Nurse Informaticist Jobs Near Me

Providence caregivers are not simply valued - they're invaluable. Join our team at Enterprise Information Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. The Clinical Informatics Specialist (CIS) serves as a professional role model in promoting the understanding, integration, and application of information technology in healthcare settings. The CIS acts as a liaison between clinical care and information technology, supporting all care givers throughout the care continuum in the implementation, learning, use, adoption, and optimization of clinical technologies. The CIS supports the analysis, design, implementation, evaluation, optimization and maintenance of clinical information applications and projects within the assigned ministry/area. The position requires team participation skills delivered in a complex, highly stressful environment, skilled use of clinical information sciences, and fundamentals of project and change management. The CIS with licensure in a clinical discipline (e.g., nursing, respiratory therapy, etc.) brings required comprehensive understanding of clinical process and practice standards, patient flow and operational processes. Please note the following important details regarding this position: This role is a hybrid position, working a combination of in office / work from home weekly The weekly hybrid work schedule is defined by manager and departmental needs This role requires for you to be located within a commutable distance of the office location listed below: Washington: Colville This role will cover a territory / region including but not limited to: Colville, Washington Chewelah, Washington Required Qualifications: Bachelor's Degree in a Clinical Discipline, Information Technology/Informatics, Business, Education, Management, Communications, or another related field of study -OR- a combination of equivalent education and experience 2 or more years of experience in a position that has the same or similar primary duties working with a clinical information system within a healthcare setting Experience with EHR systems Experience with benefits and challenges of adult learning Preferred Qualifications: Upon hire: Informatics certifications or credentialing Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Providence caregivers are not simply valued - they're invaluable. Join our team at Enterprise Information Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. The Clinical Informatics Specialist (CIS) serves as a professional role model in promoting the understanding, integration, and application of information technology in healthcare settings. The CIS acts as a liaison between clinical care and information technology, supporting all care givers throughout the care continuum in the implementation, learning, use, adoption, and optimization of clinical technologies. The CIS supports the analysis, design, implementation, evaluation, optimization and maintenance of clinical information applications and projects within the assigned ministry/area. The position requires team participation skills delivered in a complex, highly stressful environment, skilled use of clinical information sciences, and fundamentals of project and change management. The CIS with licensure in a clinical discipline (e.g., nursing, respiratory therapy, etc.) brings required comprehensive understanding of clinical process and practice standards, patient flow and operational processes. Please note the following important details regarding this position: * This role is a hybrid position, working a combination of in office / work from home weekly * The weekly hybrid work schedule is defined by manager and departmental needs * This role requires for you to be located within a commutable distance of the office location listed below: * Washington: Colville * This role will cover a territory / region including but not limited to: * Colville, Washington * Chewelah, Washington Required Qualifications: * Bachelor's Degree in a Clinical Discipline, Information Technology/Informatics, Business, Education, Management, Communications, or another related field of study -OR- a combination of equivalent education and experience * 2 or more years of experience in a position that has the same or similar primary duties working with a clinical information system within a healthcare setting * Experience with EHR systems * Experience with benefits and challenges of adult learning Preferred Qualifications: * Upon hire: Informatics certifications or credentialing Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

By The Bay Health, a non-profit established in 1975, set the standard for hospice in the U.S. by emphasizing the role of the patient in making important medical decisions. Our spectrum of home-based services now includes Skilled Home Health Care, Palliative Care, Adult Hospice Care and Pediatric Care. Our team approach strives to address practical, social, emotional and spiritual aspects of care, with the goal to maximize quality of life for our patients, caregivers and families. This full-time position offers competitive pay, generous benefits and a supportive work environment. The Clinical Informatics Specialist is responsible for the effective maintenance, optimization, and coordination of By the Bay Health's electronic medical record (Epic), in collaboration with UCSF and Epic partners. They will provide training for newly hired staff on Epic fundamentals, continuing education for clinicians, and specialized training for upgrades and changes. Schedule: Monday - Friday; 8:30am - 5:00pm Location: Remote By the Bay Health follows all CDPH vaccine requirements for healthcare personnel. Essential Duties & Responsibilities include (but are not limited to): Serves as liaison between BTBH and UCSF on projects and initiatives requiring Epic build/rebuild or integration of Epic with other clinical technologies Develops and provides training to new and current clinical employees on Epic fundamentals Regularly providing formal and informal feedback to staff and conducting periodic individual coaching Participates in Administrator On Call rotation Education/Experience: Bachelor's or Master's degree in healthcare informatics or in a healthcare-related field ACHP-SW or CHPN preferred Experience with adult clinical education, training, and development strongly preferred Epic Certification (Home Health and Hospice) REQUIRED Minimum three years clinical experience in a home health, hospice, and/or palliative care setting (including use of EMR and other clinical information systems) in the last 5 years Certificates, Licenses, Registrations: Licensure as applicable if licensed healthcare professional ACHP-SW or CHPN preferred Pay Range: $130K - $150K annually By the Bay Health is proud to serve our community as an equal employment opportunity employer. Everyone is valued and welcome at BTBH. Our organization is committed to diversity, equity and continues to build a culture of inclusion by recruiting, screening, hiring and retaining any qualified individual without regard to age, race, color, ethnicity, religion, gender, gender identity or expression, sexual orientation, disability, marital status, registered domestic partner status, citizenship, physical or mental disability, legally protected medical condition, family care status, military care status, veteran status or any other consideration made unlawful by Federal, state, or local laws.

Job Overview: This position provides general direction and support to strategic change initiatives related to clinical information systems, including but not limited to systemwide application of Epic. Coordinates and leads activities in a multi-site facility (both inpatient and ambulatory) at an enterprise level to facilitate the implementation and maintenance of current and new software and technology and its impact on current processes. Also acts as a liaison and advocate in supporting IS, Trainers, Educators, clinical areas, ancillary and business department to coordinate the analysis, development, implementation, education, evaluation, optimization and maintenance of clinical information systems to support patient care. Serves as an example for peers and other team members and provides go live support as needed for all system locations. Work Location: * Works from home, but must live within 120 miles of Cincinnati for in-person team meetings, project discussions, trainings, etc. Work Hours: * Full-time position: 80 hours bi-weekly * Day shift Job Requirements: * Bachelor's Degree in Nursing; or Healthcare, Health Administration, Informatics * Registered Nurse * Project management * Care delivery systems * Multidisciplinary documentation * Hospital information system * Trends in healthcare and their impact on delivery * Ability to facilitate the transition from a manual to a computerized system or to another EMR system * 5-7 years experience Clinical in Nursing clinical nursing and/or administrative * 5-7 years experience Progressive Leadership in Nursing Management of complex projects and/or short- and long-term initiatives with demonstrated competence Job Responsibilities: Change Management: Manages and oversees the development of clinical customer processes necessary to ensure adoption of successful electronic documentation. Includes partnering with IS on project planning, short and long term reporting needs, and general IS (Vendor) coordination. Communicates to all clinical customers across the enterprise through all appropriate means. Leads change management related to Epic upgrade changes, routine changes and optimization. Provides go live support as needed with availability at all system locations. Facilitation: Demonstrates the skill to work with all team members (including senior leaders and providers) within the organization as well as external consultants and vendors. Manages barriers to implementation. Positively influences and coaches other to minimize conflict and promote decision-making. Leadership: Organizes, coordinates and facilitates project work as assigned. Communicates with impacted groups, schedules, facilitates meetings, develops agendas, identifies appropriate timelines for task completion, and project implementation. Uses conflict management skills to reach goals. Liaison: Acts as principle liaison between the clinical customer and IS department to achieve necessary outcomes. Influences and facilitates the standardization of clinical documentation. Problem Solving: Serves as an internal consultant to the TriHealth organization. Utilizes critical thinking to lead change in work processes to execute TriHealth initiatives and projects. Collaborates and strategized in the design, development, execution and evaluation of new clinical documentation, order sets and other EMR tools using knowledge of healthcare systems. Identifies, monitors and strategizes creation solutions to unresolved issues. Exemplifies the TriHealth Code of Ethical Business and Professional Behavior. Reporting: Collaborates in providing, interpreting and process development based on data from clinical systems. Resource Person: Advises standing committees, taskforces and workgroups appropriate to areas of responsibility. Attends unit staff meetings, medical staff meetings and rounds on nursing units, ambulatory offices, and procedural areas to assess needs, guide change and assist with education and monitor progress of organizational initiatives. Educates team members on EMR changes, other technology changes, new technology and provides other relevant information needs. Other Job-Related Information: The TriHealth Nursing Vision, Mission, and Philosophy speaks to professional development, collaboration, and our nursing culture. To achieve excellence in nursing care, TriHealth encourages: pursuit of improved knowledge through continuing education classes, formal education leading to advanced degrees, and the attainment of specialty certification; nurse membership in local, regional, and national nursing organizations related to the appropriate nurse specialty; involvement in activities that better the health of our community; nursing research activities and use of evidence-based practice, and all nurses to foster, support, and personally model collaborative relationships amongst nurses, physicians, and other caregivers for the betterment of patient care. Working Conditions: Bending - Occasionally Climbing - Rarely Concentrating - Consistently Continuous Learning - Consistently Hearing: Conversation - Consistently Hearing: Other Sounds - Consistently Interpersonal Communication - Consistently Kneeling - Rarely Lifting Lifting 50+ Lbs. - Rarely Lifting Lifting 11-50lbs - Occasionally Pulling - Rarely Pushing - Occasionally Reaching - Occasionally Reading - Consistently Sitting - Frequently Standing - Frequently Stooping - Occasionally Talking - Consistently Thinking/Reasoning - Consistently Use of Hands - Consistently Color Vision - Consistently Visual Acuity: Far - Consistently Visual Acuity: Near - Consistently Walking - Consistently TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS… * Welcome everyone by making eye contact, greeting with a smile, and saying "hello" * Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist * Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS… * Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met * Offer patients and guests priority when waiting (lines, elevators) * Work on improving quality, safety, and service Respect: ALWAYS… * Respect cultural and spiritual differences and honor individual preferences. * Respect everyone's opinion and contribution, regardless of title/role. * Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS… * Value the time of others by striving to be on time, prepared and actively participating. * Pick up trash, ensuring the physical environment is clean and safe. * Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS… * Acknowledge wins and frequently thank team members and others for contributions. * Show courtesy and compassion with customers, team members and the community

Our client is a leader in the field of Healthcare data. They bring together leading experts from health tech, hospital systems, academia, and clinical AI with a mission to build the world's most comprehensive AI product development platform. We are looking for a Clinical Informaticist to join the team. Job Summary: You're a highly skilled, clinically experienced individual with a medical data science background who is adept at handling electronic medical records and hospital datasets. Your primary responsibility is to take charge of assessing and evaluating unstructured data from healthcare institutions and clinical workflows, with the goal of creating accurate analytics frameworks that effectively map a patient's medical history. You will also guarantee that the strictest data security measures are met in our systems by analyzing and tracking protected health information (PHI) and personally identifiable information (PII) in medical records so that the data can be properly anonymized. You are not afraid to tackle large-scale, highly complex, disorganized raw clinical data and structure them efficiently. You are eager to explore diverse settings, different health systems, programming tools, and new methodologies. This is an early-stage startup with big goals, and each team member contributes to supporting the mission. Key Responsibilities: Collaborate with clinical teams, IT professionals, and leadership to implement, optimize, and maintain EHR systems and other health IT solutions. Analyze and improve clinical workflows by integrating informatics tools to enhance efficiency and patient outcomes. Provide training and support to clinical staff on informatics systems, ensuring adoption and proper use. Develop and implement data-driven solutions to improve quality of care, patient safety, and regulatory compliance. Monitor system performance, troubleshoot issues, and recommend enhancements to align with best practices and industry standards. Assist in data governance, ensuring data integrity, security, and compliance with HIPAA and other regulations. Collaborate with stakeholders to evaluate new technologies, conduct usability testing, and lead implementation projects. Design and analyze reports to track clinical performance metrics and support evidence-based decision-making. Participate in research, pilot programs, and innovation initiatives to advance the field of clinical informatics. Qualifications: Required: MD/DO with Clinical Informatics board-certification/board-eligibility; or M.S. or PhD degree in a relevant field, such as Biomedical Informatics Strong knowledge of EHR systems (e.g., Epic, Cerner, Meditech) and healthcare data standards (HL7, FHIR, SNOMED, LOINC, ICD-10). Experience in process improvement, workflow analysis, and change management in clinical settings. Excellent communication, problem-solving, and project management skills. Familiarity with regulatory requirements such as HIPAA, HITECH, and Meaningful Use. Preferred: Certification in Clinical Informatics, such as CPHIMS, CAHIMS, or Board Certification in Clinical Informatics (for MDs). Experience with healthcare analytics, business intelligence tools, and AI-driven healthcare solutions. Previous experience in a healthcare organization, hospital system, or telehealth environment. Benefits: Competitive salary and performance-based incentives. Health, dental, and vision insurance. 401(k) with employer match. Continuing education and professional development opportunities. Work-from-home flexibility (if applicable). Paid time off and parental leave.

Employment Type:Full time Shift:Description: Trinity Health is recruiting Health Informatics Specialists roles to support the following work activities / segments: National Health Ministries (PACE, Trinity Health at Home, and Trinity Senior Living) Enterprise Training Team Community Space (Ambulatory Surgery Centers, Medical Groups, Urgent Cares, CIN) Virtually Connected Care Purpose Health Informatics (HI) is the specialty that integrates health care science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in clinical practice across the care continuum. Health informatics facilitates the integration of data, information, knowledge and wisdom to support operations. This support is accomplished with information structures, information processes, and information technology. The goal of informatics is to improve the health of populations, communities, families, and individuals by optimizing information management and communication. These activities include the design and use of informatics solutions and technology to support all areas of health care delivery, including, but not limited to, the direct provision of care, establishing effective administrative systems, managing and delivering education experiences, enhancing lifelong learning, and supporting health care research. Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge. Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. Maintains a working knowledge of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects safe, honest, ethical & professional behavior & safe work practices. Minimum Qualifications Must possess a comprehensive knowledge of Health Informatics through a combination of education and experience. 1. Must possess a working knowledge of Health Informatics with at least two (2) years of experience in an informatics or related role and experience with clinical information systems and health information technology. 2. Basic understanding of clinical treatment modalities, educational principles, clinical information systems, accreditation and regulatory standards, and program development. 3. Demonstrated knowledge and application of change management principles. 4. Demonstrated knowledge and application of project management principles. Additional Qualifications (nice to have) Certification from a national informatics certifying body preferred. Fellowship, academic courses, or other formal training in Health Informatics preferred. Bachelors Degree with the focus on Health Informatics or related discipline preferred OR equivalent combination of education and experience. Pay Range: $74,114- $111,172 Our Commitment to Diversity and Inclusion Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Fairfax Neonatal Associates (FNA) is seeking a NICU Informatics Specialist to join our team. The NICU Informatics Specialist is responsible for providing quality assurance for data extraction and entry into the FNA NICU clinical database system for over 1700 admissions annually. The information is used for clinical quality improvement initiatives, hospital reporting, billing and contracting. This position is a M-F hybrid-onsite/remote work position, with rotating weekend/holiday coverage. Duties/Responsibilities: · Performs initial set up of patients in the FNA clinical database. Reviews all progress notes and other clinical records for NICU patients assigned to them. Ensures that diagnoses, procedures, respiratory support, medications, history, and demographic information are properly captured in the FNA clinical database as per the FNA data protocols. Assists with maintenance of an accurate FNA clinical database census. · Provides quality assurance by alerting medical providers to new information or discrepancies in information in patient record as identified. · Assists NICU Informatics team and providers in finding important missing information in maternal/infant records. · Utilizes FNA and Inova approved database access to support the workflow of the FNA Business office as needed. Requirements · Bachelor's level Degree in Health Science or related field (Nursing, Research Biologist, etc.) · 5 years' experience as a NICU nurse in a Level III/IV NICU required. · RNC-NIC Certification required. · Database management experience required. · Microsoft Office: Excel, Power BI experience preferred. · Electronic Medical Record (EPIC) experience required.

We are currently seeking a Clinical Informatitcist to join our team. This full time role will work days. Open to remote work. Purpose of this position: To provide consultation and coordination of clinical information systems and processes that integrate clinical and information science for patient-centered care. The Informaticist is a liaison between information services and clinical end-users, ensuring the optimal clinical user adoption of safe, effective, efficient technology and analytics to support clinical care. RESPONSIBILITIES: * Identifies, develops, implements and maintains clinical information and operational systems that support clinical workflow and optimal patient care * Participates in projects pertaining to organizational goals and strategies and regulatory requirements, both in consultative and project lead roles * Partners with clinical and operational leaders and teams to facilitate prioritization of clinical projects and requests in alignment with organizational goals and initiatives * Performs assessment and analysis of system performance and usage in order to evaluate effectiveness of interventions and identify opportunities for improvement * Performs needs assessment and translation to functional requirements for projects and requests * Maintains knowledge of The Joint Commission, CMS and other relevant regulatory requirements and provides advice regarding information system impact on meeting regulatory standards * Provides education and support to clinical users of technology and promote adoption of new or changed workflows amongst clinical users * Acts as a constructive change agent and role model for information systems implementation and adoption * Provides consultative informatics services to clinical and operational staff * Supports the Analytics and Information Technology governance structure QUALIFICATIONS: Minimum Qualifications: * Advanced degree in informatics or healthcare-related field OR Bachelor's degree with a minimum of 5 years of experience in a healthcare setting * Informatics and/or clinical relational database experience * Experience with clinical workflows * OR- * An approved equivalent combination of education and experience. Preferred Qualifications: * Experience with computer programming, statistical tools, databases and evidence based medicine or medical research methodology * Experience facilitating interdisciplinary clinical/operational improvement activities with increasing complexity, responsibility and demonstrated results * Experience in healthcare setting including working directly with and providing feedback to clinicians * Epic certification in at least one Epic module Knowledge/ Skills/ Abilities: * Strong project management skills * Excellent communication skills, oral and written * General knowledge of data collection, analysis and reporting * Strong computer skills including web-based applications, word processing, spreadsheet, graphs and PowerPoint * Possesses knowledge and skills to lead and manage changes associated with implementing or optimizing clinical information systems and promoting adoption by health professionals * Demonstrates a high level of clinical knowledge, analytical ability and critical decision making skills * Possesses excellent interpersonal skills and can work effectively with a diversity of personalities, professions and departments. Must be willing to work across clinical areas and outside personal area of clinical expertise * Possesses good grasp of clinical work flows and ability to perform workflow analysis * Possesses knowledge of regulatory and compliance requirements (e.g. TJC, CMS)

Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together. Optum seeks a Medical Informaticist with experience in EHR services implementation. This role promotes the understanding, integration and application of information technology in healthcare organizations. They will advise on best practices and align with Health Informatics Operations to ensure successful project execution. Acting as a liaison between operations and the IT department, they are responsible for aligning operation process with system design by allocating time with end users to understand workflows impacted by use of information technology, assisting to achieve targeted best practice outcomes and optimization goals. This role will have a unique opportunity to engage directly with our clients and participate in creating and implementing solutions as an Epic physician builder. They will develop and deploy clinical content and tools within the EHR to enhance the effectiveness and efficiency of colleagues (physicians/advanced practice providers) using the system. We are seeking exceptional candidates who are experienced practitioners and have a deep EHR technical expertise in Epic and who want to be part of an innovative and forward-thinking team. Solid candidates for this role will be able to demonstrate self-motivation, individual leadership, and team collaboration. Most importantly, our Health Informatics Operations team will foster a culture of diversity and inclusion and drive innovation for our company and our clients. If you are located within two hours of Waukesha, WI, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: * Lead the process of identification of high opportunity areas and work with Informatics leaders and staff to develop process improvement activities to improve adoption, increase efficiencies, achieve best practice performance and improve outcomes * Assess opportunities for technology improvements with data in collaboration with clinician feedback to understand workflows, define problems, and recommend and implement solutions * Diagnosis the issues the client has identified (as well as underlying issues) then design, and where applicable and within physician builder scope develop and deploy clinical content to enhance the physician/advanced practice provider experience with the EHR * Develop specifications and perform build that will support the design and successful implementation of clinical and business applications across the organization * Collaborates regularly and closely with peers and application analysts' and training to ensure that architected build and educational design is consistent with workflows and application build design principles * Oversight and support of the development of pre and post-implementation adoption and communication plans and will partner with business/clinical leaders, and other informatics team members to drive operational adoption while demonstrating achieved value * Serve as the client informaticist for optimization solution implementations, including activities such as defining clinical strategy, leading client meetings, collaborating on best practice Epic configurations, attending clinical governance councils, and collaborate on training for users and adoption approach * Follows processes and guidelines for system build, change control, data migration, security and organizational change management * Support and participate in development and execution of testing of build performed within the software application functions * Familiar with standard concepts, practices, and procedures within the field and staying current with trends and new developments * Regular and predictable attendance is an essential job function * Other duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Doctorate Degree (MD/DO) * 3+ years of clinical experience as practicing provider * 3+ years of experience working with Epic, including Epic clinical (EpicCare Inpatient or EpicCare Ambulatory) * Proficient with Microsoft Office Suite: Word, Excel, PowerPoint, Visio and SharePoint Preferred Qualifications: * Epic Physician Builder certification or experience or willingness to obtain within 6 months of hire * 3+ years of experience in informatics, analytics or quality including application of information technology and process improvement * Proven knowledge of health information system architecture, the way software is constructed and integrates * Ability to demonstrate and have a history of team collaboration (informal or formal), cross-team communication and leadership skills, self-efficient * Clinical workflow experience * Reside within a 2 hour driving distance of Waukesha, WI Key Competencies: * Maintain Epic Physician Builder certification * Excellent time management, organizational, prioritization skills, and ability to balance multiple priorities * Solid analytical and problem-solving skills * Knowledge of Epic EHR and the full implementation lifecycle of Epic's suite of electronic medical records applications from conception through development into production * Ability to work with a minimal amount of supervision, to balance multiple tasks, be detail oriented, set priorities and complete assignments in a timely manner utilizing excellent customer service skills * Demonstrated ability to translate user requirements into system specifications * Demonstrates a solid ability to build partnerships and influence others. Work across team, group and business boundaries to drive commonality and reusability in solution to real-world problems * Demonstrate solid relationship management skills and ability to handle challenging interpersonal situations * Excellent written and verbal communication skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group 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). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

About Us At Prenuvo, we are on a mission to flip the paradigm from reactive “sick-care” to proactive health care. Our award-winning whole body scan is fast (under 1 hour), safe (MRI has no ionizing radiation), and non-invasive (no contrast). Our unique integrated stack of optimized hardware, software, and increasingly AI, coupled with the patient-centric experience of our clinics across North America, have allowed us to lead the charge against “we caught it too late again.” We are looking for a dedicated and experienced Quality Systems Nurse with MRI experience to join our team. Help reshape the world through proactive healthcare while working with cutting-edge technology and high performing teams with deep expertise - join us to make a difference in people's lives! What You'll Do The ideal candidate will play a critical role in ensuring the highest standards of quality and patient satisfaction to the Prenuvo product. This role involves overseeing and enhancing the quality control processes, assessing complaint tickets, and ensuring patient satisfaction Key Responsibilities: Quality Improvement: Work with team to develop and implement quality control procedures for MRI services Perform chart audit/review from Nurse Practitioner consults Review quality tickets and interact with radiology teams, member support teams, Nurse Practitioners and patients to implement resolution Ensure compliance with all regulatory and accreditation standards related to MRI services Patient Safety: Conduct training sessions for staff quality control measures Investigate and report any incidents or issues related to MRI services Data Management: Maintain accurate and detailed records of quality control activities and findings Analyze data to identify trends and areas for improvement Prepare and present reports on quality control performance to management Collaboration: Work closely within Prenuvo teams to ensure seamless operations Collaborate with other healthcare professionals to develop and implement best practices Participate in interdisciplinary meetings to discuss and resolve quality issues Continuous Improvement: Stay updated on the latest advancements in MRI technology, customer service and quality control practices. Recommend and implement improvements to enhance the efficiency and effectiveness of MRI services. Participate in continuing education and professional development opportunities. What You'll Bring Registered Nurse (RN) with a current and valid nursing license Candidates should be licensed within: CA, FL, NY at minimum. Those with multistate licenses strongly preferred. Minimum of 5 years of experience in a clinical setting, with specific experience in MRI services. Strong understanding of quality control principles and practices in healthcare. Excellent knowledge of MRI technology, procedures, and safety protocols. Strong analytical and problem-solving skills. Excellent remote communication and interpersonal skills, to include video conferencing, Slack, email. Ability to work independently and as part of a multidisciplinary team. Detail-oriented with strong organizational skills. Proficient in google suite, JIRA. Nice to have Certification in MRI technology (e.g., ARRT certification). Multi-state nursing license; willingness to become licensed in all states Prenuvo practices. Previous experience in a quality control or quality assurance role. Advanced training in quality management or healthcare administration. Our Values First: we are Pioneers Transforming healthcare requires divergent thinking, bias for action, disciplined experimentation, and consistent grit and determination to maintain momentum. This journey is as challenging as it is rewarding. Second: we are Platform-Builders We're always building foundations that allow us to achieve tomorrow more than we did today. We never lose sight of what's ahead - in a mindset of ownership and duty to our mission. Above all: we are Patients We could all be the next person who walks through our very doors, seeking clarity or peace of mind. We are proud of our impact on our patients' lives, and we won't stop till everyone can benefit from our work. What We Offer An avenue to make a positive impact on people's lives and their health We believe in preventative healthcare for everyone, including our team - Prenuvo provides free, whole-body scans to each team member Growth opportunities are at the heart of our people journey, we're doing big things with bright minds - there is no single path to success, it can be shaped along the way Building strong relationships is at the core of everything we do - our team gets together each week to connect, share, and socialize Recognizing time away to restore is vital to our wellbeing - we have a flexible vacation policy and we will encourage you to use it We offer a comprehensive benefits package including health, dental, vision, including Mental Health coverage, to support you and your family The base salary for this role ranges from $80,000 - $95,000 in local currency, depending upon experience We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. As part of the hiring process, successful candidates will undergo a background check in compliance to applicable federal, provincial, and state rules. Please be advised that official communication from our recruitment team will only come from our authorized domain [prenuvo.com]. If you are contacted by a recruiter, please ensure their email address ends *****************. We do not use third-party recruitment services or any other email domains for hiring purposes. If you receive communication that you believe to be fraudulent, please report it immediately to ****************.

Description Work For Good! Wage: $26.62 - $39.93 plus up to a $2/hr shift differential (DOE & Licensure) Schedule: Negotiable Options: - Monday-Friday - 2:00 pm-10:00 pm with paid on-call duties as assigned. - Friday - Sunday - 12 Hour Shifts Position Overview: Children's Home Society, a leading provider of services to vulnerable men, women, children, and families in South Dakota, is seeking a Full Time Nurse (LPN or RN) for our Sioux Falls Campus within our Residential and School setting with potential opportunity to assist with our domestic violence shelter (Children's Home Shelter for Family Safety). This role is vital to assessing and supporting the multidisciplinary team in the treatment of as we strive to meet the health needs of the children we serve. Benefits of Employment at CHS: Work-Life Balance: A set schedule with ability for negotiation; 3x12s, 4x10s, 5x8s Comprehensive Benefits: Equal up to 30% of your salary. Two health insurance options (Traditional Plan & High Deductible Health Plan with HSA), vision, dental, employer-paid Group Life Insurance and Accidental Death & Dismemberment (AD&D), Short Term & Long-Term Disability, and additional voluntary life and critical illness plans. Financial/Education Assistance: Up to $200 per month in tuition reimbursement or student loan repayment for qualifying employees. Competitive Compensation: $26.62 - $39.93 plus up to a $2/hr shift differential (DOE) with yearly merit-based raises and opportunity for growth within. Generous Paid Time Off: Includes a generous PTO package with 40 hours upfront, 10 paid holidays, and 8 hours "Day of Service" for volunteering in the community. Retirement Plans: Once entry into the plan, employees receive a 3% employer contribution each pay period and an up to an additional 5% profit sharing. Employees are 100% vested after 4 years of credited service. Referral Bonuses: Earn up to $1,000 for referring new employees. What You Will Do: Clinical Nursing Practice Utilize the nursing process (assessment, diagnosis, outcomes/planning, implementation, and evaluation) to deliver professional nursing services. Administer medications and treatments as prescribed. Demonstrate competency and practice within the full scope of nursing expertise. Collaboration and Communication Collaborate with an interdisciplinary team to plan, implement, and evaluate care. Maintain confidentiality in all patient interactions and records. Health Education and Promotion Educate children on various health-related topics. Infection Control and Safety Follow infection control policies to ensure a healthy environment. Documentation and Compliance Maintain thorough clinical documentation to ensure accurate and timely records. What We'll Love About You: You are a team player that promotes a positive work environment. You are capable of handling highly sensitive, confidential information. You are able to effectively communicate. You align with our mission, vision, and values. You are organized and are able to pay strong attention to detail. You are able to have professional and kind client and public interactions. You are able to show awareness and respect for the diverse cultural backgrounds of our employees and clients. Requirements Education: Graduate from an accredited nursing or licensed practical nursing program is required. A bachelor's degree in nursing is preferred. Experience: A Minimum of one year of professional nursing experience is required. Licensure: Must be licensed as a Registered Nurse or Licensed Practical Nurse in South Dakota or meet multi-state licensure requirements. Basic Life Support (BLS) certification is required (can be obtained within six months of hire). Valid driver's license required. Physical Demands and Work Environment: Residential environment focused on the care of children with behavioral issues. Must be able to physically restrain a child as taught by the agency and communicate effectively. Regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 50 pounds. Must successfully complete all required background and pre-employment checks EEO/AA. Join us at Children's Home Society and truly "Work for Good" every day, helping to change the world one child, one family, and one smile at a time. Apply today! Salary Description $26.62 - $39.93 (DOE and Licensure)

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters - patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 13 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. The position of UM Nurse Analyst will report to the Medical Director of Availity's Auth AI solution. The UM Nursing Analyst is responsible for the interpretation of payer medical policy guidelines and the construction of NLP/AI-enabled decision trees that accurately reflect medical necessity criteria. The role requires in-depth knowledge of utilization management principles, the role and purpose of medical necessity guidelines and prior authorization adjudication practices. This individual will work in a team environment and will be expected to perform highly complex tasks while collaborating with team members with both clinical and engineering/programming backgrounds. The successful candidate will be detail oriented with strong analytic reasoning skills, demonstrate strong communication and organizational skills while remaining open-minded, embracing change and the spirit of innovation. Sponsorship, in any form, is not available for this position. Location: Remote, US Why you want to work on this team: Dynamic, collaborative group working on innovative technologies to disrupt the status quo and solve the problem of prior authorization in healthcare. Opportunity to work directly on cutting edge AI technology and its application to the healthcare industry. Role qualifications: Bachelor's degree in nursing. At least 3+ years of experience in an outpatient Utilization Management program, either with an insurer or with a healthcare provider OR equivalent clinical experience with familiarity with prior authorization submission practices. Additional experience in fields of billing / coding, claims review or inpatient utilization management, while not necessary, would enhance the application. “Computer smart” - General power user of technology and confident with navigating new technologies and applications. Familiarity and understanding of interpreting medical records to be able to identify how physicians may document conditions and findings. You will set yourself apart: If you have exceptional critical thinking and reasoning skills. If you can synthesize complex, abstract problems, and collaborate effectively with team members with diverse skillsets to create solutions. If you are self-motivated and a quick learner with an ability to multi-task. What you will be doing: Reviewing payer Medical Policy Guidelines to identify pertinent medical necessity criteria related to specific Procedural codes or CPT codes. Use programming language to construct attestation questions that reflect medical necessity criteria. Assign coded medical constructs to attestation trees based on clinical relevance to facilitate automation of responses to the questions. Identify medical terms that should be added to the existing vocabulary of coded medical concepts. Serve as Subject Matter Expert and general medical resource to engineering teams and developers Availity culture and benefits: Availity is a certified “Great Place to Work”, a “Best Workplaces for Technology Companies”, a “Best Workplaces for Women” and a “Best Workplaces for Millennials”! Culture is important to us and there are many ways for you to make your mark here! We have several Diversity & Inclusion teams and various ways to engage with fellow Availity associates. “AvaiLadies”, “Beyond Black”, “HOLA”, “Availity Pride”, “VetAvaility” a Young Professionals Group and “She Can Code IT” a group for women in tech are some of the groups you can get involved in. Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too! We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one! We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits. Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc. Interested in furthering your education? We offer education reimbursement! Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents. Want to work for an organization that gives back to the community? You're at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign. Next steps: After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process. Interview process: Recruiter resume review Manager resume review Recruiter video interview Manager video interview Panel video interview Video Camera Usage: Availity fosters a collaborative and open culture where communication and engagement are central to our success. As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role. Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships. The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants. Disclaimers: Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at *************************** . Click the links below to view Federal Employment Notices. Family & Medical Leave Act Equal Employment Law Poster Pay Transparency Employee Polygraph Protection Act IER Right to Work Poster Important Notice about Employee Rights to Organize and Bargain Collectively with Their Employers

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet. Location: Remote CORE JOB FUNCTIONS 1. Triages new patient appointments to the appropriate provider(s) and assures timely scheduling of initial appointments. 2. Reviews outside medical records for appropriate scheduling. 3. Assess barriers to care and refers to support services, local, and national organizations when needed. 4. Educates on the treatment plan for patients based on diagnosis. 5. Supports patients throughout the care continuum. 6. Counsels individuals and patients on positive health practices. 7. Collaborates with a multidisciplinary team of experts to outline best treatment for patients. 8. Performs holistic evaluation of specialty population, making use of enhanced proven techniques and procedures to achieve better results. 9. Implements the improvement of patient care, and healthcare policies and resources. 10. Mentors other healthcare professionals by functioning as a preceptor or coordinating preceptors for visiting professionals, students, new graduates, and orienteers. 11. Maintains professional knowledge by affiliating with professional and technical organizations, and participating in applicable continuing education programs, conferences, seminars, and workshops. 12. Adheres to University and unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education: Bachelor's Degree Certification and Licensing: Registered Nurse Licensing (RN) Experience: Minimum 1 year of oncology experience Knowledge, Skills and Attitudes: * Ability to maintain effective interpersonal relationships * Ability to communicate effectively in both oral and written form * Skill in collecting, organizing and analyzing data * Proficiency in computer software (i.e. Microsoft Office) and Electronic Medical Record system(s) Department Specific Functions * Assess patient needs upon initial encounter and periodically throughout navigation, matching unmet needs with appropriate referrals and support services. * Identifies potential and realized barriers to care and facilitates referrals as appropriate to mitigate barriers. * Reviews, patients' medical records, test results and any other documentation required for the first visit. * Facilitates timely scheduling of appointments, diagnostic testing, and procedures to expedite the plan of care and to promote continuity of care. * Participates in coordination of the plan of care with the multidisciplinary team, promoting timely follow-up on treatment and supportive care recommendations. * Serves as a liaison for patients, families, caregivers, staff, and referring physicians * Orients and educates patients, families, and caregivers to the cancer healthcare system, multidisciplinary team member roles and available resources. * Help to explain treatment recommendations to patients and caregivers and appropriately answer questions. * Communicates with physicians as needed by phone, emails or in person for new patient referrals and scheduling priorities. * Help eligible patient's access appropriate clinical trials * Work with oncology administrators to understand any changes in reporting metrics. * Identify bottlenecks in the patient pathway and gaps in care; propose process improvement measures to address them * Communicates with other staff to coordinate patient care activities. * Participate with other members of the healthcare team to provide patients with supportive care services. * Refers patients to local and national community support groups/services * Coordination of Educational Activities: * Identify and document individual patient's barriers to learning * Educate patients and families about disease process, treatment options, potential side effects The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information. Job Status: Full time Employee Type: Staff Pay Grade: H13

Chronic Care Management Nurse/RN Reports to Chief Quality Officer Cahaba Medical Care Foundation Chronic Care Management Nurse/RN Supervised by: Chief Quality Officer The Chronic Care Management Nurse plays a pivotal role in providing personalized care for patients with chronic conditions, including but not limited to diabetes, hypertension, asthma, COPD, heart disease, and other long-term illnesses. This role involves monitoring patients' health status, educating them on their conditions, ensuring adherence to treatment plans, and promoting proactive measures to prevent complications. The Chronic Care Management Nurse collaborates closely with physicians, care teams, and patients to deliver high-quality care in a clinic setting. Working Environment: Clinic Hours: Monday to Friday, 8:00 AM - 5:00 PM (with occasional extended hours depending on patient needs). Environment: Fast-paced, team-oriented, and patient-focused clinic setting. Physical Demands: Standing, walking, and sitting for extended periods. Occasional lifting of patients or equipment may be required. Key Responsibilities:Patient Care & Management: Chronic Disease Management: Monitor and assess the health status of patients with chronic conditions, including vital signs, lab results, medications, and treatment adherence. Provide ongoing education and support to patients on managing their chronic conditions and improving health outcomes. Collaborate with physicians and other healthcare providers to develop and implement personalized care plans based on patient needs. Offer routine assessments for patients in both in-person and remote settings, such as phone calls or telehealth visits. Medication Management: Educate patients on the proper use of prescribed medications and monitor for adherence, side effects, and potential drug interactions. Coordinate medication refills and communicate with pharmacies/providers as necessary. Assist in adjusting medication regimens as ordered by the physician, in accordance with established protocols. Care Coordination: Act as a point of contact for patients with chronic conditions, ensuring that all aspects of care are coordinated, including referrals, tests, and specialist visits. Communicate and follow up with patients to ensure continuity of care and address any issues or concerns promptly. Monitor patients' progress and identify early signs of complications or deterioration in their condition. Education & Support: Patient Education: Provide education on managing chronic diseases, including self-management skills, lifestyle changes, diet, exercise, and coping strategies. Educate patients and their families on the importance of preventative care, such as routine screenings, immunizations, and other health-related behaviors. Use self management methods to ensure patients understand their treatment plans and health goals. Health Promotion: Help patients set realistic, measurable goals to improve their health and quality of life. Guide patients through disease-specific management strategies, including symptom monitoring, tracking triggers, and recognizing warning signs. Empower patients to take ownership of their health and become active participants in their care plans. Documentation & Reporting: Patient Records: Maintain accurate and up-to-date patient records in compliance with clinic policies and relevant regulations (e.g., HIPAA). Document patient assessments, care plans, interventions, progress notes, and any changes in condition or treatment in the electronic health record (EHR). Complete required reports related to chronic care management programs, including billing and outcome documentation. Quality Improvement: Outcomes Monitoring: Track and report on the effectiveness of chronic care management services, identifying areas for improvement in care delivery. Participate in quality improvement initiatives aimed at improving patient outcomes and enhancing the overall care process. Support the clinic's efforts to meet accreditation standards, quality measures, and performance benchmarks for chronic care management. Skills and Qualifications: Education and Certification: Registered Nurse (RN) or Licensed Practical Nurse (LPN)with an active state license. BLS (Basic Life Support) certification Experience: Minimum of 2-3 years of nursing experience, with a focus on chronic disease management, geriatrics, or related areas. Experience working in a clinic or outpatient setting preferred. Knowledge and experience in patient education, health promotion, and care coordination. Technical Skills: Proficiency with Electronic Health Records (EHR) systems. Basic knowledge of chronic care management programs and healthcare regulations. Familiarity with telemedicine platforms and remote patient monitoring is a plus. Interpersonal Skills: Excellent communication skills, both verbal and written, to effectively interact with patients, families, and healthcare professionals. Ability to work collaboratively within a multidisciplinary team. Strong critical thinking and problem-solving skills, with the ability to assess complex situations and make sound clinical decisions. Personal Attributes: Empathy and compassion for patients with chronic conditions. Strong organizational skills and attention to detail. Ability to manage a high volume of patients and prioritize care effectively. Additional Information: The Chronic Care Management Nurse is a critical member of our care team, dedicated to improving the health and quality of life of patients with chronic conditions. This role provides an opportunity to make a meaningful difference in the lives of patients, empowering them to manage their health and prevent complications associated with chronic diseases.

Denial/Appeal Management Nurse Remote - (25000653) Description What You Will DoCollaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in: • Support of positive patient health care outcomes • Increased patient/health care team outcomes and satisfaction • Improved inpatient throughput and appropriate length of stay • Improved communication, awareness and adherence to regulatory requirements associated with utilization • Support for inappropriate level of care and decreased inpatient bed day denials • Continuity and coordination of care • Appropriate and timely authorization for level of care • Decreased denials • Appropriate reimbursement Perform timely and accurate review, denial communications and construct appeals, including remaining current with regulatory / payer and internal requirement. Collaborate with physicians, UM Nurses, PAS, and other members of the Interdisciplinary team and Revenue Cycle to collect all pertinent information to support successful appeals including communication of trends and appropriate escalation to ensure appropriate resolution resulting in expected payment. Document appeal activity according to department standards to support accurate and timely reporting of denial and appeal status, outstanding revenue and to help identify trends (payer, physician, service, DRG, reviewer). 20%Collaborate with supervisor to support training, and reinforcement resulting in decreased denials. 20%Conduct all UM activities with a focus on continuous quality improvement in a manner that is supportive of UHC quality initiatives and in compliance with applicable regulatory requirements Additional ResponsibilitiesPerforms other duties as assigned. Complies with all policies and standards. For specific duties and responsibilities, refer to documentation provided by the department during orientation. Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. Qualifications Education Graduate of an accredited school of Nursing (Required) and (BSN) Bachelor's Degree in Nursing (Preferred) Work Experience3+ years Clinical experience in acute care setting (Required) and 3+ years Of experience in managed care or utilization review (Preferred) and Experience and training on Interqual or MCG criteria (Required) Knowledge, Skills, & Abilities Must have sound clinical knowledge base of the population to be served. (Required proficiency) Knowledge of Medicare, Medicaid and commercial payer regulations (Preferred proficiency) Detail-oriented and organized, with good analytical and problem solving ability. (Required proficiency) Notable client service, communication, presentation and relationship building skills. (Required proficiency) Ability to function independently and as a team player in a fast-paced environment. (Required proficiency) Must have strong written and verbal communication skills. (Required proficiency) Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i. e. printers, copy machine, FAX machine, etc. ). (Required proficiency) Demonstrated ability to apply concepts, utilize sound judgment and work independently within a framework of guidelines. (Required proficiency) CM software proficient. (Preferred proficiency) Licenses and CertificationsRegistered Nurse (RN), Ohio and/or Multi State Compact License (Required Upon Hire) Physical DemandsStanding Occasionally Walking Occasionally Sitting Constantly Lifting Rarely 20 lbs Carrying Rarely 20 lbs Pushing Rarely 20 lbs Pulling Rarely 20 lbs Climbing Rarely 20 lbs Balancing Rarely Stooping Rarely Kneeling Rarely Crouching Rarely Crawling Rarely Reaching Rarely Handling Occasionally Grasping Occasionally Feeling Rarely Talking Constantly Hearing Constantly Repetitive Motions Frequently Eye/Hand/Foot Coordination Frequently Travel Requirements10% Primary Location: United States-Ohio-Shaker_HeightsWork Locations: 3605 Warrensville Center Road 3605 Warrensville Center Road Shaker Heights 44122Job: Finance / AccountingOrganization: UHHS_Revenue_CycleSchedule: Full-time Employee Status: Regular - ShiftDaysJob Type: StandardJob Level: ProfessionalTravel: NoRemote Work: YesJob Posting: Jun 10, 2025, 2:18:33 PM

Job Description At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider—we're your trusted partner in innovation. Broadway Ventures, LLC is seeking a Remote Appeals Nurse (RN) to join our growing team. In this fully remote role, you will review medical records and claims to determine whether services meet Medicare coverage and medical necessity requirements. This role is ideal for a detail-oriented and experienced nurse who excels in documentation review and is passionate about ensuring accurate and fair healthcare adjudication. Key Responsibilities Conduct first-level appeal reviews to assess the medical necessity and compliance of services with Medicare guidelines Use clinical knowledge and professional judgment to evaluate claim documentation Write concise, well-supported explanations for decisions regarding claims Collaborate with internal team members to ensure appeal decisions are completed accurately and within expected timelines Identify high-volume or recurring issues and escalate findings to leadership Participate in quality improvement initiatives and contribute to consistent review practices Minimum Qualifications Associate's (ASN) or Bachelor's (BSN) Degree in Nursing Active, unrestricted RN license in your state of residence/practice U.S. residency for at least 3 of the last 5 years Willingness to undergo and pass federal background screenings Preferred Qualifications 4+ years of clinical nursing experience, including roles outside direct patient care Experience in Medical Management, Medical Review, Utilization Review, or Appeals Familiarity with Medicare Part A and Part B policies and procedures Prior experience working in a remote environment Previous work with a Medicare Administrative Contractor (MAC) is a plus Strong technical writing and communication skills Proficiency with Microsoft Office tools (Outlook, Teams, OneNote, Word, Excel) and ability to manage multiple online systems Remote Work Requirements A private, dedicated home workstation Wired Ethernet internet connection (satellite internet and mobile hotspots not permitted) Internet speed of at least 10 Mbps download / 1 Mbps upload (testable at speedtest.net) Work Hours and Training Regular work schedule falls between 6:00 AM – 6:00 PM Central, Monday through Friday Training is typically conducted Monday through Friday, 8:00 AM – 4:00 PM Central, though times may vary slightly What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Pediatric Specialty Care is hosting a Nursing Open House on 8/15/17 and 8/17/17. For twenty years, Pediatric Specialty Care has been successfully caring for medically fragile and technology dependent children. Our goal is to enable children with special needs to realize their fullest potential in a nurturing and supportive environment. We need nurses to help us achieve the goals we have for our children! Come join our team and help us to continue to deliver these results! Location: Pediatric Specialty Care at Lancaster 120 Rider Avenue Lancaster, PA 17603 Located in beautiful Western Lancaster County, Pediatric Specialty Care at Lancaster is just minutes from the Historic Downtown Area- a vibrant city packed with art, culture, shopping and dining and just minutes from local colleges like Franklin and Marshall. Easily accessible to Routes 30 and 283 and only a short drive away are neighboring cities Gettysburg, Hershey, Harrisburg and York. Lancaster General Hospital is less than 2 miles away and in under 30 miles is Penn State Hershey Children's Hospital with the only level I trauma center between Philadelphia and Pittsburgh. Less than 3 miles from the Amtrak/Greyhound station with free shuttle service available by request. Time: The open house will begin at 730am with appointments all day. We are able to accommodate off hour interviews with advance notice. Perks: The Perks: We offer competitive wages as well as health insurance, dental, vision and 401k retirement plan with company match! Tuition reimbursement program Free, onsite parking! We recognize great staff members who are doing a good job! Enjoy regular outings and staff appreciation events! Opportunity for extra hours! We offer referral bonuses! Start working and refer your friends/colleagues! COME OUT AND JOIN OUR OPEN HOUSE - IMMEDIATE OFFERS / IMMEDIATE INTERVIEWS. Please reply to this add to secure your spot. Additional Information All your information will be kept confidential according to EEO guidelines.

We are seeking a remote, Spanish-speaking nurse based in the USA who holds a valid nursing license (LVN or RN) in Puerto Rico. This is a fantastic opportunity for someone looking to supplement their income or work on a casual basis. You'll have the flexibility to set your own hours within the window of 8:30 a.m. to 5:00 p.m. EST, all while working from the comfort of your home. Join us at the cutting edge of medical device technology and remote healthcare delivery. About Orpyx Orpyx is a leading digital therapeutics company that is committed to extending healthspan for people living with diabetes through personalized remote care. Our flagship product, the Orpyx SI Sensory Insoles, is transforming diabetes care by helping prevent diabetic foot ulcers, a major complication of diabetes that can lead to amputation. Our dedicated remote patient monitoring team, comprised of credentialed providers and nurses, utilizes advanced data science methodologies to provide personalized support and triaged clinical escalation. With our whole-person approach, Orpyx empowers people to take control of their health, prevent debilitating complications and extend their healthspan. We are an ISO 13485 company committed to providing quality medical solutions that consistently meet customer needs and regulatory requirements. Who we are The people at Orpyx are flexible thinkers and creative innovators. We come from a variety of backgrounds and carry a wealth of expertise in multiple industries, including medical, technology, software, marketing, and finance. What we all have in common is an intense passion for the work we do. We have an extraordinary collection of talent that makes working here fun, unique and inspiring. Our hiring goal moving forward is to continue to build and grow a strong, effective team, while maintaining our friendly and innovative company culture. What we offer This is a fantastic opportunity for someone looking to supplement their income or work on a casual basis. You'll have the flexibility to set your own hours within the window of 8:30 a.m. to 5:00 p.m. EST, all while working from the comfort of your home. Join us at the cutting edge of medical device technology and remote healthcare delivery. What you'll do The Patient Care Coordinator (Remote Nurse - Puerto Rico) will work a minimum of 3 hours per week, between 8am-5pm EST you will provide casual remote patient monitoring services. This role will analyze patient data in a secure dashboard and provide clinical feedback based on this information. This role will be responsible for liaising with healthcare providers and patients to ensure that supplementary healthcare information from the monitoring platform is used to optimize the patient's care. Reporting to the Director of Nursing and working as part of a cross-functional team plays a vital role in delivering seamless and engaging patient and provider experiences to our patients. This includes: Monitoring and analyzing physiological data as supplemental support to the healthcare providers patient care plan Liaising between patient and provider to help with patient compliance to their remote monitoring care plan Making proactive outbound calls to provide clinical support and education Maintaining accurate records and documenting monitoring actions and discussions in a cloud-based dashboard Ensuring clear and consistent communication with healthcare providers and patients Addressing incoming calls requiring clinical guidance Liaising as a key stakeholder with other departments (Sales, Marketing, Customer Care, Development etc.) to optimize the overall patient and provider experience Collaborating on customer procedures, policies, and standards Assisting Clinical & Regulatory Affairs with remote patient monitoring-related tasks Performing duties in a manner that is consistent with and committed to upholding the requirements of the quality management system Additionally, due to the ever-changing and sometimes chaotic environment of an early-stage high-tech company, the Patient Care Coordinator may assume additional responsibilities, as required. What you'll bring LPN or RN with verified credentials and licensure in Puerto Rico LPN or RN Credentials and licensure in any other state is an asset but not required Located in the USA and to possess legal authorization to work in the United States Fluent in both English and Spanish (written and spoken) is required Must be considered “qualified clinical staff” by the CPT codebook Minimum 3 years of licensed clinical staff professional service with patient management experience (remote or in person) Ability to analyze data and formulate clear clinical feedback based on this information Proven record of professional and effective customer communication skills is essential Demonstrated ability to establish rapport, build relationships, and diffuse conflict situations effectively Familiar with technological troubleshooting and able to understand how multiple smartphone platforms operate Proficiency with Microsoft Office suite is required; experience with Atlassian and/or Zendesk suites an asset Familiarity with quality management systems (ISO 13485) and HIPAA/PIPEDA standards considered an asset Demonstrated excellent attention to detail, decision-making, problem solving, and critical thinking skills Proven self-motivation and ability to deliver under pressure Ability to thrive in a rapidly growing, fast-paced, high-tech start-up environment Excellent written and verbal communication skills Fluency in foreign language(s) considered an asset The details Employment status: Casual at will employment minimum 3 hours a week. Schedule: Approximately 3-6 hours per week, with the potential for additional hours based on business needs. All shifts are scheduled between 8:30am and 5:00pm EST, with flexibility in hours. Work location: Remote USA. Application instructions and deadline: To apply, please submit your resume and a cover letter that highlights how your skills and experience make you a strong fit for this role. Applications will be reviewed on a rolling basis, and the position will remain open until filled. For more information, visit: *********************

LOCATION: Remote - must live in or near Jackson, Haywood, or Swain County, North Carolina. The person in this position is required to travel to these counties to provide in-person trainings: Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, Mitchell, Polk, Swain, Transylvania, and Yancey. GENERAL STATEMENT OF JOB This position is a part of the Geriatric and Adult Mental Health Specialty Team (GAMHST) that is an initiative through the NC Division of Mental Health, Developmental Disabilities, and Substance Use Services and is responsible for overseeing operations using the set of Division of MHDDSUS Program Requirements that specifically outline the work of this team. The Geriatric Team Nurse is responsible for working collaboratively with the other members of the team in providing training, consultation, and technical assistance to recipients. Recipients are various community organizations (i.e., senior centers, faith-based organizations, law enforcement and other 1st responders, adult day, department of social services, homeless shelters, and senior meal programs), and staff of nursing homes, adult care homes, family care homes serving adults with mental illness. ESSENTIAL JOB FUNCTIONS Participate as Member of Geriatric and Adult Mental Health Specialty Team: Work independently and collaboratively to develop and teach evidence informed presentations about a variety of mental illnesses and how to manage difficult behaviors, as well as, how to navigate the behavioral health system to the above-mentioned agencies. Provide education and linkage to services for caregivers of older adults who are providing care for individuals in the community. Provide training to staff and volunteers on various topics relevant to older adult mental health (i.e., recognizing symptoms of mental illness, behavioral intervention, communication issues); Aid in identifying ongoing training resources for staff and volunteers as needed. Provide case consultation regarding behaviors that may result in the need for more intensive services including and up to hospitalization and facilitate access to those services. Assist staff in assessing behaviors. Provide input and support in the development of intervention (crisis) plans. Model for staff and provide technical assistance with implementation of intervention plans. Assist staff or caregivers with linkage to community providers/resources serving the geriatric population for the purpose of promoting aging in place and improvement of health (i.e., identification of long-term care facilities suited to specific needs). Work collaboratively with other team members on a variety of clinical issues including diagnostic criteria and evidence-based treatment options for individuals with a wide variety of serious and persistent mental illnesses as well as geriatric specific considerations such as dementia and late life depression. Provide marketing to agencies within scope of Program Requirements that are not receiving education or support through the team. Participate in community workgroups to enhance the community's ability to provide services/care for older adults. Document required elements on Division of MHDDSUS report, in Vaya electronic health record, and other internal processes (i.e., timesheet, travel sheet). Documentation deadlines are specific to each of those above items. Accurate documentation is critical. Participate in meetings with regional team, whole team, department, agency as requested/needed. Attend individual supervision on a regular basis for ongoing employee support. ** Duties are subject to change as updated Program Requirements are distributed from Division of MHDDSUS. Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES Ability to provide instruction and establish and maintain effective working relationships with staff and caregivers as defined above Knowledge of governmental, private organizations and resources in the community and an innate drive to innovate and optimize the use of these. Knowledge of policies which govern the GAMHST program (which are the MHDDSAS Program Requirements) Ability to express ideas clearly/concisely. Ability to drive and sit for extended periods of time (including in rural areas) Represent Vaya in a professional manner. An ability to initiate and build relationships with people in an open, friendly, and accepting manner. Ability to take ownership of projects from planning through execution. Strong attention to detail and superior organizational skills Ability to multitask and prioritize to manage multiple projects on tight timelines. Ability to understand the strategic direction and goals of the department and support appropriate processes to facilitate achievement of business objectives. Well-developed capabilities in problem solving and crafting efficient processes. A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure. Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change. Proficiency Microsoft Office proficiency, to include Excel, data analysis, and secondary research. Have an understanding of adult learning styles and the ability to demonstrate these styles in order to provide effective training to a variety of people. Have experience in presenting/teaching/speaking in front of an audience QUALIFICATIONS & EDUCATION REQUIREMENTS Associate degree in Nursing required and at least 1 year experience working with older adults with mental health and/or substance use disorders. Licensure/Certification Required: An active, unrestricted license to practice as a Registered Nurse in North Carolina by the NC Board of Nursing. License for any candidate must be in “good standing” with their licensing board. PHYSICAL REQUIREMENTS Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. Ability to drive and sit for extended periods of time (including in rural areas). SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit ****************************************** Vaya Health is an equal opportunity employer.