Utilization Management Nurse
Utilization review nurse job in Frankfort, KY
**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 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
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.
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.
**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 *************************************************************
Field Nurse Practitioner - Boone County, KY
Utilization review nurse job in Florence, KY
Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations.
The building B.L.O.C.K.S. of our team's success!
Bring the fun
Leverage together for better
Outperform yourself
Care at every touchpoint
Keep your word. Keep it real
Stay curious & listen well
Primary Purpose:
We are proud of the quality care we provide members and our team is rapidly expanding to meet the demands of our growing business; we are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at risk populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. This role is 1099 (PRN) and offers tremendous flexibility and opportunity for those who are balancing competing priorities.
Learn more about our primary purpose here
Follow us on LinkedIn:
******************************************
NP Responsibilities:
Perform annual in-home wellness visits and risk adjustment health assessments on a population with chronic conditions; Our thorough evaluations include: a comprehensive assessment, physical examination, body system review, vital signs, review of medication history, review of current prescriptions, review of member functional status, pain management, cognitive assessment, review of the home environment, fall risk screening, social assessment, review of daily living activities, mental health screening, documentation and communication
You will play a pivotal role in providing individualized quality care to the elderly population in their homes
Deliver patient health education on topics such as pain management, medication, etc.
Build relationships of trust with members through exceptional communication and empathy
Assist in closing quality care gaps (i.e. screenings and labs)
An enthusiastic collaborator contributing to the enhancement of care delivery
Providers are expected to commit a minimum of 30 hours per month
Locations:
Boone County, KY
Requirements
NP Qualifications:
Must have a valid unencumbered NP License for the state you will be working in
This role requires travel within the assigned job posting county up to a maximum 55-mile radius
Previous in-home risk assessment experience preferred
Previous 1099 (PRN) experience is preferred but not required
3 years patient care experience preferred (primary care/adult/geriatric, EMR)
May be requested to obtain additional NP licensure supported by Advantmed
Access to reliable transportation that will enable you to travel to member's homes within a designated area
Strong ability to work within our EMR system
Ability to work independently
Bilingual is a plus
Benefits
Advantmed offers:
Competitive compensation of ~$100 per completed in-home health assessment
Paid mileage
Flexible work schedule
Evening and weekend availability
Never on-call
Visits ready to be scheduled immediately
Appointment confirmation support
Dedicated coordinator support
Advanced member scheduling coverage
State of art technology
Auto-ApplyNurse Case Manager II
Utilization review nurse job in Louisville, KY
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Work Schedule: Monday to Friday from 9:00 AM to 5:30 PM EST, with 2-4 late evening shifts per month from 11:30 AM to 8:00 PM EST.
The Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Perform duties telephonically or on-site such as at hospitals for discharge planning.
How you will make an impact:
* Ensures member access to services appropriate to their health needs.
* Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
* Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
* Coordinates internal and external resources to meet identified needs.
* Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
* Negotiate rates of reimbursement, as applicable.
* Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures.
Minimum Requirements:
* Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* Current unrestricted RN license in applicable state(s) required.
* Multi-state licensure is required if this individual provides services in multiple states.
Preferred Experience, Skills, and Capabilities:
* Certification and experience as a Case Manager is preferred.
* BS in a health or human services related field preferred.
* Experience in telephonic case management, especially for complex and chronic care needs is strongly preferred.
* Preferred proficiency with telephonic systems and health information technology.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $76,944 to $115,416.
Locations: New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Flight Nurse
Utilization review nurse job in Bedford, KY
Join us in the enchanting town of Bedford, for an extraordinary career as a Flight Nurse with Air Methods. Nestled amidst the majestic landscapes of Bedford, KY offers a perfect blend of natural beauty and cultural richness. As a pivotal member of our team, you'll play a crucial role in providing life-saving medical transport to the community.
With a minimum of 36 months of experience in a busy ICU, ER, Flight, or Critical Care Transport setting within the last 5 years, your expertise will be invaluable. Operating on a schedule of two 24-hour shifts per week, you'll deliver top-notch critical care, adhering to the highest standards set by Air Methods Community Base Services (CBS) Medical Director(s).
Your responsibilities will encompass assessment, triage, and treatment, ensuring the safe transport of critical patients to the appropriate medical facility. From the unique vantage point of a helicopter, you'll enjoy breathtaking views of the scenic Kentucky landscape, enhancing the experience of your daily work.
Join us in Bedford, where every flight underscores our commitment to excellence and safety in medical transport. Experience the thrill of flight while making a significant impact on the well-being of those in need in this dynamic and culturally rich community.
Responsibilities
Job Summary
Responsible for providing high-quality critical care, including assessment, triage, and treatment utilizing standards and guidelines established by Air Methods Community Base Services (CBS) Medical Director(s). You'll assess the nature and extent of illness or injury to establish and prioritize the care needed for the safe transport of the critical patient to the appropriate facility and are responsible for carrying out the mission and goals of Air Methods CBS, assuring that safety remains the highest priority throughout the transport continuum.
Essential Functions and Responsibilities include the following:
* Provides nursing care within his/her scope of practice from the initial contact until patient care is relinquished to the accepting medical facility; maintains thorough patient care documentation.
* Maintains competency in knowledge and psychomotor skills by participating in ongoing laboratory and clinical experiences. Communicates educational needs to the Medical Base Supervisor and Medical Education Coordinator. Maintains documentation of required licensure, certifications, continuing education, aviation and safety training, OSHA and HIPAA training, clinical rotations, and advanced procedures and attends continuing education programs pertinent to his/her area of practice.
* Knowledgeable in using and maintaining all equipment and supplies used by Air Methods CBS. Responsible for reporting medical equipment failures and taking initial steps to ensure equipment repair as directed. Maintains adequate supplies onboard aircraft to deliver patient care. Keeps aircraft clean and orderly to ensure rapid response to all transport requests.
* Functions as a medical flight member by attending pre-mission briefings and mission debriefings and completing necessary documentation. Assists in pre-mission liftoff checklist and assists pilot as requested, i.e., radio, navigational, and visual observation activities. Complies with safety standards to assure the safety of self, medical personnel, patients, and equipment and conducts aircraft safety briefings as needed.
* Serves as a flight resource to neonatal/pediatric personnel when transporting specialty patients by helicopter and performs advanced skills and procedures as approved by Air Methods CBS Medical Director(s).
* Participates in patient and referring institution follow-up and in planned outreach marketing and education activities
* Acts as a preceptor and/or participates in orientation of new employees and students as assigned and communicates program goals and objectives.
* Participates regularly in Air Methods CBS meetings, activities, projects, and committees (to include research and publishing opportunities).
* Other Duties as assigned.
Additional Job Requirements
* Regularly scheduled attendance
* Indicate the percentage of time spent traveling: 5%
* Subject to applicable laws and Air Method's policies, regular attendance is an essential function of the position. All employees must follow Air Methods' employment practices and policies.
Supervisory Responsibilities
* This position has no supervisory responsibilities.
Qualifications
Qualifications
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. In accordance with applicable laws, Air Methods will provide reasonable accommodations that do not create an undue burden so disabled employees may perform the position's essential functions.
Education & Experience
* Graduate of an accredited School of Nursing
* Bachelor's degree in a health-related field preferred but not required
* Minimum three (3) years of recent critical care/emergency nursing experience within the last five years or as required by state/ local EMS regulations
* Pre-hospital experience preferred
* Flight experience is not required but is a plus!
Operation and Safety Requirements:
* As a member of the Clinical Flight Crew, any person employed in this position shall maintain a weight not to exceed 225 pounds, including an empty flight suit and boots.
Skills
Skills as required to practice nursing as defined by assigned state scope of practice and advanced practice skills as defined by Medical Director(s) and Medical Standards
* Maintains positive interpersonal relationships with colleagues, EMS representatives, hospitals, and the public while executing strong interpersonal skills and a high degree of collaboration at all levels
* Demonstrates high critical thinking and reasoning skills and strong attention to detail while working in a fast-paced environment that requires the ability to prioritize and multi-task
* Ability to work a flexible schedule, including overtime and 24/7 on-call rotation
* Dependable and self-motivated while working in a frequently changing environment
* Excellent communication and presentation skills, both written and verbal
Computer Skills
* Proficient with Microsoft Suite, including Word, Excel, PowerPoint and Outlook
Certificates, Licenses, Registrations
* Current RN license(s) for states of practice
* EMS or MICN certification/licensure as required by state regulations
* Current certifications in Healthcare Provider BLS/CPR; ACLS; PALS or equivalent (AHA, ARC, or ASHI only courses if state or county required) and TPATC/TNCC/ITLS/PHTLS advanced provider (if state or county required)
* If you do not have a current trauma certification, Air Methods will provide the TPATC online course to be completed prior to new hire orientation
Other certification requirements:
* Specialty certification (CFRN or CEN) are required within 24 months of hire
* Advanced Trauma Course requirement: One (1) of the following certifications are acceptable: TPATC, TNCC, ATCN, TNATC, or CAMTS-approved advanced trauma course before completion of third-rider training
* NRP certification before completion of the third-rider orientation
* NIMS Training IS 100, 200, 700, 800, and HazMat before completion of third-rider training
Benefits
Air Methods is proud to offer a comprehensive benefits package created with the diverse needs of our teammates in mind:
* Health, Dental and Vision
* Competitive 401(k) Retirement Plan
* Flexible Spending Account Benefit Plans
* Tuition Reimbursement
* Full Company-Paid Life Insurance
* AD&D Insurance
* Short-Term and Long-Term Disability Insurance
* Business Travel Accident Insurance
* Voluntary Legal
* Relocation Assistance
* Employee Assistance and Benefit Concierge Service Programs
Minimum pay
USD $77,750.40/Yr.
Maximum Pay
USD $95,022.72/Yr.
Benefits
For more information on our industry-leading benefits, please visit our benefits page here.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Nurse Case Manager - Louisville
Utilization review nurse job in Louisville, KY
About TRIUNE Health Group TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs. At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive-both professionally and personally. Why Join TRIUNE Health Group as a Nurse Case Manager?
Be part of a well-established, family-owned company that prioritizes people over profits.
Experience our culture of
People Helping People
, where every team member is treated with dignity and respect.
Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance.
Perks & Benefits:
Generous Time Off: 20 days of vacation plus 8.5 paid holidays
Retirement Savings: 401(k) match to help you plan for the future
Comprehensive Insurance: Medical, dental, and vision coverage
Disability Coverage: Short-Term (STD) and Long-Term Disability (LTD) insurance
Employee Support: Employee Assistance and Referral Program
Work-from-Home Essentials: Home office equipment, including a laptop and desktop monitor
Travel Perks: Mileage and travel reimbursement
TRIUNE Health Group is an equal opportunity employer and a values-driven organization. Compensation is competitive and commensurate with experience. I. Summary of Position: The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate. II. Essential Duties and Responsibilities:
Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source.
Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual's progress.
Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness.
Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication.
Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients' homes when required.
Communicate medical information clearly and compassionately to patients and families.
Stay current with medical terminology and the federal and state laws related to health care, Workers' Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA.
Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA.
Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for individuals.
Possess a valid driver's license with the ability to travel 90% of the time.
Perform other duties as assigned.
III. Job Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities:
Proven leadership skills.
Excellent verbal and written communication skills, including the ability to interact effectively with patients, customers, and fellow employees via phone, email, in-person, and formal presentations.
Methodical in accomplishing job-related goals.
Strong analytical and organizational skills, including the ability to multitask with attention to detail.
In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet.
Maintain a friendly, professional attitude at all times.
Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities.
Dependability and adaptability.
Education and Experience:
Graduate of an accredited school of nursing.
Current RN licensure in the state of operation.
Fluency in English (speaking, reading, and writing).
Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology.
CCM preferred.
Certificates, Licenses, Registrations: While not mandatory, individuals with one or a combination of the following certifications are preferred: COHN, COHN-S, and CDMS. IV. 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. The base salary range/hourly rate listed is dependent on job-related, non-discriminatory factors such as experience, education, and skills. This position is also eligible for incentive compensation awards. You may be eligible for the following competitive benefits: medical, dental, vision, life, accident & disability, short and long-term disability, paid holidays, paid time off and 401 (k). bination of the following certifications is preferred: COHN, COHN-S, CCM, and CDMS.
Intake Nurse Coordinator, Behavioral Health Unit
Utilization review nurse job in Danville, KY
Facility Name: Ephriam McDowell
Schedule: Monday - Friday 3p-11p
Your experience matters
Lifepoint Behavioral Health is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As an Intake Nurse Coordinator joining our team, you're embracing a vital mission dedicated to
making communities healthier
. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.
More about our team
Ephraim McDowell is a 15-bed behavioral health unit located in Danville, Kentucky.
How you'll contribute
An intake nurse coordinator who excels in this role:
Assists the PD in directing nursing activities during evening working hours.
Assists the PD in recruitment and interviewing of staff.
Conducts new employee education.
Assist in review and revision of policies and procedures.
Participates in departmental and team meetings.
This individual is responsible for working with internal and external customers to identify patients' appropriateness to admit to the unit or refer to other community
resources.
Assist with providing group therapies and train other clinical staff to execute nursing care duties to ensure quality patient care and proper execution and documentation.
Ability to cultivate and maintain relationships with internal and external customers as well as maintains patient/family confidentiality and provides sensitive, respectful, and compassionate customer service at all times.
Ability to work independently in a fast-paced hospital environment.
Demonstrates an understanding of legal issues associated with assessment/admission for voluntary vs involuntary status, EMTALA, and processes for admissions when patients have a guardian in the state of Kentucky.
Knowledge of the diagnostic statistics manual V or DSMV or most recent version.
Understanding of mental illness and stages of development. Ability to present clinical findings to attending psychiatrist and provide handoff to charge RN.
Why join us
We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:
Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
Professional Development: Ongoing learning and career advancement opportunities.
What we're looking for
Applicants should have:
Education: Graduate from an accredited program of professional nursing required.
Experience: Previous experience in a psychiatric health care facility, with direct experience working with chemical dependency, dual diagnosis, psychiatric and geriatric patients preferred.
Two years' leadership experience preferred.
License: Current unencumbered license to practice by the State Board of Nursing, valid driver's license preferred.
Additional Requirements: CPR certification and Crisis Prevention Training (CPI) within 30 days. May be required to work flexible hours.
Connect with a Recruiter
Not ready to complete an application, or have questions? Please contact Morgan Gilbert by emailing **********************************
EEOC Statement
“Lifepoint Behavioral Health is an Equal Opportunity Employer. Lifepoint Behavioral Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.”
Auto-ApplyNurse Care Coordinator
Utilization review nurse job in Paducah, KY
We are seeking a dedicated and compassionate Nurse Care Coordinator to join our dynamic team at LivWell Community Health Services. This role involves acting as a vital liaison between medical staff and case management, ensuring that our clients receive comprehensive and coordinated care. The ideal candidate will have a strong understanding of HIV care and will be committed to supporting our clients' health and well-being.
Job Responsibilities:
· Manage referrals to external providers and clinics, ensuring barriers to care are addressed and assistance is provided when necessary (ex. Transport, appointment reminders).
· Assist with directing patient flow during clinic hours.
· Collect and send required information and medical records post-appointment
· Close out referrals as necessary
· Collaborate with medical staff to address client compliance and keep referral records updated with the latest information
· Oversee referrals for diagnostic tests (e.g., mammograms, CT scans, MRIs, x-rays) including pre-certification as needed. Discuss any abnormal results with needed staff/physicians and ensure follow-up on orders
· Maintain and actively manage the referral reports, ensuring all necessary follow-ups are completed.
· Conduct adherence calls regarding medications and appointments, particularly for new clients starting medication.
· Maintain a lab calendar and follow up on lab tests that require follow-up
· Keep an accurate and comprehensive calendar of all scheduled appointments, tests and necessary transportation needs.
· Administer and read TB skin tests, vaccines, and other injections as needed, stepping in for designated staff when necessary.
· Assist in managing the interdisciplinary team (IDT) list and supporting the Linkage to care team in re-engaging individuals not retained in care.
· Schedule and perform new patient Medical Intakes.
· Reviews all new patient records, user defines all pertinent information and scans the records into the electronic chart.
· Will travel to satellite clinics to assist with rooming patients.
· Will help fill in for medical staff when there is an absence.
· Will serve as a source of knowledge for the medical assistance when they have questions or need guidance.
· Aids in the development and implementation of tactical work plans to support the goals and objectives of the medical department and the organization.
· Verifies client information.
· Comply with all LivWell CHS standards.
· Utilizes data to enhance service delivery and care quality.
· Conduct routine evaluations of service effectiveness.
· Operates office equipment as needed to assist in program operations.
· Contributes to the team effort by accomplishing related results as needed.
· Attending all primary care meetings and all staff meetings.
· Trains and certifies to perform rapid-rapid HIV testing.
· Complies with all rules, regulations, and procedures of the organization.
· Performs all other duties assigned.
Qualifications:
Education/Experience:
RN required
Experience in a healthcare setting, particularly in HIV care, is highly desirable.
Preferred knowledge of clinical immunizations, growth and development, cultural diversity, performance improvement and coding.
Familiarity with Data entry and EMR systems.
Strong organizational skills and the ability to manage multiple tasks efficiently.
Strong verbal and written communication skills.
Ability to work collaboratively in a team-oriented environment
Skills/Abilities:
Quick and accurate word processing skills; Knowledge of touch-typing system.
Excellent knowledge of word processing tools and spreadsheets. (MS Office Word, Excel etc.)
Working knowledge of office equipment and computer hardware and peripheral devices.
Basic understanding of databases.
Great attention to detail.
Strong verbal and written communication skills.
Integrity, discretion, and respect for confidentiality and privacy.
Organization and time management skills.
Ability to read, understand, evaluate, and verify a wide range of materials and information to recognize and correct discrepancies.
Strong problem-solving skills.
The ability to create data driven strategies.
The ability to analyze complex data to make conclusions about that data.
The ability to create visual models for data.
Time management skills.
Physical Demands:
The physical demands described here represent those that must be met by any worker to successfully perform the essential functions of this job. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential functions. The worker is frequently required to stand, walk, use hands to finger, handle, or feel and reach with hands and arms. The worker is occasionally required to sit and stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus.
LivWell Community Health Services is an equal opportunity employer. We encourage all applicants without regard to race, nationality, color, religion, sexual orientation, disability, sex, gender identity, age, or veteran status. We are committed to creating an inclusive, diverse, and equitable workplace for all.
Field Nurse (LPN)
Utilization review nurse job in Lexington, KY
Licensed Practical Nurse
*Up to $5,000 Sign On Bonus*
Yearly continuing education allowance
Medical, Dental, Vision and 401k
Competitive salary and bonus program
15 days of PTO
11 paid holidays yearly
Grow a relationship with your patients
Work in your community
Proprietary technological systems
Our Mission: At ConcertoCare, we believe seniors and older adults with complex care needs deserve a more holistic, equitable, and compassionate approach to health and wellness.
ConcertoCare's tech-enabled in-home care teams leverage our value-based, interdisciplinary care model to address unmet health and social needs and improve patients' quality of life, partnering with them, their caregivers, families, health providers, and communities
Our Vision: We will redefine care and aging for millions of US seniors and other adults with complex care needs by perfecting the kind of human-first, tech-enabled care in the home that we would want for our families.
ConcertoCare is seeking a Licensed Practical Nurse (LPN) to be a core member of a multi-disciplinary Field Team that delivers home- and community-based care to patients with complex needs.
This is a great fit for a Licensed Practical Nurse (LPN) who is seeking:
An opportunity for “top of license” clinical practice.
A collaborative multidisciplinary team-based approach to care.
An innovative, value-based clinical model focused on caring for patients with complex needs who are inadequately served by traditional healthcare delivery systems.
Access to professional development via dedicated clinical education programming and real-time support from our on-staff world-class experts in geriatric medicine, palliative care, geriatric psychiatry, clinical pharmacy, care management, and social determinants of health and health equity.
Licensed Practical Nurse (LPN) Responsibilities:
Partners with team members in the development and implementation of clinical treatment plans under the clinical supervision of providers and registered nurses and the direction of team members; includes active engagement and participation in all team meetings.
Supports wrap-around clinical services in the home- and field setting, including delivery of care through co-visits with other team members, assisted telehealth visits with providers and other team members, and independent LPN visits.
Provides clinical services and clinical coordination services as directed by a patient's clinical risk assessment and clinical care plan and under the clinical supervision of providers, Practice Managers, and RN Case Managers.
Conducts health screenings for newly enrolled patients and on an ongoing basis.
Performs clinical services in the field, including but not limited to wound care dressing changes, phlebotomy, medication review, and patient status checks.
Meets with unable-to-reach patients in their home setting to re-engage patients in the program.
Provides cross-coverage for planned and unplanned absences for team members to ensure that patient care is not interrupted.
Partners with interdisciplinary team members to continuously improve the quality of care, reduce the cost of care, and improve both patient and staff satisfaction.
Licensed Practical Nurse (LPN) Requirements:
Licensed Practice Nurse, license certification in the state of employment
Experience providing care for the whole person, including patients living with mental illness and substance use disorders.
Current CPR and BLS certification required
Average to advanced computer & software skills (Microsoft Word, Excel, Outlook)
Ability and means to travel as needed in a timely manner to locations that may have limited access to public transportation; proof of liability and property damage insurance on vehicle used is required.
DRIVER REQUIREMENTS: Licensed for a minimum of 5 years. No vehicle-related suspensions, DUI, reckless driving, leaving the scene of an accident, vehicular manslaughter, felony convictions, or 3 or more moving violations within the last 5 years. No more than 2 moving violations or 1 at-fault accident in the last 3 years.
Vaccination Policy
ConcertoCare requires all “frontline workers” to be fully vaccinated and to provide records for validation. Medical or religious exemption will be considered contingent upon the review of appropriate documentation.
Base Salary/ Wage Range $26.00 to $31.00/hour with annual bonus. Compensation for the role is commensurate with the candidate's qualifications, skills, competencies, and experience and
may fall outside
of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace
Cath Lab Nurse
Utilization review nurse job in Bowling Green, KY
Job Description
The CARDIAC CATHETERIZATION LABORATORY NURSE specializes primarily in the care of patients undergoing diagnostic cardiac catheterization, interventional cardiac procedures, insertion of permanent and temporary pacemakers, and insertion of intra-aortic balloon pumps. The nurse is responsible for the operation of specialized equipment in a safe and efficient manner, assisting in diagnostic catheterization, and interventional cardiac procedures, and patient care during the procedure. The nurse works under the direct supervision of the physician and Cardiac Catheterization Laboratory manager or supervisor.
ABOUT US
For more than 40 years, ATC Healthcare has provided leading nurses and healthcare professionals to hospitals and facilities nationwide. Healthcare systems around the U.S., including municipal health systems, multi-unit senior care companies, governments, school systems, VMS and MSP vendors trust us to deliver more than 100,000 nurses and other healthcare professionals on-demand. If you have a track record of success in healthcare, we want you to join us!
We offer the following benefits:
Medical insurance
Dental insurance
Vision insurance
Referral program
Tuition reimbursement
401k Plan
Flexible Schedules
Life insurance
Disability insurance
Identity theft insurance
Compensation $73/hour
EDUCATION
Graduate of an accredited Diploma, Associate or Baccalaureate School of Nursing.
LICENSURE
Current and unrestricted state license as a Registered Nurse in the state of practice.
EXPERIENCE
At least one year experience as a cardiac catheterization laboratory nurse in a clinical setting.
CREDENTIALS:
Advanced CPR credentials, such as ACLS; NALS may be required for cardiac catheterization nurses working with the pediatric population; health and screening tests as required by specific facilities and/or regulatory agencies.
ENVIRONMENTAL WORKING CONDITIONS
Various client facility settings; possible exposure to blood, bodily fluids, and other potentially infectious materials.
REPRESENTATIVE DUTIES AND RESPONSIBILITIES
Complies with ATC policies/procedures.
Complies with client facility nursing policies/procedures.
Documents accurately and completely services provided.
Maintains confidentiality relative to patient care and facility practices in accordance with the
Health Insurance Portability and Accountability Act.
Communicates information effectively to appropriate personnel.
Provides required care while maintaining a safe, therapeutic environment.
Evaluates and modifies the plan of care based on observable responses by the patient.
Performs continuous nursing assessment of the patients' physical and emotional needs and corresponding therapeutic interventions.
Provides patient services in a non-judgmental, non-discriminatory manner that considers cultural diversity and age appropriateness so that autonomy, rights, and dignity are preserved.
Advocates patient rights with respect to advance directives and organ donation.
Provides care to the patient pre-procedure, during, and post-procedure in the cardiac catheterization laboratory.
Performs non-invasive hemodynamic monitoring, such as continuous telemetry monitoring band 12 lead EKG monitoring and dysrrhythmia interpretation.
Assists physician with non-invasive diagnostic procedures.
Assists physician with invasive diagnostic procedures, such as cardiac catheterization.
Assists physician with invasive interventional procedures, such as permanent pacemaker insertion.
Maintains competency by participating in continuing education programs and meets state specific requirements.
Complies with accepted ethical conduct and professional standards of nursing practice as set forth by the American Nurses Association or equivalent nursing organization.
Other Duties: Please note this job summary is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may vary by assignment and may change at any time with or without notice.
Equal Opportunity Employer: ATC Healthcare Services is an Equal Opportunity Employer. All applicants will be considered for employment without regards to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status or any other category protected by Federal, State or local law. M/F/D/V EOE
ADD TAG
Nocturnist NP/PA
Utilization review nurse job in Lexington, KY
Job Description
Excellent Nocturnist NP/PA Opportunity in Lexington, KY.
We welcome the challenge of complex cases, working in an open ICU with 24-hour intensivist coverage. Our providers are welcome to perform procedures consistent with their privileges, but procedures are not a requirement.
We have team huddles at least three times a week and a monthly all-staff meeting to connect about the practice, hospital-related topics, and developments within the company.
We have monthly educational CME meetings and hospital-wide hospital medicine committee meetings.
Hospitalist APPs independently manage pre-op patients in a clinic setting with support staff and available supervising physicians.
Most of us like to spend time with our families or outdoors, so a flexible schedule is available,?and we cover for each other when we're out.
Benefits include medical, dental, vision, life, and AD&D insurance, long- and short-term disability, 401k with match, paid medical malpractice and tail coverage, and annual CME allowance.
About the location:
If you're considering relocating to Lexington, the area offers a blend of cultural richness, a strong horse industry, affordable living, and outdoor recreational opportunities. It appeals to those seeking a welcoming community with a touch of Southern charm and historical significance.
Job # VRKYNOCNPPA2583
For more information, please email a copy of your CV to ************************** or call Vicky Rinehart at ************.
Easy ApplyNp - 15342091
Utilization review nurse job in Paducah, KY
Advanced Practice - NP (Nurse Practitioner) - Paducah, KY
Employer: Veterans Evaluation Services - Paducah Job Type: Locums Shift: Per Diem Days
Veterans Evaluation Services (VES), a Maximus company, is a government contractor helping our nation's Veterans. Exams are primarily interview-based with some physical assessment: range of motion testing, muscle strength testing. Proficient in METs testing, evaluating and diagnosing respiratory, cardiovascular, and neurological conditions. Reporting/DBQs must be submitted within 48 hours upon exam completion - no narrative report. End product is completion of standardized form(s). ***Hourly, Overtime, Holiday rates are NOT applicable with VES. All Gen Med providers must follow the rate structure below.
Position Highlights
Per Diem 1 day/week
DETAILS:
MUST have OWN OFFICE CLINIC and be within 50 Miles of market
Need is on a PRN basis, ongoing
Option to work half days (4-hours) and/or full days (8-hours) depending on market scheduling needs
One-Time non-treatment C&P exams + separation health assessments
No prescribing, no treatment
Quick credentialing & onboarding
Use of Goniometer required
Familiar with Musculoskeletal, Diabetes, and Cardio required
Own personal laptop (NO MACs)
Training shall be provided for all Reporting/Disability Benefits Questionnaires (DBQs)
Evaluations to be completed in VES's provider portal
Record review is required in most cases
Follow up administrative work will be required on a regular basis (addendums, medical opinions, and reading diagnostics)
RATE STRUCTURE :
Half-day Rate - $400 flat rate for 4 hour shifts or less (includes times to complete exams, submit report, including any addendums, no OT)
Daily Rate - $800 flat rate for 5 hour shifts or longer (includes times to complete exams, submit report, including any addendums, no OT)
Bonus - onetime bonus of $650 for completing all required training and performing first exams
local candidates only, travel included in rates
Proficient in METs testing, evaluating and diagnosing respiratory, and cardiovascular
Own a laptop (no Mac/Apple products)
Active and unrestricted full license
Must be willing to complete DMA training to become DMA certified
Qualifications
DMA certification available (can get CME credits) \u2013 will need to obtain once privileged if not already certified- Client does not reimburse for DMA certifications or the portal training before starting
Client does not reimburse for DMA certifications or the portal training before starting.
REQUIREMENTS:
AANP Certification
Upon applying, StaffDNA will connect you directly with the hiring decision-maker-whether that's the facility manager or their dedicated recruiter-to discuss this opportunity in detail and outline your next steps.
Utilization Management Nurse
Utilization review nurse job in Frankfort, KY
**Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others.
**Use your skills to make an impact**
**Required Qualifications**
+ Active unrestricted RN license with the ability to obtain Compact Nursing License
+ A minimum of three years clinical RN experience;
+ Prior clinical experience, managed care experience, **OR** utilization management experience
+ Demonstrates Emotional Maturity
+ Ability to work independently and within a team setting
+ Willing to work in multiple time zones
+ Strong written and verbal communication skills
+ Attention to detail, strong computer skills including Microsoft office products
+ Ability to work in fast paced environment
+ Ability to form positive working relationships with all internal and external customers
**Preferred Qualifications**
+ Education: BSN or bachelor's degree in a related field
+ Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
+ Previous experience in utilization management within Insurance industry
+ Previous Medicare Advantage/Medicare
+ Current nursing experience in Hospital, SNF, LTAC, DME or Home Health.
+ Bilingual
**Alert**
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
**Interview Format - HireVue**
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
**Work-At-Home Requirements**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**Benefits**
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-25-2025
**About us**
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
Easy ApplyField Nurse Practitioner - Boone County, KY
Utilization review nurse job in Florence, KY
Job Description
Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations.
The building B.L.O.C.K.S. of our team's success!
Bring the fun
Leverage together for better
Outperform yourself
Care at every touchpoint
Keep your word. Keep it real
Stay curious & listen well
Primary Purpose:
We are proud of the quality care we provide members and our team is rapidly expanding to meet the demands of our growing business; we are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at risk populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. This role is 1099 (PRN) and offers tremendous flexibility and opportunity for those who are balancing competing priorities.
Learn more about our primary purpose here
Follow us on LinkedIn:
******************************************
NP Responsibilities:
Perform annual in-home wellness visits and risk adjustment health assessments on a population with chronic conditions; Our thorough evaluations include: a comprehensive assessment, physical examination, body system review, vital signs, review of medication history, review of current prescriptions, review of member functional status, pain management, cognitive assessment, review of the home environment, fall risk screening, social assessment, review of daily living activities, mental health screening, documentation and communication
You will play a pivotal role in providing individualized quality care to the elderly population in their homes
Deliver patient health education on topics such as pain management, medication, etc.
Build relationships of trust with members through exceptional communication and empathy
Assist in closing quality care gaps (i.e. screenings and labs)
An enthusiastic collaborator contributing to the enhancement of care delivery
Providers are expected to commit a minimum of 30 hours per month
Locations:
Boone County, KY
Requirements
NP Qualifications:
Must have a valid unencumbered NP License for the state you will be working in
This role requires travel within the assigned job posting county up to a maximum 55-mile radius
Previous in-home risk assessment experience preferred
Previous 1099 (PRN) experience is preferred but not required
3 years patient care experience preferred (primary care/adult/geriatric, EMR)
May be requested to obtain additional NP licensure supported by Advantmed
Access to reliable transportation that will enable you to travel to member's homes within a designated area
Strong ability to work within our EMR system
Ability to work independently
Bilingual is a plus
Benefits
Advantmed offers:
Competitive compensation of ~$100 per completed in-home health assessment
Paid mileage
Flexible work schedule
Evening and weekend availability
Never on-call
Visits ready to be scheduled immediately
Appointment confirmation support
Dedicated coordinator support
Advanced member scheduling coverage
State of art technology
Nurse Case Mgr II (US)
Utilization review nurse job in Louisville, KY
Telephonic Nurse Case Manager II Hours: Monday - Friday 9 - 5:30 pm EST, plus 3 times a month 11:30 - 8 pm EST. Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
* This position will service members in different states; therefore Multi-State Licensure will be required.
The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically.
How you will make an Impact:
* Ensures member access to services appropriate to their health needs.
* Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
* Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
* Coordinates internal and external resources to meet identified needs.
* Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
* Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues.
* Assists with development of utilization/care management policies and procedures.
Minimum Requirements:
* Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* Current, unrestricted RN license in applicable state(s) required.
* Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Skills, Capabilities, and Experiences:
* Certification as a Case Manager is preferred.
* BS in a health or human services related field is preferred.
For candidates working in person or virtual in the below locations, the salary* range for this specific position is $76,944 to $115,416.
Locations: New York.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Flight Nurse
Utilization review nurse job in Bedford, KY
Join us in the enchanting town of Bedford, for an extraordinary career as a Flight Nurse with Air Methods.
Nestled amidst the majestic landscapes of Bedford, KY offers a perfect blend of natural beauty and cultural richness. As a pivotal member of our team, you'll play a crucial role in providing life-saving medical transport to the community.
With a minimum of 36 months of experience in a busy ICU, ER, Flight, or Critical Care Transport setting within the last 5 years, your expertise will be invaluable. Operating on a schedule of two 24-hour shifts per week, you'll deliver top-notch critical care, adhering to the highest standards set by Air Methods Community Base Services (CBS) Medical Director(s).
Your responsibilities will encompass assessment, triage, and treatment, ensuring the safe transport of critical patients to the appropriate medical facility. From the unique vantage point of a helicopter, you'll enjoy breathtaking views of the scenic Kentucky landscape, enhancing the experience of your daily work.
Join us in Bedford, where every flight underscores our commitment to excellence and safety in medical transport. Experience the thrill of flight while making a significant impact on the well-being of those in need in this dynamic and culturally rich community.
Responsibilities
Job Summary
Responsible for providing high-quality critical care, including assessment, triage, and treatment utilizing standards and guidelines established by Air Methods Community Base Services (CBS) Medical Director(s). You'll assess the nature and extent of illness or injury to establish and prioritize the care needed for the safe transport of the critical patient to the appropriate facility and are responsible for carrying out the mission and goals of Air Methods CBS, assuring that safety remains the highest priority throughout the transport continuum.
Essential Functions and Responsibilities include the following:
• Provides nursing care within his/her scope of practice from the initial contact until patient care is relinquished to the accepting medical facility; maintains thorough patient care documentation.
• Maintains competency in knowledge and psychomotor skills by participating in ongoing laboratory and clinical experiences. Communicates educational needs to the Medical Base Supervisor and Medical Education Coordinator. Maintains documentation of required licensure, certifications, continuing education, aviation and safety training, OSHA and HIPAA training, clinical rotations, and advanced procedures and attends continuing education programs pertinent to his/her area of practice.
• Knowledgeable in using and maintaining all equipment and supplies used by Air Methods CBS. Responsible for reporting medical equipment failures and taking initial steps to ensure equipment repair as directed. Maintains adequate supplies onboard aircraft to deliver patient care. Keeps aircraft clean and orderly to ensure rapid response to all transport requests.
• Functions as a medical flight member by attending pre-mission briefings and mission debriefings and completing necessary documentation. Assists in pre-mission liftoff checklist and assists pilot as requested, i.e., radio, navigational, and visual observation activities. Complies with safety standards to assure the safety of self, medical personnel, patients, and equipment and conducts aircraft safety briefings as needed.
• Serves as a flight resource to neonatal/pediatric personnel when transporting specialty patients by helicopter and performs advanced skills and procedures as approved by Air Methods CBS Medical Director(s).
• Participates in patient and referring institution follow-up and in planned outreach marketing and education activities
• Acts as a preceptor and/or participates in orientation of new employees and students as assigned and communicates program goals and objectives.
• Participates regularly in Air Methods CBS meetings, activities, projects, and committees (to include research and publishing opportunities).
• Other Duties as assigned.
Additional Job Requirements
• Regularly scheduled attendance
• Indicate the percentage of time spent traveling: 5%
•Subject to applicable laws and Air Method's policies, regular attendance is an essential function of the position. All employees must follow Air Methods' employment practices and policies.
Supervisory Responsibilities
•This position has no supervisory responsibilities.
Qualifications
Qualifications
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. In accordance with applicable laws, Air Methods will provide reasonable accommodations that do not create an undue burden so disabled employees may perform the position's essential functions.
Education & Experience
• Graduate of an accredited School of Nursing
• Bachelor's degree in a health-related field preferred but not required
• Minimum three (3) years of recent critical care/emergency nursing experience within the last five years or as required by state/ local EMS regulations
• Pre-hospital experience preferred
• Flight experience is not required but is a plus!
Operation and Safety Requirements:
· As a member of the Clinical Flight Crew, any person employed in this position shall maintain a weight not to exceed 225 pounds, including an empty flight suit and boots.
Skills
Skills as required to practice nursing as defined by assigned state scope of practice and advanced practice skills as defined by Medical Director(s) and Medical Standards
• Maintains positive interpersonal relationships with colleagues, EMS representatives, hospitals, and the public while executing strong interpersonal skills and a high degree of collaboration at all levels
• Demonstrates high critical thinking and reasoning skills and strong attention to detail while working in a fast-paced environment that requires the ability to prioritize and multi-task
• Ability to work a flexible schedule, including overtime and 24/7 on-call rotation
• Dependable and self-motivated while working in a frequently changing environment
• Excellent communication and presentation skills, both written and verbal
Computer Skills
• Proficient with Microsoft Suite, including Word, Excel, PowerPoint and Outlook
Certificates, Licenses, Registrations
• Current RN license(s) for states of practice
• EMS or MICN certification/licensure as required by state regulations
• Current certifications in Healthcare Provider BLS/CPR; ACLS; PALS or equivalent (AHA, ARC, or ASHI only courses if state or county required) and TPATC/TNCC/ITLS/PHTLS advanced provider (if state or county required)
• If you do not have a current trauma certification, Air Methods will provide the TPATC online course to be completed prior to new hire orientation
Other certification requirements:
• Specialty certification (CFRN or CEN) are required within 24 months of hire
• Advanced Trauma Course requirement: One (1) of the following certifications are acceptable: TPATC, TNCC, ATCN, TNATC, or CAMTS-approved advanced trauma course before completion of third-rider training
• NRP certification before completion of the third-rider orientation
• NIMS Training IS 100, 200, 700, 800, and HazMat before completion of third-rider training
Benefits
Air Methods is proud to offer a comprehensive benefits package created with the diverse needs of our teammates in mind:
· Health, Dental and Vision
· Competitive 401(k) Retirement Plan
· Flexible Spending Account Benefit Plans
· Tuition Reimbursement
· Full Company-Paid Life Insurance
· AD&D Insurance
· Short-Term and Long-Term Disability Insurance
· Business Travel Accident Insurance
· Voluntary Legal
· Relocation Assistance
· Employee Assistance and Benefit Concierge Service Programs
Minimum pay USD $77,750.40/Yr. Maximum Pay USD $95,022.72/Yr. Benefits
For more information on our industry-leading benefits, please visit our benefits page here.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Auto-ApplyNurse Care Coordinator
Utilization review nurse job in Paducah, KY
Job DescriptionSalary:
We are seeking a dedicated and compassionate Nurse Care Coordinator to join our dynamic team at LivWell Community Health Services. This role involves acting as a vital liaison between medical staff and case management, ensuring that our clients receive comprehensive and coordinated care. The ideal candidate will have a strong understanding of HIV care and will be committed to supporting our clients' health and well-being.
Job Responsibilities:
Manage referrals to external providers and clinics, ensuring barriers to care are addressed and assistance is provided when necessary (ex. Transport, appointment reminders).
Assist with directing patient flow during clinic hours.
Collect and send required information and medical records post-appointment
Close out referrals as necessary
Collaborate with medical staff to address client compliance and keep referral records updated with the latest information
Oversee referrals for diagnostic tests (e.g., mammograms, CT scans, MRIs, x-rays) including pre-certification as needed. Discuss any abnormal results with needed staff/physicians and ensure follow-up on orders
Maintain and actively manage the referral reports, ensuring all necessary follow-ups are completed.
Conduct adherence calls regarding medications and appointments, particularly for new clients starting medication.
Maintain a lab calendar and follow up on lab tests that require follow-up
Keep an accurate and comprehensive calendar of all scheduled appointments, tests and necessary transportation needs.
Administer and read TB skin tests, vaccines, and other injections as needed, stepping in for designated staff when necessary.
Assist in managing the interdisciplinary team (IDT) list and supporting the Linkage to care team in re-engaging individuals not retained in care.
Schedule and perform new patient Medical Intakes.
Reviews all new patient records, user defines all pertinent information and scans the records into the electronic chart.
Will travel to satellite clinics to assist with rooming patients.
Will help fill in for medical staff when there is an absence.
Will serve as a source of knowledge for the medical assistance when they have questions or need guidance.
Aids in the development and implementation of tactical work plans to support the goals and objectives of the medical department and the organization.
Verifies client information.
Comply with all LivWell CHS standards.
Utilizes data to enhance service delivery and care quality.
Conduct routine evaluations of service effectiveness.
Operates office equipment as needed to assist in program operations.
Contributes to the team effort by accomplishing related results as needed.
Attending all primary care meetings and all staff meetings.
Trains and certifies to perform rapid-rapid HIV testing.
Complies with all rules, regulations, and procedures of the organization.
Performs all other duties assigned.
Qualifications:
Education/Experience:
RN required
Experience in a healthcare setting, particularly in HIV care, is highly desirable.
Preferred knowledge of clinical immunizations, growth and development, cultural diversity, performance improvement and coding.
Familiarity with Data entry and EMR systems.
Strong organizational skills and the ability to manage multiple tasks efficiently.
Strong verbal and written communication skills.
Ability to work collaboratively in a team-oriented environment
Skills/Abilities:
Quick and accurate word processing skills; Knowledge of touch-typing system.
Excellent knowledge of word processing tools and spreadsheets. (MS Office Word, Excel etc.)
Working knowledge of office equipment and computer hardware and peripheral devices.
Basic understanding of databases.
Great attention to detail.
Strong verbal and written communication skills.
Integrity, discretion, and respect for confidentiality and privacy.
Organization and time management skills.
Ability to read, understand, evaluate, and verify a wide range of materials and information to recognize and correct discrepancies.
Strong problem-solving skills.
The ability to create data driven strategies.
The ability to analyze complex data to make conclusions about that data.
The ability to create visual models for data.
Time management skills.
Physical Demands:
The physical demands described here represent those that must be met by any worker to successfully perform the essential functions of this job. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential functions. The worker is frequently required to stand, walk, use hands to finger, handle, or feel and reach with hands and arms. The worker is occasionally required to sit and stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus.
LivWell Community Health Services is an equal opportunity employer. We encourage all applicants without regard to race, nationality, color, religion, sexual orientation, disability, sex, gender identity, age, or veteran status. We are committed to creating an inclusive, diverse, and equitable workplace for all.
Cath Lab Nurse
Utilization review nurse job in Bowling Green, KY
The CARDIAC CATHETERIZATION LABORATORY NURSE specializes primarily in the care of patients undergoing diagnostic cardiac catheterization, interventional cardiac procedures, insertion of permanent and temporary pacemakers, and insertion of intra-aortic balloon pumps. The nurse is responsible for the operation of specialized equipment in a safe and efficient manner, assisting in diagnostic catheterization, and interventional cardiac procedures, and patient care during the procedure. The nurse works under the direct supervision of the physician and Cardiac Catheterization Laboratory manager or supervisor.
ABOUT US
For more than 40 years, ATC Healthcare has provided leading nurses and healthcare professionals to hospitals and facilities nationwide. Healthcare systems around the U.S., including municipal health systems, multi-unit senior care companies, governments, school systems, VMS and MSP vendors trust us to deliver more than 100,000 nurses and other healthcare professionals on-demand. If you have a track record of success in healthcare, we want you to join us!
We offer the following benefits:
Medical insurance
Dental insurance
Vision insurance
Referral program
Tuition reimbursement
401k Plan
Flexible Schedules
Life insurance
Disability insurance
Identity theft insurance
Compensation $73/hour
EDUCATION
Graduate of an accredited Diploma, Associate or Baccalaureate School of Nursing.
LICENSURE
Current and unrestricted state license as a Registered Nurse in the state of practice.
EXPERIENCE
At least one year experience as a cardiac catheterization laboratory nurse in a clinical setting.
CREDENTIALS:
Advanced CPR credentials, such as ACLS; NALS may be required for cardiac catheterization nurses working with the pediatric population; health and screening tests as required by specific facilities and/or regulatory agencies.
ENVIRONMENTAL WORKING CONDITIONS
Various client facility settings; possible exposure to blood, bodily fluids, and other potentially infectious materials.
REPRESENTATIVE DUTIES AND RESPONSIBILITIES
Complies with ATC policies/procedures.
Complies with client facility nursing policies/procedures.
Documents accurately and completely services provided.
Maintains confidentiality relative to patient care and facility practices in accordance with the
Health Insurance Portability and Accountability Act.
Communicates information effectively to appropriate personnel.
Provides required care while maintaining a safe, therapeutic environment.
Evaluates and modifies the plan of care based on observable responses by the patient.
Performs continuous nursing assessment of the patients' physical and emotional needs and corresponding therapeutic interventions.
Provides patient services in a non-judgmental, non-discriminatory manner that considers cultural diversity and age appropriateness so that autonomy, rights, and dignity are preserved.
Advocates patient rights with respect to advance directives and organ donation.
Provides care to the patient pre-procedure, during, and post-procedure in the cardiac catheterization laboratory.
Performs non-invasive hemodynamic monitoring, such as continuous telemetry monitoring band 12 lead EKG monitoring and dysrrhythmia interpretation.
Assists physician with non-invasive diagnostic procedures.
Assists physician with invasive diagnostic procedures, such as cardiac catheterization.
Assists physician with invasive interventional procedures, such as permanent pacemaker insertion.
Maintains competency by participating in continuing education programs and meets state specific requirements.
Complies with accepted ethical conduct and professional standards of nursing practice as set forth by the American Nurses Association or equivalent nursing organization.
Other Duties: Please note this job summary is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may vary by assignment and may change at any time with or without notice.
Equal Opportunity Employer: ATC Healthcare Services is an Equal Opportunity Employer. All applicants will be considered for employment without regards to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status or any other category protected by Federal, State or local law. M/F/D/V EOE
ADD TAG
Auto-ApplyField Nurse (LPN)
Utilization review nurse job in Frankfort, KY
Licensed Practical Nurse * Up to $5,000 Sign On Bonus* * Yearly continuing education allowance * Medical, Dental, Vision and 401k * Competitive salary and bonus program * 15 days of PTO * 11 paid holidays yearly * Grow a relationship with your patients * Work in your community
* Proprietary technological systems
Our Mission: At ConcertoCare, we believe seniors and older adults with complex care needs deserve a more holistic, equitable, and compassionate approach to health and wellness.
ConcertoCare's tech-enabled in-home care teams leverage our value-based, interdisciplinary care model to address unmet health and social needs and improve patients' quality of life, partnering with them, their caregivers, families, health providers, and communities
Our Vision: We will redefine care and aging for millions of US seniors and other adults with complex care needs by perfecting the kind of human-first, tech-enabled care in the home that we would want for our families.
ConcertoCare is seeking a Licensed Practical Nurse (LPN) to be a core member of a multi-disciplinary Field Team that delivers home- and community-based care to patients with complex needs.
This is a great fit for a Licensed Practical Nurse (LPN) who is seeking:
* An opportunity for "top of license" clinical practice.
* A collaborative multidisciplinary team-based approach to care.
* An innovative, value-based clinical model focused on caring for patients with complex needs who are inadequately served by traditional healthcare delivery systems.
* Access to professional development via dedicated clinical education programming and real-time support from our on-staff world-class experts in geriatric medicine, palliative care, geriatric psychiatry, clinical pharmacy, care management, and social determinants of health and health equity.
Licensed Practical Nurse (LPN) Responsibilities:
* Partners with team members in the development and implementation of clinical treatment plans under the clinical supervision of providers and registered nurses and the direction of team members; includes active engagement and participation in all team meetings.
* Supports wrap-around clinical services in the home- and field setting, including delivery of care through co-visits with other team members, assisted telehealth visits with providers and other team members, and independent LPN visits.
* Provides clinical services and clinical coordination services as directed by a patient's clinical risk assessment and clinical care plan and under the clinical supervision of providers, Practice Managers, and RN Case Managers.
* Conducts health screenings for newly enrolled patients and on an ongoing basis.
* Performs clinical services in the field, including but not limited to wound care dressing changes, phlebotomy, medication review, and patient status checks.
* Meets with unable-to-reach patients in their home setting to re-engage patients in the program.
* Provides cross-coverage for planned and unplanned absences for team members to ensure that patient care is not interrupted.
* Partners with interdisciplinary team members to continuously improve the quality of care, reduce the cost of care, and improve both patient and staff satisfaction.
Licensed Practical Nurse (LPN) Requirements:
* Licensed Practice Nurse, license certification in the state of employment
* Experience providing care for the whole person, including patients living with mental illness and substance use disorders.
* Current CPR and BLS certification required
* Average to advanced computer & software skills (Microsoft Word, Excel, Outlook)
* Ability and means to travel as needed in a timely manner to locations that may have limited access to public transportation; proof of liability and property damage insurance on vehicle used is required.
* DRIVER REQUIREMENTS: Licensed for a minimum of 5 years. No vehicle-related suspensions, DUI, reckless driving, leaving the scene of an accident, vehicular manslaughter, felony convictions, or 3 or more moving violations within the last 5 years. No more than 2 moving violations or 1 at-fault accident in the last 3 years.
Vaccination Policy
ConcertoCare requires all "frontline workers" to be fully vaccinated and to provide records for validation. Medical or religious exemption will be considered contingent upon the review of appropriate documentation.
Base Salary/ Wage Range $26.00 to $31.00/hour with annual bonus. Compensation for the role is commensurate with the candidate's qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace
Nurse Case Mgr I (US)
Utilization review nurse job in Louisville, KY
Nurse Case Manager I Hours: 9am-5:30pm EST with 2 -3 evening shifts a month 11:30am-8pm EST Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Nurse Case Manager I is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning
How you will make an impact:
* Ensures member access to services appropriate to their health needs.
* Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
* Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
* Coordinates internal and external resources to meet identified needs.
* Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
* Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
* Negotiates rates of reimbursement, as applicable.
* Assists in problem solving with providers, claims or service issues.
* Assists with development of utilization/care management policies and procedures
Minimum Requirements:
* Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* Current, unrestricted RN license in applicable state(s) required.
* Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Skills, Capabilities and Experiences:
* Certification as a Case Manager is preferred.
* BS in a health or human services related field preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $68,880- $108,240
Locations: Illinois, New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Field Nurse Practitioner - Jefferson County, Kentucky
Utilization review nurse job in Louisville, KY
Job Description
Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations.
The building B.L.O.C.K.S. of our team's success!
Bring the fun
Leverage together for better
Outperform yourself
Care at every touchpoint
Keep your word. Keep it real
Stay curious & listen well
Primary Purpose:
We are seeking a highly skilled and compassionate Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare and other populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care.
NP Responsibilities:
Perform annual wellness visits and health assessments on a population with chronic conditions
Deliver patient health education opportunities
Assist in closing quality care gaps (i.e. screenings and labs)
An enthusiastic collaborator contributing to the enhancement of care delivery
Providers are expected to commit a minimum of 30 hours per month
Locations:
Jefferson County, Kentucky
Requirements
NP Qualifications:
Must have a valid unencumbered NP License for the state you will be working in
Previous in-home Risk Assessment experience preferred
3 years patient care experience preferred (primary care/adult/geriatric, EMR)
Bilingual is a plus
Benefits
Advantmed offers:
Competitive wages (contractor per diem, per completed in-home assessment rate ~$100)
Paid mileage
Flexible work schedule
Evening and weekend availability
Dedicated coordinator support
Advanced member scheduling coverage
State of art technology