Case Management Nurse
Utilization review nurse job in Charlottesville, VA
2 year of case manager experience
Must have pediatric case management experience
Must have acute care hospital inpatient CM experience
Job Requirement
BLS
Will accept VA pending license
Registered Nurse, Staff RN -Urgent Care
Utilization review nurse job in Virginia Beach, VA
The RN - C/C Core Charge Nurse leads and oversees nursing staff on their scheduled shifts. This position collaborates with Nursing Department Directors, Managers, and Hospital Supervisors to provide the personnel, workplace, and technology resources necessary for the provision of safe, high-quality patient and family care. The RN - C/C Core Charge Nurse solves problems effectively, communicating and collaborating with all stakeholders. This position maintains clinical expertise by providing direct patient and family care, working with staff on a regularly scheduled basis. Reports to department leadership.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Collaborates with the Nursing Department Director(s) and the department leadership team to establish department priorities. Maintains knowledge of regulatory requirements that impact clinical services and professional practice.
Models the shared vision, mission, values, and EXCEL standards in every action.
Utilizes the nursing process and organizational policy and procedure to plan and provide a comprehensive, collaborative, age-appropriate plan of care for patients and families.
Oversees and conducts the recruitment, hiring, team/department orientation, performance appraisals and disciplinary actions including up to termination processes for a team or department.
Leads, manages, coaches, and trains a team or department, provides guidance, support, and mentors to ensure optimal performance and productivity.
Promotes cohesive work teams and constructive conflict resolution, within the department.
Oversees and coaches staff to provide input and make decisions to improve patient and family care and the work environment. Acts as a resource for newer staff, teaching and precepting as needed, eliciting individual strengths and competencies.
Assigns work by balancing patient and family care requirements with available personnel and technology resources and assigns and directs patient care responsibilities based on knowledge of staff qualifications and competencies.
Monitors department workload, incorporating feedback from staff to assure high quality patient care, efficiency, and cost effectiveness.
Provides direction and assistance in significant events (e.g., urgent patient care needs, psychosocial or behavioral crisis, etc.) by providing situation awareness, anticipating needs, and assuring availability of resources.
Provides leadership for effective problem solving, communication, and collaboration between stakeholders to achieve the common goal of safe, high quality patient care. Resolves workplace issues and personnel concerns during scheduled shifts, communicating resolution status to other appropriate leadership.
Communicates effectively at all levels, role modeling a professional approach with all situations and individuals, even when faced with disagreement or conflict. Promotes a positive work environment by building trust and strengthening relationships with staff within and between units.
Participates on initiatives that improve patient care quality and safety, operational excellence and nursing process, education, and research, in order to role model and support others to do the same.
Performs all other duties as assigned.
LICENSES AND/OR CERTIFICATIONS
Required Licenses and/or Certifications
Registered Nursing License in the State of Virginia or Registered Nurse holding a valid Compact State license required at time of hire.
Advanced Cardiovascular Life Support (ACLS), PALS (Pediatric Advanced Life Support (PALS), and Trauma Nurse Core Curriculum (TNCC) training required at time of hire or must be obtained within 60 days of hire.
Preferred Licenses and/or Certifications
None preferred.
MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS
Required Education and Experience
Bachelor's degree in Nursing from an accredited program, college or university required at time of hire or must be obtained within 3 years of hire.
Three or more years of clinical experience in a setting committed to collaborative decision making and team development required.
At time of hire, a record of completion and/or enrollment for all education, licenses, training and/or certifications is required.
Continuous re-certification and/or maintenance of state licensures, certifications, educational and application requirements is required during employment.
Preferred Education and Experience
None preferred.
Required Knowledge, Skills, and Abilities
Demonstrated professional knowledge of areas of responsibility to include theory, practice, and administration to direct planning and implementation.
Critical thinking and analytical skills necessary to organize and provide direction.
Highly motivated, enthusiastic team player who takes initiative.
Strong organizational skills with attention to detail and commitment to accuracy.
Excellent time management skills, able to shift priorities and able to work independently and problem solve in a fast paced, fluid environment.
Possesses strong verbal, written, and interpersonal skills as well as, the ability to interact with and build collegial relationships with diverse individuals.
Ability to follow Health Insurance Portability and Accountability Act (HIPPA) policies and procedures and maintain confidentiality of all facility and facility-related (patients/families) information.
WORKING CONDITIONS
Clinical work environment with little exposure to excessive noise, dust, temperature and the like.
~ PHYSICAL REQUIREMENTS
~ #CHKDHS
Additional Information
CHKDHS is an Equal Opportunity Employer.
Equal Employment Opportunity is the Law -
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, gender identity, national origin, sexual orientation, veteran status, or any other status protected by federal, state, or local law. If assistance is needed, please reach out to us at T alent *************
Utilization Management Nurse
Utilization review nurse job in Richmond, VA
**Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others.
**Use your skills to make an impact**
**Required Qualifications**
+ Active unrestricted RN license with the ability to obtain Compact Nursing License
+ A minimum of three years clinical RN experience;
+ Prior clinical experience, managed care experience, **OR** utilization management experience
+ Demonstrates Emotional Maturity
+ Ability to work independently and within a team setting
+ Willing to work in multiple time zones
+ Strong written and verbal communication skills
+ Attention to detail, strong computer skills including Microsoft office products
+ Ability to work in fast paced environment
+ Ability to form positive working relationships with all internal and external customers
**Preferred Qualifications**
+ Education: BSN or bachelor's degree in a related field
+ Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
+ Previous experience in utilization management within Insurance industry
+ Previous Medicare Advantage/Medicare
+ Current nursing experience in Hospital, SNF, LTAC, DME or Home Health.
+ Bilingual
**Alert**
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
**Interview Format - HireVue**
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
**Work-At-Home Requirements**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**Benefits**
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-25-2025
**About us**
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
Easy ApplyClaims Review Nurse (CERT)
Utilization review nurse job in Richmond, VA
Catapult Consultants is a global, professional services and management consulting company specializing in business, analytical and information systems solutions. We support mission-critical programs in the Intelligence Community and Defense and Civilian sectors. Our health care soultions division is currently looking for Registered Nurse to support our transplant program quality assessment and performance improvement program. For more information about us go to
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Job Description
This position provides support for a federal government project to review Medicare documentation as part of the Centers for Medicare & Medicaid Services' (CMS) Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare fee-for-service (FFS) program.
Full-Time, Monday - Friday
Two open positions located in Richmond, Virginia
Responsibilities:
Review claim documentation and associated medical records related to the CMS CERT program and determine whether Medicare FFS program services qualify for coverage and payment.
Assess whether claim documentation and associated medical records complies with Medicare coverage, coding and billing rules.
Compare documentation assessments to those of the Medicare contractor who originally reviewed and paid the claims and note which claims are in “error” if they have been incorrectly billed, paid or processed the services.
Other duties as assigned
Qualifications
Registered Nurse (RN) with an active license
Associate's, Diploma or Bachelor's degree in Nursing
5 years of full-time work experience
3 to 5 years of experience in coding
At least 2 years of experience in inpatient, acute care coding for Medicare reimbursement and MS-DRG experience
Knowledge of standard coding conventions, such as DRGs, ICD-9-CM, HCPS and CPT
Knowledge of Payment methodologies and Medicare guidelines
Familiarity and understanding of Medicare rules, regulations, policies and procedures
Familiar with Microsoft Word, Excel and Outlook
Highly-motivated, detail-oriented, quick learner with a professional demeanor
Ability to effectively work independently
Additional Information
Catapult Consultants does not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other proscribed category set forth in federal or state regulations.
Nurse Case Manager I
Utilization review nurse job in Virginia
This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Work Shift: Monday - Friday 8:00AM - 4:30PM (twice per month 11:30AM - 8:00PM)
The Nurse Case Manager I is responsible for performing 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.
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.
Certification as a Case Manager and a 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 $68,883 to $118,086
Locations: Cleveland, OH, Maryland, Massachusetts, 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, paid time off, stock, 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.
Auto-ApplyNurse Case Manager
Utilization review nurse job in Richmond, VA
**Responsibilities:** Richmond VA and surrounding area. Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues
Facilitates optimal outcomes. Identifies and follow through with continuous quality/ compliance opportunities . Educates/ empowers members to ensure compliance, satisfaction and promote patient advocacy.
**Duties**
+ Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to programs and plans.
+ Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
+ Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
+ Reviews prior claims to address potential impact on current case management and eligibility.
+ Assessments include the member's level of work capacity and related restrictions/limitations.
+ Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
+ Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
+ Utilizes case management processes in compliance with regulatory and company policies and procedures.
+ Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
**Experience**
Case management and/or discharge planning experience preferred
**Position Summary**
+ Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
+ Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.
+ Services strategies policies and programs are comprised of network management and clinical coverage policies.
**Education**
Active RN license in Virginia required
Associate or Bachelor's in nursing
**Skills:**
RN, Case management
**About US Tech Solutions:**
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (*********************************** .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Nursing Coordinator
Utilization review nurse job in Alexandria, VA
PRIMARY FUNCTIONS: The Nursing Coordinator works with the Nursing Manager and Chief Medical Officer to facilitate access to high quality, safe, patient-centered medical care for all Neighborhood Health patients regardless of race, age, or ability to pay. The Nurse Coordinator is responsible for the supervision of the site's clinical support staff and performs clinical duties when needed including triage and high-risk case management.
Demonstrates commitment to Neighborhood Health's mission of improving health and advancing health equity in Alexandria, Arlington, and Fairfax by providing access to high quality primary care regardless of ability to pay.
DUTIES/ RESPONSIBILITIES: ( Essential Functions: Duties and responsibilities noted with bullets are considered to be the essential functions of the job)
Works with multidisciplinary team, to include the medical provider, behavioral health provider, dental provider, family support worker, referral coordinator, and medical assistant to provide high quality, coordinated, and patient-centered primary care.
Supervises, trains, evaluates, and manages schedules of clinical site's medical assistant team and site's care coordinator.
With nurse manager, helps plan and coordinate medical assistant training activities.
Facilitates daily flow of medical care in clinic.
Oversees ordering and maintenance of clinical supplies, onsite medications, and equipment.
Works with prior authorization coordinator to obtain insurance authorization for patient medications.
Submits prior authorization requests for urgent patient procedures.
Oversees patient safety practices at site to conform with ambulatory standards of The Joint Commission.
Implements Primary Care Medical Home practices at site.
Oversees administration of Virginia state vaccine program.
Oversees performance and quality of in-house laboratory tests.
Oversees medical provider daily patient schedules, leave requests, and coverage schedules.
Performs clinical duties when needed, including phone or in-person triage, nurse visits for chronic care education and management, and communication of clinical information.
Manages high risk patient care, including patients with multiple co-morbidities or those at high risk for hospitalization or readmissions.
Reports morbidity and reportable conditions to local health department.
Along with care coordinators, assists patients in efficiently navigating the health care system.
Participates in clinic quality improvement and risk management activities, including data collection, and committee meetings as appointed.
Assist with developing, coordinating and recommending changes for the improvement of clinical services in the designated site.
Employee will be asked to perform additional duties and take on other responsibilities as dictated by events and circumstances.
OTHER DUTIES:
Assists with developing, coordinating, and/or recommending improvements in program area.
May be assigned to various projects to advance the development or program area.
May be asked to assist during weekend or evening.
Able to work under minimal supervision.
Other duties may be assigned.
QUALIFICATION/EDUCATION and/or EXPERIENCE REQUIREMENTS:
Registered Nurse licensed in Virginia or compact state.
Current Virginia Registered Nurse (RN) license or compact state.
Strong interpersonal communication skills.
Experience within primary care environment, preferably with Federally Qualified Health Center.
Ability to demonstrate commitment to the mission of Neighborhood Health.
Ability to work effectively with a diverse work force.
Ability to work effectively with diverse and low income patient population.
Employee development and performance management skills.
Experience with information technology, electronic health records, medical records.
Knowledge of local health care environment and capacity to develop partnerships with community partners.
Bachelors of Science in Nursing (BSN) preferred.
Fluency in Spanish a plus.
Auto-ApplyNurse Case Manager I
Utilization review nurse job in Ashburn, VA
Shift: Monday - Friday; 8:30am - 5:00pm EST Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.
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 performing 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.
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.
* For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
* Current and active RN license required in applicable state(s).
* Multi-state licensure is required if this individual is providing services in multiple states.
Preferred skills, capabilities, and requirements:
* Certification as a Case Manager and a BS in a health or human services related field preferred.
* Previous OB/NICU experience preferred.
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.
Auto-ApplyNeurology APP (Nurse Practitioner or Physician Assistant) NP or PA
Utilization review nurse job in Fairfax, VA
Inova is looking for a dedicated PRN Neurology Advanced Practice Provider (NP/PA) to join the team. Sign-on bonus and relocation assistance eligible.
Positions available for various specialty areas.
Stroke | General Neurology
Inova Neuroscience is a regional leader in the diagnosis, treatment and research of complex neurological conditions involving the brain, spine and nervous system. With twelve specialized programs, the Institute is the largest program of its kind in Northern Virginia. Our highly trained and nationally recognized physicians treat a wide range of conditions, including neurotrauma, spine conditions, epilepsy, movement disorders, brain and spinal tumors, memory disorders and stroke and cerebrovascular disease. Our comprehensive research program is committed to the advancement of treatment protocols. Inova Neuroscience and Spine Institute employs a multidisciplinary approach so that patients and their families experience expert, coordinated care from diagnosis through rehabilitation.
Inova is consistently ranked a national healthcare leader in safety, quality and patient experience.
We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.
Featured Benefits:
Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules.
Neurology Advanced Practice Provider (NP/PA) Job Responsibilities:
Patient Care Management: Provides safe, holistic, and patient-centered care for a defined patient population under the supervision of a physician. Independently assesses, diagnoses, and initiates medical treatments in accordance with Virginia nurse practitioner licensure regulations.
Neurology Expertise: Acts as a subject matter expert in Neurology and performs necessary procedures as required.
Team Collaboration: Communicates effectively and works collaboratively with the healthcare team to achieve optimal patient outcomes. Demonstrates respect for all clinical disciplines and promotes an integrated care approach.
Evidence-Based Practice: Follows evidence-based guidelines and protocols to guide care. Uses data and insights to improve patient care and clinical practice.
Professional Development: Engages in lifelong learning to enhance clinical practice. Mentors and provides guidance to others while demonstrating leadership in decision-making and problem-solving.
Minimum Requirements:
Work schedule: PRN
Education: Masters in Advanced Clinical Practice or graduate of a post masters certificate program for nurse practitioners, OR certificate from an education program that is accredited by the Council of Nurse Anesthesia Educational Programs/Schools, American College of Nurse Midwives, American Association of Colleges of Nursing of the National League for Nursing. For physician Assistants, graduate of an accredited Physician Assistant program and certification by National Commission on Certification of Physician Assistants.
Experience: No experience required.
Certification: Basic Life Support (BLS) upon start
Licensure: Licensed Physician Assistant or Nurse Practitioner; If Nurse Practitioner: RN Compact License(depending on State of primary residence) AND a license (or eligibility for) as a nurse practitioner or physician assistant in the Commonwealth of Virginia AND a "Practice Agreement" signed by sponsoring/ supervising physician(s), AND a written "Scope of Practice/Protocol" signed by the supervising physician, AND "Drug Enforcement Administration License" (if prescribing controlled substances)
Payer Credentialing: Ability to successfully complete the credentialing process by third-party payors and Ability to enrolled as a CMS Medicare/Medicaid payor
Medical Staff Credentialing: Successful completion of credentialing for Medical Staff membership and appropriate clinical privileges sufficient to perform all required services
Preferred Qualifications:
Minimum of one year of experience in Neurology
Applicants may be considered for current and future opportunities for PRN positions.
Positions available for various facilities, shifts and specialty areas.
Stroke | General Neurology
Facilities:
Inova Alexandria Hospital 4320 Seminary Rd, Alexandria, VA 22304
Inova Fairfax Medical Campus 3300 Gallows Rd, Falls Church, VA 22042
Inova Fair Oaks Hospital 3600 Joseph Siewick Dr, Fairfax, VA 22033
Inova Loudoun Hospital 44045 Riverside Pkwy, Leesburg, VA 20176
Inova Mount Vernon Hospital 2501 Parkers Ln, Alexandria, VA 22306
Shifts: All (Day shift)
Specialty Areas: Inpatient and Outpatient Facilities
Auto-ApplyFlight Nurse Medic
Utilization review nurse job in Martinsville, VA
Come fly with us in Martinsville, VA! You must be a dual qualified registered nurse/paramedic.
Responsibilities
Responsible for providing high quality critical care and pre hospital advanced life support including assessment, triage, and treatment utilizing standards and guidelines established by Air Methods Community Base Services (CBS) Medical Director(s). You'll assess the nature and extent of illness or injury to establish and prioritize the care needed for safe transport of the critical patient to the appropriate facility and are responsible for carrying out the mission and goals of Air Methods CBS assuring that safety remains the highest priority throughout the transport continuum.
Essential Functions and Responsibilities include the following:
Provides nursing care and high quality pre-hospital advanced life support care within his/her scope of practice from the initial contact until patient care is relinquished to the accepting medical facility; maintains thorough patient care documentation.
Maintains competency in knowledge and psychomotor skills by participating in ongoing laboratory and clinical experiences. Communicates educational needs to the Clinical Base Lead and Education Manager. Maintains documentation of required licensure, certifications, continuing education, aviation and safety training, OSHA and HIPAA training, clinical rotations, and advanced procedures and attends continuing education programs pertinent to his/her area of practice.
Knowledgeable in use and routine maintenance of all equipment and supplies used by Air Methods CBS. Responsible for reporting medical equipment failures and taking initial steps to insure repair of equipment as directed. Maintains adequate supplies onboard aircraft to deliver patient care. Keeps aircraft clean and orderly to insure rapid response to all transport requests.
Functions as a medical flight member by attending pre-mission briefings and mission debriefings and completing necessary documentation. Assists in pre-mission liftoff checklist and assists pilot as requested, i.e., radio, navigational, and visual observation activities. Complies with safety standards to assure safety of self, medical personnel, patient, and equipment and conducts aircraft safety briefings as needed.
Serves as a flight resource to neonatal/pediatric personnel when transporting specialty patients by helicopter and performs advanced skills and procedures as approved by Air Methods CBS Medical Director(s).
Participates in patient and referring institution follow-up and in planned outreach marketing and education activities
Acts as a preceptor and/or participates in orientation of new employees and students as assigned and communicates program goals and objectives.
Participates regularly in Air Methods CBS meetings, activities, projects and committees (to include research and publishing opportunities). Maintains awareness of current issues related to pre-hospital care through participation in professional activities, i.e., national, state legislative--elected or appointed.
Other Duties as assigned.
Additional Job Requirements
Regular scheduled attendance
Indicate the percentage of time spent traveling - 5%
Supervisory Responsibilities
This position has no supervisory responsibilities.
Qualifications
Qualifications
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. In accordance with applicable laws, Air Methods will provide reasonable accommodations that do not create an undue burden so disabled employees may perform the essential functions of the position.
Education & Experience
Graduate of an accredited School of Nursing
Bachelor's degree in health-related field preferred
Requirements as outlined in the MOM Flight Paramedic to Flight Nurse Bridge must be met in order to qualify for the Flight Medic/RN position
Minimum three (3) years' recent experience in a busy 911 system
Flight experience preferred for full and part-time positions
Operation and Safety Requirements:
As a member of the Clinical Flight Crew, any person employed in this position shall maintain a weight not to exceed 225 pounds including empty flight suit and boots.
Skills
Skills as required to practice nursing as defined by assigned state scope of practice and advanced practice skills as defined by Medical Director(s) and Medical Standards
Maintains positive interpersonal relationships with colleagues, EMS representatives, hospitals and the public while executing strong interpersonal skills and a high degree of collaboration at all levels
Demonstrates high critical thinking and reasoning skills and strong attention to detail while working in a fast paced environment that requires ability to prioritize and multi-task
Ability to work a flexible schedule including 24 hour shifts, overtime and an on-call rotation
Dependable and self-motivated while working in a frequently changing environment
Excellent communication and presentation skills, both written and verbal
Computer Skills
Proficient with Microsoft Suite, including Word, Excel, PowerPoint and Outlook
Certificates, Licenses, Registrations
Current RN license(s) for states of practice
EMS or MICN certification/licensure as required by state regulations
Registered EMT-P licensed in state(s) served
National Certification may be required to meet state licensure requirements
Specialty certification: (FP-C or CCP-C) required within two (2) years of hire
Current certifications in Healthcare Provider BLS/CPR; ACLS; PALS or equivalent (AHA courses if state or county required) and TNCC/ITLS/PHTLS advanced provider (if state or county required)
Specialty certification (CFRN) required
Advanced Trauma Course requirement: One (1) of the following certifications are acceptable: TNCC, ATCN, TNATC or CAMTS-approved advanced trauma course prior to completion of third-rider orientation (Please note, advanced skills lab must accompany all the above-mentioned advanced trauma courses)
NRP certification prior to completion of third-rider orientation
NIMS Training IS 100, 200, 700, 800 and HazMat upon hire
Air Methods is an EEO/AA employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Minimum pay USD $77,750.40/Yr. Maximum Pay USD $95,022.72/Yr. Benefits
For more information on our industry-leading benefits, please visit our benefits page here.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Auto-ApplyNurse
Utilization review nurse job in Laurel, VA
Job Description
About the Opportunity
The Nurse serves as part of a team providing medical and health services to clients. They serve as the acting nurse for VHBG's contractual psychiatrist and manages all related duties and documentation. As needed, the nurse assesses client health problems and needs and provides training and coaching to direct care staff. May advise clients on health maintenance and disease prevention. License required.
Core duties and responsibilities:
Assists with psychiatric services provision, record keeping and writing of orders or prescriptions
Ensures standing orders are current and maintained for OTC medications
Monitors EMAR for missed medications and exceptions daily. Contacts GHMs to complete necessary related reports.
Receives narcotic count sheets upon completion of medication and stores documentation.
Disposes of narcotics/monitors return of unused medications to pharmacy, if not disposed of in Stericyle
Orders medication and regulates their distribution
Maintains an inventory of non-prescription medication, personal protection and first aid supplies agency-wide.
Leads staff training on health and medical issues as directed, including CPR and MATY
Conducts TB screening for clients and staff
Receives medication deliveries from pharmacy and delivers to GC Homes
Serves as nurse for students attending John G. Wood School
Orders lab work and drug screens as needed for clients.
Maintains clean work area
Assesses the health needs of clients (minor injuries), provides care if appropriate, and makes referrals as needed.
Maintains daily clinic and historic medical records and prepares other required reports.
Serves as the primary health care consultant and expert on treatment teams.
Champion for Employee Wellness, particularly in regard to outbreaks or epidemic related issues and communication
Other duties as assigned by supervisor
Experience and Education:
Must be a Registered Nurse licensed in the Commonwealth of Virginia. Must possess thorough knowledge of local medical services and ability to use these services. Must have a valid driver's license with acceptable driving record.
Work Environment:
Office space provided with sufficient supportive equipment. Some weekend and evening work required. The noise level is usually moderate. This is a drug free environment.
VHBG will provide you a hiring bonus of $500 on your second paycheck and then a retention bonus of $1,500 on the first paycheck following your first year anniversary. If your employment with VHBG is ended for any reason prior to six months of employment, the first installment will be recouped in your final paycheck.
About the Culture at VHBG
VHBG's leadership team encourages employees to bring their authentic self to work, whatever that means for that employee. We do this through unbiased recruiting practices, advocating for employees to participate in our inclusion ambassador council, implementing employee feedback and offering training opportunities focused on diversity, inclusion and equity. VHBG nurtures belonging and retains a highly engaged workforce in order to achieve the best experience and outcomes for our clients.
VHBG is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, genetic information, age, gender (including pregnancy and childbirth), sexual orientation, gender identity or expression, marital status, status as a protected veteran, disability, or other status protected under federal, state, or local law.
Locum Tenens NP - Neonatology Job Opportunity in VA
Utilization review nurse job in Virginia Beach, VA
Enjoy the locum tenens lifestyle knowing Weatherby is here to support you every step of the way. Call and speak to one of our consultants today for available dates and details.
24 hour shifts
Average daily census of 20 babies
Level III NICU facility
HFOV, HFJV high frequency ventilation and nitric oxide available
NRP certification required
Ongoing coverage
Private room NICU
No cardiac surgery or ECMO
Health, vision, dental, and 401(k) retirement benefits offered
Competitive compensation
Paid malpractice insurance
24-hour access to your Weatherby Healthcare consultant and support team
Covered transportation and housing expenses
"
Since 1995, Weatherby Healthcare has established itself as an expert in locum tenens staffing for physicians, physician assistants, and nurse practitioners. The company employs nearly 600 employees committed to filling locum tenens assignments in large-scale healthcare networks, hospitals, and clinics nationwide. Learn more at ******************************
Nurse / Healthcare Coordinator - Senior Living
Utilization review nurse job in Woodstock, VA
All candidate applications must be submitted online. **************************************
Now Hiring:
LPN Nurse - Senior Living
Greenfield Senior Living: In collaboration with our residents and care teams, we will transform the experience of senior living and allow our residents to lead full and enriching lives. A dedicated team of professionals providing outstanding care to the Residents of our communities
The Healthcare Coordinator in nursing protocols that reflect current clinical trends, professional standards, and Community philosophy while overseeing the general health and wellness of all assisted living residents through the proper assessment process, care plan development, wellness visits, and communication
Duties include:
A timely and effective response to all changes in health status
Medication management
Medical record management
Leads interdisciplinary-based care and provides training for team members and families
Conducts ongoing assessment of resident's physical and psycho-social status
Assist in developing Individualized Service Plans
Manages safety and infection control processes
Communicates medical information to family, staff, and physicians
Delivers quality nursing care and supervision through daily rounds to monitor staff
Act as Resident advocate in medical situations
Collaborates with medical professionals, consultants, and healthcare organizations
Serves periodically as weekend manager and rotates on-call with Management Team
Assist Management of health outcome trends and implement systems to achieve acceptable thresholds.
Qualifications:
Maintains a current state (Virginia) license
Professional Licensed Nurse [LPN] or Registered Nurse [RN]
Minimum of one (2) years of experience in assisted living or long-term care
Experience with a dementia population
Nursing management experience preferred
Exhibits a caring heart with a passion to care for an elderly population
Good clinical assessment skills
Experience using healthcare technology
Good organizational and time management
Able to work flex hours, every other weekend, evenings.
Possesses good judgment, problem-solving, and decision-making skills
Possesses the ability to effectively read, write and communicate
All candidate applications must be submitted online. **************************************
Competitive wage & benefit package and career growth.
As a condition of employment with Greenfield Senior Living, any successful job applicant will be required to pass a pre-employment drug screen and to successfully complete a background investigation. Greenfield Senior Living is an Equal Opportunity Employer.
All candidate applications must be submitted online. **************************************
COVID-19 Vaccinations - Greenfield Senior Living has adopted a policy requiring all associates to be fully vaccinated against COVID-19, subject to limited exemptions based on medical conditions, sincerely held religious beliefs, or applicable state laws and regulations
******************************
New Graduate Nurse Residency
Utilization review nurse job in Arlington, VA
Job Description
New Graduate RN Residency:
VHC Health Nurse Residency Program is based on the Vizient and American Association of Colleges of Nursing (Vizient/AACN) Nurse Residency Program™. The Vizient/AACN Nurse Residency Program (NRP) is designed to effectively support new nurse graduates as they transition into their first professional roles. Built on an evidence-based curriculum developed by experts from academic medical centers and nursing schools across the country, the program focuses on three critical areas: leadership, patient outcomes, and professional role.
Hospital Information:
VHC Health is a 453-bed not-for-profit Hospital and teaching facility that has been delivering high quality care to the Washington, DC metropolitan area for over 75 years. Recent accomplishments include recognition by Newsweek as a 2025 "World's Best Hospital" and VHC becoming the Washington Commanders Football provider for women's health. VHC Health is a designated Level II Trauma Center and a recognized Magnet Facility by the American Nurses Credentialing Center. At VHC Health, we are always striving to provide continued excellence and growth for our employees as well as top notch care for our patients and that is made clear with our recent accomplishments!
Goals:
One of the primary goals of the program is to improve the residents' critical thinking/clinical reasoning skills and ability to understand and use outcomes data to promote patient safety
Further develop effective decision-making skills related to clinical judgment and performance
Provide clinical nursing leadership at the point of care
Strengthen your commitment to the profession of nursing
Evolve in the formation of an individual professional development plan
Incorporate research-based evidence linked to practice outcomes into the care he or she provides
Structure of the residency program:
Full-time Employment; schedules vary by department
At least 6-8 weeks of unit-specific orientation and preceptorship will be integrated into program (new graduate RN will work the same schedule as preceptor)
Program lasts about 1 year and Residents will meet regularly as a cohort once a month for four hours with access to preceptors and expert resident facilitators
Completion of an evidence-based project
Mentoring on a professional development plan
Nurse and program evaluation, including completion of the required Vizient/AACN and institutional surveys
Responsibilities
Pay & Benefits:
Commensurate with experience. Team members are eligible to receive benefits on the first day of the month following the date of hire, with 30 days to apply for benefits of choice.
Employee-Led Engagement and Wellness Committee dedicated to make work a fun and healthy place to work
Annual Employee Survey - Your Voice is Heard at VHC!
Paid Major Holidays
Generous Paid Time Off / Vacation / Sick Time
Health Insurance
Dental Insurance
Tuition Reimbursement
Student Loan Repayment
Career Counseling, Leadership Development and Training
Clinical and Research Pathways Eligible
Annual Merit Review and Merit Increases
Employee Assistance Program (EAP)
Flexible Spending Accounts (FSA)
Health Savings Account (HSA)
Health Fitness & Education Class Discounts
Employee Wellness Benefits
Hospital Discount for Employees and Family
VHC Health Outpatient Pharmacy
VHC Retirement Program
Workforce Enhancement Program
Work/Life Discounts Program
Free onsite parking
Commuter Benefits
Family Leave
401(k) + Match
and much more!
Qualifications
Purpose & Scope:
Across all levels, the registered professional nurse is responsible for the direct and indirect total nursing care of their assigned patients. The RN is also responsible for the supervision of assigned personnel. The position requires knowledge of both department and hospital policies and procedures relevant to the delivery of nursing care. Interpretive skills, frequent interactive and consultative associations, along with management and supervisory skills are inherent in the position. The ability to retrieve, communicate or otherwise present information in a written, auditory or visual fashion is essential. The primary method to express or exchange ideas is through the spoken word. Written, telephone, and manual dexterity skills are required for this position.
Education:
Associate's in Nursing Required or,
Bachelor's in Nursing Required
Experience:
New Graduate: under one year of Nursing/Patient Care in an acute care setting
Certification/Licensure:
Licensed as a Registered Nurse by the Virginia Department of Health Professions required or,
Compact State Licensure in Nursing required
BLS certification required
Peds NP
Utilization review nurse job in Lynchburg, VA
Essential Duties and Responsibilities: Patient Relations: 1. Obtains complete medical history from patient, and/or family, and/or previous medical record, etc. 2. Explains treatment to patients and families. 3. Provides culturally sensitive health education and counseling for patients, parents, and
teachers as deemed appropriate.
Staff Relations/Team Building:
1. Consults with physicians and other members of the health care team as necessary. Acts to
facilitate communication between the members of the health care team, including clinical and
non-clinical staff.
2. Performs other necessary duties as required by the Johnson Health Center to meet the goal of
providing primary health care services.
Clinical Duties:
1. Assesses, diagnoses, implements treatment, evaluates and monitors patients' health status.
2. Performs complete physical examinations on patients.
3. Orders routine and diagnostic lab and x-ray studies based on clinical guidelines and medical
judgment.
4. Diagnoses acute and chronic illness on the basis of clinical findings, laboratory and x-ray
reports and/or the results of other diagnostic procedures according to approved protocols.
5. Formulates, initiates and monitors patient management plans for patients assigned to the
Pediatric Nurse Practitioner, using protocols and/or consultation with a supervising
physician.
6. Provide routine preventive physical examinations for children birth to age 18 years.
7. Refers patients requiring hospitalization or assessment and management of conditions to
supervising physicians, emergency department physicians, or appropriate specialists.
8. Renders emergency care and treatment including cardiopulmonary resuscitation, starting I-V
fluids, and ordering of appropriate emergency medications. Sutures lacerations and addresses
acute orthopedic injury with splinting if within provider's scope of care.
9. Stresses the importance of preventive health care measures and provides educational
materials to support diagnosis and treatment.
10. Participates in the pediatric on call rotation and works in immediate care clinic on Saturday.
11. Performs other necessary duties as required by the Johnson Health Center to meet the goals
of providing primary health care.
12. Physical attendance is an essential element of the job and necessary to perform the essential
functions of the Pediatric Nurse Practitioner position.
Administrative Duties:
1. Reviews other providers' notes as per the "Chart Review Policy" of the Johnson Health
Center.
2. Maintains all patient records to comply with required standards, reviews records regularly
and obtains physician counter signatures where necessary.
3. Closes all patient charts within 72 hours and conducts regular review of all other jellybeans.
Performance Improvement Activities:
1. Attends all medical staff meetings, huddles, and participates in the Johnson Health Center QI
program.
Safety/Infection Control Activities:
1. Attends all mandatory OSHA infection control seminars, and follows general OSHA
guidelines for infection control, including "Universal Precautions."
2. Abides by all Johnson Health Center infection control policies, including acute response
measures in the setting of a public health concern or disease outbreak.
Competencies:
1. Attached.
Other Functions:
1. Staff member will abide by the Code of conduct as documented in the Corporate Compliance
Manual.
2. Must demonstrate a personal and professional commitment to Johnson Health Center and its
mission.
3. Treats all patients and staff with dignity and respect, mindful of the cultural differences of the
diverse population we serve.
4. Assure that any job functions that are added or changed as organizational needs required by
Management are performed accurately, completely, and efficiently.
5. Keep professional licenses required for the position current and up to date. Obtain all
continuing education required for license renewal.
JHC Core Values:
Staff members must actively demonstrate dedication and commitment to the core values of JHC.
1. Respect - We value and respect each patient, their family, ourselves, and each other.
Every individual associated with Johnson Health Center will be treated with dignity and
respect. We value and respect people's differences, show empathy to our patients, their
families and each other, and work collectively to build Johnson Health Center as a health
center and an employer of choice.
2. Integrity - We are committed to doing the right thing every time.
Our actions reflect our commitment to honesty, openness, truthfulness, accuracy and ethical
behavior. We are accountable for the decisions we make and the outcome of those decisions.
3. Excellence - We will pursue excellence each and every day in activities that foster,
teamwork, quality improvement, patient care, innovation, and efficiencies.
At Johnson Health Center, our medical, dental, pharmacy, behavioral health, front desk and
administrative teams are passionately committed to the highest quality of care for our
patients. We continually seek out ways to enhance the patient experience and promote an
environment of continuous quality improvement.
4. Innovation - We value creativity, flexibility, and continuous improvement efforts.
We are advocates and instruments of positive change, encouraging staff members to engage
in responsible risk-taking and working to make a difference. Out of the box thinking enables
us to build on successes and learn from failures.
5. Teamwork - We understand that teamwork is the essence of our ability to succeed.
We work across functional boundaries, for the good of the organization. Our collaborative
approach ensures participation, learning and respect and serves to improve the quality of
patient care. By focusing on a team-based approach, the expertise of each Johnson Health
Center employee is leveraged to optimize the patient experience.
Qualifications:
1. Graduation from an accredited school of nursing, a Nurse Practitioner program recognized by
the Board of Nursing or from a program otherwise designated for Pediatric Nurse
Practitioners which has been approved by the State Board of Nursing.
2. The ability to relate with effectiveness to patients and providers.
3. Must be qualified in Basic Life Support techniques.
4. Sufficient experience to carry out the duties of this position.
5. Must obtain certification from American Academy of Nurse Practitioners, the National
Certification Board of Pediatric Nurse Practitioners and Nurses, or the American Nurses
Credentialing Center through the American Nurses Association within 9 months of
employment to avoid potential reduction in employment status and compensation.
Physical Demand and Working Environment:
Fast paced office setting. Travel periodically to the immediate care clinic for Saturday work and
may be asked to work at another location for coverage periodically. Lifting and/or exerting force
up to 25 pounds and occasionally heavier, with frequently moving of objects. Work requires
speaking, sitting, bending, walking, standing, hearing, and stooping, kneeling, and repetitive
motion with certain activities. 8 to 10 hours of constant computer usage. OSHA high risk
position
EOE/M/F/V/D
Claims Review Nurse (CERT)
Utilization review nurse job in Richmond, VA
Catapult Consultants is a global, professional services and management consulting company specializing in business, analytical and information systems solutions. We support mission-critical programs in the Intelligence Community and Defense and Civilian sectors. Our health care soultions division is currently looking for Registered Nurse to support our transplant program quality assessment and performance improvement program. For more information about us go to ****************************
Job Description
This position provides support for a federal government project to review Medicare documentation as part of the Centers for Medicare & Medicaid Services' (CMS) Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare fee-for-service (FFS) program.
Full-Time, Monday - Friday
Two open positions located in Richmond, Virginia
Responsibilities:
Review claim documentation and associated medical records related to the CMS CERT program and determine whether Medicare FFS program services qualify for coverage and payment.
Assess whether claim documentation and associated medical records complies with Medicare coverage, coding and billing rules.
Compare documentation assessments to those of the Medicare contractor who originally reviewed and paid the claims and note which claims are in “error” if they have been incorrectly billed, paid or processed the services.
Other duties as assigned
Qualifications
Registered Nurse (RN) with an active license
Associate's, Diploma or Bachelor's degree in Nursing
5 years of full-time work experience
3 to 5 years of experience in coding
At least 2 years of experience in inpatient, acute care coding for Medicare reimbursement and MS-DRG experience
Knowledge of standard coding conventions, such as DRGs, ICD-9-CM, HCPS and CPT
Knowledge of Payment methodologies and Medicare guidelines
Familiarity and understanding of Medicare rules, regulations, policies and procedures
Familiar with Microsoft Word, Excel and Outlook
Highly-motivated, detail-oriented, quick learner with a professional demeanor
Ability to effectively work independently
Additional Information
Catapult Consultants does not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other proscribed category set forth in federal or state regulations.
Nurse Case Manager II
Utilization review nurse job in Richmond, VA
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Work Schedule: Monday to Friday from 9:00 AM to 5:30 PM EST, with 2-4 late evening shifts per month from 11:30 AM to 8:00 PM EST.
The Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Perform duties telephonically or on-site such as at hospitals for discharge planning.
How you will make an impact:
* Ensures member access to services appropriate to their health needs.
* Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
* Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
* Coordinates internal and external resources to meet identified needs.
* Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
* Negotiate rates of reimbursement, as applicable.
* Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures.
Minimum Requirements:
* Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* Current unrestricted RN license in applicable state(s) required.
* Multi-state licensure is required if this individual provides services in multiple states.
Preferred Experience, Skills, and Capabilities:
* Certification and experience as a Case Manager is preferred.
* BS in a health or human services related field preferred.
* Experience in telephonic case management, especially for complex and chronic care needs is strongly preferred.
* Preferred proficiency with telephonic systems and health information technology.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $76,944 to $115,416.
Locations: New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Nurse Case Manager I
Utilization review nurse job in Norfolk, VA
Shift: Monday - Friday; 8:30am - 5:00pm EST Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.
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 performing 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.
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.
* For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
* Current and active RN license required in applicable state(s).
* Multi-state licensure is required if this individual is providing services in multiple states.
Preferred skills, capabilities, and requirements:
* Certification as a Case Manager and a BS in a health or human services related field preferred.
* Previous OB/NICU experience preferred.
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.
Auto-ApplyNurse
Utilization review nurse job in Laurel, VA
About the Opportunity
The Nurse serves as part of a team providing medical and health services to clients. They serve as the acting nurse for VHBG's contractual psychiatrist and manages all related duties and documentation. As needed, the nurse assesses client health problems and needs and provides training and coaching to direct care staff. May advise clients on health maintenance and disease prevention. License required.
Core duties and responsibilities:
Assists with psychiatric services provision, record keeping and writing of orders or prescriptions
Ensures standing orders are current and maintained for OTC medications
Monitors EMAR for missed medications and exceptions daily. Contacts GHMs to complete necessary related reports.
Receives narcotic count sheets upon completion of medication and stores documentation.
Disposes of narcotics/monitors return of unused medications to pharmacy, if not disposed of in Stericyle
Orders medication and regulates their distribution
Maintains an inventory of non-prescription medication, personal protection and first aid supplies agency-wide.
Leads staff training on health and medical issues as directed, including CPR and MATY
Conducts TB screening for clients and staff
Receives medication deliveries from pharmacy and delivers to GC Homes
Serves as nurse for students attending John G. Wood School
Orders lab work and drug screens as needed for clients.
Maintains clean work area
Assesses the health needs of clients (minor injuries), provides care if appropriate, and makes referrals as needed.
Maintains daily clinic and historic medical records and prepares other required reports.
Serves as the primary health care consultant and expert on treatment teams.
Champion for Employee Wellness, particularly in regard to outbreaks or epidemic related issues and communication
Other duties as assigned by supervisor
Experience and Education:
Must be a Registered Nurse licensed in the Commonwealth of Virginia. Must possess thorough knowledge of local medical services and ability to use these services. Must have a valid driver's license with acceptable driving record.
Work Environment:
Office space provided with sufficient supportive equipment. Some weekend and evening work required. The noise level is usually moderate. This is a drug free environment.
About the Culture at VHBG
VHBG's leadership team encourages employees to bring their authentic self to work, whatever that means for that employee. We do this through unbiased recruiting practices, advocating for employees to participate in our inclusion ambassador council, implementing employee feedback and offering training opportunities focused on diversity, inclusion and equity. VHBG nurtures belonging and retains a highly engaged workforce in order to achieve the best experience and outcomes for our clients.
VHBG is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, genetic information, age, gender (including pregnancy and childbirth), sexual orientation, gender identity or expression, marital status, status as a protected veteran, disability, or other status protected under federal, state, or local law.
Auto-ApplyNurse Case Manager I
Utilization review nurse job in Ashburn, VA
Shift: Monday - Friday; 8:30am - 5:00pm EST
Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.
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 performing 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.
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.
For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
Current and active RN license required in applicable state(s).
Multi-state licensure is required if this individual is providing services in multiple states.
Preferred skills, capabilities, and requirements:
Certification as a Case Manager and a BS in a health or human services related field preferred.
Previous OB/NICU experience preferred.
Job Level:
Non-Management Exempt
Workshift:
1st Shift (United States of America)
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.
Auto-Apply