Utilization review nurse jobs in New York, NY - 435 jobs

RN Case Manager / Utilization Review (Inpatient) Shift: Days, Monday-Friday 8:00 AM-4:00 PM; every other Saturday required (8:00 AM-4:00 PM) Guaranteed Hours: 40/week Contract Length: ~13 weeks Position Summary: RN Case Manager responsible for coordinating inpatient care, utilization management, and discharge planning. The role focuses on concurrent review, high-risk patient identification, collaboration with physicians and interdisciplinary teams, and communication with third-party payers to ensure appropriate level of care and timely discharge. Key Responsibilities: Perform concurrent utilization and continued-stay reviews Identify high-risk patients and develop discharge plans for uncomplicated cases Coordinate with physicians to establish and update time-oriented plans of care Communicate clinical information to third-party payers and complete retro reviews Monitor delays, duplication of services, and appropriateness of care Collaborate with social work and interdisciplinary teams to facilitate discharge Ensure accurate documentation and participation in quality and performance improvement activities Requirements: Active New York State RN license BSN required Minimum 3 years of direct patient care experience BLS and ACLS required Strong utilization review, discharge planning, and interdisciplinary collaboration skills Preferred: MSN CCM (Certified Case Manager) PALS Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts. Best Regards, Tabish Ahmad

Requisition ID JR1004947 Category Managed Care Type Regular Full-Time AmTrust Financial Services, a fast-growing commercial insurance company, has a need for Clinical Review Nurse remote or in an office location. PRIMARY PURPOSE: The Clinical Review nurse has the responsibility of reviewing the medical necessity, appropriateness, quality and efficiency of services in the appropriate setting for Workers' Compensation claimants. This position assesses the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the AmTrust Claims Adjuster team to expedite medically necessary treatment for each claim. They also review pharmacy authorizations to determine appropriateness of pharmaceutical treatment. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of the AmTrust organization. This position will be hybrid out of one of our AmTrust office locations! Responsibilities Perform Utilization Review activities prospectively, concurrently, or retrospectively in accordance with the appropriate jurisdictional guidelines. Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level, are medically necessary and appropriately delivered. Responsible for helping to ensure injured employees receive appropriate level and intensity of care directly related to the compensable injury using industry standard and/or state specific medical treatment guidelines and formularies. Objectively and critically assesses all information related to the current treatment request to make the appropriate medical necessity determination. Sends determination letters as needed to requesting physician(s) and refers to physician advisors for second level reviews as necessary. Responsible for accurate comprehensive documentation of Utilization Review activities in the case management and pharmacy benefit management systems. Responsible for completing timely reviews according to state's requirements and communicating the UR determination to all parties. Uses clinical/nursing skills to help coordinate the individual's treatment program while maximizing quality and cost-effectiveness of care. Communicates effectively with providers, claims adjuster, client, and other parties as needed to expedite appropriate medical care Keeps current with market trends and demands. Performs other functionally related duties as assigned Qualifications Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license. 5+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR2+ years of utilization management required. Education & Licensing Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. Acquisition and maintenance of Insurance License(s) may be required to comply with state requirements. Preferred for license(s) to be obtained within three - six months of starting the job. Skills & Knowledge Proficiency in all Microsoft Office products including Project, Word, Excel, PowerPoint, Visio, and SharePoint Knowledge of workers' compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, Utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers compensation guidelines, periods of disability, and treatment needed Excellent oral and written communication, including presentation skills Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability Strong organizational, communication and analytical skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding Auditory/Visual: Hearing, vision and talking The expected salary range for this role is $53,300-$92,500. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-GH1 #LI-HYBRID #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Connect With Us! Not ready to apply? Connect with us for general consideration.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. If you are located within Essex County, New Jersey, territory and willing to travel up to 80% of your time to assigned territory, you will have the flexibility to work remotely as you take on some tough challenges Primary Responsibilities: Comprehensive Assessment & Care Planning Conduct thorough health assessments, including medical history, chronic conditions, behavioral health, and social determinants of health Develop individualized care plans that address medical, rehabilitation, behavioral health, and social needs Create personalized interventions that integrate medical treatment, support services, and community resources Member Engagement, Education & Self-Management Build and maintain relationships with an established caseload of high-risk members Provide education to members and caregivers on disease processes, treatment adherence, and lifestyle changes Encourage self-management strategies that support long-term wellness and reduce complications Maintain consistent outreach to support adherence to care plans and monitor evolving needs Intensive Care Coordination Coordinate services across providers, including PCPs, specialists, hospitals, LTSS, behavioral health, and pharmacy. Facilitate referrals for home health, hospice, palliative care, and DME Collaborate with Medical Directors during interdisciplinary rounds to review and align care for complex cases Discharge Planning & Transitional Care Support members through transitions of care such as hospitalization, skilled nursing, and rehabilitation Conduct "welcome home" and follow-up calls to ensure post-discharge services, medications, and follow-up appointments are in place Deliver intensive outreach during the 30-day post-discharge period to reduce avoidable readmissions and ED utilization Advocate for safe, coordinated, and timely transitions of care that align with the member's individualized care plan Field-Based Care Management (20% of Time) Conduct home and hospital visits in North Jersey as required by program guidelines Perform in-person assessments and provide care coordination to address high-risk needs and ensure continuity of care Collaborate directly with providers, facilities, and families during field visits to close care gaps and reinforce the care plan Monitoring & Clinical Oversight Monitor members' clinical conditions, care plan progress, and treatment adherence Reassess care plans regularly and adjust interventions based on changing needs or barriers Identify red-flag conditions and escalate urgent or complex cases for higher-level review and intervention Documentation, Compliance & Quality Outcomes Document all assessments, care plans, interventions, and communications per NCQA, CMS, and state regulatory requirements Ensure care management services align with DSNP/NCQA standards and contract requirements Track outcomes tied to quality metrics (HEDIS, STARs), utilization management, and member satisfaction Maintain audit readiness through timely, accurate, and comprehensive documentation You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in New Jersey 2+ years of Case Management Experience serving complex, elderly and disabled Experience with government health programs (Medicaid/Medicare) Proficient in Microsoft Office Suite; tech-savvy with ability to navigate multiple systems simultaneously Demonstrated ability to talk and type proficiently at the same time Access to reliable transportation and the ability to travel up to 80% within assigned territory. Available for occasional in-person meetings as needed Preferred Qualifications: Certified Case Manager (CCM) Experience working with populations with special needs (DSNP) Experience with Managed Care Population Bilingual - English/Spanish Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $40.00 to $54.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Responsible for the care activities and goal achievements of assigned patients by assessing, diagnosing, planning and intervening in actual or potential health problems and evaluating patient's response to care Responsibilities 1. Conducts Nursing assessment based on interview, examination, observation and review of records of the patient 2. Ensures that the patients progress, or lack of progress, is reflected in progress notes and in the revised care plans 3. Discharge planning consistent with the patient's status and reflects inter-departmental and inter-agency communication 4. Communicates information to the patient based on the patient's level of awareness and readiness to learn 5. Supports orientation of new staff members by observing professional behaviors, providing feedback to the staff member and by acting as a preceptor, role model and a resource person 6. Functions as a professional role model and mentor for students and volunteers. 7. Patient care assignments reflecting an awareness of patient needs and skill level of personnel 8. Organization of provision of care to meets priority needs of patients and unit 9. Communicates condition of patients and unit requiring additional intervention to the leadership person in the relevant discipline 10. Participates in the development of other staff members 11. Communicates with peers in an appraisal of practice as it relates to self and other nursing personnel 12. Reflects a collaborative effort in meeting the needs of the patient and unit through communication and nursing actions 13. Provides direction, assistance and support 14. Assumes accountability and responsibility for completion and quality of assigned tasks 15. Identifies and communicates to immediate supervisor the need for further staff education 16. Reflects awareness of authorities and responsibilities of nursing management levels by communication with nursing leadership 17. Seeks and utilizes nursing leaders as role models and resource persons 18. Reflects collaborative effort in meeting patient and unit needs by communication with other disciplines 19. Reflects the philosophy, goals and objectives of the Department of Nursing and the Hospital Center in communication and interaction with families and other groups Qualifications Graduation from an accredited Nursing program. Bachelor's Degree in Nursing or active matriculation in a Bachelor's Degree in Nursing Program preferred Documented previous experience or educational preparation to support credentials. Specials skills/experience may be required in specialized areas. Name: Neonatal Resuscitation Program Certificate (Required Depts.: L&D, NICU) Issuing Authority: American Heart Association Name: ACLS (Required Depts.: ED; PACU/ASU; ICUs; Telemetry Units; SDU; IR, Interventional Cardiology (CCL/EP/Echo); L&D; Endoscopy, and APN Adult Oncology) Issuing Authority: American Heart Association Name: BCLS Issuing Authority: American Heart Association Name: PALS (Required Depts.: ED; PACU; IR; Peds ICU, and APNs Pediatric Oncology) Issuing Authority: American Heart Association Collective bargaining unit: SEIU 1199-MSBI-RN About Us Strength through Unity and Inclusion The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history. About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's "Best Children's Hospitals" ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The World's Best Smart Hospitals" ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: 9:30am-6:00pm local time, with rotating weekends. New Grads are encouraged to apply! The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * Knowledge in Microsoft office. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12/hr - $56.77/hr Locations: New York, New Jersey, Washington, Nevada, Maryland, Massachusetts, Illinois, District of Columbia 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 Non-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.

One of the largest health benefits companies in the United States. Through its networks nationwide, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, WellPoint, Inc. is an independent licensee of the Blue Cross and Blue Shield Association serving members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin; and specialty plan members in other states through UniCare. Job Description This role is specific to the LTSS department. RN will be responsible for providing case management services and evaluating the necessity/appropriateness/efficiency of the use of Medical Services for Long-Term Support Services (LTSS). Will be responsible for collaborating with providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. May also manage appeals for services denied. Provides plan of care for members based on authorization and concurrent review. Provides monthly telephonic outreach to ensure members needs are assessed and met based on information. Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. MAJOR JOB DUTIES AND RESPONSIBILITIES Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs, or community resources. Applies clinical knowledge to work with facilities and providers for care coordination. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. Additional Info: *possible remote opportunity after training if candidate demonstrates understanding of processes and policy expectations* Qualifications Must have clear and active RN license in the state of NY Requires an AS/BS in Nursing At least 2 years of acute care clinical experience; or any combination of EDU/experience that would provide an equivalent background Excellent written and verbal communication skills Additional Information Advantages of this Opportunity: Competitive salary, negotiable based on relevant experience Benefits offered, Medical, Dental, and Vision Fun and positive work environment Monday through Friday 8am-5pm

The Utilization Management Nurse will conduct reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination in accordance with Utilization Management policies and procedures. ESSENTIAL FUNCTIONS Perform utilization management, utilization review, or concurrent review (on-site at a hospital, or telephonic inpatient care management) of hospitalized members ensuring medical necessity, appropriateness of admission, and continued stay following evaluation of medical and benefit determination guidelines. Maintains compliance with all state mandated regulations. Collaboration with hospital staff, physicians, care/service coordinators, plan Medical Director, members and their families to provide the level of care necessary to meet member's health needs. Maintain an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital discharge planners and health plan social workers or other staff in the early identification of potential home care candidates or less restrictive level of care placement. Identification and management of members at high risk for readmission or with complex medical and psychosocial needs. Collaboration with Case Manager to coordinate post discharge care and services aimed at: increasing rates of timely outpatient follow-up, ensuring provider treatment plan, medications & outpatient services are in place, safe transition to outpatient setting, improving self management skills, addressing members psychosocial and non-medical needs Communicate directly with physician providers/designees when appropriate to gather all clinical information to determine the medical necessity of requested healthcare services. Maintains courteous, professional attitude when working with Affinity staff, hospital and physician providers, and members. Collect pertinent clinical information and documents all UM review information using the appropriate software system. Manage medical / benefits resources effectively and efficiently while ensuring quality care is provided as determined by guidelines of meeting Medical necessity. Communicate directly with appropriate internal staff regarding all inpatient cases and outpatient/ambulatory requests for health care services that do not meet medical necessity or appropriate level of care and out of network transfer issues. Manage assigned workload within established performance standards. Follow relevant client time frame standards for conducting and communicating UM review determination. Maintain and submit reports and logs on review activities as outlined by the UM program operational procedures. Contribute to MM program goals and objectives in containing health care costs and maintaining a high quality medical delivery system through the program procedures for conducting UM activities. Participate in a multi-disciplinary team approach to address member needs from the acute care phase through the post-acute care phase. Identify and coordinate quality of care issues or trends with the Quality Management department. Demonstrate proficiency with the principles and methodologies of process improvement. Apply these in the execution of responsibilities in support of a process focused approach. Perform other duties as necessary or assigned. QUALIFICATIONS: Registered Nurse or Licensed Practical Nurse with current, unrestricted, licensure required for state of New York Associates degree in Nursing required; BSN preferred 3+ years Clinical experience and 2 or more years experience working in utilization management required Experience working in Medicaid and/or Medicare managed care, including regulatory and compliance requirements strongly preferred Experience with MCG guidelines preferred Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint and Outlook required Ability to work with minimal guidance; seeks guidance on only the most complex tasks Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Advanced interpersonal (e.g., mediating, counseling, mentoring, influencing), negotiating and management skills required to manage critical internal and external relationships and activities that are diverse and complex. Ability to collaborate constructively with others within and outside the organization. Ability to work resourcefully and creatively, to think independently, and to exercise sound judgment in a complex and dynamic environment. Commitment to the corporate mission, vision, and values. High level of integrity as demonstrated by a) appropriate treatment of confidential information, b) adherence to policies, procedures, rules and regulations, c) professional conduct in dealing with persons internal and external to the organization, and d) sensitivity to the populations served by Affinity and the providers with which Affinity works.

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

Job DescriptionDescription: Tillman FiberCo is building a network with future-forward technologies, systems and network architecture that will be ultimately capable of delivering 40Gbps+ to customers. Tillman FiberCo is a portfolio company of Tillman Global Holdings, a holding company focused on building premier digital infrastructure businesses globally. We have an incredible opportunity for a Utility Coordinator to support the work in Hernando, Citrus, Sumter, Marion, Volusia, Seminole, Brevard, Palm Beach, Broward and Miami-Dade Counties. Ideal candidate location would be based in Osceola, St. Lucie, or Indian River County. Responsibilities: Oversee relations between our vendor and the jurisdictions as well as manage the quality and direction requested by the jurisdiction and intervene when necessary to ensure that permit requirements are being fulfilled. Only if it's an electrical permit. Ensure all permit payments are timely and invoiced appropriately and Audit and Maintain SFU/MDU OSP permits and ROW payment records in Sitetracker. Power company/construction invoices. Work with our vendor partners in getting utility accounts set up with power companies Review Utility and permit Work Plans and recommend for approval. Pertains to vetting the locations. As necessary, interfaces with jurisdictional staff to ensure compliance with applicable laws, codes, and ordinances, and leverage regulatory status to support deployment objectives. Tracks project progress and maintain accurate data entry. Communicate with the electrician. Acts as a point of contact for internal and external customers regarding specific power companies. Ensures all permits are submitted in a timely manner to ensure fiber build projects are not delayed. Additional Responsibilities: Identifying and resolving conflicts between existing utilities and proposed construction designs. Field verification of proposed location and existing utilities. Travel to locations will be expected. Create utilities project work orders with all utility companies involved in projects. Communicate with engineers to ensure smooth interactions and project development. Collaborating with utility companies, project designers, and other stakeholders to ensure smooth coordination. Develop working relationships with engineers and customer service. Maintaining accurate records of utility locations, drawings, and documentation. Include design and permit prints, verify for accuracy. Trackers that include utilities milestones (permits for electrical, gas, water, etc.) submittal and approval dates. Managing the relocation of utilities, including obtaining necessary permits and ensuring compliance with regulations. Providing support to design teams by attending meetings, reviewing documents, and facilitating site visits. Tracking the progress of relocation efforts and ensuring timely completion. Communicate with municipality personnel to identify projects that may affect project construction progress. Assisting with the preparation of contingency plans for unplanned utility events. Identifying and locating utilities within project boundaries using various methods and technologies. Preparing and reviewing utility agreements with utility companies. Obtaining necessary permits for utility relocation and construction. Providing schedule oversight for utility work integrated with the overall construction schedule. Conducting utility coordination meetings and documenting meeting minutes. Communicate with customer service to initiate service accounts. In some instances, travel to the proposed construction locations is expected. Maintain a good driving record. Maintain service on company vehicle up to date. Requirements: What we are looking for Location: Must reside within the service area spanning the counties listed and be willing to travel regularly throughout these locations . Candidates outside the area will be considered only if able to relocate or travel frequently within the region. Experience: High school diploma or GED required. Minimum 2+ years of utility coordination experience with power companies (e.g., TECO, Duke Energy, FPL, KUA). Hands-on fielding experience strongly preferred, including: Vetting proposed cabinet locations Verifying transformer proximity Assessing site conditions (e.g., flood zones) Experience with and understanding of wireline technologies for OSP fiber builds (buried, aerial, underground). Knowledge of National Electrical Safety Code (NESC), Rural Utilities Service (RUS) codes, and relevant building codes is a plus. Technical Skills: Proficient in Microsoft Office and Adobe Acrobat. Working knowledge of Excel and Google Earth/Maps. Salesforce Sitetracker experience preferred. Key Competencies: Highly organized, self-starter with excellent time management and attention to detail. Strong written, verbal, and interpersonal communication skills, including negotiation, consensus building, and problem-solving. Ability to take direction, adapt to changing priorities, and work independently or collaboratively. Critical thinking skills to assess challenges, anticipate conflicts, and develop solutions. Additional Requirements: Valid driver's license with a clean MVR (Motor Vehicle Record). Ability to work 50% in the field (site vetting, coordination with engineers and power companies, attending meter set appointments) and 50% from home (updating SiteTracker, managing invoices/accounts, maintaining trackers, coordinating with internal teams). Willingness to travel within assigned geographic area. Successful completion of MVR check. As a growing company, we are committed to attracting and developing the absolute best talent by offering a workplace where results are recognized and rewarded. We offer a terrific opportunity for you to grow: Challenging, rewarding career within a growing company, backed by a global investor and owner of digital infrastructure assets. Competitive Salary East Coast based company (will work on EST time) Direct Hire Opportunity Collaborative environment, with on-the-job training and mentorship opportunities Competitive benefits and wellness package, including medical, dental and vision coverage. 401k plan with company match Generous PTO and 11 holidays annually Paid parental leave. Employee Recognition Program

Leading social service organization seeks a Nurse Case Manager (RN) to oversee comprehensive nursing care for individuals with developmental disabilities in a residential setting. The Nurse Case Manager also supervises and trains nursing and direct support staff while coordinating all ongoing and acute healthcare needs. Key Responsibilities Provide and oversee direct nursing care in accordance with physician/Nurse Practitioner orders and regulatory standards Conduct regular nursing assessments and ongoing health monitoring for residents Develop, implement, and update individualized nursing care plans Coordinate and manage all medical services, appointments, and treatments Monitor labs, medications, and treatment effectiveness; communicate changes to clinical teams Maintain accurate, timely, and compliant medical documentation in electronic health records Supervise and support LPNs, AMAPs, and Direct Support Professionals Train staff on medication administration, health and hygiene, infection control, seizure management, and other medical needs Ensure new hires are properly trained prior to independent client care Conduct annual clinical competency evaluations for unlicensed staff Participate in interdisciplinary team (IDT) meetings and quality improvement initiatives Promote a patient-centered, respectful, and safe care environment Qualifications Licensed Registered Nurse Minimum of 3 years of clinical nursing experience Experience working with individuals with intellectual or developmental disabilities preferred Schedule: Monday - Friday, 9AM - 5PM (No Weekends or Holidays) Salary: $100,000 - $110,000 Please email resume to: Joshua Albucker Senior Vice President NOOR Staffing Group 646-492-5653 jalbucker@noorstaffing.com

1. Graduate from an accredited School of Nursing, (BSN preferred) 2. Two years of Oncology, Home Care, ER or Critical Care nursing experience required 3. New York State RN licensure 4. Valid NYS Driver's license required 5. 1 year of Case Management experience preferred Job description: The Hospice Field Case Manager is a field based, full time position. You will visit Hospice and Palliative Care patients to perform both physical and psycho-social assessments and electronically document visit occurrences. Patient visits will be made in both community and facility settings. In addition, you will also supervise, train and evaluate home health aides and homemakers working with our hospice patients. **They need candidates who can speak both English and Russian** Plus

A Growing Homecare Company is currently seeking compassionate and experienced Field Nurses to do home visits for our patients in all boroughs of New York. Our goal is to provide superior, compassionate home care workers and healthcare services for elderly and disabled individuals in the comfort and dignity of their homes. We work closely with hospitals, physicians, and private caregivers for hire to develop and coordinate an individual plan of care while maintaining their independence at home. The Field Nurse is responsible for providing professional nursing care to patients requiring in-home care. Responsibilities Assess the patient/family situation for nursing and health-related problems. Educate the patient/family regarding the disease process, self-care techniques, and prevention strategies. Document on a timely basis, all nursing services provided to patients as well as periodic reports to coordinate care and remain in compliance with state/federal regulations. Instruct and supervise patients, caregivers, and home health aides in aspects of patient care as appropriate. Perform other related duties as assigned. Qualifications 1-2 years of experience in Certified Home Health Agency (CHHA) or Long-term care preferred. New York State RN License Strong Assessment and Clinical Skills Bilingual in Mandarin is preferred. Professional Liability Insurance Able to drive an automobile in good working order and available for use in the field. Compensation Initial assessment visit = $130.00 Reassessment visit = $100.00 Resumption of Care visit = $100.00 Supervisory visit = $80.00 **Per Diem and Full-time positions available.

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. Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. * This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience. * Certification as a Case Manager. * Minimum 2 years' experience in acute care setting. * Managed Care experience. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126.408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

X-Treme Care is a leading home care agency in New York that has been operational for almost 20 years. We are looking for fee for service UAS Assessment nurses to assess patients in the Bronx and Yonkers. You will be required to visit patients homes and be paid per visit. Qualifications: New York State Registered Nursing (RN) license in good standing. Proven knowledge of UAS-NY Assessments and proficiency of UAS-NY. At least 2 years' experience as a NY licensed RN working in a home care environment or in an acute, sub-acute, or long-term care (LTC) setting or managed long-term care (MLTCP). Seeking candidates fluent in English and Cantonese or Chinese. Skills Required: Solid UAS assessment and documentation skills. Ability to effectively communicate verbally and in written formats at all levels. Ability to use computerized systems such as Microsoft Outlook, Microsoft Word Requirements: Solid assessment and documentation skills. Ability to effectively communicate verbally and in written formats at all levels. Ability to use computerized systems such as Microsoft Outlook, Microsoft Word, Excel. Fluent in English and Cantonese Experience working with MLTC plans Pay per assessment $190-$200 We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Monarch/Brandywine Senior Living Company Culture and Values: At Monarch Communities, we value compassion, innovation, and community. Our team is committed to making a meaningful impact on the lives of our residents and fostering a collaborative and supportive work environment. Job Description LPN - Brandywine Living - Livingston, NJ Salary Range: $32/hr to $36/hr Led by the community's Health and Wellness Director (RN), our Wellness Nurse is a Licensed Practical Nurse (LPN) who provides direct nursing care to the Residents with an emphasis on holistic wellness. They also help supervise the day-to-day nursing activities performed by care staff of Certified Nursing Assistants. Schedule: The Wellness Nurse (LPN) is Part-Time Responsibilities and Duties Monitors the health, safety, and well-being of all residents Assisting in training and monitoring of medication administration Supervise care staff in accordance with current state regulations and community policies Maintaining clinical quality assurance in accordance with federal, state and local standards Promote the highest degree of service to our residents while leading and demonstrating the mission of the company Conduct thorough resident assessments Qualifications Graduation from an accredited School of Nursing, with current LPN license At least 2 years' experience with long-term care, assisted living, home health or hospital setting preferred Experience working with residents with Alzheimer's or other related dementias Ability to handle multiple tasks Knowledge of federal and state regulations, and of nursing practices, techniques and methods applied to health and wellness resident Proficiency in computer skills, Microsoft Office (Windows, Outlook, Excel) with the ability to learn new applications While performing the duties of this job, the associate is often required to stand, walk, sit, use fine and gross motor skills, reach with hands and arms, balance, stoop, kneel, crouch, talk, hear, and smell. An individual in this position will be required to lift or carry weight in up to 50 lbs. Intermittent physical activity includes lifting and supporting residents. The associate must use proper body mechanics. Additional Information Benefits Offered (for Part-Time Employees): · Paid Time Off (PTO) and Holidays · Flexible Schedule · On the job training · Employee Assistance Program (EAP) · Free Parking Other Compensation Programs: · Employee Referral Bonus · Resident Referral Bonus Equal Opportunity Statement: Monarch Communities and Brandywine Senior Living is an Equal Opportunity Employer. We comply with all applicable federal, state, and local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

Job Description Leading social service organization seeks a Nurse Case Manager (RN) to oversee comprehensive nursing care for individuals with developmental disabilities in a residential setting. The Nurse Case Manager also supervises and trains nursing and direct support staff while coordinating all ongoing and acute healthcare needs. Key Responsibilities Provide and oversee direct nursing care in accordance with physician/Nurse Practitioner orders and regulatory standards Conduct regular nursing assessments and ongoing health monitoring for residents Develop, implement, and update individualized nursing care plans Coordinate and manage all medical services, appointments, and treatments Monitor labs, medications, and treatment effectiveness; communicate changes to clinical teams Maintain accurate, timely, and compliant medical documentation in electronic health records Supervise and support LPNs, AMAPs, and Direct Support Professionals Train staff on medication administration, health and hygiene, infection control, seizure management, and other medical needs Ensure new hires are properly trained prior to independent client care Conduct annual clinical competency evaluations for unlicensed staff Participate in interdisciplinary team (IDT) meetings and quality improvement initiatives Promote a patient-centered, respectful, and safe care environment Qualifications Licensed Registered Nurse Minimum of 3 years of clinical nursing experience Experience working with individuals with intellectual or developmental disabilities preferred Schedule: Monday - Friday, 9AM - 5PM (No Weekends or Holidays) Salary: $100,000 - $110,000 Please email resume to: Joshua Albucker Senior Vice President NOOR Staffing Group 646-492-5653 jalbucker@noorstaffing.com

**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._** **Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST.** *****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 Capabilities, Skills and Experiences:** + Certification as a Case Manager. + Ability to talk and type at the same time. + Demonstrate critical thinking skills when interacting with members. + Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. + Ability to manage, review and respond to emails/instant messages in a timely fashion. + Minimum 2 years' experience in acute care setting. + Minimum 2 years "telephonic" Case Management experience with a Managed Care Company. + Managed Care experience. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126,408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Monarch/Brandywine Senior Living Company Culture and Values: At Monarch Communities, we value compassion, innovation, and community. Our team is committed to making a meaningful impact on the lives of our residents and fostering a collaborative and supportive work environment. Job Description LPN - Brandywine Living - Livingston, NJ Salary Range: $32/hr to $36/hr Led by the community's Health and Wellness Director (RN), our Wellness Nurse is a Licensed Practical Nurse (LPN) who provides direct nursing care to the Residents with an emphasis on holistic wellness. They also help supervise the day-to-day nursing activities performed by care staff of Certified Nursing Assistants. Schedule: The Wellness Nurse (LPN) is Part-Time Responsibilities and Duties Monitors the health, safety, and well-being of all residents Assisting in training and monitoring of medication administration Supervise care staff in accordance with current state regulations and community policies Maintaining clinical quality assurance in accordance with federal, state and local standards Promote the highest degree of service to our residents while leading and demonstrating the mission of the company Conduct thorough resident assessments Qualifications Graduation from an accredited School of Nursing, with current LPN license At least 2 years' experience with long-term care, assisted living, home health or hospital setting preferred Experience working with residents with Alzheimer's or other related dementias Ability to handle multiple tasks Knowledge of federal and state regulations, and of nursing practices, techniques and methods applied to health and wellness resident Proficiency in computer skills, Microsoft Office (Windows, Outlook, Excel) with the ability to learn new applications While performing the duties of this job, the associate is often required to stand, walk, sit, use fine and gross motor skills, reach with hands and arms, balance, stoop, kneel, crouch, talk, hear, and smell. An individual in this position will be required to lift or carry weight in up to 50 lbs. Intermittent physical activity includes lifting and supporting residents. The associate must use proper body mechanics. Additional Information Benefits Offered (for Part-Time Employees): · Paid Time Off (PTO) and Holidays · Flexible Schedule · On the job training · Employee Assistance Program (EAP) · Free Parking Other Compensation Programs: · Employee Referral Bonus · Resident Referral Bonus Equal Opportunity Statement: Monarch Communities and Brandywine Senior Living is an Equal Opportunity Employer. We comply with all applicable federal, state, and local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees.