Remote Registered Nurse (RN) Jobs

$25 / hour

We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services. Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com. Why Join Us Base pay at $25 an hour with multiple opportunities to increase the hourly rate with a potential to earn up to $28 an hour within your first 6 months of hire 3 weeks of paid remote training Supportive clinical team Work from home allows you to create a comfortable and personalized workspace Shorter shifts that provide a better work-life balance and reduce potential for burnout Working remotely gives you more time to spend with those you love! What do our nurses say? When asked what inspires her, 2024 IntellaTriage Nurse of the Year shared: “Helping people. That’s it. And knowing this team has your back—that makes all the difference. People say it takes a special kind of person to do hospice, and I think that’s true. You’re walking with people and their families through one of the most sacred times in life. It’s an honor to support them and guide them through that journey. I’m so grateful to have been chosen for this award.” At IntellaTriage we recognize nurses who go above and beyond to make a meaningful impact on patients’ lives. This years' honoree exemplifies what it means to lead with compassion, skill, and dedication. Read more about being a nurse at IntellaTriage, and the reward: https://intellatriage.com/telehealth-solutions-media/2024-nurse-of-the-year/ Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination Key responsibilities Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls. All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn up to $28 an hour within your fist 6 months of hire. All nurses are eligible for a $1 shift differential for overnights and a $1 shift differential for weekends (Friday evening, Saturday & Sunday). All part-time and full-time nurses accumulate PTO, based on the number of hours worked (per year). All part-time and full-time nurses are eligible to participate in our 401(k) plan. Full-time nurses may also participate in medical, dental, vision, and/or supplemental insurances.

Clinical Care Reviewer II - Multi State License - RN - Behavioral Health

CareSource

$62,700 - $100,400 / year

Job Summary: Clinical Care Reviewer II – Behavioral Health is responsible for processing medical necessity reviews for appropriateness of authorization for behavioral health care services, assisting with discharge planning activities (i.e. outpatient services, home health services) and care coordination for members. Essential Functions: Complete prospective, concurrent and retrospective review of Behavioral Health services Identify, document, communication and coordinate care engaging collaborative care partners to facilitation transition to an appropriate level of care Engage with medical director when additional clinical expertise if needed Maintain knowledge of state and federal regulations, including State Contracts and Provider Agreements, benefits, and accreditation standards Identify and refer quality issues to Quality Improvement Identify and refer appropriate members for Care Management Provide guidance to non-clinical staff Provide guidance and support to LPN staff Attend medical advisement and State Hearing meetings, as requested Assist Team Leader with special projects or research, as requested Perform any other job related duties as requested. Education and Experience: Associates of Science (A.S) in Nursing required or Bachelor of Science (B.S) in Social Work required Three (3) years clinical experience required Utilization Management/Utilization Review experience preferred Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: Proficient data entry skills and ability to navigate clinical platforms successfully Working knowledge of Microsoft Outlook, Word, and Excel Effective oral and written communication skills Ability to work independently and within a team environment Attention to detail Proper grammar usage and phone etiquette Time management and prioritization skills Customer service oriented Decision making/problem solving skills Strong organizational skills Change resiliency Licensure and Certification: Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) required MCG Certification is required or must be obtained within six (6) months of hire required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

Certified Diabetes Education Specialist - Registered Nurse

CVS Health TX

$54,095 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Must be a Certified Diabetes Care and Education Specialist (CDCES) This is a full-time telework role. Working schedule: Monday-Friday, standard business hours, including 2 evening shifts per week from 11:30am-8pm CST. Rotating Saturdays may be required about once per quarter following training. Work day consists of scheduled member appointments and member outreach. Position Summary: In this position the focus is on educating members with diabetes and other conditions as well as providing resources to the members. Assisting with closing gaps members may have in their care is also a priority. -The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status. - Assessment of members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. -Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. -Enhancement of Medical Appropriateness & Quality of Care: -Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. -Using holistic approach consults with supervisors, Medical Directors and/or others to overcome barriers to meeting goals and objectives. -Identifies and escalates quality of care issues through established channels. -Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. -Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. -Interprets and utilizes clinical guidelines/criteria to positively impact members health Provides up-to-date healthcare information to help facilitate the member¡¦s understanding of his/her health status. -Helps member actively and knowledgably participate with their provider in healthcare decision-making. -Monitoring, Evaluation and Documentation of Care - Develops and monitors established plans of care, in collaboration with the member and/or attending physician, to meet the member's goals. - Utilizes internal policy and procedure in compliance with regulatory and accreditation guidelines. Position Requirements: -Must be an RN and a Certified Diabetes Care and Education Specialist (CDCES) - A Registered Nurse with an active and unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states. - 3+ years of clinical nursing experience post licensure - Experience working with patients with diabetes - Must possess or be willing and able to obtain high speed broadband internet access Preferred Qualifications - Previous coaching experience - Managed care experience (MCO) - Experience with Microsoft Word, Outlook, Excel, and comfortable using various computer programs Education - Associate's degree minimum required as a Registered Nurse Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/10/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant (Weekend)

CVS Health PA

$29.10 - $62.32 / hour

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days including every Weekend , both Saturday and Sunday, and two weekday shifts of 10hrs each (to be determined). Also includes holiday and late rotations. 12.5% Shift Premium applies once M-F training schedule completed and UMNC participating in non-traditional, weekend shift rotation. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or benefit programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. UMNC meets set productivity and quality expectations. Effective communication skills, both verbal and written Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Work from home position: During work hours, Colleagues who are working from home must be available by phone, videoconference, and email in a manner and frequency that is required by the Colleague's Leader. Colleagues must be available from time to time to come into the office or client location on a given day for work-related meetings, training sessions or other events, as directed by their Leader. Required Qualifications Active and unrestricted Registered Nurse in state of residence 3+ years of experience as a Registered Nurse 1+ years of clinical experience in acute setting (ex: ER, triage, ICU, Med/Surg) Willing and able to work four 10hr days including every Weekend, both Saturday and Sunday, and two weekday shifts of 10hrs each (to be determined), also includes Holiday and late rotations. 12.5% Shift Premium applies once M-F training schedule completed and UMNC participating in non-traditional, weekend shift rotation Preferred Qualifications Utilization review experience Experience with LTAC, skilled rehab, or home health Managed Care experience Education Minimum Diploma RN acceptable or Associate degree in Nursing required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/07/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Bilingual Pediatric Registered Nurse

Imagine Pediatrics

$40 - $47 / hour

Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this position is remote (CST required). Expected schedule will be 3x12s (Monday-Wednesday or Wednesday-Friday) 7:00am-7:00pm CST. Nurses must physically be working in the United States. What You’ll Do As a Pediatric Registered Nurse at Imagine Pediatrics, you are the primary point of contact for our families as you work to deeply know our patients through frequent virtual touchpoints and are the first line of defense when our patients are having a clinical problem. You leverage an integrated technology platform and are complimented by an entire interdisciplinary team including MDs, APPs, social workers, navigators, pharmacists, and dietitians. In this role, you will: Provide professional and friendly proactive care and triage for clinical issues. Embed a family centered care philosophy in care delivery. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Transition of care for ED/IP/UC care coordination with clinical providers following discharge. Perform a comprehensive assessment of a patient’s clinical, psychosocial, discharge planning and financial needs. Establishes clinical milestones and goals related to these issues. Establish rapport and a relationship with the patient and family in order to understand their needs and expectations and to assist them in setting realistic and mutual goals. Integrate an awareness of cultural factors in the patient/family interview process and elicit clinically relevant cultural information. Establish, in conjunction with the physician, the patient and interdisciplinary team, a comprehensive plan of care to appropriately address clinical milestones. Communicate plan of care, including changes and issues related to plan of care to patient/family, physicians and other members of the healthcare team. Gather sufficient information from all relevant sources to determine the effectiveness of the plan of care to assure it is done in an accurate, safe, timely and cost-effective manner. Document all care management assessments and interventions. Refer to Social Worker or Behavioral Health for complex psychosocial and discharge planning issues (per criteria) and ensures appropriate follow-up. Consults with other members of the interdisciplinary team (dietary, pharmacy, etc.) to provide safe discharge as appropriate. Perform other duties as assigned What You Bring & How You Qualify First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need: Licensed RN in at least one state with eligibility to register for other state licensures. Bachelor’s in nursing from an accredited university required. Pediatrics experience required in outpatient (primary care and/or subspecialty), home health, complex care, pediatric ICU, emergency medicine, etc. Minimum 1 year care coordination or case management experience preferred. Bilingual Spanish required Familiarity with Medicaid regulations and services a plus Value Based Care (VBC) experience a plus Virtual care experience a plus What We Offer (Benefits + Perks) The hourly rate for this position ranges from $40 - 47 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We’re guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Mom and Baby Care Manager - RN - Must reside in Nevada

CareSource

$62,700 - $100,400 / year

Job Summary: The Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population with culturally competent delivery of care, services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification, person-centered planning, assist the member in creation and evaluation of person-centered care plans to prioritize and address what matters most, behavioral, physical and social determinants of health needs with the aim to improve the of lives our members. Essential Functions: Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member Engage with the member to establish an effective, professional relationship via telephonic or electronic communication Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member’s desires, needs and preferences Identify and manage barriers to achievement of care plan goals Identify and implement effective interventions based on clinical standards and best practices Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management Facilitate coordination, communication and collaboration with the member the ICT in order to achieve goals and maximize positive member outcomes Educate the member/ natural supports about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made Employ ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP Evaluate member satisfaction through open communication and monitoring of concerns or issues Monitors and promotes effective utilization of healthcare resources through clinical variance and benefits management Verify eligibility, previous enrollment history, demographics and current health status of each member Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders Oversee (point of contact) timely psychosocial and behavioral assessments and the care planning and execution of meeting member needs Participate in meetings with providers to inform them of Care Management services and benefits available to members Assists with ICDS model of care orientation and training of both facility and community providers Identify and address gaps in care and access Collaborate with facility-based healthcare professionals and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner Coordinate with community-based organizations, state agencies, and other service providers to ensure coordination and avoid duplication of services Adjust the intensity of programmatic interventions provided to member based on established guidelines and in accordance with the member’s preferences, changes in special healthcare needs, and care plan progress Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required on going care coordination. Provide clinical oversight and direction to unlicensed team members as appropriate Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation Continuously assess for areas to improve the process to make the members’ experience with CareSource easier and shares with leadership to make it a standard, repeatable process Adherence to NCQA and CMSA standards Perform any other job duties as requested Education and Experience: Nursing degree from an accredited nursing program or Bachelor’s degree in a health care field or equivalent years of relevant work experience is required Advanced degree associated with clinical licensure is preferred A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required Three (3) years Medicaid and/or Medicare managed care experience is preferred Competencies, Knowledge and Skills: Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel Ability to communicate effectively with a diverse group of individuals Ability to multi-task and work independently within a team environment Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices Adhere to code of ethics that aligns with professional practice Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice Strong advocate for members at all levels of care Strong understanding and sensitivity of all cultures and demographic diversity Ability to interpret and implement current research findings Awareness of community & state support resources Critical listening and thinking skills Decision making and problem-solving skills Strong organizational and time management skills Licensure and Certification: Current unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Professional Clinical Counselor is required. Licensure may be required in multiple states as applicable based on State requirement of the work assigned Case Management Certification is highly preferred Working Conditions: Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

Case Manager - Registered Nurse

$60,522 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: We’re seeking an experienced Registered Nurse (RN) Case Manager to join our team in a fully remote role. In this position, you’ll partner with members to assess needs, coordinate care, and drive better health outcomes—while enjoying the flexibility of working from home. What You’ll Do Assess, plan, and coordinate care telephonically (and occasionally in person) to support member wellness Develop proactive care plans to address complex medical and social needs Use clinical judgment, data, and assessments to reduce risk factors and improve outcomes Collaborate with members and refer them to appropriate benefit programs and services Engage members through effective interviewing and strong communication skills Ensure case management activities meet regulatory and company standards Schedule & Location 100% remote (candidates may reside in any U.S. state) Monday–Friday, 9:00 AM–5:30 PM EST (8-hour scheduled shift) Weekends and holidays are currently on-call only and voluntary Less than 5% travel for meetings, training, or licensure requirements Required Qualifications Active, unrestricted RN license in your state of residence Willingness to obtain additional state licenses (company paid) 3+ years of acute care RN experience (medical, surgical, ICU, pediatrics, discharge planning, or case management) Comfort working with multiple systems/screens for extended periods Private, distraction-free workspace with high-speed internet Preferred Qualifications Nurse Licensure Compact (NLC) license 1+ year of case management experience CCM certification Strong customer service and telephonic communication skills Proficiency with Microsoft Office (Word, Excel, PowerPoint) Education Associate Degree in Nursing (required) Bachelor of Science in Nursing (preferred) Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/11/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Clinical Care Reviewer II - Nevada Licensed - RN - PST Hours

CareSource

$62,700 - $100,400 / hour

Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services. Essential Functions: Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care Engage with medical director when additional clinical expertise if needed Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards Identify and refer quality issues to Quality Improvement Identify and refer appropriate members for Care Management Provide guidance to non-clinical staff Provide guidance and support to LPN clinical staff as appropriate Attend medical advisement and State Hearing meetings, as requested Assist Team Leader with special projects or research, as requested Perform any other job related duties as requested. Education and Experience: Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required Three (3) years clinical experience required Med/surgical, emergency acute clinical care or home health experience preferred Utilization Management/Utilization Review experience preferred Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: Proficient data entry skills and ability to navigate clinical platforms successfully Working knowledge of Microsoft Outlook, Word, and Excel Effective oral and written communication skills Ability to work independently and within a team environment Attention to detail Proper grammar usage and phone etiquette Time management and prioritization skills Customer service oriented Decision making/problem solving skills Strong organizational skills Change resiliency Licensure and Certification: Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required MCG Certification or must be obtained within six (6) months of hire required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

Remote Hospice Triage RN PT 4:30a-10a + rotating Sat & Sun 7:30a-4p CST

$25 - $28 / hour

We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services. Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com. Why Join Us Base pay at $25 an hour with multiple opportunities to increase the hourly rate with a potential to earn up to $28 an hour within your first 6 months of hire 3 weeks of paid remote training Supportive clinical team Work from home allows you to create a comfortable and personalized workspace Shorter shifts that provide a better work-life balance and reduce potential for burnout Working remotely gives you more time to spend with those you love! What do our nurses say? When asked what inspires her, 2024 IntellaTriage Nurse of the Year shared: “Helping people. That’s it. And knowing this team has your back—that makes all the difference. People say it takes a special kind of person to do hospice, and I think that’s true. You’re walking with people and their families through one of the most sacred times in life. It’s an honor to support them and guide them through that journey. I’m so grateful to have been chosen for this award.” At IntellaTriage we recognize nurses who go above and beyond to make a meaningful impact on patients’ lives. This years' honoree exemplifies what it means to lead with compassion, skill, and dedication. Read more about being a nurse at IntellaTriage, and the reward: https://intellatriage.com/telehealth-solutions-media/2024-nurse-of-the-year/ Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination Key responsibilities Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls. All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn up to $28 an hour within your fist 6 months of hire. All nurses are eligible for a $1 shift differential for overnights and a $1 shift differential for weekends (Friday evening, Saturday & Sunday). All part-time and full-time nurses accumulate PTO, based on the number of hours worked (per year). All part-time and full-time nurses are eligible to participate in our 401(k) plan. Full-time nurses may also participate in medical, dental, vision, and/or supplemental insurances.

Remote Hospice Triage RN PT 3:30p-11p + rotating Sat & Sun 3:30p-11p CST

$25 - $28 / hour

We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services. Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com. Why Join Us Base pay at $25 an hour with multiple opportunities to increase the hourly rate with a potential to earn up to $28 an hour within your first 6 months of hire 3 weeks of paid remote training Supportive clinical team Work from home allows you to create a comfortable and personalized workspace Shorter shifts that provide a better work-life balance and reduce potential for burnout Working remotely gives you more time to spend with those you love! What do our nurses say? When asked what inspires her, 2024 IntellaTriage Nurse of the Year shared: “Helping people. That’s it. And knowing this team has your back—that makes all the difference. People say it takes a special kind of person to do hospice, and I think that’s true. You’re walking with people and their families through one of the most sacred times in life. It’s an honor to support them and guide them through that journey. I’m so grateful to have been chosen for this award.” At IntellaTriage we recognize nurses who go above and beyond to make a meaningful impact on patients’ lives. This years' honoree exemplifies what it means to lead with compassion, skill, and dedication. Read more about being a nurse at IntellaTriage, and the reward: https://intellatriage.com/telehealth-solutions-media/2024-nurse-of-the-year/ Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination Key responsibilities Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls. All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn up to $28 an hour within your fist 6 months of hire. All nurses are eligible for a $1 shift differential for overnights and a $1 shift differential for weekends (Friday evening, Saturday & Sunday). All part-time and full-time nurses accumulate PTO, based on the number of hours worked (per year). All part-time and full-time nurses are eligible to participate in our 401(k) plan. Full-time nurses may also participate in medical, dental, vision, and/or supplemental insurances.

Remote Hospice Triage RN PT 10:30p-5a + rotating Sat & Sun 11:30p-8a CST

$25 - $28 / hour

We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services. Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com. Why Join Us Base pay at $25 an hour with multiple opportunities to increase the hourly rate with a potential to earn up to $28 an hour within your first 6 months of hire 3 weeks of paid remote training Supportive clinical team Work from home allows you to create a comfortable and personalized workspace Shorter shifts that provide a better work-life balance and reduce potential for burnout Working remotely gives you more time to spend with those you love! What do our nurses say? When asked what inspires her, 2024 IntellaTriage Nurse of the Year shared: “Helping people. That’s it. And knowing this team has your back—that makes all the difference. People say it takes a special kind of person to do hospice, and I think that’s true. You’re walking with people and their families through one of the most sacred times in life. It’s an honor to support them and guide them through that journey. I’m so grateful to have been chosen for this award.” At IntellaTriage we recognize nurses who go above and beyond to make a meaningful impact on patients’ lives. This years' honoree exemplifies what it means to lead with compassion, skill, and dedication. Read more about being a nurse at IntellaTriage, and the reward: https://intellatriage.com/telehealth-solutions-media/2024-nurse-of-the-year/ Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination Key responsibilities Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls. All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn up to $28 an hour within your fist 6 months of hire. All nurses are eligible for a $1 shift differential for overnights and a $1 shift differential for weekends (Friday evening, Saturday & Sunday). All part-time and full-time nurses accumulate PTO, based on the number of hours worked (per year). All part-time and full-time nurses are eligible to participate in our 401(k) plan. Full-time nurses may also participate in medical, dental, vision, and/or supplemental insurances.

Utilization Management Nurse Consultant - Medical Review (Remote)

$26.01 - $56.14 / hour

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Information Schedule: Monday–Friday 8:00am-5:00pm EST Location: 100% Remote (U.S. only) About Us American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members. Position Summary Join a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect. Key Responsibilities Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to the client. Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and feedback. Actively cross-trains to perform reviews of multiple case types to provide a flexible workforce to meet client needs. Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction. Must be able to work independently without personal distractions to meet quality and metric expectations. Remote Work Expectations This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed. Minimum 3 years of clinical experience. 5 years demonstrated to make thorough independent decisions using clinical judgement. 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems. 1+ Year of Utilization Review Management and/or Medical Management experience. Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity. MCG Milliman, CPB or other criteria guideline application experience is preferred. Education Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/28/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Clinical Claims Review Nurse

$26.01 - $68.55 / hour

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. • This role requires the nurse to exercise clinical judgment and perform the following duties: • Review and interpret clinical documentation obtained from medical records or systems. • Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims • Coordinate clinical resolutions independently, with clinician/MD support as required • Act as a resource for customer service and claims processing teams • Train new staff and provide cross-training to existing team members • Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified Remain current with applicable laws, regulations, and internal workflows to ensure full compliance with organizational and state-specific requirements • Required Qualifications • Nursing degree (RN) • A minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience • Strong analytical skills to assess medical claims Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $68.55 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Case Manager Registered Nurse

$60,522 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Case Manager RN role is 100% remote work from home and candidates must have an active RN licensure (any state). Normal Working Hours: Monday through Friday 9:00am – 5:30pm in time zone of residence. Occasional evening, weekend, and holiday shifts per the needs of the team. No travel is expected with this position. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. RN Case Manager: – Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. – Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. – Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. – Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. – Reviews prior claims to address potential impact on current case management and eligibility. – Assessments include the member’s level of work capacity and related restrictions/limitations. – Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. – Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. – Utilizes case management processes in compliance with regulatory and company policies and procedures. – Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Required Qualifications -Must have an active RN licensure in the state where you reside. -Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company) -2+ years of clinical experience as an RN -All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing. Preferred Qualifications -Certified Case Manager (CCM) certification -Prefer candidates who reside in compact states. -3+ years’ experience with Microsoft Office Suite -Case Management in an integrated model -Discharge Planning experience -Managed care experience -BSN preferred Education -Associates Degree in Nursing Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Case Manager Registered Nurse

$60,522 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Case Manager RN role is 100% remote work from home and candidates must have an active RN licensure (any state). Normal Working Hours: Monday through Friday 9:00am – 5:30pm in time zone of residence. Occasional evening, weekend, and holiday shifts per the needs of the team. No travel is expected with this position. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. RN Case Manager: – Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. – Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. – Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. – Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. – Reviews prior claims to address potential impact on current case management and eligibility. – Assessments include the member’s level of work capacity and related restrictions/limitations. – Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. – Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. – Utilizes case management processes in compliance with regulatory and company policies and procedures. – Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Required Qualifications -Must have an active RN licensure in the state where you reside. -Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company) -2+ years of clinical experience as an RN -All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing. Preferred Qualifications -Certified Case Manager (CCM) certification -Prefer candidates who reside in compact states. -3+ years’ experience with Microsoft Office Suite -Case Management in an integrated model -Discharge Planning experience -Managed care experience -BSN preferred Education -Associates Degree in Nursing Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant

$29.10 - $62.32 / hour

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Schedule: This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage. Position Summary: Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members. Key Responsibilities: * Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care. * Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs. * Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization. * Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. * Meet set productivity and quality expectations as established by UMNC. Required Skills and Abilities: * Effective verbal and written communication skills. * Proficiency with computer skills, including navigating multiple systems and keyboarding. * Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment. * Capacity to sit for extended periods, talk on the telephone, and type on the computer. Work Location: This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed. `Required Qualifications Registered Nurse Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience Must have active current and unrestricted RN licensure in state of residence. May be required to obtain additional Nursing Licenses as business needs require. * Preferred Qualifications - Utilization Management experience preferred Education Associates Degree BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Case Manager Registered Nurse

$60,522 - $129,615 / hour

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This RN Case Manager position is 100% remote and candidates can apply from any state but must work the stated hours. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate overall wellness. RN Case Manager: – Collaboratively develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. – Through the use of clinical tools and information/data review (e.g., assessments, claims, etc.) conducts an evaluation of member’s needs and available benefits to collaborate and refer to programs offered by the plan sponsor. – Applies clinical judgment to reduce risk factors, address complex health issues and social indicators. – Utilizes case management processes in compliance with regulatory and company policies and procedures. – Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Required Qualifications: - Must have an active current and unrestricted RN license in state of residence. If located within the Nurse Licensure Compact jurisdiction, the ability to use their compact license without restriction - Willingness and ability to obtain additional state licenses upon hire (paid for by the company) - 3+ years of acute care clinical experience as an RN (general medical, post-surgical, specialty including pediatrics, ICU, case management and discharge planning) - Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time - A private designated workspace free of distractions and high-speed internet - Must be willing and able to work Monday through Friday between the hours of 8:30-5pm EST for a scheduled 8-hour shift. - Must be willing and able to work Weekends and holidays per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis. - Less than 5% travel may be required for on-site meetings, trainings, or system updates Preferred Qualifications: - Compact RN licensure - 1+ years of case management experience - Certified Case Manager (CCM) certification - Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues. - Experience with all types of Microsoft Office including PowerPoint, Excel, and Word - Strong telephonic communication skills - 1+ years of experience utilizing computers and navigating multiple monitors while speaking with someone on the telephone. Education: Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Contract

Illinois Licensed Registered Nurse Care Coach - Remote

CircleLink Health

This is a remote role. CircleLink Health is looking for passionate, tech savvy ILLINOIS registered nurses to work remotely and serve patients enrolled in Medicare’s Chronic Care Management Program. In this part time role (requires about 20 to 25 hours per week, depending on caseload), an RN Care Coach will be assigned a group of patients that they will be following and calling each month. In these monthly calls the Care Coach will provide education, coordinate care, close preventive care gaps, and coach on strategies for self-management to keep patients out of the hospital. This Role Requires Precision, Discipline, and Accountability The Care Manager role is not a step back from bedside nursing — it’s a step into a more complex, structured, and performance-driven environment. To succeed, you must bring more than clinical knowledge: ✅ Excellent documentation skills — Your charting must be complete, timely, and accurate. ✅ Strong time management — Case tasks must be prioritized and closed on schedule. ✅ Ownership of outcomes — Each case is closely tracked for quality, compliance, and effectiveness. Expectations are high, and performance is regularly reviewed. This is not a role where details can be missed or timelines pushed — we need professionals who take initiative, stay organized, and consistently deliver. If you’re ready for a challenging, fast-paced environment where your work is held to high standards and makes a real difference, we encourage you to apply. Key Responsibilities: Utilize our specialized care management software to call a full caseload of Medicare patients with two or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made Connect the patient with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc. Conduct Transitional Care Management activities to high-risk patients discharged from the hospital and the ER to reduce unnecessary readmissions. Close care gaps by encouraging preventive care measures, i.e. annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc. Fluent in English Self-directed, able to work independently with little supervision while meeting performance metrics Passion for nursing and improving patient outcomes Good with technology and eager to learn and use new software Excellent organizational and time management skills Strong communication and telephonic skills Strong critical thinking and problem-solving skills Education and Experience: Current, unrestricted Illinois RN license is required. Proficiency with EHRs (electronic health records) and web-based applications 3 or more years' experience as a Registered Nurse Preferred Education and Experience: Case Management or Chronic Disease Management experience preferred Certified Diabetes Educator desired, but not required Experience with Motivational Interviewing or other behavior change communication techniques is a plus. Scheduling and Other Requirements Must have a STRONG internet-connected computer. Equipment is NOT provided by the company. A minimum of 20 hours of day time availability per week is required. You will commit to your own schedule using our software. This is a 1099 contract position with no end date. Care Coaches are responsible for their own equipment, taxes and insurance. Compensation: Compensation is paid at the rate of $15.00 per initial clinical encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call and the patient has 20 minutes or more of time in their chart timer. Ex: If in one hour you called and spoke with 2 patients and spent 20 minutes with each of them, your pay for that hour would be $30.00 ($15.00/pt reached x 2). Pay Timing: *Your first check will be paid monthly via direct deposit, 40 days after the last day of the month of service. This is due to the time it takes Medicare to process reimbursements. All other checks after the first one will be deposited about 30 days after the last day of the month of service.* Fraud Alert: CircleLink Health has identified fraudulent emails sent from @joincirclelinkhealth.team, which is NOT affiliated with our company. Official CircleLink emails come only from @circlelinkhealth.com. Please report any suspicious messages to info@circlelinkhealth.com. About CircleLink Health: CircleLink Health is a company of passionate clinicians, technologists and businesspeople tackling the $600B problem of preventable chronic and post-acute complications. We’re building a world-class Care Management platform to enable providers while accelerating the shift to preventative care instead of status quo reactive care. Learn more about us here.

Care Manager, RN - Medicaid

Humana

$71,100 - $97,800 / year

Become a part of our caring community and help us put health first The Care Manager Nurse 2 works primarily in a telephonic environment. The nurse assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state. The nurse guides members/families toward and facilitates interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. You will report to the Manager, Care Management. Additionally, you will be in a field role and will require up to 25% travel visiting members or facilities within the state of South Carolina. The Care Manager Nurse 2 employs a variety of strategies and techniques to manage a member's physical, environmental and psycho-social health issues. Medicaid population experience preferred. Identify and resolve barriers that hinder care. Ensure patient is progressing towards desired outcomes by monitoring patient care through assessments and evaluations. Create member care plans. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Use your skills to make an impact Required Qualifications Unrestricted Current Licensed Registered Nurse (RN) in the state of South Carolina or a compact license with no active disciplinary action Must live in the state of South Carolina 3 or more years of clinical acute care experience 1 or more years case management, care coach, or care coordination Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook Preferred Qualifications Bachelor's degree Medicaid or Managed care experience Experience with case management, discharge planning and patient education for adult acute care Certified Case Manager (CCM) Additional Information Workstyle: Remote Work at Home with Field requirements Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Location: South Carolina Work Schedule: Monday - Friday; 8:00 AM - 5:00 PM Eastern Time Travel: 25% Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information TB This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Driving Statement: This role is part of our company's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. Medicaid Mileage Reimbursement We provide mileage reimbursement for work-related travel. Eligible mileage includes: Travel from your home to your first work location of the day. Travel between client or assignment locations during the workday. Travel from your final work location back to your home. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Mgr-RN, Clinical Documentation Improvement

SSM Health

It's more than a career, it's a calling. WI-REMOTE Worker Type: Regular Job Summary: Oversees and manages the daily operations and activities of the regional Clinical Documentation Improvement (CDI) program. Promotes consistent and standardized operations and documentation across the network. Builds and maintains productive inter/intra departmental and vendor work relationships to optimize operations. Job Responsibilities and Requirements: PRIMARY RESPONSIBILITIES Manages the daily operations and resources of assigned Clinical Documentation Improvement (CDI) team, including the development and monitoring of strategic operating goals, objectives, and data analysis; and report operational performance, justification, and/or corrective action. Provides on-going support of CDI with extensive collaboration with physicians, nursing, coding, quality, and leadership. Facilitates improvements to clinical documentation through chart review and educational training sessions (with CDI Educator), which could be performed onsite, with physicians and/or other clinical professionals. Initiates corrective actions to resolve any problem areas identified between CDI and any other areas of the organization. Collaborates with CDI educator for regional education. Provides ongoing clinical documentation management program education for new staff, including new clinical documentation registered nurses, physicians, nurses, and allied health professionals. Participates in the direction and education of all phases of the clinical documentation process. Supports and implements technologies designed to improve and/or ensure the accurate depiction of clinical services, patient’s severity of illness, and risk of mortality. Conducts audits on CDI reviews against quality, coding, and mortality. Provides feedback to staff and CDI educator and director. Reports monthly CDI metrics regarding KPIs and staff productivity. Strengthens technical coding practices and clinician documentation by reviewing patient records with flagged complications to ensure coding accurately reflects the patient’s clinical course and complexity to validate accurate risk-adjustment for administrative metrics used in government incentive/penalty programs. Collaborates with interdisciplinary teams including physicians, nurse practitioners, physicians assistants, and the department managers for revenue integrity, coding and data quality, case management and health information management. Demonstrate leadership and management skills to promote effective and efficient review of physician documentation and the medical record. Communicates with assigned regional/ministry physician leaders. Participates in monthly medical management meetings to report CDI metrics and act as subject matter expert for inquiries. Recruits, engages, develops, leads, and manages assigned staff. Performs other duties as assigned. EDUCATION Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE Two years' acute hospital experience or surgical area as a clinical nurse Three years' clinical documentation specialist Two years' demonstrated progressive leadership experience PHYSICAL REQUIREMENTS Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc. Frequent keyboard use/data entry. Occasional bending, stooping, kneeling, squatting, twisting and gripping. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Rare climbing. REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Missouri Division of Professional Registration State of Work Location: Oklahoma Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services Work Shift: Day Shift (United States of America) Job Type: Employee Department: 8746010033 Sys Clinical Documentation Improvement Scheduled Weekly Hours: 40 Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. Upfront Tuition Coverage : we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status , or any other characteristic protected by applicable law. Click here to learn more.

Acute Care Pediatric Registered Nurse

Imagine Pediatrics

$44 - $48 / hour

Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this remote in Tennessee. The schedule for this role is 3x12s, 12-hour shifts (5:00am-5:00pm, 7:00am-7:00pm, 11:00am-11:00pm, and 7:00pm-7:00am). What You'll Do: As an Acute Care Registered Nurse on Imagine’s acute care team, you will be part of a team that is focused on delivering acute virtual care to patients in markets nationwide. In the role of an Acute Care Registered Nurse, you will: Provide professional and friendly proactive care for our patients. Utilize standard triage protocols to accurately assess and provide a disposition for clinical issues using our platform. Perform virtual nursing assessments as needed Embed a family centered care philosophy in care delivery. Demonstrate knowledge and expertise in nursing assessment and triage. Recognize and collaborate with acute care providers, patient and family in planning and implementing care. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Perform other duties as needed. How You Qualify & What You Bring: First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need: Graduate with a bachelor's in nursing from an accredited university required Multistate Compact Licensed RN required 4+ year's experience in pediatric nursing required 1-2 years' experience in a Pediatric ED/Urgent Care required Virtual care experience preferred What We Offer (Benefits + Perks) The hourly rate for this position ranges from $44-48 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We’re guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Acute Care Pediatric Registered Nurse

Imagine Pediatrics

$44 - $48 / hour

Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this remote in New Jersey. The schedule for this role is 3x12s, 12-hour shifts (5:00am-5:00pm, 7:00am-7:00pm, 11:00am-11:00pm, and 7:00pm-7:00am). What You'll Do: As an Acute Care Registered Nurse on Imagine’s acute care team, you will be part of a team that is focused on delivering acute virtual care to patients in markets nationwide. In the role of an Acute Care Registered Nurse, you will: Provide professional and friendly proactive care for our patients. Utilize standard triage protocols to accurately assess and provide a disposition for clinical issues using our platform. Perform virtual nursing assessments as needed Embed a family centered care philosophy in care delivery. Demonstrate knowledge and expertise in nursing assessment and triage. Recognize and collaborate with acute care providers, patient and family in planning and implementing care. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Perform other duties as needed. How You Qualify & What You Bring: First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need: Graduate with a bachelor's in nursing from an accredited university required Multistate Compact Licensed RN required 4+ year's experience in pediatric nursing required 1-2 years' experience in a Pediatric ED/Urgent Care required Virtual care experience preferred What We Offer (Benefits + Perks) The hourly rate for this position ranges from $44-48 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We’re guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Clinical Review Nurse - Concurrent Review (RN)

Centene

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required For Health Net of California: RN license required RN - Registered Nurse - State Licensure and/or Compact State Licensure For State of Nevada required *Must be licensed in Nevada. Location: Position is remote. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Utilization Management Nurse Consultant