Nurse Jobs Near Me

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We serve the Commonwealth of Massachusetts in partnering with onsite audits and projects. We have collaborative team scheduling and there is an occasional opportunity for remote work based on business needs. For the role there will be no weekends, no holidays, and no on-call work. If you are located in Massachusetts, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Audit entire medical record for accuracy of the coding on the MDS/ MMQ to support payment to the nursing facility Discuss Patient Care specifics with peers or providers in overall patient care and benefits Communicate clinical findings and present rationale for decisions to medical professionals and members at the appropriate level for understanding Review the entire medical record for accuracy, and appropriate clinical treatment Communicate findings of audits to client, and community as needed Education of findings with community, identifying plans for correction Comply with HIPAA guidelines related to Personal Health Information (PHI) when communicating with others Leverage experience and understanding of disease pathology to review chart/clinical information, ask appropriate questions, and identify appropriate course of care in a given situation Perform medical chart review that includes a review of current and prior patient conditions, documents, and evaluations, and relevant social and economic situations to identify patients' needs Research and identify information needed to review assessment for accuracy, respond to questions, or make recommendations Apply knowledge of pharmacology and clinical treatment protocol to determine appropriateness of care Work collaboratively with peers/team members and other levels or segments within Optum, UHC, or UBH (e.g. Case Managers, Field Care Advocates) to identify appropriate course of action (e.g. Appropriate care, follow up course of action, make referral) Required to travel within geographic territory 75% of the time and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite) 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: Undergraduate degree or 4+ years of equivalent nursing experience Current unrestricted RN nurse license in Massachusetts MDS certification OR ability to obtain and provide proof prior to start date Experience working within medical insurance and/or healthcare industries Experience analyzing inventory, researching, identifying, and resolving issues Experience with defining and managing processes within a team Proficient in Microsoft Office Proficient written and verbal skills Ability to travel within geographic territory 75% of the time and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite) Preferred Qualifications: Recent long-term care MMQ, MDS, staff development or management experience (in long-term care) Experience trouble shooting issues for users within teams, IT and or business partners Proven knowledge of Medicaid and Medicare benefit products including applicable state regulations Demonstrated knowledge of applicable area of specialization Demonstrated knowledge of Massachusetts DPH guidelines Demonstrated knowledge of computer functionality, navigation, and software applications *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $71,600 to $140,600 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.

Job Description Remote but must be located in Connecticut!! We are Local Infusion. Local Infusion is a venture-backed healthcare company shaping the way care is delivered to patients with chronic autoimmune disease on specialty infusion medications. Our focus on patient experience, technology, and clinical integration allows us to deliver a differentiated care model that leads to lower costs for patients and enhanced outcomes. Through a blend of patient-centered design and a people-first team culture, Local Infusion puts the "local feel" of community, comfort and connection back into the patient and provider experience. At our care centers, all patients—and our team—can feel truly supported, every step of the way. What We’re About We’re a team of innovators, clinicians, and technologists on a mission to improve outcomes for patients, save time for physicians and make infusion therapy more affordable for everyone involved. Our mission is to transform the infusion care industry, because patients deserve better. Ownership—Takes initiative, being accountable and caring about the outcome Excellence—Do what it takes to raise the bar, being an example for our colleagues, patients and partners Getting to Yes— There will be obstacles, but we find a way, even when there isn’t a defined road forward Curious & Inquisitive— Always seek to gather information and knowledge, and understand the way It’s a Marathon, not a Sprint - We have large problems to solve, and they won’t be solved overnight. We are persistent every day. Urgent — We move quickly and with purpose. Patients are waiting, and our work matters. We’re looking for a Per Diem Nurse Practitioner who is passionate about raising the bar in infusion therapy care. The ideal candidate has experience working autonomously, and experience starting IVs and working with biologic drugs. The Nurse Practitioner role is perfect for those wishing to remain at the forefront of healthcare innovation, while having predictable hours, autonomy, and a manageable workload. In this role, you will: Provide remote supervision over group of RN’s, performing chart audits and reviewing adherence to company policies Assess and document the health status of new patients Assist with annual staff review process including skill competency assessments Openly communicate with referring/prescribing providers, such as order clarification, patient status, and plan of care Remote but must be located in and licensed in Connecticut with working hours up to 4hrs per week! Here’s what we’re looking for: Medicare PTAN preferred Board certified through ANCC or AANP Current BLS CPR certification Excellent IV skills (infusion therapy experience a plus) Experience and strong familiarity utilizing Electronic Health Records (EHR) systems The Local Infusion Way Local Infusion is a respectful, upbeat, and remote-first team united by our mission of shaping the way specialty infusion care is delivered. We are highly ambitious, but understand that in order to do a great job, we have to take care of ourselves; we expect that you will have time and energy devoted to your families, friends and hobbies. As part of our team, part-time employees get: First priority, if desired, to move to open full-time positions Flexible schedule Work/life balance We invest in you. Our company is growing quickly, and we'll give you the opportunity to do the same. You'll have access to a number of professional development opportunities so that you can keep up with the company's evolving needs and grow with us. We don’t discriminate—Local Infusion is an Equal Employment Opportunity (EEO) Employer. We fundamentally believe that a more diverse and inclusive team leads to a stronger company more able to achieve our vision.

Job Type: Full-time, 1099 position OnSite Medical House Calls is seeking a Nurse Practitioner to join our growing team! This position will be traveling and delivering primary care to patients in Anne Arundel, Queen Annes and Baltimore Counties that are home-bound. At OnSite Medical, we bring primary care right to where our patients call home. The nurse practitioner will provide comprehensive care to patients diagnosing and treating acute or chronic health conditions. Nurse Practitioner/NP Job Education and Experience Requirements: Active State NP license AANP or ANCC board-certified as ANP, AGNP, FNP Current BLS certification Active CDS Active DEA 12 months experience as an NP Prior Home Health Nursing/house call experience, a plus but not required Job Types: Full-time, Contract Salary: $109,417.02 - $200,000.00 per year Benefits: 401(k) Medical specialties: Primary Care Standard shift: Day shift Weekly schedule: Monday to Friday Work setting: Outpatient License/Certification: Certified Nurse Practitioner (Required) Work Location: On the road Flexible work from home options available.

Job Description Specialty:Nurse Practitioner Family or Internal Medicine Company:Optigy Type:Permanent | Full-Time | Remote Outpatient Salary:$115,000 annually We are aFederally Qualified Health Center (FQHC)seeking a dedicated and compassionate Nurse Practitionerto join ourremote care team. This is a full-time, virtual opportunity providing primary care services via secure telemedicine platforms, in close collaboration with an experienced clinical team. Position Highlights: Base Salary: $115,000 EMR: eClinicalWorks Schedule: MonFri, 10a7p; Sat 9a1p 1820 Patients per Day Call: 34 Weeks per Year (Phone Only Very Light) 100% Outpatient Immediate Need Client Will Move Quickly Candidate Must Live Within 2 Hours of Clinic Compensation & Benefits: Health, Dental, Vision, and Life Insurance 401(k) Retirement Plan Malpractice Insurance Paid Time Off + CME Allowance Eligible for Loan Forgiveness through NHSC Location Richmond, VA: Nestled in the heart of Virginia,Richmondblends rich historical significance with modern living. With roots in the American Revolution and Civil War, this city also boasts avibrant arts and cultural scene, well-preserved architecture, and access to nature. An ideal location for history buffs, urban explorers, and families alike. Interested? Apply today and reach out directly to: Michelle Montejo Recruiter | ************

pJob description/ppstrong Telemedicine -NP or PA- Remote for Part-time for Dermatology amp; Primary Care Experience/strong/pp Callondoc in Dallas, TX is seeking a part-time remote nurse practitioner/physician assistant to join our team. Candidates must have dual experience in strongprimary care and dermatology. /strong/ppstrong REQUIRED:/strong/ppstrong 2-year contract- Due to licensing providers in additional state licenses. /strong/ppstrong Must be residing in any the following states:/strong/pullistrong Maryland, Florida, Illinois, Kentucky, Louisiana, Missouri, New Jersey, New York, Ohio,Tennessee, California, Texas, Georgia, Mississippi. /strong/li/ulpbr//ppstrong Please follow this link to apply/strong/ppstrong************* talenthr. io/callondoc/telemedicine-np-or-pa-remote-for-part-time-for-dem-primary-care-experience/17/strong/ppbr//pp Medical provider must have strong Dermatology and Primary care experience (more than 2years of experience)/strong. This is a remote part-time position for an independent contractor/pul li We are looking for an energetic mid level with both strong Dermatology and Primary care experience/strong /li listrong Must be flexible to work night shifts (6pmCST-midnight)/strong/li listrong Shifts required- evening shifts-Fridays 6pmCST-midnight and alternating weekends 6pmCST-midnight/strong/li li Paid Training/li /ulp Work Location:/pulli Remote/li/ulp Salary:/pulli$55. 00-$60. 00 per hour/li/ulp Medical specialties:/pul listrong Dermatology/strong/li listrong Primary care/strong/li /ulp Job Type: Part-time/pp Pay: $55. 00 - $60. 00 per hour/pp Expected hours: Part-time/pp Work Location: Remote/pp Job Type: Part-time/ppbr//pp Pay: $55. 00 - $60. 00 per hour/ppbr//pp Expected hours: 20 - 25 per week/ppbr//pp Medical Specialty:/pulli Dermatology/li/ulp Application Question(s):/pulli Required- Did you follow and complete your application and questions? ************* talenthr. io/callondoc/telemedicine-np-or-pa-remote-for-part-time-for-dem-primary-care-experience/17/li/ulp Work Location: Remote/p

We are seeking a dedicated and compassionate Wound Care Nurse, Telehealth Coordinator within the skilled nursing environment. The Wound Care Nurse, Telehealth Coordinator is the link between healthcare providers and patients while providing dressing changes to wounds, under direct supervision, utilizing real-time, imaging technologies. If you are passionate about excellent wound care and recognize the role telehealth has for consistent, convenient attention to patients in need, we encourage you to apply for the Telehealth Coordinator position and join our dedicated team. Responsibilities: Act as the in-person, hands on assistant to conduct weekly virtual wound rounds using technology under the guidance of wound care specialists, nurses, or healthcare providers. Photograph wounds using designated telehealth technology and ensure accurate documentation of images for clinical review. Aid patients in navigating telehealth platforms, troubleshoot technical issues, and ensure a seamless virtual connection for appointments. Facilitate patient telehealth scheduling, provide education on virtual visits to patients and staff as needed. Administer all aspects of wound care as per evidence based practice and facility policies, including dressing changes and rounds. Maintain strict adherence to patient confidentiality and privacy regulations, including HIPAA compliance, during all telehealth interactions and documentation processes. Submit orders for wound care products. Qualifications: Graduate of an accredited school of nursing required. Must possess current CPR certifications. Minimum of one (1) year of Wound Care experience required, (2) years preferred. Wound care certification is preferred. Must possess a current, unencumbered, active license to practice as a RN or LPN in state of practice. Excellent communication skills with the ability to convey medical information clearly to physicians, staff, patients and family Empathy, patience, and a genuine desire to provide quality healthcare services to patients at the bedside as well as through telehealth technology. Commitment to maintaining patient confidentiality, privacy, and data security in accordance with healthcare regulations (e.g., HIPAA). Ability to multitask, and adapt to changing telehealth workflows, job requirements, and patient populations. Prior experience in SNF, LTC, or Assisted Living preferred. Travel to assigned facilities using your personal car, valid driver's license, and mileage reimbursement offered. Role starts out Part-Time with the opportunity to be Full-Time.

tdpstrong Location:/strong Avenia has several available openings throughout the USA for Psychiatric Preceptors/p pstrong Reports to:/strong Chief Executive Officer and/or Training Director/p pstrong Scope of work:/strong Provides monitoring and clinical skills training amp; exposure to nurse practitioner and physician assistant students./p pstrong Education: /strongM.D. from accredited University or Medical School/p ul li Completion of a Psychiatric Residency Program/li /ul pstrong Experience:/strong/p ul li Has experience in mental health services/li li Has medical license within the U.S./li /ul pstrong Responsibilities:/strong/p ul li pProvide monitors and proctors nurse practitioner and physicians assistant students in psychiatric services/p /li li pProvides feedback and training on clinical skills development with NP and PA students/p /li /ul p /p /td

What we offer: * Comprehensive Benefits: * Medical * Dental * Vision * FSA/HSA * Life and Disability * Accident/Hospital Plans * Retirement with Employer Contributions * Vacation, sick, and extended illness time off options * Open communication with leadership and mission-focused engagement * Training and growth opportunities with a supportive team invested in your success * Eligible employees may transition to a hybrid work model after 6 months, subject to site demand and staffing needs. Compensation: Approximately $33.16 - $41.23 per hour. All individual pay rates are calculated based on the candidate's experience and internal equity. Overview of Role: * Must be bilingual in Spanish and English.* Candidates must live within one hour of our clinics to be considered. The Triage Nurse is part of the Clinica Family Health & Wellness nursing team, responsible for using decision-making skills to assess patient needs. You will apply clinical knowledge and judgment and use decision-making skills to analyze and act on patient care issues. You may provide support in assessment of symptoms, determination of symptom acuity, offering information related to symptom management, patient education and care coordination. While answering calls, you demonstrate the ability to initiate appropriate nursing interventions in prompt, precise and a professional manner. Assists patients and family members or other clients with concern and empathy. ESSENTIAL DUTIES AND RESPONSIBILITIES: * Assess patients' medical problems and complaints by phone. * Obtain history and gather triage information to determine appropriate avenue for care, such as emergency room, urgent care, clinic appointment, or home advice. * Assist in the management of patient utilization of health care system and provide patient education relative to health care needs, use of community resources and responsibilities of membership in managed care. * Provide telephone advice according to established guidelines and protocols. * Arrange for evaluation by a provider when indicated either by scheduling an appointment or telephone follow-up. * Educate patients and families by phone about minor illnesses, medication usage, health maintenance needs, blood sugar monitoring, nebulizer usage and other prescribed health care regimens, operational procedures, and specialist referrals. * When necessary, secure appropriate interpreting services to handle communication with patients. * Participate in Quality Assurance activities as directed. * Work collaboratively with other Clinica Family Health staff in meeting HRSA, AAAHC, OSHA and other regulatory and/or funding requirements. * Accurately document patient care in electronic health record. * Provide safe, comfortable, therapeutic environment for patients and families. * Manage patient tasks and patient/provider follow-up with assistance from team and according to nurse task guidelines. POSITION QUALIFICATIONS: Education and Experience: * RN licensure from an accredited school required. BSN preferred. * Two years of experience in community health preferred. Knowledge, Skills and Abilities: * Ability to flourish in a team management system. * Experience with electronic health record preferred. * Sensitivity to low income, ethnic minority community. * Critical thinking. * Bilingual in Spanish is required. * Interacts with colleagues, team, and all staff in a professional and collegial manner. * Strong computer skills. We are an Equal Opportunity Employer. We prohibit unlawful discrimination against applicants or employees on the basis of age 40 and over, race, color, religion, national origin, sex, disability, sexual orientation, gender identity, or any other applicable status protected by federal, state, or local laws.

We are looking to hire a qualified, passionate Physician (MD/DO), Physician Assistant and/or a Family Nurse Practitioner to join our team at CommuniCare+OLE. Digital Administrative Provider (PA, FNP, MD, DO) DEPARTMENT: Medical REPORTS TO: Site Medical Director SUPERVISION GIVEN: Clinical & Administrative Sponsors (Medical Director and Administrative Health Center Manager) FULL TIME EQUIVALENT: 0.5 FTE with opportunity to grow to 1.0 FTE PAY RANGE BASED ON 20 HOUR WORK WEEK: MD/DO: $123,531.20 to $145,600.00 NP/PA: $78,842.40 to $96,356.00 LOCATION: Remote About CommuniCare+OLE Established in 2023, CommuniCare+OLE is the result of a union of two health centers with over 50 years of deep roots in their respective communities and reputations for providing high-quality primary care to all, regardless of insurance or ability to pay: OLE Health of Napa and Solano Counties and CommuniCare Health Centers of Yolo County. Building on a legacy established by both organizations in 1972, CommuniCare+OLE is a network of Federally Qualified Health Centers (FQHCs) with 17 sites across Napa, Solano, and Yolo Counties. The organization offers comprehensive health care including medical, dental, behavioral health and substance use treatment, nutrition, optometry, pharmacy, care coordination, referrals, and enrollment assistance to more than 70,000 individuals, and no one is turned away due to lack of insurance, immigration status, or ability to pay. Many services are offered outside of its sites, including mobile health, and community and school-based programs. Benefits Sign On Bonus through Partnership Health Plan of California (prorated per Full-Time Equivalent and for qualifying candidates) CME/CE of up to $2,000 per Calendar Year (prorated per Full-Time Equivalent) 10 Paid Holidays PTO (Vacation & Sick) Medical, Dental, Vision Coverage Employer covers 75% of employee medical premium and 50% of dependent medical premium 4% Employer Match for 403(b) retirement plan Tuition Reimbursement per Calendar Year for part-time and full-time employees (prorated per Full-Time Equivalent) Life & Accidental Insurance Coverage Employer contribution for Health Savings Account Flexible Spending Account (FSA) and Limited FSA Options JOB SUMMARY: Responsible for providing remote digital in-basket management including triage, lab review, and prescription refill response as well as limited teleheath visits for on-site providers in a team approach with an on-site clinical support team. KNOWLEDGE OF WORK Knowledge of Electronic Health Records and related computer systems, EPIC experience preferred. Ability to collaborate with the primary care team. Ability to prioritize, multi-task and have strong time management skills. Ability to triage patient care in a remote setting and have strong patient-centered communication skills. DUTIES AND RESPONSIBILITIES Prior to starting remote work, 4-6 weeks of in-person training will be provided to ensure knowledge and efficiency in the EHR, familiarity with clinic workflows and relationship development with in-person staff who will be providing support remotely. Administrative support expectations: Review and provide Epic in-basket support for providers who are out of office, scheduled day off, paid time off (PTO), leave of absence (LOA), etc. as well as rotating schedule as directed by the site health center manager. Communicate effectively to support staff regarding patient communications as needed for results (diagnostic imaging, labs, etc.) and any subsequent orders or follow up as necessary. Assessment of appropriateness for covered work to convert to telehealth appointments for patient review, education, and next steps in management within the assigned direct-patient care time allotment. Effectively communicate with on-site staff for scheduling needs, patient in-person assessments based on acuity, or coordination of other care and services as necessary. Direct Patient Care Expectations: Assessment/evaluation, diagnosis, treatment/prescribing, planning and education for patients who are scheduled for telehealth visits. Consult with staff physicians as needed. Review and manage patient information including labs, diagnostic images, prescription refills, outside consultation notes, previous medical records, order and authorize orders, specialist referrals, etc. Prescribe and administer medications and treatment regimens based on assessed medical conditions during telehealth appointments. Review medication(s) that patients are currently taking, prior to prescribing to prevent adverse reactions. Refer patients to specialists and to relevant patient care services as appropriate during telehealth appointments. Provide acute triage over the phone. Provide education and information to patients on various issues. Document all appropriate information in electronic health record system. Respond to messages and relay information to patients and any other internal or external sources as needed. Complete various medical related forms as needed. Direct and coordinate the patient care activities of nursing and support staff as appropriate. Utilize UpToDate, specialist curbside consults, as needed for clinical decision-making. Utilize referrals to local emergency room or Adult Integrated Transfer Center Access Center Hotline, Pediatric Access Center, as needed for stat emergency care. May participate in and collaborate with staff/teams on various support-related functions including quality assurance, care team development, system optimization, empanelment, policy and procedure development, etc. Perform other duties as assigned. EDUCATION AND CERTIFICATION REQUIREMENTS NP or PA-C candidates with at least 3 years of experience preferred. MD or DO candidates with at least 1 year of experience preferred. Graduate of an accredited Master of Science in Nursing program required, or graduate of a Physician Assistant Program from an accredited school, or MD/DO licensed in California with board certification. Current Family Nurse Practitioner certification required for FNP applicants. Current Physician Assistant License required and National Commission on the Certification of Physician Assistants Certificate required for PA applicants. Current California Provider certification/licensing required. Must have or obtain current California medication furnishing license. Must have or obtain current DEA License. Must certify and remain current in CPR certification. Experience in a community healthcare center preferred. Strong verbal and written communication skills; Bilingual (English/Spanish) language preferred but not required. Phone interpreter services are available. Excellent interpersonal and customer service skills required; must have ability to treat patients with complex medical and social needs. Must have strong time management skills, ability to prioritize, and work in a fast-paced environment. Computer and data entry skills required. Excellent problem-solving skills required. CommuniCare+OLE requires pre-employment drug-testing (4-panel drug-test includes: amphetamines, cocaine, opiates, and PCP).

Salary: $2280 / Week The Utilization Review Specialist is responsible for the assessment and review of the healthcare delivery system with a concentration on tasks that promote cost-effective quality care and cost containment in accordance with various federal and/or state statutes, regulations and guidelines as well as facility policy. Minimum Requirements: + Current license for the state in which the nurse practices if nursing licensure is required by contract + A Bachelor's Degree in Nursing or at least two years' experience in Utilization Review preferred + Certification in Utilization Review or Utilization Management preferred + Experience with Microsoft Office Suite and the ability to learn new information systems and software programs + General knowledge of managed care delivery system + Current CPR if applicable + TB questionnaire, PPD or chest x-ray if applicable + Current Health certificate (per contract or state regulation) + Must meet all federal, state and local requirements + Must be at least 18 years of age Benefits At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits: + Competitive pay & weekly paychecks + Health, dental, vision, and life insurance + 401(k) savings plan + Awards and recognition programs *Benefit eligibility is dependent on employment status. About Amergis Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions. Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. "Pursuant to the San Francisco Fair Chance Initiative, Amergis will consider for employment qualified applicants with arrest and conviction records"

Key Responsiblities: · Provide phone-based triage, assessing patient needs and offering appropriate guidance. · Utilize our electronic medical records system to review patient histories and ensure accurate documentation. · Work collaboratively with the care team to ensure a comprehensive support system for our patients. · Manage patient calls with a focus responsiveness and compassion. Requirements: · Must possess an active RN License for the state of Georgia. · Residency in Georgia is required. · Prior experience in hospice, palliative, or end-of-life care. · Access to high-speed internet and a private. HIPAA-compliant workspace. · Proficiency in technology with strong computer skills. Ability to navigate multiple software applications. · Ability to work efficiently in a fast-paced environment. · Must have a strong background in critical care or similar medical setting. Schedule: Part-time; Saturdays and Sundays 8:00 AM - 8:00 PM Pay Rate: $25.00 / HR

Sidecar Health is redefining health insurance. Our mission is to make excellent healthcare affordable and attainable for everyone. We know that to accomplish this lofty mission, we need driven people who will make things happen. The passionate people who make up Sidecar Health's team come from all over, with backgrounds as tech leaders, policy makers, healthcare professionals, and beyond. And they all have one thing in common-the desire to fix a broken system and make it more personalized, affordable, and transparent. If you want to use your talents to transform healthcare in the United States, come join us! *Must reside in Florida, Georgia, Kentucky, or Ohio for consideration* About the Role As a Utilization Review Nurse, you'll be at the forefront of evaluating the medical necessity and quality of healthcare services for our members, guaranteeing adherence to established guidelines. You will also be responsible for reviewing upcoming services and good faith estimates for our members and writing letters based on the Sidecar Health policy. What You'll Do Utilize Milliman Care Guidelines (MCG) to evaluate the medical necessity and appropriateness of proposed and ongoing treatments for our members Participate in quality improvement initiatives to enhance the efficiency and effectiveness of the clinical review process Ensure compliance with established clinical guidelines, policies, and regulatory requirements Review and analyze medical records to assess the appropriateness and necessity of healthcare services Evaluate good faith estimates and “prebills” to determine scheduled care, including highlighting care that may not be included in the estimate (labs, radiology, pre-op visits, etc) Collaborate with healthcare providers to gather additional information when needed Drafts letters to send to members outlining benefits and other considerations Collaborate with provider team and Member care team to evaluate care shopping options Review claims reconsiderations and appeals, providing expert guidance to ensure accurate processing and resolution of issues coverage determination Assess claims for balance billing protections to ensure compliance with applicable regulations and internal policies What You'll Bring Clinical credentials (RN) 5+ years of experience as a nurse providing direct patient care, preferably in a hospital setting 3+ years of utilization review experience, preferably in a health plan, managed care, or third-party administrator environment Hands-on experience using Milliman Care Guidelines (MCG) Medical billing and/or coding experience - this can be in a provider setting (billing, revenue cycle management, clinical auditing, legal compliance nurse) or payor setting (utilization management, prior auth review, payment integrity, etc.) Excellent written communication skills with experience drafting member, patient, and provider-facing letters Ability to think critically and make decisions with limited information Exceptional cross-functional collaboration skills with the ability to make recommendations to leadership Ability to problem solve and handle escalated cases Prior authorization experience (preferred) Bachelor's degree What You'll Get Competitive salary, bonus opportunity, and equity package Comprehensive Medical, Dental, and Vision benefits A 401k retirement plan Paid vacation and company holidays Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S Sidecar Health adopts a market-based approach to compensation, where base pay varies depending on location and is further influenced by job-related skills and experience. The current expected salary range for this position is $80,000 - $95,000. Sidecar Health is an Equal Opportunity employer committed to building a diverse team. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

Job Title: Clinical Review Registered Nurse Why work at OpTech? OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at ***************** SUMMARY: * Our Client is looking for a Clinical Review Registered Nurse to support operations within its Utilization Management team. * This is a full-time (40 hours, M-F) remote opportunity for a 1-3 month duration with potential to extend as needed. * This position executes utilization management processes to ensure the delivery of medically necessary and appropriate, cost-effective and high-quality care through the performance of clinical reviews. * Reviews requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization. * Identifies questionable cases and refers to superior or a medical director for review. * There is no travel required for this role. RESPONSIBILITIES: * This position executes utilization management processes to ensure the delivery of medically necessary and appropriate, cost-effective and high-quality care through the performance of clinical reviews. * Reviews requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization * Identifies questionable cases and refers to superior or a medical director for review * Perform related duties as required or directed PRIMARY RESPONSIBILITIES: * Conduct clinical reviews of all prior approval, post service reviews, customer service and claim requests * Determine adequacy of clinical elements of clinical information submitted * Determine essential elements of clinical information for decision-making and request same as appropriate * Make determinations based on medical policy, evidence-based guidelines, and medical necessity * Communicate directly with requesting providers to obtain additional clinical information as needed in order to make utilization management decisions. * Review late and out of network prior approval / referral authorizations for appropriateness and make determination on benefit level based on medical necessity * Provide timely and accurate review for procedure/service appropriateness, reconsideration, and appeals based on Rule 9-03, DRF, and NCQA Standards * Perform monthly audits related to prior approval processes as well as weekly guidelines to confirm medical necessity and appropriateness of reviewed services * Use sound clinical judgment along with appropriate review criteria and practice guidelines to confirm medical necessity and appropriateness of reviewed services * Provide support to Provider Relations and Provider Reimbursement in regard to clinical issues relating to new procedure, coding, pricing and provider communications * Provide appropriate and timely referrals to the medical director. Identify and report any potential quality of care of services issue to the medical director. * Perform timely case review information, case entry and updates to case file in the appropriate systems * Participate in medical policy committee including research and development of policies and collaboration with participating provider * Assist in review of health service delivery and utilization and cost data * Determine through clinical review members that would potentially benefit from case management. Initiate referrals to triage to assess these members for effective case management intervention * Determine and interpret member eligibility, coverage and available benefits. Contribute to member and provider satisfaction within program and organization * Assist the claims payer in accurate adjudication of care management approved services as needed QUALIFICATIONS: * RN with Vermont License required * Also open to candidates who have a compact license * BSN desired * 5-7 years of clinical practice required * 1-3 years of insurance related experience desired * Must be willing to participate in on-going CEU training Top 3 Required Skills/Experience: * Subject Matter Expertise: * Strong knowledge base in health care delivery systems, health insurance, medical care practices and trends, regulatory and accreditation agencies/standards, and provider network management * Strong knowledge of all Plan products and services benefits that effect clinical decision making * Strong knowledge of clinical nursing practice * Computer Skills: * Proficient in all Microsoft Office applications * Proficient in CPT, HCPCS coding and ICD-10 diagnosis codes * Proficient in specialized computer applications preferred including SalesForce Health Cloud, Acuity, Microsoft CRM, Onbase (or similar document mgt system), Jira * Analytical Skills: * Strong analytical skills, including statistical data analysis Required Skills/Experience - The rest of the required skills/experience. Include: * Communication Skills - Strong written and oral communication skills * Interpersonal Skills - Strong interpersonal skills * Organizational Abilities - Strong organizational skills * 5 - 7 years of clinical practice required Preferred Skills/Experience - Optional but preferred skills/experience. Include: * 1- 3 years of insurance related experience desired * Willing to participate in required on-going CEU training Education/Certifications - Include: * Licensed RN ; BSN desired; Licensed in compact state desired Supervision Received - Discretion and Judgment: * Is expected to regularly use discretion and judgment to make decisions without approval such as planning projects, analyzing accounts, solving problems, or improving processes. Nature of Duties: * Primary duties are non-manual in nature (i.e., call handling, accounting) Focus of Work: * Primary duties are directly related to general business operations (nearly all of Our Clients) Knowledge Requirements: * Ability to perform the job duties requires sue of advance knowledge acquired by a lengthy course of study and/or instruction. Physical Demands in Performing Essential Job Functions (amount of time): This section is to comply with the Americans with Disabilities Act (ADA): * Stand - 1/3 * Walk - 1/3 * Talk to hear - 2/3 * Sit - 2/3 * Reach with hands and arms - 1/3 * Push/pull - 1/3 * Stoop, kneel, crouch or crawl - 1/3 * Fine dexterity - 1/3 to 2/3 * Repetitive use of hands - 2/3 * Visual activity - 2/3 * Aural acuity - 2/3 The above is intended to describe the general contents and requirements of work being performed by people assigned to this position. Nothing in this position description of Our Client's right to assign or reassign duties and responsibilities to this position at any time. OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. *************************************************

$40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. pay rate is $40/hour This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers and facilities. Registered Nurse (RN) with valid, current, unrestricted license in the state of operations. * 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company. * Knowledge of medical terminology and procedures. * Verbal and written communication skills. PREFERRED JOB REQUIREMENTS: * Utilization management experience * MCG or InterQual experience

MUSC seeking FT Utilization Management Nurse for our new Leatherman Behavioral Health Care Pavilion in Florence, SC. (Remote) Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type Regular Cost Center CC005493 LBH - Case Mgmt Pay Rate Type Salary Pay Grade Health-28 Scheduled Weekly Hours 40 Work Shift Conducts utilization reviews to determine if patients are receiving care appropriate to severity of illness or condition and intensity of services required. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with providers and other stakeholders as needed. Minimum Training and Education: Bachelor's degree in Nursing from an accredited school of nursing and five years of nursing work experience to include two years utilization / case management experience in a hospital setting required. Prior leadership experience preferred. Evidence of committee involvement within a healthcare setting needed (either departmental or hospital-wide). Must possess excellent verbal and written communication skills. Familiarity with InterQual and/or MCG screening criteria desired. Required Licensure, Certifications, Registrations: Licensure as a registered nurse by the state of South Carolina or compact state required. Additional Job Description This position is remote support for the MUSC Leatherman Health Pavilion in Florence SC. ================================================ Leatherman Behavioral Health Pavilion will serve as a regional behavioral health center and include a combination of triage, crisis stabilization, telehealth, outpatient, and inpatient services that will expand much-needed behavioral health resources in the Pee Dee region. Once built, the center will occupy the site of an MUSC-owned property currently known as the Cedar Tower campus on E. Cedar Street in Florence. The project was coordinated through an advisory committee convened by South Carolina Department of Health and Human Services (SCDHHS) Director Robby Kerr. (Opening October 2025) The MUSC Health Leatherman Pavilion features will include: * A rapid access center to provide walk-in triage and assessment and offer transition to care. * Telepsychiatry services to strengthen access to psychiatric services throughout the region. * Sixteen adult and four adolescent beds for crisis services to rapidly stabilize patients. * Outpatient adult and pediatric behavioral health clinics. * A 63-bed inpatient psychiatric unit to treat patients needing more acute care, including the transfer of the 23 psychiatric hospital beds at the McLeod Behavioral Health Center in Darlington to the new facility. The behavioral health center develops individualized treatment plans. Services and treatments include: Services * Mental Health Services * Addiction Services * Therapy About Florence, SC: "Florence, South Carolina, is a city that blends a fascinating history with a vibrant present. From its humble beginnings as a railroad town to its thriving arts scene and diverse economy, Florence has become a destination that offers something for everyone. Whether you're interested in history, culture, or outdoor activities, Florence is sure to captivate your heart and leave you wanting to explore more." (quote from hollymelody.com). For more information, please visit About Florence - Greater Florence Chamber of Commerce (flochamber.com) Benefits MUSC is a state facility, therefore our full-time positions come with the option of the State of South Carolina health and retirement benefits. If you like working with energetic enthusiastic individuals, you will enjoy your career with us! The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: ***************************************

Join the Team at Concierge Home Care - Where Care Changes Lives! At Concierge Home Care, we believe in the power of home health care to change lives-for patients and team members alike. Our mission, “Caring for people who care for people,” is the foundation of who we are and what we do. Guided by our values-Integrity, Caring, Quality, Service, Innovation, and Team-we are dedicated to delivering compassionate, high-quality care that empowers patients to heal in the comfort of their own homes. Since we opened our doors in 2015, Concierge Home Care has grown to serve over 57 counties across Florida, offering incredible opportunities for growth and career advancement. Location: This position is FULLY REMOTE , serving patients in Northeast, FL, and surrounding areas. Hours include Friday-Monday . Your Role as a Clinical Manager, RN: Supervise home health services to ensure patients receive high-quality care as prescribed by physicians. Review clinical documentation to ensure compliance with Medicare, Federal, Insurance, and Company guidelines. Follow and enforce Agency policies and procedures to set a strong example for the team. Maintain compliance with accepted professional standards, principles, and Standard Operating Procedures. Stay up to date on all relevant guidelines, policies, and protocols to support quality care. Qualifications: An unencumbered Florida Nursing License (required) Valid driver's license, auto insurance, and reliable transportation (required) Two years of experience as an RN in acute care, med/surge, ICU, or ER settings (required) One year of experience in skilled, geriatric home health care with proficiency in Medicare OASIS documentation (required) One year of experience in a supervisory/clinical manager role in a Medicare-certified Home Health Care agency (required) Why Choose Concierge Home Care? Whether you're new to home health or an experienced professional, you'll have access to the tools and support needed to excel. You'll also be part of a team that values collaboration and autonomy. While you'll have the independence to manage your role, you'll never be without the support of experienced clinical supervisors and a dedicated team focused on delivering exceptional care. And when it comes to what we offer, we've got you covered: Professional Development: Ongoing training, mentorship opportunities, and support for career development. Compensation: $80,000-$90,000 Comprehensive Benefits: Enjoy three weeks of PTO and annually increases to four weeks after five years. Earn quarterly bonuses based on individual and team performance. Plan for the future with our 401(k) options. Employee Assistance Program (EAP), pet insurance, legal assistance, and employee referral bonuses. Health, dental, vision, and HSA options. Mileage reimbursement or company vehicle (per company policy). Data plan reimbursement. Take the First Step Join Concierge Home Care and make a meaningful impact! Apply today to begin an exciting and rewarding career where care truly changes lives. **************************************

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.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Remote Option; Available for any of Partners' NC locations Projected Hiring Range : Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: The TCL Complex Care Nurse Coordinator's primary objective is to gather Behavioral Health and Medical assessment information on eligible members transitioning from Adult Care Homes. This position will provide assessment of the members medical, behavioral health, and functional needs prior to transitioning to the community to provide recommendations to the members treatment team. This position will evaluate medical and behavioral health information provided for each member. This position works with TCL members currently in adult care homes, adult care home staff, Primary Care Doctor, Specialist, family members, service providers and other medical professional to provide informed assessments and recommendations to the members treatment team. This position will assist in coordinating additional medical services and supports as needed. This position will work collaboratively with In-Reach Staff, Transition Coordinators, Care Managers, Service Providers, and Medical Providers. This is a mobile position that will require working in various locations throughout and beyond Partners catchment area. TCL Complex Care Nurse Role and Responsibilities: Complex Care Nurse to assigned TCL individuals who may have identified needs with behavioral health, physical health, co-occurring, co-morbid or multi-morbid conditions. Complete Medical, Psychosocial, functional assessments. Review assessments and medical records to provide recommendations for services and treatment. Identify disqualifying health conditions, or conditions that will need specific services recommendations if the individual is living in the community. Collaborates with Complex Care Staff to provide integrated care. Educate individuals and referral entities about TCL. Coordinates and gathers assessment information from providers, and other resources. Review medical documentation. Coordinates with Behavioral Health and Medical service providers to ensure additional assessments are completed. Works with referral entities to address and assess the needs of the individuals, educate on appropriate services and levels of care as needed. Identifies gaps in services and intervenes to ensure that the individual receives appropriate care. Ensures that services for the individual are identified and coordinated across the LME/MCO's system and with other systems, including primary care. Provide members with information on community based services in order for them to make an informed choice. Assures data is tracked and all reporting requirements are met. Develop clear documentation on each individual. Track number of assessment and where the individual went to live. Other specific functions as they relate to Diversion, In-Reach, Transition Process and Post-Transition responsibilities as indicated from DMA/DMH. Performs related tasks as required. Collaboration: Collaborates with other members of TCL team in reviewing information, providing clinical oversight, to determine eligibility within established time frames. Serves as a collaborative partner in identifying system barriers. Manages and facilitates meetings with community stakeholders as appropriate to TCL. Works in partnership with other LME/MCO departments to address identified needs within the catchment area. Knowledge, Skills and Abilities: Extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) Extensive understanding of medical terms, conditions and treatment. Considerable knowledge of the MH/SU/IDD service array provided through the network of the LME/MCO's providers Knowledge of Medicaid eligibility determinations. Highly skilled at assuring that both long and short-range goals and needs of the individual are addressed and updated, while assuring through monitoring activities that service implementation occurs appropriately Exceptional interpersonal and communication skills Excellent computer skills including proficiency in Microsoft Office products (Word, Excel, Outlook, and PowerPoint) Excellent problem solving, negotiation, arbitration, and conflict resolution skills Detail-oriented, able to organize multiple tasks and priorities and effectively manage projects from start to finish Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships Ability to change the focus of his/her activities to meet changing priorities A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance Education/Experience Required: Licensed to practice as a Registered Nurse in North Carolina and two years of experience in mental health or substance use disorders and medical care. For Dual Diagnosis (MHSU/IDD) - experience in intellectual/developmental disabilities. Other requirements: Must reside in North Carolina. Must have ability to travel regularly as needed to perform the job duties Education/Experience Preferred: Licensed to practice as a Registered Nurse in North Carolina and two years of experience in psychiatric nursing; care management/care coordination experience. Experience in collaborative care. Licensure/Certification Requirements: Must be licensed as a Registered Nurse in North Carolina. Employee is responsible for complying with respective licensure board's continuing education/training requirements in order to maintain an active license.

Requirements Applicants must have a minimum of a doctorate degree in nursing practice with a certification in AGACNP and successful completion of at least 18 hours of directly related graduate coursework. Preference will be given to applicants with prior successful online teaching.