Utilization review nurse jobs in Mobile, AL - 761 jobs

Patient Accommodation LPN is responsible for all patient status review and related correction on discharge as needed. Under the supervision of Utilization Review Manager the LPN will review all activity sheets and physician orders to ensure all patient status requirements were met. The LPN will work closely with Patient Accommodations and Case Management. Evaluates patients for appropriateness of admission type and setting, utilizing a combination of clinical information and InterQual guidelines. The Utilization Review Nurse utilizes clinical skills to support the coordination and documentation and communication of medical services and/or benefit Administration determinations. Collect information, to render appropriate medical necessity, benefit determinations. Identify patients for referral opportunity to integrate with other product services and programs. The Utilization Nurse also serves on the liaison between the Physicians, patients, payers and Case Managers regarding termination of payment, denial notification and expedited appeals. Has access to highly sensitive, confidential information. Expected to work under minimal management supervision. Responsibilities Analyzes each of the assigned medical records for the purpose of admission and concurrent review using screening criteria. Intervenes with appropriate parties regarding inappropriate admissions, delays in discharge and the over-utilization of hospital resources. Monitors the utilization of observation services and collaborates with the Case Manger regarding correct status. Collaborates with the Case Manager to determine patient's appropriateness for acute hospital level of care. Monitors patient's clinical course to verify patients continued need for acute hospital level of care. Enter documentation into third-party system as required. Provides clinical information as necessary to obtain authorization for acute inpatient care. Refers cases not meeting acute inpatient criteria to a physician advisor and assists with his/her review of the case Works with Patient Registration/Financial Counselor(s) to identify correct insurance source and proper billing. Verifies patient admission information for each assigned patient within 24 hours of patient's admission (next business day). Collaborates with the Case Manager to identify referrals to Financial Counselors. Provides third party payers with concurrent review information as needed to comply with payers requirements for documentation of medical necessity. Document denial billing requirements in the Billing Office system. Negotiates resolution disagreements over the need for acute hospital level of care with the insurer. Collects and documents data on each admitted patient on an ongoing basis. Documents all patient status and/or observations status according to policies and procedures. Demonstrates a working knowledge of the order entry process and transcription of physician orders. Identifies Potential Avoidable Days per department policy. Gathers information for statistical monitors, plus special projects within Case Management Department. Delivers denial letters from all payers to the beneficiary or proper representative; explain appeal rights. Maintains records in a complete, detailed and orderly manner. Updates and documents in the Case Management system pertinent clinical information by utilizing screening criteria and assigns next review date. Responsible to support and participate in department strategies and efforts focused on improving length of stay (LOS). Responsible to support and participate in department strategies and efforts focused on improving clinical documentation by physicians. Is knowledgeable of hospital mission, vision, and values and performs in a manner to support them. Identifies and reports Quality and Risk Management concerns. Demonstrates Age Specific competency in managing assigned cases. Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation. Must be able to successfully complete the Interrator Reliabililty Tool for InterQual Level of Care Acute Criteria. (Adult and Pediatric) after successful orientation. DCH Standards: Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation. Performs compliance requirements as outlined in the Employee Handbook Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self. Performs essential job functions in a manner that ensures the safety of patients, visitors and employees. Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees. Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees. Requires use of electronic mail, time and attendance software, learning management software and intranet. Must adhere to all DCH Health System policies and procedures. All other duties as assigned. Qualifications Minimum of Licensed Practical Nurse with current Alabama license. Minimum 2 years experience as LPN. Minimum of 2 years of Med Surgical experience required; Utilization Review experience preferred. Efficient use of basic computer skills Ability to multi task, prioritize and effectively adapt to a fast paced changing environment Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the phone and typing on the computer. Work requires the ability to perform close inspection of computer generated documents as well as a PC monitor. Typical office working environment with productivity and quality expectations. Ability to establish priorities, meets deadlines, and maintains proper productivity. Ability to form positive, collaborative relationships with hospital staff, patients, families and payers. Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge. Ability to effectively negotiate with internal and external providers of patient care services. Ability to develop leadership skills and to serve as a role model for clinical staff. Ability to lead and actively participate in multidisciplinary teams. Ability to work independently or within a team structure. Excellent interpersonal skills, communication style and organization. Must be able to read, write legibly, speak, and comprehend English. WORKING CONDITIONS Is able to lift at least 20 lbs. Ability to tolerate prolonged periods of sitting, or standing and/or walking. Ability to reach reasonable distances to handle equipment. Good manual and finger dexterity. Good communication skills Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Are you an experienced LPN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Daily Responsibilities: The Utilization Review LPN is responsible for the pre-certification of determined procedures utilizing the organizations Plan approved criteria. The position helps manage healthcare costs by influencing patient care decision making through case-by-case assessments of the care prior to it's delivery. ESSENTIAL DUTIES AND RESPONSIBILITIES: Evaluates requested services following Plan approved criteria. Demonstrates effective communication methods and skills, using lines of authority appropriately. Establishes a relationship with providers in order to determine/provide needed services for members Arranges discharge planning services prior to pre-planned admissions when available. Acts as liaison and member advocate between the member/family, physician and facilities/agencies. Maintains accurate record of pre-certification decisions. Performs decisions within time frames required by regulatory agencies. Adheres to quality standards and confidentiality policies and procedures. Ensures compliance with all state and federal regulations and guidelines in day-to-day activities. Adapts to changes in policies, procedures, new techniques and additional responsibilities. Qualifications Active FL LPN license with a minimum of 2 years varied clinical experience required. Managed Care experience (utilization review, pre-certification, concurrent review) is preferred. Proficiency in MS Office with basic computer and typing skills. Additional Information Advantages of this Opportunity: • Competitive salary $19 - $26/hr+ (based off experience) • Excellent Medical Benefits Offered • Growth potential • Fun and positive work environment If you are interested in applying to this position please call Jonathan Comstock at (407) 478-0332 Ext. 133

The range for this role is $31.25 - $42.79/hour Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants must be willing and able to work onsite minimum 4 times per week in either our Melbourne, FL or Orlando, FL office. The Mission At Christian Care Ministry we believe that Christians can, and should, share in one another's burdens. Through the use of Medi-Share , a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility. The Team Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren't perfect people, we are serving our perfect God and our Members to the best of our ability. The Job The Medical Review Nurse (Senior Clinical Reviewer) works to summarize and correlate concise, accurate information on medical reviews to determine eligibility of medical bills per the program guidelines. In this role, 70% of the time is spent performing pre-service and post-service medical reviews and/or reviews for high dollar, complex medical cases and collaborating with other departments to optimize cost savings. This position will be expected to make independent decisions regarding timing and omission of medical reviews in deference to other department processes based on the dollar amount of the bill and the Ministry's cost strategy. Essential Job Duties & Responsibilities Organize and review medical records, lab results, radiology, and pathology reports for conditions ineligible for sharing (CIF's) Determine eligibility of members' medical bills and/or upcoming procedures/treatments according to the program guidelines Collaborate with other departments to maximize cost savings for individual cases and optimal outcomes for the members Appropriately apply the program guidelines to the individual cases reviewed Work autonomously to prioritize and manage workload Document effectively in appropriate systems Comply with all organizational HIPAA requirements Contribute to the exercise and expression of the Ministry's Christian beliefs All other duties as assigned Essential Skills & Abilities Understanding of medical bill processing and provider bill negotiation Understand diversity of systems and work flows as they relate to the type of review or assignment Able to multitask in multiple operating systems Able to work for extended periods of time on the computer Proficiency at interpreting medical records and writing detailed reports and conclusions Strategic understanding of negotiations, third party processes, bill validation, and care management to determine when to utilize/defer to these processes for active review cases Ability to be objective and impartial and conclude a case Ability to communicate effectively with both internal and external customers Practice good interpersonal skills and work as a member of a team Possess the ability to adapt to changing processes Working knowledge and application of program guidelines Understanding of systems and work flows as they relate to the type of review or assignment Ability to utilize the internet including e-mail and search engines Word processing skills of at least 25 wpm Basic knowledge in Microsoft Office (Excel, Word, Outlook) and ability to use a database system Knowledge of document imaging system Core Competencies/Demonstrable Behaviors Collaborates - builds partnerships and works collaboratively with others to meet objectives. This role requires strong interdepartmental understanding and communication. Thoroughness - ensures information is complete, accurate; remediates errors when identified and applies feedback to avoid future mistakes. Innovation - able to develop and introduce new, improved methods for completing assignments Managing Change - demonstrates support for departmental improvements with positive attitude Forward Thinking - the ability to anticipate the implications and consequences of situations and take appropriate action to be prepared for possible contingencies Education and/or Experience Current Unrestricted LPN/LVN license with 5+ years' experience in a healthcare payer industry OR RN license with sound knowledge of anatomy and physiology and disease processes required 1-3 years' experience in medical reviews required 2-3 years of clinical experience strongly preferred Experience with Utilization Review or Case Management preferred Supervisory Responsibilities This job has no supervisory responsibilities Incentives & Benefits We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others. For full-time employees working 30 hours or more, some of our benefits include, but are not limited to: • 100% paid Medical for employees/99% for family • Generous employer Health Savings Account (HSA) contributions • Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance • 6 weeks of paid parental leave (for both mom and dad) • Dental - two plans to choose from • Vision • Short-term Disability • Accident, Critical Illness, Hospital Indemnity • 401(k) - up to 4% match on ROTH or Traditional contributions • Generous paid-time off and 11 paid holidays • Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo • Employee Assistance Program including no cost, in-person mental health visits and employee discounts • Monetary Anniversary Awards Program • Monetary Birthday Awards Minimum Age Requirement: Due to the nature of the responsibilities associated with this position-including independent decision-making, access to confidential information, and potential exposure to regulated environments-candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.

Title: HEDIS Utilization Review Nurse Reports to: Director of Managed Care FLSA Status: Exempt Personnel Supervised: None The HEDIS Utilization Review Specialist is responsible for performing comprehensive reviews of medical records to collect data required for HEDIS reporting. This role supports quality improvement initiatives by identifying gaps in care, validating clinical documentation, and ensuring compliance with NCQA (National Committee for Quality Assurance) standards. KEY RESPONSIBILITIES: * Review medical records and clinical data for HEDIS-specific measures. * Abstract and input accurate clinical data from electronic health records (EHRs) into reporting tools. * Identify and report documentation deficiencies or care gaps. * Collaborate with providers, coders, and clinical teams to ensure proper documentation and follow-up. * Assist in the coordination and execution of the annual HEDIS data collection cycle. * Maintain knowledge of current HEDIS specifications and regulatory updates. * Support audits and internal quality improvement initiatives related to clinical outcomes. * Ensure HIPAA compliance and confidentiality of patient information. SKILLS: * Strong knowledge of HEDIS measures and NCQA guidelines. * Proficient in EHR systems and chart review processes. * Detail-oriented with strong analytical and organizational skills. * Excellent communication and collaboration abilities. MINIMAL QUALIFICATIONS: * Education: RN, LPN, LVN. * Experience: * 2+ years of clinical experience in a healthcare setting. * Prior experience with HEDIS abstraction or utilization review strongly preferred. * License: Florida unrestricted license * BLS certification * Computer literacy KNOWLEDGE AND SKILLS: * Knowledge of current professional nursing theory, practice, and techniques * Knowledge of current nursing practices in an outpatient primary care setting * Knowledge of assessment of patient needs and services * Knowledge of current professional nursing and pharmaceutical products, Universal Precautions, and emergency situations * Knowledge of basic pathophysiology of diseases commonly managed in Family Medicine * Knowledge of the application of nursing techniques (example: Triage, blood pressure monitoring, glucose monitoring, etc.) * Knowledge of patient teaching and education (example: self-blood pressure monitoring, nutrition instruction, diabetes self-care instruction) * Knowledge of general patient care and treatment procedures, equipment, rules, regulations, and ethics * Knowledge of Utilization Review Accreditation Commission (URAC) Policies and Procedures * Knowledge of processing and obtaining prior authorizations * Knowledge of making observations of general physical condition and needs of patients and when to confer with a physician about the emotional or physical condition of a patient * Knowledge of the principles of aseptic and sterile techniques and infection control techniques * Knowledge of the techniques of administration of common medications, including immunizations, inoculations, and allergy injections using sterile technique, and knowledge of the side effects of these medications * Knowledge of state and federal drug control laws, rules, and regulations * Knowledge of emergency techniques and procedures * Knowledge of common medical supplies and equipment * Excellent interpersonal, communication and leadership skills * Ability to demonstrate priority-setting and ability to work in a complex environment * Ability to function with a high degree of independence and collaboration with other health care providers * Commitment to service, quality, and departmental core values RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following: * Be familiar with CFHC's program philosophies, goals and objectives. Be cognizant of and comply with all CFHC's policies and procedures, as well as state and federal regulations. * Be competent in performing the duties of a nurse. * Understand the requirements of CFHC's Exposure Control Plan. Personally, utilize universal precautions when practicing in a clinical setting. * Participate in staff outreach and off-site health care programs as requested by the DMC, ACMO, CMO, or CEO. Represent CFHC in the community. * Report as needed to DMC and any pertinent information or situations that impact on patient care or CFHC liability. * Attend and participate in mandatory CFHC meetings (Center Specific meetings, Corporate meetings, and other meetings as designated by the DMC, ACMO, CMO, or CEO). * Demonstrate ability to work cooperatively with other members of the clinical team. Be supportive of coworkers. * Maintain a neat and professional appearance at all times. * Carry out any other activities deemed appropriate by the DMC, CMO, or CEO. Primary Duties include, but are not limited to, the following: * Assess, identify problems, plan goals, monitor and evaluate patient plans, and develop strategies that meet the patients immediate and long-term goals. * Work closely with PCP to manage patient "care items" which could include; medication refills per protocol, lab triage, document management, management of durable medical equipment (i.e. Glucometer, test strips, lancets), prior authorizations of needed medications or other services. * Use patient data to track and schedule follow up appointments. * Provide proactive utilization management for patients with high risk needs. * Assist patients in obtaining appropriate medications and medical supplies and equipment, including coordination of pharmaceutical patient assistance programs. * Participate in quality improvement, quality assurance and innovation activities to ensure optimal level of care delivery. * This position will ensure all HEDIS measures have been met for those assigned patients and all care gaps have been identified. * Assist in the coordination of warm hand-offs or "transfer of trust" between care team, pharmacy or other support services during the office visit. * Carry out other duties as assigned by the DMC. The is not intended to be all-inclusive, and employees will also perform other reasonable related business duties as assigned by supervisor. * This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract or employment. * BENEFITS: Competitive Salary Federal Student Loan Forgiveness: PSLF - 10-year commitment, 120 loan payments and at the end of the commitment, the remaining loan is forgiven Excellent medical, dental, vision, and pharmacy benefits Employer Paid Long-Term Disability Insurance Employer Paid Life Insurance equivalent to 1x your annual salary Voluntary Short-Term Disability, additional Life and Dependent Life Insurance are available Malpractice Insurance Paid Time Off (PTO) - 4.4 weeks per year pro-rated Holidays (9.5 paid holidays per year) Paid Birthday Holiday CME Reimbursement 401k Retirement Plan after 1 year of service (w/matching contributions) Staff productivity is recognized and rewarded PHYSICAL REQUIREMENTS * Requires 80% or more time spent sedentary. * Independently mobile. * Ability to lift weight equivalents that would be required with re positioning equipment and lifting supplies. * Ability to adapt and function in varying environments of workload, patient acuity, work sites, and work shifts. American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.

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

Working Title: REGISTERED NURSING CONSULTANT - 64045206 Pay Plan: Career Service 64045206 Salary: $54,000.00-$58,000.00 Total Compensation Estimator Tool Open Competitive * Anticipated Vacancy Your Specific Responsibilities: Reviews, on a regular basis, infant, child, maternal and reproductive health and other health related materials that impact policy and program development. Participates as lead and/or team member in the planning, development and implementation of new and/or expanded infant, children, maternal and reproductive health initiatives, aiding with technological efforts, providing technical assistance and serving as a liaison with other agencies and organizations. Provides consultation and technical assistance to staff, county health departments, contract providers and others as requested in matters related to comprehensive infant, child, maternal, and reproductive health services and/or other areas as assigned responsibility and as requested. Responds to requests for information regarding the operation of maternal child health services. Participates in Quality Assurance reviews of Healthy Start coalitions, county health departments and private providers. Provides technical assistance and monitoring of services for compliance with state and federal guidelines. Participates in analyzing data and trends related to the health of the infants, women of reproductive age, pregnant women and nursing issues in order to improve services and systems throughout the state. Serves as a contract manager as required by section 287.057(14), Florida Statute for program/division/county health department as needed. This includes participating in quality improvement activities, providing ongoing monitoring, desk audits, site visits, or technical assistance reviews to ensure that contractual services have been rendered in accordance with the contract terms before the agency processes the invoice for payment. The procedures shall include, but need not be limited to, reviewing and documenting all deliverables for which payment is requested by vendors, and providing written certification by contract managers of the agency's receipt of goods and services. Serves on interdepartmental and intradepartmental workgroups and meetings and participates in work efforts related to those workgroups and meetings. Attends conferences and seminars to enhance knowledge base. Coordinates and develops training programs, plans and conducts meetings, workshops, or seminars for county health department and Healthy Start staff, providers and the community to build capacity and integrate a variety of topics and services affecting infants, children, and women of reproductive age, pregnant women and nursing issues. Assists with the analysis of proposed legislative bills, budget issues, grant applications and research relevant to infant, child, maternal and reproductive health. Performs other duties and responsibilities as may be assigned or required, utilizing knowledge of the basic principles and practices. Required Knowledge, Skills, and Abilities: Knowledge of the methods of data collection and analysis; ability to collect, evaluate and analyze data to develop alternative recommendations, solve problems, document work flow and other activities relating to the improvement of operational and management practices; ability to organize data into logical format for presentation in reports, documents and other written materials; ability to conduct fact-finding research; ability to utilize problem-solving techniques; ability to work independently; ability to understand and apply applicable rules, regulations, policies and procedures relating to operational and management analysis activities; ability to plan, organize and coordinate work assignments; ability to communicate effectively. Qualifications: Licensure as a Registered Professional Nurse in accordance with Florida Statute 464 or eligible to practice nursing in accordance with Florida Administrative Code 210-8.27. Serves as contract manager as required by section 287.057(15), Florida Statutes. Ability to travel within and outside the State of Florida. Purchasing -This position is responsible for the preparation of purchasing and the approval of purchasing. Florida Department of Health Mission, Vision, and Values: Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Vision: To be the Healthiest State in the Nation. Values: I nnovation: We search for creative solutions and manage resources wisely. C ollaboration: We use teamwork to achieve common goals & solve problems. A ccountability: We perform with integrity & respect. R esponsiveness: We achieve our mission by serving our customers & engaging our partners. E xcellence: We promote quality outcomes through learning & continuous performance improvement. Where You Will Work: Tallahassee, Florida The Benefits of Working for the State of Florida: Working for the State of Florida is more than a paycheck. The State's total compensation package for employees features a highly competitive set of employee benefits including: * Annual and Sick Leave benefits; * Nine paid holidays and one Personal Holiday each year; * State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options; * Retirement plan options, including employer contributions (For more information, please click *************** * Flexible Spending Accounts; * Tuition waivers; * And more! For a more complete list of benefits, including monthly costs, visit ***************************** Please be advised: Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process. This position requires a security background check and/or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration. Note: You will be required to provide your Social Security Number (SSN) in order to conduct this background check Successful completion of a drug test is a condition of employment for safety-sensitive positions. Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS. For more information, please visit the SSS website: ****************** If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement. The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system. E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility. Incumbents may be required to perform emergency duty before, during, and/or beyond normal work hours or days. All Florida Department of Health positions require the incumbent to be able to learn and communicate effectively, orally and in writing, in English. Applicants who do not meet this requirement will not be considered. The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace. Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (***************. Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act. Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women. The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and/or expertise. Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of an honorable discharge. These initiatives help ensure that the transition from military service into the workforce is as smooth as possible and reflects our appreciation for the dedication devoted to protecting our country. The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace. Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (***************. Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act. VETERANS' PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans' Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement. Location:

The Nursing Consultant (Nursing Education Option) is a permanent, full-time position with the Alabama Board of Nursing. Positions are located in Montgomery. This is responsible administrative and professional work in the regulation of licensure and practices in the state.

Make a difference in the lives of others while personally thriving! Join Bridge Senior Living - a certified Great Place to Work (2025-2026)! Now Hiring! Wellness Nurse Qualifications of an ideal Wellness Nurse: High school diploma or equivalent (GED) LPN License in applicable state First Aid & CPR Certified At least 1 year of related work experience Wellness Nurse Job Summary: Wellness Nurse will implement and coordinate the delivery of care in collaboration with physicians and care associates. Above all, you will exhibit a passion for serving seniors and contributing to the positive environment our residents are proud to call home. Assessment, planning, implementation, and evaluation of our residents Provide high level of care by making frequent rounds, ensuring continuity of care, documenting all pertinent care information, and observing our residents' overall condition and behavior. Assist the Director of Wellness in the development and update of resident care plans. Maintain ongoing communication with residents, families, and physicians regarding the resident's care. EEO Statement: We are an Equal Employment Opportunity employer committed to providing equal opportunity in all of our employment practices, including selection, hiring, assignment, re-assignment, promotion, transfer, compensation, discipline, and termination. The Company prohibits discrimination, harassment, and retaliation in employment based on race; color; religion; genetic information; national origin; sex (including same sex); sexual orientation; gender identity; pregnancy, childbirth, or related medical conditions; age; disability or handicap; citizenship status; service member status; or any other category protected by federal, state, or local law. Attention Applicants: If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternate way for you to apply. Please contact ******************************** or ************** for assistance with an accommodation.

Make a difference in the lives of others while personally thriving! Join Bridge Senior Living - a certified Great Place to Work (2025-2026)! Now Hiring! Wellness Nurse Qualifications of an ideal Wellness Nurse: * High school diploma or equivalent (GED) * LPN License in applicable state * First Aid & CPR Certified * At least 1 year of related work experience Wellness Nurse Job Summary: Wellness Nurse will implement and coordinate the delivery of care in collaboration with physicians and care associates. Above all, you will exhibit a passion for serving seniors and contributing to the positive environment our residents are proud to call home. * Assessment, planning, implementation, and evaluation of our residents * Provide high level of care by making frequent rounds, ensuring continuity of care, documenting all pertinent care information, and observing our residents' overall condition and behavior. * Assist the Director of Wellness in the development and update of resident care plans. * Maintain ongoing communication with residents, families, and physicians regarding the resident's care. EEO Statement: We are an Equal Employment Opportunity employer committed to providing equal opportunity in all of our employment practices, including selection, hiring, assignment, re-assignment, promotion, transfer, compensation, discipline, and termination. The Company prohibits discrimination, harassment, and retaliation in employment based on race; color; religion; genetic information; national origin; sex (including same sex); sexual orientation; gender identity; pregnancy, childbirth, or related medical conditions; age; disability or handicap; citizenship status; service member status; or any other category protected by federal, state, or local law. Attention Applicants: If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternate way for you to apply. Please contact ******************************** or ************** for assistance with an accommodation.

Job DescriptionDescription: Leader of Nurses Needed!!!! Are you a Registered Nurse and looking to put your leadership skills to the test? Can you manage multiple sites? Do you love developing future nurses? Are you a subject matter expert on Long Term Care? If you answered yes on these questions, CES has an opportunity for you!! Come be our Regional Nurse Consultant for five long term care facilities in West Tennessee. What do we do? Connect People 2 Life! How do we Connect People 2 Life? Through reconnecting them to the relationships that make life full: S(Sprint) N(Nature) O(Others) W(Work) S(Self)! We make it SNOW every day! Requirements: • Visible commitment to the CES vision. • Emphasize and model the need for collaboration and teamwork. • Participate in collaborative efforts to identify and develop new programs and services in furtherance of the company's vision. • Assist RDO and facility management with implementation of appropriate resident care policies and procedures. • Conduct and/or assist with assessment of level of care and make recommendation regarding staffing, assignments, referrals and admissions, and training. • Provide education and training, to assist facilities with the oversight and maintenance of staff development programs, including staff efficacy with systems utilization and documentation. • Assist with recruiting, selection, and orientation of facility Director of Nurses and other clinical staff as requested. • Assist facilities in maintaining a constant state of readiness for all regulatory surveys. • Assist facilities in creating and achieving survey Plan of Corrections. • Provide integration support of resident care services involving staff, therapists, Medical Directors, and other consultants/care providers. • Conduct consistent reviews of facility QI reports to ensure and maintain compliance. • Assist facility Administrator in performance review of DON, making recommendations as needed. • Assist Regional Director of Operations in interpreting, identifying, and applying how reimbursement programs impact nursing services and documentation. • Consistently attend QA/PI and PAR meetings for each facility. • Maintain open and consistent dialog with Medical Directors. • Present timely reports on clinical performance as requested. • Assist RDO and/or Director of Clinical Services with development and/or improvement of clinical policy, process and/or procedure. • Ensure that the facility adheres to clinical policies, procedures, and systems set forth by the company. • Assist the facility Administrator and the Director of Nursing with reporting and investigating unusual occurrences. EDUCATION and/or EXPERIENCE • Master's degree in nursing or related field preferred bachelor's degree required. • 2-4 years related experience and/or training or equivalent combination of education and experience required. • Must be a Registered Nurse (RN) licensed in good standing with the State. • Must have prior experience as a Director of Nursing. KNOWLEDGE, SKILLS AND ABILITIES • Excellent written and verbal communication skills. • Outgoing and energetic personality. • Ability to multi-task while being detail-oriented. • Intermediate computer skills. • Experience with MS Office Word, Excel, and PowerPoint preferred. • Experience with PointClickCare preferred.

New Season Reports to: Program Director Job Code: TC50 Department: Clinic FLSA: Non-Exempt Direct Reports: 0 For over 30 years, New Season Treatment Centers have been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, quality and best in class care for individuals living with Opioid Use Disorder ("OUD"). Operating in over 70 treatment centers in multiple states, our team members are engaged in medication-assisted treatment, counseling, support, and care management of individuals living with OUD. We treat the whole person and, in so doing, address the underlying causes of OUD in an effort to provide a continuum of care that not only addresses treatment needs but supports the patient on their journey to recovery. Job Summary: Under the direction and supervision of the Medical Director or Registered Nurse for medical matters and under the direction of the Program Director for administrative matters participates in the promotion and restoration of patients' health, collaborates with physicians and multidisciplinary team members; and provides support to patients. Essential Functions: * Supplies and administers medication pursuant to physician order and, records dosage administered in the medical record. * Conducts an actual sight and count inventory of the medication supply daily. * Maintains absolute accuracy in daily accounting of medication that is supplied or administered in inventory. * Assumes responsibility for safeguarding medication inventory. * Collects fees in the absence of a cashier position. * Performs daily cash reconciliation in the absence of a cashier position; ensures all cash collected is given to Program Director daily so the final count can be completed. * Receives and ensures the accuracy of incoming medication shipments; advises necessary staff of any discrepancies in a timely fashion. * Ensures disposal of medical waste through the proper protocol. * Observes the patient's demeanor prior to dosing and seeks guidance from the Medical Director or Registered Nurse when an issue or concern is noted. * Promptly communicates patient issues or concerns to the Medical Director or Registered Nurse for medical matters and to the Program Director for other matters. The former includes but is not limited to dose requests, behavior, or any other aspect of patient care that may need to be addressed. * Contacts other centers to verify dosages as needed. * Administers appropriate lab tests as required including patient vital signs, TB tests when required, and collects data for review by Medical Director or RN. * Schedules and screens patients to be seen by the Medical Director. * Assists Medical Director in collecting data for the history and physical as required. * Makes medical record entries as directed by the Medical Director or RN and consistent with clinic protocol. * Receives medical orders; ensures that medical orders are documented and signed by the physician and ensures orders are understood by Program Director and other staff members as needed. * Maintains absolute control, tracking, and confidentiality of all patient medical paperwork. * Complies with federal and state privacy rules, including 42 CFR Part 2 and 45 CFR Parts 160 and 164 as well as applicable clinic policies and procedures. * Is responsible for obtaining and maintaining proper licensure and/or certification according to specific state requirements. * Actively participates in CARF preparation and state audit process. * Participates in all staff meetings. * Complies with all Local, State, Federal, and company rules, regulations, and policies. * Acts always in the best interest of patients, the program, and company; honors, supports, and protects the proprietary rights of patients and the company. * Interfaces with the public and patients by answering phones, greeting visitors, and monitoring patient activities while on center premises * Must provide nurse services for multiple clinical locations as assigned and needed. * Performs other duties as required Other Responsibilities For Minnesota staff only: responsible for satisfying Freedom from Chemical Use Problems Supervisory Responsibilities: (Scope of the person's authority, including a list of jobs that report to this job). None Essential 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 competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions). Education/Licensure/Certification: Has and maintains required nursing licensure within the state in which work is being done. Required Knowledge: Understanding of opiate addiction, medical terminology. General nursing knowledge and techniques. Basic mathematics skills. Must be computer literate and have basic knowledge of all Microsoft products including Word, Outlook and Excel. Must have basic typing skills. Experience Required: Minimum of 1 year direct patient contact. Prior experience in clinical environment helpful. Skill and Ability: Must possess excellent customer service and interpersonal skills. Must have great attention to detail and be extremely accurate in performing daily functions. Physical Demands/Work Environment: (The physical demands and work environment characteristics 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.) Finger Dexterity: Use primarily when operating hands to medicate patients, utilize keyboard and telephone. Talking: To convey detailed or important instructions to patients and employees. Hearing: Ability to hear normal conversations and receive ordinary information. Vision: Job or State Requirements RN in FL or multistate

Please read before applying: * This is NOT a remote or classroom teaching role. * To be considered, candidates must be willing to travel up to 100% of the time to various locations across the US during clinical rotations. Nightingale faculty are required to work all three 15-week semesters (spring, summer, fall). Clinical rotations take place during at least 11 of these weeks. * This is NOT a state-specific travel position. Assignments can be located across the country in any of the Supervised On-Ground Field Experience (SOFE) Areas (click the hyperlink to see a map of all of our SOFE Areas). * The organization will provide travel and lodging accommodations. Travel Nurse Clinical Instructor Position Summary: The Travel Nurse Clinical Instructor (internally referred to as Assistant Professor, Nursing Education) facilitates on-ground education instruction by incorporating innovative teaching methodologies, cutting-edge technologies, and other industry trends reflecting advancements in the discipline by promoting an interdisciplinary approach to advanced practice nursing education and healthcare delivery within and outside the College. The incumbent will be accountable for delivering the nursing curriculum in accordance with the Program's mission, vision, values, and purposes. The Assistant Professor will engage with learners in all aspects of the nursing education process, including evaluating the potential for achievement in the program, and is accountable for Nursing Education Services' successful attainment of key performance indicators, program and functional outcomes, and the success of the College's mission. The Assistant Professor functions as a valued team member within the nursing faculty. Role and Responsibilities: * Facilitates learning in the various supervised on-ground focused education (SOFE) sites, including clinical, simulation, or skills labs across the United States. * Responsible for teaching and evaluating learners in the Practical Nursing, Baccalaureate, and Master's Degree Nursing Programs. * Monitors, engages, and maintains open communication with learners in all aspects of the nursing education process, including attendance, performance, comprehension, and evaluation in accordance with course outcomes, and submits required reports according to published deadlines. * Adheres to and holds learners accountable for partner facilities' expectations. * Attends nursing faculty meetings, participates in committees, engages in shared decision-making, and other faculty activities as required. * May be assigned to various modalities, including experiential, didactic, evaluations, and NCLEX coaching based on the needs of the College. * May carry additional teaching load outside of primary assignment. * Participates in the successful implementation of other functional projects as they arise. * Other duties as assigned. Qualifications and Education Requirements: * Earned Graduate degree with a major in nursing from an accredited institution supplemented by 0-1 year of relevant experience. * Active, unencumbered RN or APRN license from state of residence and ability to obtain RN and NP licensure in any jurisdiction required by the College, including a valid multi-state license. * Either has an earned Certified Nurse Educator (CNE) credential or commits to obtaining this certification within a one-year period. * Maintains current knowledge in multiple areas of nursing practice. * Two (2) years of experience in clinical nursing, within the past five (5) years. * Two (2) years of experience supervising clinical education activities preferred. * Maintains immunizations and certification records as required by accreditation, facility, or state board of nursing. * Additional Contributions: Annual Professional Development, Service as SME, Service on Committees, and learner load will be congruent with current faculty matrix for the assigned course(s). * One (1) year of experience in delivery of Concept-Based Nursing Education is preferred. * One (1) year of distance education experience preferred. * Familiarity with learning management software, Canvas preferred. * Proficiency in modern technology platforms and ability to quickly adapt to various software. Reminder: * This is NOT a remote or classroom teaching role. * This position requires 100% travel to help facilitate on-ground clinical experiential learning. * This is NOT a state-specific travel position; assignments can be located across the U.S. at any of the Nightingale SOFE Areas. COMPENSATION & FACULTY LADDER: Nightingale College utilizes a faculty ladder with five levels to determine salary and position title. Nursing Education has the following levels: Instructor, Assistant Professor I, Assistant Professor II, Associate Professor, and Professor. Placement on the faculty ladder is determined at the time of an offer and is based on degree level and years of nursing academia experience. Budgeted Hiring Range $93,500-$102,850 USD All new hires are required to attend New Collaborator Orientation (NCO) in Salt Lake City, Utah. The College will cover travel, lodging, and other accommodations. Nightingale's commitment to diversity and inclusion is reflected both in our learners and collaborators because we believe the best outcomes for learners from underserved and diverse populations are achieved through collaborators with similar backgrounds and cultures. Nightingale Education Group is an equal opportunity employer. Our Mission (not just words on the wall, we live it, love it, and daily contribute to it): With the primary focus on higher learning in healthcare professions, Nightingale Education Group contributes to elevating education, health, and employment systems through facilitation of academic achievement, personal growth, and professional development of its learners, alumni, and collaborators, while serving diverse communities. At Nightingale Education Group, our Innovative Education model helps transform rural health landscapes through our blended-distance learning platform. Every person involved with Nightingale Education Group helps to change the lives of our learners, our communities, and ultimately the world by adding to the quality of healthcare. We are proud to have graduated nearly 5,000 nurses serving communities in need. We are serious about our outcomes and have a little bit of fun getting there. The professional and personal development of our learners and our collaborators is our company's foundation. Not only do we develop strategies that promote a positive work-life integration, but we also create an environment that invites you to become an expert in your field, be it through higher education or professional development. Put simply, we elevate employment, elevate health, and elevate education. We're so happy that you've found us! Employment is contingent upon successful completion of a background check and drug screen.

Job Description Alabama Anesthesiology & Pain Consultants (AAPC) is seeking a skilled and compassionate PACU Nurse to join our Ambulatory Surgery Center team in Pell City, AL. If you're dedicated to delivering exceptional post-anesthesia care and thrive in a fast-paced, patient-focused environment-with no nights, weekends, or call-this is the role for you. About the Role As a PACU Nurse at AAPC, you will provide high-quality post-anesthesia care to patients recovering from interventional pain and outpatient procedures. You will play a vital role in patient safety, comfort, and recovery while collaborating with physicians, anesthesia providers, and clinical staff to ensure seamless, compassionate care. Key Responsibilities Patient Recovery & Monitoring Receive patients from the procedure suite and perform immediate post-anesthesia assessments. Monitor vital signs, airway, pain level, and surgical sites throughout recovery. Administer medications, fluids, and oxygen per provider orders. Recognize and respond to complications or changes in patient condition. Ensure all clinical discharge criteria are safely met. Patient & Family Communication Provide supportive, compassionate care during recovery. Educate patients and families on post-procedure care and medications. Verify understanding and document all discharge teaching. Clinical Documentation & Compliance Accurately document assessments, interventions, and medications in the EMR. Maintain compliance with HIPAA, OSHA, state/federal regulations, and accrediting standards. Participate in safety huddles and quality initiatives. Team Collaboration Communicate effectively with anesthesia providers, physicians, and pre-op staff for smooth care transitions. Help maintain PACU supplies and equipment. Contribute to continuous quality improvement and a positive team culture. Qualifications Education & Licensure Graduate of an accredited School of Nursing (BSN preferred). Active RN license in the State of Alabama. Current BLS and ACLS certifications (required). Experience Minimum 2 years of nursing experience required. At least 1 year of PACU, ICU, or ED experience strongly preferred. Ambulatory surgery center or interventional pain experience is a plus. Skills & Competencies Strong clinical assessment and post-anesthesia care capabilities. Excellent communication and patient education skills. Proficiency with EMR systems. Commitment to patient-centered care, safety, and confidentiality. Physical Requirements Ability to stand, walk, and assist patients for extended periods. Ability to lift and position patients/equipment as needed. Must be able to respond quickly in emergency situations. Schedule & Benefits Full-time, Monday-Friday (daytime hours) No weekends, holidays, or on-call Enjoy a stable, supportive work environment focused on teamwork and patient care. Powered by JazzHR M6b5SWKNw4

Lutheran Services Florida (LSF) envisions a world where children are safe, families are strong, and communities are vibrant. LSF is looking for a talented Program Nurse who wants to make an impact in the lives of others. The preferred ideal candidate will be bilingual and have experience with Microsoft! The schedule for this position is night shift, weekends, and on-call on a rotating basis (4 x 10 hours). Purpose and Impact: This position's primary role is to treat and care for the youth in this program as well as providing information about any treatment procedures or any aspect of their care. This individual works closely with the Nurse Practitioner, Medical Providers, Program Director, Assistant Program Director, and other related departments. Essential Functions: Manage and monitor the delivery of services to patients ensuring compliance in the performance of all aspects of youth care in accordance with Company policy and procedures, State and Federal guidelines. Prepare youth for examinations and record the medical intake, take vital signs, height and weight. Initiate routine lab tests after triage of a youth such as pregnancy tests. Assist the medical providers staff with examination procedures when is needed such as patient screening and triage. Administer medications under the providers' orders. Update youth charts in regards to allergies, medication use, and immunization history at each visit. Administer immunizations under standing orders from provider. Educate and counsel youth concerning their disease, treatment, and prevention of disease. Answer youth's questions after consultation with the provider or as per established procedures in that regard (to include but not limited to: health questions, medication refills, and lab results.) Continually assess for areas of improvement and develop plans and evaluation criteria for such. Oversee and direct all youth care staff to ensure adequate monitoring. Ensure delivery of safe and efficient quality care. Assist in health education classes when necessary. Obtain, compile, and maintain medical files on each intake. Ensure proper daily documentation and maintain hard copy of required documents and medical record. Schedule and comply with required medical appointments and timelines. Respond and comply to individual emergency medical needs immediately. Maintain and review for accurate and complete list of medical supplies, prescribed medications, and over-the-counter medication. Order medical supplies, and medication when necessary. Collect, maintain, and submit weekly, monthly, quarterly, and annual reports and audits to the supervisors. Facilitate and conduct self-administration of medication and side effects training to employees as required. Provide a fail-safe plan with medication count, label accuracy, and self-administration of medication, including over-the-counter drugs. Schedule and provide transportation when is needed to clients on medical appointments with assistance from other staff when necessary. Submit, review and follow up all the Significant Incidents Report regarding Medical Issues. Participate in Quality Improvement as required. Other Functions: Able to react to change productively and handle other essential tasks as assigned. Develop and maintain effective communication and working relationships with staff, co-workers, physicians, and youth. Develop and expand medical, specialty and dental services with local providers. Maintain Health Information Privacy HIPAA. The ability to maintain control and work under pressure to meet deadlines. Physical Requirements: Bending, stooping, and lifting a minimum of 15-25 lbs. required to complete daily tasks. Must have the ability to remain in standing position for extended periods of the workday. Education: Register Nurse degree from an accredited college or university in Nurse or Health Sciences, RN License according to State requirements. Must have graduated from an approved RN nursing program approved by the National Council of State Boards of Nursing (NCSBN) Must have passed the appropriate NCLEX-RN Exam Experience: Minimum 1 years of full-time direct service delivery experience Must possess medical assessment and treatment skills with diverse populations of children/adolescents. One (2-3) year of full-time experience in a hospital, clinic, medical record department or physician's office. One (2-3) year experience in file maintenance working with troubled adolescents or youth services; may include part-time, volunteer or internship experience. Why work for LSF? LSF offers 60 programs across the state of Florida serving a wide range of populations in need. Mission Driven staff members become part of the LSF community while transforming the lives of those in need. Our staff additionally find growth opportunities as they explore areas of interest within the organization. Amazing benefits package including : Medical, Dental and Vision Telehealth (24/7 online access to Doctors) Employee Assistance Program (EAP) Employer paid life insurance (1X salary) 13 paid holidays + 1 floating holiday Generous PTO policy (starting at 16 working days a year) Note: Head Start employees paid time off and holiday schedule may differ 403(b) Retirement plan with 3% discretionary employer match OR 3% student loan repayment reimbursement Tuition reimbursement LSF is proud to be an equal opportunity employer. Lutheran Services Florida is mandated to perform background screenings for employment in accordance with the Florida Care Provider Background Screening Clearinghouse as outlined in Section 435.12, Florida Statutes. Additionally, pursuant to House Bill 531 (2025), Lutheran Services Florida must ensure that all job vacancy postings and advertisements include a clear and conspicuous link to the AHCA Clearinghouse website and its requirements. For more information on background screening requirements please visit: Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Conducts pre-admission, concurrent and retrospective acute care, sub-acute, hospice, qualification of transitional care and long-term care needs for medical necessity Perform case reviews and complete all required documentation in appropriate database Collaborate with primary or attending physician, case managers, patient and/or family to provide continuity and quality of care in the most cost-effective manner. Timely completion of admission reviews (within 48-hours for weekday, 72-hours for weekend) Provide outpatient or pharmacy services utilization review Qualifications Current Florida RN License 3+ years in recent medical/surgical or critical care experience 3+ years of Utilization Review / Case Management experience Strong reasoning ability: define problems, collect data, establish facts, and draw conclusions Additional Information Hours for this Position: M-F 8-5 Advantages of this Opportunity: Competitive salary $28.85/hr - $31.25/hr pending experience Excellent Medical benefits Offered, Medical, Dental, Vision, 401k, and PTO Growth potential Fun and positive work environment

Oversees the evaluation of patients for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria and third-party information across the DCH System. Serves as the primary educator for all DCH PA's, Case Managers, Social Workers, CDI personnel, Utilization Review Coordinators (URC), in the principles of utilization management and serves as a consultant for issues regarding regulations, compliance, payor specific criteria and the denial management process for the DCH System. Responsibilities Supervises utilization review professional and clerical employees. Establishes, manages, approves, and constantly evaluates staffing levels, performance, assignments, skills, learning needs and deployment of Utilization Review. Responsible to support and participate in DCH System strategies and efforts focused on improving length of stay (LOS) and reducing readmissions. Ensures orientation and training in Utilization Review for Utilization Review Staff. Manages the day to day operations for the DCH System Commercial Utilization Review function. Displays sound managerial judgment in all areas. Supervises and initiates or recommends personnel actions for Utilization Review staff members. Manages departmental budget and productivity standards. Interviews, selects, hires, and retains employees 1 0. Performs compliance requirements as outlined in the Employee Handbook Approves payroll and is responsible for accurate payment of employees 1 2. Is knowledgeable of hospital mission, vision, and values, and performs in a manner to support them. 1 3. Manages the performance of URC t s providing feedback and direction. 1 4. Informs staff of any insurance changes involving InterQual guidelines or in providing clinical reviews. 1 5. Functions as a consultant to staff for solving challenging utilization issues throughout the DCH System. 1 6. Analyzes each of the assigned medical records for the purpose of medical necessity and appropriate billing status. Collaborates with Business Office Personnel to identify correct insurance source, initial pre-certification information and provides clinical information as necessary to obtain authorization for payment. Manages utilization of Commercial observation process. Collaborates with the Case Manager to determine patient's appropriateness for acute hospital level of care, Evaluates patient's clinical course to verify patients continued need for acute hospital level of care. Provides third party payers with clinical information as needed to comply with payers' requirements for documentation of medical necessity. Negotiates a resolution of any DCH System disagreement over the need for acute hospital level of care with the insurer. Intervenes with appropriate parties regarding inappropriate admissions, delays in discharge and the overutilization of hospital resources. Intervenes with appropriate individuals regarding delays in service that may have an impact on the quality of patient care and/or length of stay. Refers appropriately to Performance Improvement and Risk Management for patient safety occurrences and sentinel events. Refers cases not meeting acute inpatient criteria to the physician advisor and assists with his/her review of the case. Gathers information for monthly statistical reports, special projects as assigned by the Corporate Director of Case Coordination. Assists in discharge planning by confirming patient's insurance benefits. Updates and documents in the computer system pertinent clinical information by utilizing screening criteria. Maintains records in a complete, detailed and orderly manner. Identifies potentially avoidable days per department policy. Establish appropriate staffing levels, assignments, and deployment of Utilization Review staff. Collaborates with Medical Records and patient Accommodations regarding patient billing status. Collaborates with the Financial Counselors to facilitate the Medicaid application process. Manages the delivery of the denial notification for the DCH Health System. Manages work list of BC/Commercial patients with Hospital acquired conditions/Never Events. Responsible to support and participate in department strategies and efforts focused on improving length of stay (LOS). Responsible to support and participate in department strategies and efforts focused on improving clinical documentation by physicians and staff. Manages the BC/BS's Concurrent Utilization Review program (CURP) for RMC, NMC, and FMC for the DCH System. Liaison between hospital & payers during concurrent and retrospective medical necessity audits for the DCH System. Manages continuation of benefits notices issued by Physician Advisor (i.e. pt. notification business office). Conducts retrospective medical record audits to verify appropriate administration of criteria and reports findings as directed. Conducts special focused reviews as directed. Collaborates with the Compliance Officer to assure accurate billing on cases with ambiguous orders. Supports departmental operations to ensure consistency with health system/departmental policies. Provides service in the most cost-effective manner, without compromising the quality of care, or customer satisfaction. Assists Corporate Director of Care Coordination in planning and implementation of opportunities and new ideas to promote department growth and development. Designs and develops processes related to special projects as assigned by Director. Maintains, monitors, and audits accuracy of outpatient and inpatient appeals and interventions and observation according to department policies based on medical necessity. Develops a working knowledge of IMAC's, eFR, and EPSI computer software. Monitors hospital effectiveness for managing patient billing status, identifies opportunities for improvement and informs leadership through monthly reports. Manages hospital appeals for reconsideration of denied payment by insurance companies. Maintains confidentiality at all times related to both patient and employee information. Manaqer Manages departmental budget Interviews, selects, hires, and retains employees Ensures orientation and training for employees Manages performance Promotes, demotes, or transfers employees to meet organizational needs Executes employee accountability process up to and including termination Manages departmental productivity standards Performs compliance requirements Approves payroll and is responsible for accurate payment of employees Manages front line operations of area of accountability related to meeting/exceeding departmental goats DCH Standards: Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation. Performs compliance requirements as outtined in the Employee Handbook Must adhere to the DCH Mission, Vision, and Values including creating positive relationships with patients/families, coworkers, colleagues and with self. Performs essential job functions in a manner that ensures the safety of patients, visitors and employees. Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees. Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees. Requires use of electronic mail, time and attendance software, learning management software and intranet. Must adhere to all DCH Health System policies and procedures. All other duties as assigned. Qualifications Registered Nurse with current Alabama license; very good organizational and interpersonal skills required. Computer knowledge required At least three years acute hospital Utilization Review experience required Can write legibly and speak and read English. A minimum of five (5) years Utilization Review experience preferred Ability to establish priorities, meet deadlines, and maintains proper productivity. Ability to form positive, collaborative relationships with hospital staff, patients, families and post-acute providers. Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge. Excellent leadership skills and to serve as a role model for staff. Ability to lead and actively participate in multidisciplinary teams. Intermediate computer skills. Ability to work independently or within a team structure. Excellent interpersonal skills and communication style. Must be able to read, write legibly, speak, and comprehend English. WORKING CONDITIONS Is able to lift at least 201bs. Ability to tolerate prolonged periods of sitting, or standing and/or walking Ability to reach reasonable distances to handle equipment Good manual and finger dexterity. Hearing and vision must be corrected to within normal range. Good communication skills. Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.

Title: HEDIS Utilization Review Nurse Reports to: Director of Managed Care FLSA Status: Exempt Personnel Supervised: None The HEDIS Utilization Review Specialist is responsible for performing comprehensive reviews of medical records to collect data required for HEDIS reporting. This role supports quality improvement initiatives by identifying gaps in care, validating clinical documentation, and ensuring compliance with NCQA (National Committee for Quality Assurance) standards. KEY RESPONSIBILITIES: Review medical records and clinical data for HEDIS-specific measures. Abstract and input accurate clinical data from electronic health records (EHRs) into reporting tools. Identify and report documentation deficiencies or care gaps. Collaborate with providers, coders, and clinical teams to ensure proper documentation and follow-up. Assist in the coordination and execution of the annual HEDIS data collection cycle. Maintain knowledge of current HEDIS specifications and regulatory updates. Support audits and internal quality improvement initiatives related to clinical outcomes. Ensure HIPAA compliance and confidentiality of patient information. SKILLS: Strong knowledge of HEDIS measures and NCQA guidelines. Proficient in EHR systems and chart review processes. Detail-oriented with strong analytical and organizational skills. Excellent communication and collaboration abilities. MINIMAL QUALIFICATIONS: Education: RN, LPN, LVN. Experience: 2+ years of clinical experience in a healthcare setting. Prior experience with HEDIS abstraction or utilization review strongly preferred. License: Florida unrestricted license BLS certification Computer literacy KNOWLEDGE AND SKILLS: Knowledge of current professional nursing theory, practice, and techniques Knowledge of current nursing practices in an outpatient primary care setting Knowledge of assessment of patient needs and services Knowledge of current professional nursing and pharmaceutical products, Universal Precautions, and emergency situations Knowledge of basic pathophysiology of diseases commonly managed in Family Medicine Knowledge of the application of nursing techniques (example: Triage, blood pressure monitoring, glucose monitoring, etc.) Knowledge of patient teaching and education (example: self-blood pressure monitoring, nutrition instruction, diabetes self-care instruction) Knowledge of general patient care and treatment procedures, equipment, rules, regulations, and ethics Knowledge of Utilization Review Accreditation Commission (URAC) Policies and Procedures Knowledge of processing and obtaining prior authorizations Knowledge of making observations of general physical condition and needs of patients and when to confer with a physician about the emotional or physical condition of a patient Knowledge of the principles of aseptic and sterile techniques and infection control techniques Knowledge of the techniques of administration of common medications, including immunizations, inoculations, and allergy injections using sterile technique, and knowledge of the side effects of these medications Knowledge of state and federal drug control laws, rules, and regulations Knowledge of emergency techniques and procedures Knowledge of common medical supplies and equipment Excellent interpersonal, communication and leadership skills Ability to demonstrate priority-setting and ability to work in a complex environment Ability to function with a high degree of independence and collaboration with other health care providers Commitment to service, quality, and departmental core values RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following: Be familiar with CFHC's program philosophies, goals and objectives. Be cognizant of and comply with all CFHC's policies and procedures, as well as state and federal regulations. Be competent in performing the duties of a nurse. Understand the requirements of CFHC's Exposure Control Plan. Personally, utilize universal precautions when practicing in a clinical setting. Participate in staff outreach and off-site health care programs as requested by the DMC, ACMO, CMO, or CEO. Represent CFHC in the community. Report as needed to DMC and any pertinent information or situations that impact on patient care or CFHC liability. Attend and participate in mandatory CFHC meetings (Center Specific meetings, Corporate meetings, and other meetings as designated by the DMC, ACMO, CMO, or CEO). Demonstrate ability to work cooperatively with other members of the clinical team. Be supportive of coworkers. Maintain a neat and professional appearance at all times. Carry out any other activities deemed appropriate by the DMC, CMO, or CEO. Primary Duties include, but are not limited to, the following: Assess, identify problems, plan goals, monitor and evaluate patient plans, and develop strategies that meet the patients immediate and long-term goals. Work closely with PCP to manage patient “care items” which could include; medication refills per protocol, lab triage, document management, management of durable medical equipment (i.e. Glucometer, test strips, lancets), prior authorizations of needed medications or other services. Use patient data to track and schedule follow up appointments. Provide proactive utilization management for patients with high risk needs. Assist patients in obtaining appropriate medications and medical supplies and equipment, including coordination of pharmaceutical patient assistance programs. Participate in quality improvement, quality assurance and innovation activities to ensure optimal level of care delivery. This position will ensure all HEDIS measures have been met for those assigned patients and all care gaps have been identified. Assist in the coordination of warm hand-offs or “transfer of trust” between care team, pharmacy or other support services during the office visit. Carry out other duties as assigned by the DMC. The is not intended to be all-inclusive, and employees will also perform other reasonable related business duties as assigned by supervisor. *This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract or employment. * BENEFITS: Competitive Salary Federal Student Loan Forgiveness: PSLF - 10-year commitment, 120 loan payments and at the end of the commitment, the remaining loan is forgiven Excellent medical, dental, vision, and pharmacy benefits Employer Paid Long-Term Disability Insurance Employer Paid Life Insurance equivalent to 1x your annual salary Voluntary Short-Term Disability, additional Life and Dependent Life Insurance are available Malpractice Insurance Paid Time Off (PTO) - 4.4 weeks per year pro-rated Holidays (9.5 paid holidays per year) Paid Birthday Holiday CME Reimbursement 401k Retirement Plan after 1 year of service (w/matching contributions) Staff productivity is recognized and rewarded PHYSICAL REQUIREMENTS Requires 80% or more time spent sedentary. Independently mobile. Ability to lift weight equivalents that would be required with re positioning equipment and lifting supplies. Ability to adapt and function in varying environments of workload, patient acuity, work sites, and work shifts. American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.

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

Alabama Anesthesiology & Pain Consultants (AAPC) is seeking a skilled and compassionate PACU Nurse to join our Ambulatory Surgery Center team in Pell City, AL. If you're dedicated to delivering exceptional post-anesthesia care and thrive in a fast-paced, patient-focused environment-with no nights, weekends, or call-this is the role for you. About the Role As a PACU Nurse at AAPC, you will provide high-quality post-anesthesia care to patients recovering from interventional pain and outpatient procedures. You will play a vital role in patient safety, comfort, and recovery while collaborating with physicians, anesthesia providers, and clinical staff to ensure seamless, compassionate care. Key Responsibilities Patient Recovery & Monitoring Receive patients from the procedure suite and perform immediate post-anesthesia assessments. Monitor vital signs, airway, pain level, and surgical sites throughout recovery. Administer medications, fluids, and oxygen per provider orders. Recognize and respond to complications or changes in patient condition. Ensure all clinical discharge criteria are safely met. Patient & Family Communication Provide supportive, compassionate care during recovery. Educate patients and families on post-procedure care and medications. Verify understanding and document all discharge teaching. Clinical Documentation & Compliance Accurately document assessments, interventions, and medications in the EMR. Maintain compliance with HIPAA, OSHA, state/federal regulations, and accrediting standards. Participate in safety huddles and quality initiatives. Team Collaboration Communicate effectively with anesthesia providers, physicians, and pre-op staff for smooth care transitions. Help maintain PACU supplies and equipment. Contribute to continuous quality improvement and a positive team culture. Qualifications Education & Licensure Graduate of an accredited School of Nursing (BSN preferred). Active RN license in the State of Alabama. Current BLS and ACLS certifications (required). Experience Minimum 2 years of nursing experience required. At least 1 year of PACU, ICU, or ED experience strongly preferred. Ambulatory surgery center or interventional pain experience is a plus. Skills & Competencies Strong clinical assessment and post-anesthesia care capabilities. Excellent communication and patient education skills. Proficiency with EMR systems. Commitment to patient-centered care, safety, and confidentiality. Physical Requirements Ability to stand, walk, and assist patients for extended periods. Ability to lift and position patients/equipment as needed. Must be able to respond quickly in emergency situations. Schedule & Benefits Full-time, Monday-Friday (daytime hours) No weekends, holidays, or on-call Enjoy a stable, supportive work environment focused on teamwork and patient care.