prioritize and handle multiple tasks and projects concurrently. * Must have scheduling flexibility and be able to work extra hours if needed. * Careful attention to detail. * Performs related duties as requested. * Participates in quality assurance activities and audits as directed. KNOWLEDEGE, SKILLS AND ABILITIES REQUIREMENTS * Provides professional nursing care within the department * Coordinates care planning with other disciplines * Provides care that meets the psychosocial, physical general aspects of care * Determines priorities of care based on physical psychosocial needs of patients, as well as factors influencing patient flow through the system * Communicates regarding changes in patient status, symptomatology results of diagnostic studies * Responds quickly accurately to changes in condition or response to treatment * Excellent verbal skills and Good written skills * Excellent Customer Service skills * Must be able to develop caring relationships with their patients and treat them with respect and empathy. * Possess medical-surgical experience or knowledge in phlebotomy and venous access, both of which deal with the collection of blood. * Must be able to work independently, as well as on a team. * Must teach the patient how to properly care for their IV or PICC line and be able to communicate with patients clearly while giving instructions. * Ability to work under high levels of stress, know how to handle critical situations in the home. Communication Skills * Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. * Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information. Computer Skills * Become and remain proficient is all programs necessary for execution. PHYSICAL DEMANDS AND WORK ENVIRONMENT * This position requires driving to patient homes and other HC facilities, walking, sitting, standing, kneeling or stooping. * This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms. * This position requires constant talking and hearing. * Specific vision abilities required by this job include close vision and the ability to adjust focus. * This position must occasionally lift and/or move up to 20 pounds * Required to move/lift physical hardware. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If needing a reasonable accommodation within the application process, please contact the BioMatrix People & Culture team at ************************* or ************ x 1425. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. OTHER * Will participate in legal and ethical compliance training each year. * Will consistently behave in compliance with the BioMatrix, LLC's legal and ethical policies and procedures. * Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual. * Will not participate in any conduct considered to be unethical or illegal. EXPECTATION FOR ALL EMPLOYEES Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins. GENERAL INFORMATION: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate. Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others). 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.
    $36k-56k yearly est. Easy Apply 21d ago

Learn more about utilization review nurse jobs

How much does a utilization review nurse earn in Jefferson City, MO?

The average utilization review nurse in Jefferson City, MO earns between $44,000 and $74,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.

Average utilization review nurse salary in Jefferson City, MO

$57,000

What are the biggest employers of Utilization Review Nurses in Jefferson City, MO?

The biggest employers of Utilization Review Nurses in Jefferson City, MO are:
  1. Humana
  2. Centerwell
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