Utilization review nurse jobs in Riverview, FL - 148 jobs

One organization. Countless opportunities. At Johns Hopkins All Children's Hospital, we provide expert pediatric care for infants, children and teens with some of the most challenging medical problems. We are committed to providing family-centered care. Taking part in pediatric medical education and clinical research helps us to provide high quality care in more than 50 pediatric specialties and subspecialties. We are seeking a physician assistant (PA) or pediatric acute care nurse practitioner (PNP-AC) committed to caring for pediatric patients with complex cardiac diagnoses. The critical care team in the Cardiovascular Intensive Care Unit (CVICU) cares for neonates, infants, children, and young adults with congenital and acquired heart disease who need intensive medical and surgical management. APPs are an invaluable part of the team in this high-acuity and fast-paced environment in the Heart Institute at Johns Hopkins All Children's Hospital. Passion for learning, critical thinking, and caring for cardiac patients and their families are highly encouraged for success in this role. Responsibilities: Assess, diagnose, and treat pediatric cardiac patients in the CVICU. Conduct comprehensive physical exams, order and interpret diagnostic tests, and formulate evidence-based treatment plans. Recommend pharmacologic and non-pharmacologic therapies, monitor patient responses, and respond appropriately. Provide family-centered care by communicating with patients' families, addressing their concerns, and involving them in the decision-making process. Collaborate with a multidisciplinary team including Cardiology, Cardiovascular Surgery, and many other specialties. Participate in medical rounds, simulations, and educational activities to enhance team knowledge and clinical practice. Contribute to quality improvement initiatives and research projects to advance pediatric cardiac critical care practices. Qualifications: Pediatric Acute Care Nurse Practitioner (PNP-AC) or Physician Assistant (PA) certification and licensure in the state of Florida. Master's degree in Nursing (PNP-AC) or Physician Assistant Studies (PA) from an accredited program. Prior experience in pediatrics, cardiology, and/or critical care fields are preferred but not required. Excellent clinical judgment, critical thinking, and problem-solving skills. Strong communication and interpersonal skills, with the ability to collaborate effectively within a multidisciplinary team. Dedication to providing compassionate and family-centered care to pediatric cardiac patients. Commitment to ongoing professional development and continuous learning. If you are a motivated and compassionate Pediatric Acute Care Nurse Practitioner (PNP-AC) or Physician Assistant (PA) seeking a rewarding career in pediatric cardiac critical care, we encourage you to apply! Join us in our mission to improve the health and well-being of children with congenital and acquired heart disease. What Awaits you? Diverse and collaborative environment Career Growth and development Affordable and comprehensive benefits package. Flexible spending Accounts. Paid Time Off (PTO) 403(b) Savings plan with matching Free Parking Tuition Reimbursement Dependent Child Tuition Relocation Salary Range: Minimum 52.02/hour - Maximum 80.63/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices. Johns Hopkins Health System and its affiliates are drug-free workplace employers.

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

Nurse Reviewer PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely. Essential Duties and Responsibilities: Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply via the HQSI Careers Page at: ************ > Careers > Current Employment Opportunities EOE: Minorities/Females/Disabled/Veterans Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace Healthcare Quality Strategies, Inc. is an E-Verify Employer

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.

Nurse Case Manager I Hours: 9am-530pm with 2-3 late evenings a month 1130am-8pm Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Nurse Case Manager I is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures Minimum Requirements: * Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state(s) required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: * Certification as a Case Manager is preferred. * BS in a health or human services related field preferred For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $68,880- $103,320 Locations: New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

BHI helps you manage your TDD patients. And your practice. Today's targeted drug delivery and infusion needs require confident coordination among physicians, provider staff, and patients. BHI helps connect all three to allow doctors to extend care beyond the office, provider staff to centralize management for greater efficiency, and patients to receive TDD right in their own home with experienced nurses. BHI helps bring physicians, provider staff, and patients together for Better Home Infusion. Basic Home Infusion is hiring for a Home Infusion Nurse in the Jacksonville, FL area. This role involves providing high-quality, patient-centered care to individuals receiving intrathecal pain or spasticity management therapy in the comfort of their homes, or in a clinic setting. You will have the ability to maintain your own schedule while traveling within the area (up to, but not limited to 180 miles). This is a full-time, permanent position that operates Monday-Friday, that operates in the home & in a clinic setting. Key Responsibilities · Administer and manage intrathecal pump therapy for patients with chronic pain or spasticity. · Perform pump refills, reprogramming, and troubleshooting in coordination with prescribing providers. · Educate patients and caregivers on medication regimens, pump function, and signs of adverse reactions or infection. · Collaborate with physicians, pharmacists, and other healthcare team members to ensure continuity and quality of care. · Document all care activities, assessments, and communications accurately and in a timely manner in electronic medical records. Qualifications Registered Nurse (RN) with an active, unencumbered license in the state of practice. Additional licensure or compact status preferred Minimum 2 years of nursing experience with at least 1 year in home infusion or pain management. Home health experience preferred Current BLS certification (ACLS preferred). Current TB Skin test or QuantiFERON blood test (within the past 12 months) Excellent clinical judgment, problem-solving, and communication skills. Comfortable working independently in a home setting and managing a mobile work schedule. Valid driver's license and reliable transportation What We Offer: 7 weeks paid, comprehensive training Classroom training in our newly built Simulation Lab and field training with an assigned Preceptor Competitive salary and mileage reimbursement. Comprehensive benefits package (for full-time employees). Supportive and collaborative clinical team environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to perform one-person CPR continuously, according to American Heart/Red Cross standards. The employee is frequently required to travel via car, train or plane, stand, sit, walk, see, hear; use hands and fingers regularly, handle, or feel objects, tools, or controls, reach with hands and arms, bend at the knees and waist - such as to access supplies, equipment and patients and administer medications with precision (e.g. using syringes) The employee must frequently lift and/or move, push and pull equipment, up to 5 pounds and occasionally lift and/or move up to 40 pounds. Nothing in this restricts management's right to assign or reassign duties and responsibilities to this job at any time. This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. At Basic Home Infusion, we are deeply committed to promoting diversity, equity, and inclusion in our provision of intrathecal infusion pain management services. We recognize that these core values are essential for achieving optimal patient outcomes and creating a supportive and inclusive environment for our team members.

Working Title: REGISTERED NURSING CONSULTANT - 50000327 Pay Plan: Career Service 50000327 Salary: $66,686.87 Total Compensation Estimator Tool Requisition # 867418 REGISTERED NURSE CONSULTANT FLORIDA DEPARTMENT OF VETERANS' AFFAIRS Mary Grizzle Office building Homes Program Largo, Pinellas County Starting Salary : $66,686.87 Paid Bi Weekly Excellent retirement package and optional deferred compensation plan. Health, vision, dental, disability, and other supplemental insurance available at reasonable premium rates. Paid vacation and sick leave. Nine (9) paid holidays and personal day. Tuition waiver available for State Universities and Community Colleges (up to 6 credits per semester). Education and employment history must be verifiable. Please attach any credentials you claim (degrees, certifications, etc.) to your application. MINIMUM QUALIFICATIONS: * Must be willing to obtain MDS Certification within first year of employment. * Must possess a current Florida licensure as a Registered Professional Nurse. * Must possess a Bachelor's degree from an accredited college or university with a major in nursing or a related field and two (2) years of nursing experience - OR - have six (6) years of professional nursing experience - OR - possess an Associate's degree and have four (4) years of professional nursing experience. * Availability to travel 75% includes overnight required. * Successful completion of the due diligence process to include, but not limited to, a Level II Background check and drug screen. PREFERRED QUALIFICATIONS: * At least one (1) year of experience working in a long-term care facility with a geriatric population. * Proficiency with Microsoft Office Suite, especially Outlook, Word, and Excel. * Basic experience and familiarity with MDS and Care Plans. * Infection Control Preventionist Certification. Position Description: Serve as a liaison between nursing staff and executive leadership of the FDVA Homes Program. Ensure safe, effective, and evidence-based nursing care. Monitor resident outcomes and quality measures. Coordinates and oversees all functions of the FDVA Homes Program's MDS Assessment process to assure compliance with Federal and State requirements. Performs audits to assure prompt completion and transmission of the required MDS Assessment. Coordinates with Billing to assure accurate RAI-MDS and billing process. Develops and provides educational programs to the Interdisciplinary Team members. Prepare for and participate in regulatory surveys and inspections. Assist in identifying and correcting deficient practices. Ensure staff competency and licensure compliance. Review and update nursing policies, procedures, and standards of care. Oversee infection control and patient safety programs. Performs Other Duties as Assigned. Knowledge Skills and Abilities: Knowledge of Nursing Home State and Federal regulations. Strong analytical and critical-thinking skills. Excellent written and verbal communication skills. This position is a Career Service Position 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:

Mission Statement The Children's Network of Hillsborough is committed to working with the community to protect children and preserve families. General Purpose of Job To provide nurse care coordination for children in the child welfare system. This includes children with special health care needs. The Nurse Care Coordinator (NCC) will coordinate, assist, and consult regarding medical health services to promote quality outcomes. The NCC will monitor the timelines and coordination of health services and integration of those services in support of permanency goals for children in care, ensuring a coordinated effort to maximize the potential of children and to provide them with optimal care. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Duties and Responsibilities Act as liaison between Health Plans, Case Management Organization (CMO), the Department of Children & Families (DCF) and specialty and/or community providers regarding health services. Create plan of care and coordinate medical services for dependent children, including Health Risk Assessments, timely Well-Child Checkups and follow-up for specialty appointments and required referrals. Works with child welfare case managers to coordinate health care and meet all wellness measures. Provide reviews of medical, dental and optometric services and inform child welfare case managers and caretakers of needed follow-up. Documents reviews in FSFN and assures records are uploaded into the appropriate computer program. Provide information for and attend court hearings and case staffings as needed or requested. Participate in health plan case management integrated care team and/or CBC Multidisciplinary team meetings if needed. Participate with health care plan in discharge planning and coordination from in-patient health care facility including monitoring of post-discharge follow-up appointments, ordered services, durable medical equipment and assuring that prescriptions are filled as needed. Process information on any medication compliance concerns and notify physician, case manager and health plan. Review the health and wellness reports, FSFN reports and other data sources for status of required annual physical, dental and vision screenings for children placed in out of home care. Participate, as needed, in planning for youth who are transitioning from the child welfare system. This may include participation in routine staffings to providing education and coordination of services. Cultivate and coordinate an effective communication system with providers and child welfare staff for the exchange of appropriate information. Provide education and support to families related to the care of their child. Monitor email on daily basis. Circulate pertinent child-related information to Child Welfare Case Managers and other designated Case Management Organization employees. Enter data into automated systems and produce required reports from the data system. Data entered into FSFN must be done within 48 hours of receiving the information. Works in a collaborative and positive manner as a member of the healthcare team with the co-workers, families, caseworkers, guardians, physicians and their office personnel, schools, vendors and other related organizations. Other duties may be assigned as special projects may be requested. Working Hours CNHC's work week is Monday through Friday, 20-30 hours per week. This is an hybrid based position with business office hours are 8:00 am to 5:00 pm. You direct supervisor will discuss expectations for in-office requirements. Travel Travel inside of Circuit 13 (Hillsborough County) may be required as well as occasional travel outside the circuit for training purposes. Training All employees must complete fifteen (15) hours of on-line or classroom Training on an annual basis. If the employee is a Certified Child Welfare Professional, Training hours must total twenty (20) annually. Complete required training to maintain license as a nurse. Supervisory Responsibilities This position does not have supervisory responsibilities Qualifications Education and/or Experience Registered Nurse (RN), with current Florida nursing license is required. Three (3) years nursing experience in the child welfare or behavioral health care setting, preferred Pediatric and/or care coordination experience is helpful. Skills and Abilities Must possess strong clinical expertise and the ability to assess the medical and developmental needs of children and families involved in the welfare system. Exceptional organizational and time-management skills are essential for coordinating care plans, managing health records, and ensuring timely access to medical, therapeutic, and support services. Effective communication and interpersonal abilities are crucial for collaborating with child welfare staff, healthcare providers, and families to advocate for the well-being of children. The role requires critical thinking and problem-solving skills to navigate complex cases, address barriers to care, and adapt to evolving needs while prioritizing the safety and health of children. Proficiency in documenting and utilizing care management systems is necessary for tracking progress and maintaining compliance with regulations Pre-employment Requirements Certificates, License, Registrations, backgrounds, drug screens, Etc. Licensure in the State of Florida as a Nurse Valid driver's license required, with proof of insurance Driver's license check is a requirement Criminal background screening (fingerprinting) (Local Law Enforcement and FBI/FDLE) Drug Screening is a requirement Children's Network participates in E-Verify Other Requirements Language Skills Must possess strong language skills, including the ability to communicate clearly and effectively with diverse stakeholders, such as families, healthcare providers, social workers, and legal professionals. This involves the ability to explain medical information in an easily understandable way, ensuring that families and caregivers can make informed decisions about their child's care. Strong written communication skills are essential for documenting care plans, progress notes, and reports accurately and professionally. Additionally, the ability to listen actively and empathetically, especially in sensitive or high-stress situations, is critical for building trust and supporting families in navigating the child welfare system. Cultural competency in language use is also important to ensure that communication is respectful, inclusive, and tailored to the needs of the children and families served. Mathematical Skills Must possess the ability to interpret and analyze numerical data from medical records, treatment plans, and financial documents. Proficiency in using mathematical formulas for health assessments, tracking growth and development metrics, and calculating medical statistics is essential. Additionally, the role may require the ability to manage and allocate resources effectively, ensuring the most efficient use of healthcare services within a budget. Attention to detail and accuracy in all numerical tasks are critical to ensuring the safety and well-being of children and families under care. Reasoning Ability Must demonstrate strong reasoning abilities to assess complex medical and emotional needs of children and families, ensuring that care plans are both effective and responsive. This includes the capacity to analyze medical histories, understand psychosocial factors, and apply clinical guidelines to create comprehensive care strategies. The role requires critical thinking to evaluate the effectiveness of interventions, address emerging challenges, and identify barriers to achieving optimal health outcomes. The ability to anticipate potential risks, prioritize urgent needs, and make informed decisions that align with child welfare policies is essential. Additionally, strong reasoning skills help in collaborating with other professionals, ensuring that decisions are evidence-based, ethical, and focused on the best interests of the children and families served. Physical Demands The physical demands of this position are generally moderate. The role may require extended periods of sitting, standing, and using a computer. Occasional lifting of office supplies, files, or materials up to 25 pounds may be required. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential job functions. Work Environment This is an in-office-based position focused on administrative work, where the noise level may be moderate. The role may involve occasional travel among agency locations, extended periods of computer work, and frequent interactions across multiple departments. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions. ADA: Children's Network of Hillsborough, LLC will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990. EEO: Children's Network of Hillsborough, LLC does not discriminate based on race, national origin, gender, religion, veteran status, or disability in employment, in provision of services, or in access to programs. Children's Network of Hillsborough, LLC is a Drug-Free Workplace.

Job Description About Company: Founded in 1993, Intercoastal Medical Group is an association of more than 100 highly credentialed physicians encompassing many medical specialties serving Sarasota County and Manatee County, Florida with nine locations. Intercoastal is the premier provider of choice in the Sarasota / Bradenton area. Intercoastal Medical Group also prides itself on offering this area's most current technology and resources. Extensive laboratory and diagnostic equipment and a day surgery center allow for fast and accurate diagnostic tests and procedures at conveniently located Intercoastal facilities. We are always looking for qualified and compassionate professionals to join our team of dedicated providers and staff. If you enjoy working in a fast-paced environment where you can truly make a difference in the lives of patients, then Intercoastal Medical Group is the place for you. About the Role: As a Licensed Practical Nurse (LPN) within our Health Care Services team, you will play a critical role in delivering high-quality patient care across various clinical settings. Your primary objective will be to support physicians by providing direct nursing care, monitoring patient health, and administering prescribed treatments. You will be responsible for maintaining accurate patient records, communicating effectively with patients and their families, and ensuring compliance with healthcare regulations and standards. This role demands a compassionate approach, attention to detail, and the ability to work collaboratively within a multidisciplinary team to enhance patient outcomes. Ultimately, your contributions will be vital in promoting patient well-being and supporting the overall efficiency of our healthcare services at Intercoastal Medical Group. Positions available in Primary Care, Vascular Surgery, Cardiology, Endocrinology, Pulmonology, Gastroenterology, Rheumatology and Oncology in the Sarasota locations. Minimum Qualifications: Valid and current Licensed Practical Nurse (LPN) license in the applicable state or jurisdiction. Completion of an accredited practical nursing program. Basic Life Support (BLS) certification. IV Certification (for Rheumatology role) Demonstrated experience in a clinical or healthcare setting providing direct patient care. Strong understanding of nursing principles, patient safety, and infection control standards. Preferred Qualifications: Familiarity with electronic health record (EHR) systems and healthcare documentation software. Excellent interpersonal and communication skills tailored to patient-centered care. Responsibilities may include but not limited to: Obtain prior authorizations on medications and/or ancillary authorizations; follow protocol for documenting authorization in computer system. Perform nursing/medical assisting duties including (but not limited to)- administer prescribed medications and injections, perform treatments and tests according to provider orders. Assist provider with exams and treatments as directed by provider. Prepare patient for exam and treatment. Collect and document accurately - patient clinical history, allergies, medications, vital signs, and chief complaint into the electronic medical record. Perform chart prep for upcoming appointments when needed. Communicate with provider in regards to patient care and treatment. Notify patients regarding test results. Document patient information accurately and timely in medical records, ensuring compliance with healthcare regulations. Communicate effectively with patients, families, and healthcare team members to provide education and support. Maintain a safe and clean environment by adhering to infection control protocols and organizational policies. Respond promptly to patient needs and emergencies, escalating concerns to appropriate medical personnel as necessary. Participate in ongoing training and professional development to stay current with nursing best practices and regulatory requirements. May be assigned to provide coverage at another location when needed. Skills: The required skills enable the LPN to deliver safe and effective patient care by accurately assessing patient conditions and administering treatments as prescribed. Strong communication skills are essential for educating patients and collaborating with healthcare team members to ensure coordinated care. Proficiency in documentation and familiarity with electronic health records support compliance with legal and organizational standards. Preferred skills such as additional certifications and experience with diverse patient populations enhance the nurse's ability to address complex care needs and adapt to various clinical settings. Together, these skills ensure that the LPN can provide compassionate, efficient, and high-quality nursing care on a daily basis. Intercoastal is a drug free workplace and EEO compliant. Monday-Friday with 8-9 hour shifts

Work/life Balance Opportunity Centurion is proud to be the provider of Comprehensive Healthcare services to the Florida Department of Corrections. We are currently seeking a full-time Nurse Practitioner or Physician Assistant to join our team at the Hardee Correctional Institution located in Bowling Green, Florida. Responsibilities: The Nurse Practitioner / Physician Assistant works under the supervision of a physician in a correctional environment and is responsible for assisting in the delivery of health care and patient care management. This includes collaborating with a multidisciplinary team, performing assessments, diagnosing patients, and medication management. Available Shift - M-F Day shift 8:00 - 4:30 Centurion Health contracts with state and local governments nationwide to provide comprehensive healthcare services to correctional facilities, state hospitals, and other community settings. Our dedication to making a difference and our passionate team of the best and the brightest healthcare employees has made us one of the leaders of the correctional health industry. Whether you are driven by purpose and impact or on a journey of professional growth, our opportunities can offer both. Benefits We offer excellent compensation and comprehensive benefits for our full-time team members including: Health, dental, vision, disability and life insurance 401(k) with company match Generous paid time off Paid holidays Flexible Spending Account Continuing Education benefits Much more... Qualifications Must have a Florida license ARNP certification DEA License or ability to obtain CPR up to date Be able to pass a criminal background and NPDB For more information contact Jane Dierberger ************ ********************** indmhm

LifeWorks Wellness Center is looking for a Registered Nurse to join our team of health care professionals. Our clinic is expanding at a rapid rate and so is our team! LifeWorks Wellness Center is the largest integrated practice in the US, as well as Florida's top natural health clinic. We are proud to provide patients with alternative medical doctors that treat a wide range of chronic health conditions, naturally. People travel from all over the world to see our practitioners and receive our lifesaving holistic treatment programs. BONUS - $1,000 SIGN-ON BONUS UPON COMPLETION OF 6 MONTHS OF CONTINUOUS EMPLOYMENT. Job Duties: Understands patient's treatment program. Monitors patient's progress through their treatment program. Order services (labs, x-ray, etc.) based on practitioner's instructions. Manages specialty referrals to ensure results received back in a timely manner. Ensure patient has follow up exams at necessary points on their treatment program. Works in close coordination with Nutritional Consultant to ensure patient questions are answered regarding supplements and diet. Instruct patients and the family about best practices on home care. Support practitioners in managing patient emergencies to resolution. Maintaining a level-head throughout any emergency situations and communicating to patients with empathy. Maintains patient charts with all patient communication, interactions, and instructions. Provides patient education as directed by the doctor. Maintains safe, secure, and healthy work environment by establishing and following protocols and policies. Complying with all legal and health regulations. Serves and protects the doctor's practice by adhering to professional standards, policies, protocols, and federal, state, and local requirements. Education and/or Experience: Current Registered Nurse (RN) license in the state of practice. Graduate of Highschool/GED or equivalent 2+ years in healthcare Experience using EMR software Superior communication and patient service skills Excellent attention to detail. Ability to multitask and experience working in a fast paced environment Basic IV Holistic Nursing Certification is a plus Language Skills: Must speak English. Any other language is a plus. Must have excellent interactive communication skills, making patients feel comfortable and at-ease. Physical Demands: While performing the duties of this job, will be on the computer and phone minimum 6 hours a day. May meet with patients in person at the clinic. There is an emotional demand with patient's who may be upset or are very sick. Must be able to be an emotional support for the patients as well as parents/caregivers. Compensation: $36- $38 / hour Benefits: Employer sponsored Health, dental and vision insurance Health savings account Employee discount Paid Time Off Holiday Pay No weekend hours/no night hours LifeWorks Wellness Center (LWC) is an equal employment opportunity employer. All individuals seeking employment are considered without prejudice to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, pregnancy status, veteran status, gender identity, sexual orientation or any other characteristic protected under applicable federal, state, or local law. Additionally, LWC will provide all reasonable accommodations for qualified individuals with known disabilities, unless doing so would result in undue hardship to the company.

Benefits: 401(k) matching Health insurance Paid time off We are seeking a knowledgeable, highly skilled Infusion Nurse RN / LPN to join our fast-paced infusion suite. The ideal candidate will have strong IV experience, excellent clinical judgment, and a passion for patient care. Responsibilities & Requirements: · Must be IV certified and proficient in peripheral IV access · Must successfully complete a skills check-off upon hire · Quick learner, comfortable with infused medications for autoimmune disorders (biologics) · CPR and AED certification required and must be current · Strong critical thinking skills and ability to work independently · Adaptability and flexibility in a dynamic clinical environment · Microsoft Excel and Word proficiency a plus Benefits: · Competitive compensation · Medical, Dental, and Vision Insurance · 401(k) with company match · Supportive and collaborative work environment If you are a dedicated professional with exceptional infusion skills and a desire to make a difference in patients' lives, we'd love to hear from you! Compensation: $30.00 - $37.00 per hour

Part-Time Functional Medicine Specialist wanted for our rapidly growing Wellness Program at LivingYoung Center! Our services include: peptides, vitamin injection and IV therapy, pellet hormone replacement therapy, specialty testing, LDN, and MORE! We're looking for a provider passionate about functional medicine to grow this program in our Palm Harbor and Odessa locations. This will be a part time position to start and will ideally grow into full time as patient demand increases. Qualifications Responsibilities: Perform consults, physical examinations and procedures, discuss expected patient outcomes, prepare treatment plans, and manage patients with facial aesthetic needs Some administrative duties such as following up with patients, charting, and meticulous documentation of patient care. Leveraging strong organization, communication, and customer service skills with a passion for providing high-quality patient care Working both as a collaborative team member and independently as a solo provider Requirements: Board-certified NP or PA. Corresponding state license to practice in good standing. Knowledge of healthcare regulations and compliance requirements. Excellent customer support, communication, and integrity. Ability to build rapport with customers and follow-through with aftercare product recommendations. Desire to work in a dynamic environment and grow skills. Able to work well in a dynamic and fast-paced environment. Demonstrates skills in sales, customer service, and time management. Enthusiastic, energetic, personable, friendly, passionate, intelligent, and knowledgeable in wellness/functional medicine. Benefits (Eligible for Full-Time Employees): • Competitive benefit package • 401k matching • Medical, Health, Dental, Vision • PTO

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding thattogetherwe are even better. The ARNPfunctions as a member of the medical care management team for physician practice patients (surgical and non-surgical). Provide services similar to those of a physician.The ARNP may diagnose medical conditions, plan and implement treatment collaboratively agreed to in the AdventHealth Medical Group medical staff delineation of clinical privileges for Advanced Registered Nurse Practitioners.Examine patients, take medical histories, maintain patient records, identify health risks factors, prescribe medications, make referrals.Focus on patient wellness and disease prevention.Provide health education services and/or counsel patients on how to make healthy lifestyle choices.Will need to work weekdays, occassional weekends and nights for call coverage. EDUCATION AND EXPERIENCE REQUIRED: • Masters of Nursing • One + years' experience • Valid AHA BLS Certification Licensure as an APRNin the State of Florida • Advanced Registered Nurse Certification

Children's Medical Center is a busy general pediatric office that has serviced our communities for over 27 years. We have 4 locations and offer great benefits including paid time off, health, dental, vision, life, and long and short-term disability insurance. We also offer 401K and profit sharing after one year of service and opportunities to grow within the organization. We are looking for a team member who can serve in a full-time Nurse position. The Nurse is a member of the Patient Centered Medical Home Team and provides clinical support to the provider, patient, and their family, and other care team members to ensure smooth patient workflow and quality patient care. Hours include evening and weekend shifts on a rotated basis Required skills include but are not limited to: Administrate Vaccines Administrate Blood draws/venipuncture Rocephin Shots Telephone Triage Knowledge of emergency protocol Collecting lab specimens Send out lab specimens while following lab procedures Perform in house labs Perform quality controls Other duties as assigned Communication / Presentation / Team Skills Required: Exemplifies excellent customer service, verbal communication skills, conflict resolution with patients/parents/guardians, visitors, and other employees; shows courtesy, friendliness, helpfulness, and respect. Strong detail and organization skills. Consistently demonstrates respect for the capabilities, different cultures and/or personalities of internal and external customers. Works well independently. Relates well and works collaboratively as a team member with, all levels of staff in a professional manner. Attends daily huddles, weekly and monthly staff meetings. Consistently alters plans/routines when situation requires and continues to perform without projecting stress/frustration that would adversely affect the work environment. Records and maintains complete and accurate records of patient and physician communications regarding medical care according to standard medical record documentation requirements Maintains and ensures patient privacy and confidentiality. Takes the initiative to proactively assist other team members without direct supervision and to resolve problems. Maintains open and effective communication with providers and employees to ensure quality patient care. Strong phone, spelling and grammar, computer, and keyboarding skills. Maintains professional appearance, follows dress and uniform policy, and maintains neat work habits. Participates in ongoing skills development. Initiate with physicians approval referral to emergency room and after-hours care. Informs Clinical Manager when potential problem is communicated by patient regarding physician-patient relationship or regarding patient concern with care rendered. When necessary, calls patients with test results and follow up care or instructions per physician order within provider's guidelines. Always displays a professional behavior Telephone Skills Identifies self by name when answering telephone. Politely asks caller to hold and waits for an affirmative response before placing caller on hold. When transferring a call, informs caller to whom and where the call is being transferred if possible. Verifies patient name and date of birth to ensure accuracy of patient's identity. When making an appointment, repeats doctors name, date, and time of appointment before completing call. Refers unusual circumstances appropriately to Physician, Business Office, or the Clinical Manager. Understands and utilizes features of the telephone and phone mail system (i.e. hold, transfer, forward, retrieving new, saved, and old messages). Qualifications QUALIFICATIONS: Education: Minimum high school diploma or equivalent. Certification: Licensed Practical Nurse or Registered Nurse Certification Experience: 1-2 years experience in the medical field preferred Compensation is competitive and based on experience, qualifications, and other factors We are an Equal Opportunity Employer / Drug-Free Workplace To apply please visit npcmc.com and navigate to "about us" and "careers" .

Nurse Reviewer PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely. Essential Duties and Responsibilities: Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply via the HQSI Careers Page at: ************ > Careers > Current Employment Opportunities EOE: Minorities/Females/Disabled/Veterans Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace Healthcare Quality Strategies, Inc. is an E-Verify Employer

Why You Should Work For Us: 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 You, as the Nurse Reviewer will be held responsible for the comprehensive review of the medical information for the assigned medical record review and completion of all paperwork, communication and data entry involved. Reviews will include quality of care, medical necessity; DRG validation, focused, readmission, Emergency Medical Treatment and Active Labor Act [EMTALA], and all others are required by contract. Communicates with the Medicare beneficiary/family members, healthcare providers and/or practitioners as needed during the course of the identified review. Essential Duties: • Maintains current knowledge of the QIO contract, QIO Manual, SDPS Memorandums and Healthcare Communities Website to locate and apply up to date rules and protocols • Recognizes barriers to completing work and uses clinical judgment to determine when to seek assistance from the Review Supervisor • Communicates with the providers/practitioners via mail or phone regarding the need for clarification of requests and information provided in the correspondence letters. • Responds in a timely manner to the providers and/or practitioners if there is a request for information or assistance in order to facilitate the completion of the assigned medical record reviews. • Applies knowledge and expertise, analytical skills, critical thinking and business acumen to best meet customer needs. • Communicates with Medicare beneficiary via mail or phone as needed • Responds in a timely manner to the beneficiary if there is a request for information • Frequently seeks and accepts feedback with regards to the review process; listens actively; maintains frequent and open communication. • Collaborates to accomplish common goals to include accurate medical assessment of the beneficiary complaint and accurate Quality of Care Reviews. • Recommend actions that may increase quality /productivity related to the review process. • Communicates the current status of workload and availability for additional assignments • Collaborates with the KEPRO team to identify additional process improvements that support enhanced beneficiary satisfaction and overall improvement of heal care. • Collaborates with the KEPRO staff to support all contract requirements and identify additional contract improvements. Qualifications • Active RN or LPN Licensure • Graduate from an accredited School of Nursing or college • 3+ years of clinical experience within any healthcare setting [Acute Care, Inpatient, Outpatient, etc] • Quality Review experience [Medical Necessity, Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews] Additional Information Shift: Monday - Friday 8:00am - 5:00pm • This is an immediate contract opening! • Pay range $29.00 - $30.00/hr), salary negotiated based on relevant experience

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.

**Nurse Case Manager I** **Hours: 9am-530pm with 2-3 late evenings a month 1130am-8pm** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The **Nurse Case Manager I** is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning **How you will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. + Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. + Coordinates internal and external resources to meet identified needs. + Monitors and evaluates effectiveness of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. + Negotiates rates of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management policies and procedures **Minimum Requirements:** + Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted RN license in applicable state(s) required. + Multi-state licensure is required if this individual is providing services in multiple states. **Preferred Skills, Capabilities and Experiences** : + Certification as a Case Manager is preferred. + BS in a health or human services related field preferred For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $68,880- $103,320 **Locations: New York** In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._ * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law 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.