RN Telehealth
L.A. Care Health Plan

Clinical Policy Clinical Coder RN II

L.A. Care Health Plan Los Angeles, CA
$102,183 - $163,492 / year
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Clinical Policy Clinical Coder RN II is responsible for analyzing, interpreting, and operationalizing medical and utilization management policies to ensure accurate coding, appropriate authorization requirements, compliant claims processing, and effective utilization oversight. This position serves as a key clinical and coding resource, translating medical policy requirements into diagnosis, procedure, and service code logic, including determining which codes require prior authorization. Conducts in-depth research and analysis of legislation and regulatory requirements, clinical outcomes, utilization, claims, and financial data to identify utilization trends, fiscal risk, and opportunities for policy enhancement and cost containment. This position works cross-functionally with internal teams to ensure policies are codified, consistently applied, and monitored through reporting and data analysis. This position collaborates closely with internal stakeholders and external entities to support standardized benefit administration, effective program implementation, and organizational compliance with state, federal, and accreditation requirements. Duties Translate approved clinical policies and utilization management criteria into clear, codified claims rules and system logic to support accurate claims adjudication. Develop, revise, and recommend clinical policies and internal utilization management criteria when standard clinical guidelines are insufficient to support appropriate decision-making based on codified claim rules. Assess the downstream claims impact of new or revised clinical policies prior to implementation and recommend configuration updates to mitigate operational or financial risk. Participate in validation of claims configuration changes to ensure policies are applied correctly and consistently across all lines of business. Monitor post-implementation claims activity to identify configuration issues, unintended denials, or payment discrepancies related to clinical policy application. Support remediation of claims configuration defects by identifying root causes and coordinating corrective actions with internal teams. Participate in and lead specialty and cross-functional workgroups and committees focused on healthcare services clinical policies, utilization management processes, strategic initiatives, policy governance, operational alignment, and continuous improvement efforts. Ensure timely dissemination of accurate and consistent policies and procedures across departments. Promote collaboration, engagement, and a positive work environment while supporting departmental initiatives and team-based activities. Manage assigned projects from concept through implementation, ensuring timelines, quality standards, and deliverables are met. Analyze and interpret medical and utilization management policies to identify applicable diagnosis, procedure, and service codes and determine authorization, pre-payment, or post-payment review requirements. Define and maintain code lists that require prior authorization or other utilization management controls based on clinical evidence, regulatory guidance, utilization trends, and financial risk.Duties Continued Collaborate with internal teams to ensure authorization requirements and coding logic are accurately configured in authorization and claims systems based on authorization matrix requirements. Support accurate claims processing by validating codified authorization and policy requirements are correctly applied and aligned with approved medical policies. Provide clinical and coding recommendations to support the development, revision, and implementation of new or updated medical and utilization management policies. Investigate and resolve coding and authorization related issues, including claim denials, coding edits, authorization discrepancies, and policy interpretation questions. Review and assess claims edits, authorization matrixes, and coding rules to identify root causes of errors or inconsistencies and recommend corrective actions. Ensure coding, authorization requirements, and claims-related guidance align with medical necessity criteria, benefit structures, and applicable state, federal, and regulatory requirements. Develop, review, and maintain reporting related to authorization required codes, approval and denial rates, utilization patterns, claims payment outcomes, and policy effectiveness. Prepare reports, summaries, and presentations and communicate findings, recommendations, and action plans to internal and external stakeholders. Analyze claims, authorization, and utilization data to identify trends, measure policy impact, and recommend opportunities for policy refinement, cost containment, or reduction of administrative burden. Monitor post-implementation performance of authorization-required codes and recommend additions, removals, or modifications to authorization requirements based on regulatory thresholds and utilization outcomes. Perform other duties as assigned.Education Required Associate's Degree in NursingEducation Preferred Bachelor's Degree in NursingExperience Required: At least 8 years of experience in Clinical Nursing. At least 3 years of experience with Medi-Cal and Medicare in a managed care environment. Experience in performing and creating clinical documentation. Experience in regulatory compliance for a health plan. Experience with medical coding systems. Preferred: At least 1 year of experience in editing and writing clinical health services policies within a managed care health plan. Skills Required: Proficient with clinical policy through skills in literature searching and clinical research analysis based on the best available evidence. Working knowledge of clinical policies. Working knowledge of CPT/HCPC codes and claims. Ability to translate regulatory requirements into auditable tools. Ability to perform independent research on complex medical topics. Excellent verbal and written communication skills. Strong analytical, problem solving, and team building skills. Ability to work independently with strong self-direction. Advanced proficiency in Microsoft Word, Excel, and PDF documentation tools. Ability to work effectively with diverse teams in cross-functional work groups. Ability to multitask, re-prioritize tasking, and streamline day-to-day operations. Ability to identify discrepancies, assess risk, and recommend actionable solutions. Knowledge of medical coding systems, including ICD-10-CM, CPT, and HCPCS, and their application in authorization and claims environments. Strong organizational and time-management skills. Preferred: Advanced skills in assessing clinical policy deficiencies through literature searching and clinical research analysis based on the best available evidence. Proficient in claims configuration, including claims adjudication workflows, configuration of claims edits and rules, and the translation of clinical and utilization management policies into system-based claims logic to support accurate, compliant payment outcomes. Understanding of the managed care industry and market conditions.Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California LicenseLicenses/Certifications Preferred Certified Professional Coder (CPC)Required Training Physical Requirements LightAdditional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)
RN Telehealth Full-time
Methodist Healthcare System

Registered Nurse RN Surgical Tele

Methodist Healthcare System Shavano Park, TX
Introduction Do you have the career opportunities as a Registered Nurse RN Surgical Tele you want in your current role? We invest in what matters most to nurses like you – at home, at work, and at every stage in your career. We have an exciting opportunity for you to join Methodist Hospital Landmark which is a part of the nation’s leading provider of healthcare services, HCA Healthcare. Do you want to work where you have a voice? Nurses are at the forefront of our commitment to the care and improvement of human life. At HCA Healthcare, there are many ways for nurses to have a voice through professional practice councils, advisory councils, vital voices surveys, and units of distinction. We learn from our multi-generational nursing family. We partner with our Nurses at Methodist Hospital Landmark! Job Summary and Qualifications As a Registered Nurse, you will be responsible for delivering high-quality, patient-centered care in line with the requirements of the department and the standards of practice for the relevant state and specialty. Collaborating with medical providers and the care team, you will provide personalized, comprehensive, and compassionate care, following established nursing models such as "Assess, Perform, Teach, and Manage." You will also act as an advocate for patients, families, and caregivers, embodying the organizations vision, mission, and values to ensure an outstanding patient experience and positive clinical outcomes. What you will do in this role: Assess the patients condition during admission and each scheduled shift, promptly identifying and reporting any changes in patient status. Perform procedures, monitoring, or other functions as ordered by the medical provider(s), and ensure thorough and timely documentation of care administration in the patients medical record. - Administer prescribed medications, monitor the patient for therapeutic response, and take appropriate action in the event of an unintended response to the medication. Provide exceptional care by responding promptly to patient requests, proactively anticipating patient needs, and resolving them. Educate patients, families, and caregivers about the patients medical condition, treatment plan, medications, possible side effects, and follow-up measures, ensuring complete understanding by translating complex medical terminology. What qualifications you will need: Basic Cardiac Life Support must be obtained within 30 days of employment start date (RN) Registered Nurse Associate Degree, or Bachelors Degree, or Registered Nurse Diploma Benefits Methodist Hospital Landmark, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services Wellbeing support, including free counseling and referral services Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence Savings and retirement resources , including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. "Nurses play a pivotal role and are the backbone of healthcare delivery. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing." Sammie Mosier, DHA, MA, BSN, NE-BC Senior Vice President and Chief Nursing Executive, HCA Healthcare Methodist Hospital | Landmark allows Methodist Healthcare to expand its surgery services into a rapidly growing area of San Antonio in the Northwest in a way that’s never been done before. The facility provides the most unique and personalized patient and physician healthcare experience in the region. With 54 beds, 12 ORs, 27 private patient rooms and eight VIP rooms with private nurse stations, Methodist Hospital | Landmark delivers a true concierge experience. With convenience and access in mind, this hospital offers a four-story parking garage, an on-site Starbucks, and beautiful aesthetics, creating a space that truly allows patients to heal faster. Methodist Surgery Center | Landmark is part of the campus to serve the growing outpatient surgery needs in the community. It is part of a 72,000+ square foot Medical Office Building that also houses a South Texas Radiology Imaging Center (STRIC). If this opportunity is your next step in your career path, we encourage you to apply for our Registered Nurse RN Surgical Tele opening. We review all applications. Qualified candidates will be contacted by a member of our team. We are interviewing apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
RN Telehealth Part-time
St. Luke's University Health Network

Clinical Triage Specialist RN, Eves, Nights, Weekends - PA/NJ residents only

St. Luke's University Health Network Allentown, PA
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Clinical Triage Specialist (CTS) (RN) - Access Center will compassionately deliver an exceptional patient experience and provide clinical support to CTS-MA team members by serving as a clinical resource. The CTS-RN is responsible for using nursing judgment in answering/returning patient calls related to direct care provided by the practices. When appropriate, the caller’s symptoms will be assessed and triaged using approved nursing protocols and guidelines to assist in obtaining the appropriate level of care and/or self-care advice. JOB DUTIES AND RESPONSIBILITIES: Answers telephones, prioritizes clinical triage calls, follows clinical protocols, and coordinates services, as needed. Verifies patient demographic information and accurately enters the updated information into electronic health record. Serves as an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. Manages and responds to escalated electronic patient messages whenever not answering inbound patient calls and uses clinical judgment to prioritize and accommodate patients. Creates a positive patient experience at every encounter, attempting to independently resolve any issues or concerns of the patient at the time of the phone call, within the scope of the role. Consistently meets productivity, schedule adherence, and quality standards as set by the Access Center. Utilizes all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule appointments, or refer calls when necessary to the appropriate medical facility or personnel. Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. Partners with other Access Center teams/PODs and respective practice clinical team on behalf of the patient to assist with clinical concerns, medication refills, or scheduling appointments. Other duties as assigned. EDUCATION: Graduate of an accredited nursing program. Active Registered Nurse licensure in the state of Pennsylvania and New Jersey or other nursing compact state and other states as deemed necessary by state law. TRAINING AND EXPERIENCE: Minimum 2 years recent clinical experience in a physician office, home health, critical care and/or emergency room is required. Strong communication skills Focused on compliance Demonstrates continuous growth Quality-driven Service-oriented Excels at time management Strong problem-solving skills Ability to work from home in accordance with the Network Work from Home Policy if needed. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
RN Telehealth Full-time
AccentCare, Inc.

Call Center Triage Nurse (NE)

AccentCare, Inc. Houston, TX
$35 / hour
Overview Compensation: $35.00/hour with $2.00 shift differential for weekend Position: Call Center Triage RN Remote Position: Yes Schedule: Saturday and Sunday -9:00 AM to 9:30 PM CST 2 weekdays - 3:30 PM CST to Midnight CST Reimagine Your Career in Corporate Healthcare As a professional, you know that what you do impacts you as much as our patients and their families, and at AccentCare, we are united in our relentless drive to reimagine care because we want to provide the service we would seek for our own families. We think it’s really special to be a part of our patient’s health journey and create incredible memories while providing world-class patient care. Offer Based on Years of Experience What You Need to Know Our Investment in You We are committed to offering comprehensive benefits and rewards to full-time employees who work over 30 hours per week and their families, including: Medical, dental, and vision coverage Paid time off and paid holidays Professional development Company-matching 401(k) Flexible spending and health savings accounts Company store credit for your first AccentCare-branded scrubs for patient-facing employees Why AccentCare? Be the Best Call Center Triage Nurse - Registered Nurse / RN You Can Be If you meet these qualifications, we want to meet you! Excellent customer service, assessment, and verbal communication skills Computer skills Required Certifications and Licensures: Licensed to practice as a registered nurse in the state of agency operation Come As You Are At AccentCare, our care is most compassionate when we empathize and engage with everyone, and we are at our best when we value diverse perspectives, foster open dialogue, and enact change. And we are stronger when each of us is empowered to grow, be our unique selves, and feel a sense of inclusion and belonging. AccentCare is proud of how we are building a culture and inclusive infrastructure to help elevate the voice of all our employees with a special focus on the underrepresented and marginalized. We offer equal employment opportunities regardless of a person’s race, ethnicity, sex, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental disability, physical disability, or any other protected classification.
RN Telehealth Full-time
UMass Memorial Health

Registered Nurse, Hospital at Home, 36 Hours, Nights

UMass Memorial Health Franklin Plantation, MA
$37.51 - $81.95 / hour
Are you a current UMass Memorial Health caregiver? Apply now through Workday. Exemption Status: Non-Exempt Hiring Range: $37.51 - $81.95 Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations . Schedule Details: Holidays - Every Third Holiday, Sunday through Saturday, Weekends - Every Third Weekend Scheduled Hours: 7PM-7:30AM Shift: 3 - Night Shift, 12 Hours (United States of America) Hours: 36 Cost Center: 10020 - 6614 Hospital At Home Union: MNA-Memorial/Hahnemann This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Responsible for the planning, coordinating, delivering and management of direct patient care utilizing the nursing process and adhering to the standards of nursing practice while delivering optimal family-centered patient care. Manages and directs day-to-day work responsibilities for the Hospital at Home program to assure optimal patient flow and satisfaction. I. Major Responsibilities: 1. Utilizes the Nursing Process for the delivery and management of patient’s care from Admission to Discharge, appropriate to the developmental age of the patient population. 2. Performs patient assessment/reassessment according to standard procedure. 3. Develops and coordinates individual plan of care including discharge planning. Develops, implements/coordinates and documents Education Plan for patient/family/ significant other. 4. Directs, supervises, coordinates and evaluate nursing care within assigned clinical setting. 5. Delegates appropriately to others in accordance with job description and competency level. Standard Staffing Level Responsibilities: 1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Participates in performance improvement initiatives and demonstrates use of Quality Improvement in daily operations. 4. Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc. Develops and maintains procedures necessary to meet regulatory requirements. 5. Complies with all health and safety regulations and requirements. 6. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 7. Develops and maintains established departmental policies, procedures, and objectives. 8. Ensures that department complies with hospital established policies, quality assurance programs, safety, and infection control policies and procedures. 9. Maintains open lines of communication with Program leadership, other departments, staff, physicians, resident staff, and other support personnel. 10. Maintains, regular, reliable, and predictable attendance. 11. Performs other similar and related duties as required or directed. All responsibilities are essential job functions. II. Position Qualifications: License/Certification/Education: Required: 1. Current Massachusetts Nursing licensure and registration. 2. Current unrestricted Driver’s license. 3. BLS is a requirement for every RN unless an advance certification is current (ex ACLS, PALS, NRP). In addition, unit specific certification and competencies are defined in the Unit Profile. Preferred: 1. Bachelor of Science degree in Nursing. Experience/Skills: Required: 1. Minimum 5 year’s Nursing experience. 2. Thorough knowledge of the discipline of Nursing. Preferred: 1. Homecare or Telehealth experience. 2. Phlebotomy, IV insertion and telemetry experience. Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements. Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents. III. Physical Demands and Environmental Conditions: Work is considered heavy. Position requires travel from operations center to local hospitals and patient residences with primary work being indoors in an alternative patient care environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day. As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law. If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.
RN Telehealth Full-time
United Energy Workers Healthcare

REMOTE Nurse Navigator HME

United Energy Workers Healthcare Salt Lake City, UT
$83,000 - $93,600 / year
Overview: We are a compassionate company driven by a personal commitment to exceptional care. Founded by the grandchildren of a former Department of Energy worker, we elevate the lives of energy workers with unwavering compassion and whole-person care. Our mission is guided by our founders' deep commitment to high-quality care under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). With over 14 years of experience and operations across 24 states, we strive to make a meaningful difference in the lives of energy workers and their families. We are seeking a skilled Nurse Navigator HME to join our durable medical services team. This role is crucial in assessing patient needs, coordinating care, and ensuring effective communication among all parties involved in patient care. The Nurse Navigator HME (“Home Medical Equipment”) is responsible for coordinating, reviewing, and managing the authorization and delivery of durable medical equipment (“DME”) for patients based on their clinical needs. Utilizing advanced clinical knowledge and nursing judgment, this role ensures that requested medical equipment aligns with clinical necessity, regulatory guidelines, and patient care plans. The Nurse Navigator HME serves as a critical liaison between physicians, patients, families, and equipment vendors to optimize patient independence and safety at home. This position typically reports to a Director or above Director of HME Operations. Responsibilities: Essential Duties and Responsibilities · Clinical Review & Utilization Management: Evaluate medical records, physician prescriptions, and clinical documentation to determine the medical necessity of complex DME requests. · Patient & Caregiver Education: Assess patient and family understanding of equipment operation, safety protocols, and maintenance, providing virtual or telephonic clinical guidance as needed. · Interdisciplinary Collaboration: Partner with physicians and home healthcare agencies’ case managers to modify care plans and troubleshoot barriers to equipment acquisition. · Compliance & Quality Assurance: Ensure compliance with HIPAA, EEOICPA, and Company standards and policies. · Documentation: Maintain compliant electronic health records detailing clinical justifications that are in-line with patient care plans. Qualifications: What We’re Looking For Current RN License : Valid and active Registered Nurse license in good standing. · Education: Graduate of an accredited School of Nursing. · Licensure: Active, unrestricted Registered Nurse (RN) license in the state of practice or RN compact license. · Experience: Minimum of 2–3 years of clinical nursing experience. Prior experience in home health, utilization review, case management, or a DME environment is highly preferred. Pay Range: USD $83,000.00 - USD $93,600.00 /Yr.
RN Telehealth Full-time
Blue Ridge Care

RN Nurse Navigator

Blue Ridge Care Winchester, VA
$10,000 Sign-On Bonus – Join Blue Ridge Care Today! Your neighbors need you. Your nursing skills can change lives. Join Blue Ridge Care and become a Future Maker—where your compassion and clinical expertise help patients confidently manage complex chronic conditions and improve their quality of life every day. Our mission is simple yet powerful: “Delivering extraordinary care to improve life’s journey.” As a mission-driven, not-for-profit healthcare system, we provide integrated services in hospice, serious illness care, PACE, community thrift shops, and grief support—serving our community with heart, hope, and respect. About the Role We’re seeking a compassionate Registered Nurse (RN) to serve as a Nurse Navigator – Principal Care Management (PCM). In this role, you will provide comprehensive, patient-centered care coordination for individuals living with a high-risk, complex chronic condition requiring intensive clinical oversight. As the primary clinical contact for enrolled patients, you’ll create proactive, personalized care plans that improve outcomes, reduce fragmentation of care, and empower patients to better manage their health. You’ll collaborate closely with providers and interdisciplinary partners to ensure care is coordinated, compliant, and meaningful. How You’ll Make a Difference Identify and enroll eligible patients into the PCM program and complete comprehensive initial assessments. Develop individualized, disease-specific care plans aligned with clinical guidelines and patient goals. Conduct monthly PCM interactions with accurate CMS-compliant time tracking and documentation. Monitor symptoms, treatment adherence, labs, and clinical changes—intervening early to prevent deterioration. Provide medication education, lifestyle coaching, and motivational support to improve self-management. Coordinate referrals, diagnostic testing, follow-up visits, and interdisciplinary communication. Address barriers to care including transportation, social determinants of health, and financial concerns. Track outcomes, engagement, and quality metrics to continuously improve chronic condition management. Participate in periodic call rotation and collaborate in quality improvement initiatives. What You’ll Bring Current Registered Nurse (RN) license. Minimum 2–3 years of clinical nursing experience (chronic disease management preferred—cardiology, pulmonology, endocrinology, rheumatology, or similar specialties). Strong knowledge of chronic condition management and patient coaching strategies. Experience with care coordination and EMR documentation. Bachelor of Science in Nursing (BSN) preferred. Prior experience in Principal Care Management (PCM), Chronic Care Management (CCM), Case Management, or Population Health preferred. Certification in care coordination or chronic disease management (e.g., RN-BC in Care Coordination & Transition Management) preferred. Strong clinical judgment, organizational skills, and the ability to build meaningful relationships with patients and providers. A proactive, compassionate spirit ready to serve your community and improve life’s journey.
RN Telehealth Full-time
MedStar Health

Clinical Informatics Nurse Specialist (RN)

MedStar Health Leonardtown, MD
$89,065 - $162,801 / year
About this Job: General Summary of Position The Clinical Informatics Nurse Specialist functions as the clinical expert consultant leader researcher and educator for clinical information and communication systems. Reviews recommends designs develops implements maintains supports optimizes and evaluates clinical information and communication systems in collaboration with an interdisciplinary team of health care team members information services vendors and other informatics professionals. Leads and manages initiatives and projects for the introduction and optimization of clinical information and communication systems. Provides oversight and leadership of clinical information system downtime and emergency preparation and support. Provides clinical data stewardship analysis and visualization creation. Liaises between teams clinicians leadership and IS regarding clinical information and communication systems. Leads initiatives in the field in respect to research innovation and professional development. Primary Duties and Responsibilities Provides oversight and participates in the system development life cycle (SDLC) for clinical information systems and clinical communication systems in collaboration with key stakeholders: project planning workflow assessment systems analysis/requirements gathering design development testing implementation evaluation and maintenance. Identifies opportunities for optimization of clinical system functionality and adoption and clinical workflows and how clinical information or communication systems could provide improvement. Collaborates with other resources to develop and implement educational content related to clinical information and communication systems use at system implementation user onboarding and on an ongoing basis. Supports of end users of clinical information and communication systems during systems implementation and throughout the life cycle of the system including elbow support troubleshooting optimization change management. Evaluates factors and develops solutions related to safety effectiveness cost clinical quality and regulatory compliance when developing and implementing clinical information systems. Participates in MedStar Health projects for the selection of enterprise clinical information and communication systems including the evaluation of vendor product presentations and demonstrations. Participates in the design validation implementation and optimization of data sets visualizations and reports for their constituents. Promotes the integrity of the nursing data collected retrieved and disseminated from clinical information systems. Acts as a change agent anticipates the future needs of clinicians and innovates in the best interest of their clinicians and patients and assisting others in understanding the importance necessity impact and process of change. Liaises between groups where constituents data and technology interface. Contributes to the clinical nursing informatics body of knowledge by disseminating best practices through conference presentations posters and publication. Maintains and advances knowledge and skills in nursing informatics through continuing education and/or advanced education. Provides consultation in the field of nursing informatics by participating on nursing and nursing informatics councils at the local or system level and on hospital and relevant MedStar Health committees. Collaborates with clinical practice and learning/education experts to ensure clinical information systems support evidence-based practice and MedStar's clinical practice guidelines. Adheres to the State Nursing Practice Act regulatory ethical and accreditation standards and organizational/departmental policies and procedures. Upholds MedStar's SPIRIT Values and Code of Conduct. Minimal Qualifications Education Associate's degree in Nursing required or Bachelor's degree in Nursing required or Master's degree in Nursing Informatics Computer Science or related field required Experience 3-4 years of clinical nursing practice experience including in leadership roles required Experience in the development and evaluation of clinical applications tools processes and structures that assist healthcare providers with the capture and management of clinical data in delivering care to patients required Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure in Maryland required ANCC Informatics Nursing Certification or specialty certification in informatics within 2 years required Knowledge Skills and Abilities Advanced knowledge and skills in the science of informatics attained through job experience advanced education or certification. Working knowledge in adapting or customizing existing information technology and clinical software. Ability to prioritize manage and implement complex projects with strong analytical ability to solve complex clinical workflow problems. Demonstrates the use of evidence-based practice using analytical methods statistics and decision support tools in support of clinical practice. Ability to prioritize activities relative to goals and time frames managing multiple levels of deliverables. Ability to communicate goals and priorities within a complex clinical/technical environment and to work effectively with a variety of groups and multidisciplinary teams. Demonstrated ability to present data and information to multiple levels of the organization and educate staff in the use and application of clinical information systems and point of care technologies. This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.
RN Manager/Supervisor Telehealth Full-time
St. Luke's University Health Network

Supervisor, Clinical Triage (RN) - Neuroscience (PA & NJ Residents Only)

St. Luke's University Health Network Allentown, PA
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Supervisor, Clinical Triage (RN) is responsible for successfully managing a team of Clinical Triage Specialists (CTSs) and Patient Engagement Partners (PEPs) to deliver an exceptional patient experience in an afterhours setting. The Supervisor will ensure patients receive appropriate clinical triage advice using approved protocols and guidance. This role will also perform mentoring and leadership support to the team such as providing performance feedback, resolving queries, and day-to-day training. JOB DUTIES AND RESPONSIBILITIES: Oversees a team of Patient Engagement Partners (PEPs) and Clinical Triage Specialists-RN which serves as a resource and Subject Matter Expert (SME) for other team members and internal customers. Researches complex issues and works with support resources to resolve patient issues and/or partners with others to resolve escalated issues. Effectively collaborates and maintains close relations with Medication Management Supervisors to ensure an appropriate streamlined process remains in place for responding to clinical patient messages. Serves as an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. Monitors productivity, clinical protocol adherence, and quality standards and proactively works to achieve defined service levels. Monitors activity, performance and call quality to facilitate recognition, coaching/feedback, and escalation of variances to Manager, Connect to Care-Access Center. Collaborates with Manager, Connect to Care – Access Center and Workforce Management Analyst to effectively plan, optimize staffing and flex daily staffing, and monitor supply and demand in order to maintain service levels. Ensures PEPs and CTSs are properly equipped with necessary technology, resources, and tools required to address patient inquiries and/or triage patients and address clinical patient messages efficiently. Provides clinical leadership to CTSs; regularly provides coaching and feedback to their team members for ongoing improvement and fosters a culture of collaboration and inclusivity. Analyzes current procedures, bringing suggestions for improvement to the attention of the Manager, Connect to Care-Access Center. Collaborates with practices and PODs to maintain connection with the while serving as a point of contact for specialty team matters. Other related duties as assigned. PHYSICAL AND SENSORY REQUIREMENTS: Requires sitting for extended periods of time (up to 8 hours at time). Requires continual use of fingers, writing and computer entry. Requires ability to hear normal conversation and good general near and peripheral vision. EDUCATION: Required: Graduate of an accredited nursing program. Active Pennsylvania Nursing License. Active New Jersey Nursing License or ability to obtain within 90 days. Preferred: Bachelor’s degree in Nursing. TRAINING AND EXPERIENCE: Minimum 3+ years recent clinical experience in a physician office, home health, critical care and/or emergency room required. Electronic Medical Record system experience required. Epic experience preferred. Previous contact center experience preferred. Previous management experience preferred. Strong business acumen. Skilled in all forms of communication. Effectively able to develop self and others. Leadership presence/EQ, presents as a composed and competent leader. Quality focused. Exudes patient and customer service focus. Ability to work from home in accordance with the Network Work from Home Policy if needed. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
RN Telehealth Full-time
CVS Health

Case Manager - Registered Nurse - Southeast Region

CVS Health
$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 Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. 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/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. Required Qualifications Candidates must live in the Southeast Region (States Include- FL, GA, AL, MS, NC, SC, TN, AR, LA) Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence 3+ years clinical practical experience with preference in the following areas: diabetes, Congestive Heart Failure (CHF), Chronic Kidney Disease (CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members 2+ years case management, discharge planning and/or home health care coordination experience 2+ years of experience with Microsoft Word, Excel, and Outlook Preferred Qualifications Previous work from home experience in a healthcare related field Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills Ability to work independently Certified Case Manager National professional certification (CRC, CDMS, CRRN, COHN, or CCM) Efficient and effective computer skills including navigating multiple systems and keyboarding Education Associate's Degree in Nursing or Nursing Diploma (REQUIRED) Bachelor's Degree in Nursing (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 07/16/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Part-time
St. Luke's University Health Network

Weekend Registered Nurse, Virtual Nursing, Part Time

St. Luke's University Health Network Allentown, PA
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Registered Nurse, Virtual Nursing who partners with bedside caregivers to provide technology-enabled clinical support across the inpatient care setting. Through the use of virtual care technology, enhances patient education, care coordination, patient safety, and clinical workflow efficiency while allowing bedside nurses to focus on direct patient care activities. JOB DUTIES AND RESPONSIBILITIES: Completes assigned virtual nursing activities, including patient education, documentation, and care coordination. Assists with care progression, discharge readiness, and escalation of patient care concerns. Supports evidence-based care delivery and continuity of care. Conducts virtual patient interactions and promotes patient and family engagement. Reinforces plans of care, discharge instructions, and medication education. Supports patient safety initiatives and escalates concerns to the appropriate care team members. Partners with bedside nurses, providers, care management, and interdisciplinary team members. Maintains timely communication to support high-quality patient care. Serves as a resource for virtual nursing workflows and patient education. Utilizes virtual care platforms, Epic, and communication technologies to support clinical workflows. Maintains confidentiality of all materials handled within the Network/ Entity as well as the proper release of information. Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements. Demonstrates/models the Network’s Service Excellence Standards of Performance in interactions with all customers (internal and external). Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety. Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes and practices. Complies with Network and departmental policies regarding attendance and dress code. Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated. PHYSICAL AND SENSORY REQUIREMENTS: Ability to sit for extended periods while utilizing multiple computer monitors and communication platforms. Visual and auditory ability sufficient to monitor patient interactions and clinical information. Ability to communicate effectively through video, telephone, and electronic communication systems. EDUCATION: Graduate of an accredited School of Nursing. BSN preferred. TRAINING AND EXPERIENCE: Current Registered Nurse license in PA and NJ and/or Multistate Nursing license. BLS certification required. Clinical nursing experience preferred. Experience with Epic and virtual care technologies preferred. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
RN Manager/Supervisor Telehealth
Detroit Medical Center

Charge Nurse (RN) - Neuro Tele

Detroit Medical Center Goodyear, AZ
Overview Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters! At Abrazo West Campus, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include: Medical, dental, vision, and life insurance 401(k) retirement savings plan with employer match Generous paid time off Career development and continuing education opportunities Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance Note : Eligibility for benefits may vary by location and is determined by employment status Job Summary Sign-on Bonus: Up to $15,000 Bonus Based on Eligibility Job Summary Coordinates functions and activities related to a single departmental function. Position is responsible for a clinic unit. Position coordinates the scheduling efforts of the unit RN's. Acts as liaison person to internal and external customers (i.e., pre-hospital providers, medical and nursing staff, hospital administration). Responsible for developing and implementing plans/processes for meeting regulatory requirements. Trains and mentors staff. Responsibilities Patient Care: Provides patient care according to designated standards and practices. Assists in ongoing monitoring and evaluation of the appropriateness and effectiveness of patient care. Makes assignments, delegates and supervises care provided by other RNs, LPNs and CNAs by matching patient care needs with resources and competencies. Employee Development and Management: Responsible for day to day staffing and making appropriate decision based on patient needs and skill level of caregiver. Assist with the orientation process for new team members in collaboration with nursing management, RN staff, and other team members. Schedules the department's day to day activies i.e. breaks, sending people home, etc. Coordinates and participates in assuring completion of the orientation competency checklist for new hires and annual competencies for all employees. Customer Service Interacts with customers to assure professional conduct of staff. Establishes a mechanism to track customer service performance and takes corrective action to address any issues. Other related job tasks or responsibilities as assigned Qualifications Special Skills: Effective interpersonal and communication skills. Ability to effectively implement change and assist with the management of departmental budget. Must be able to independently make decisions in high-stress situations. Minimum Requirements: Education: Nursing Degree from an accredited nursing school L&D only: Advanced Fetal Monitoring or must obtain within six months of hire. updated 12/09/09. Experience: Two years relevant clinical nursing experience Level II EQ Only: A minimum of two years of current Level III NICU experience including neonatal ventilator. License/Certifications: License to practice as a Registered Nurse in the State of Arizona. CPR. ACLS as applicable by Facility/by Department ER, ICU, Endoscopy, Tele, Cardiac Cath Lab, L&D: ACLS required upon orientation completion. ER: PALS or ENPC required or must obtain within ninety days Post-partum, Nursery, L&D: NRP required upon orientation completion. Bariatrics: Certification or specialized training in bariatrics specialty area of practice. Wound Care: Wound-Ostomy Certification or Training in Wound Care and/or Ostomy Care. Preferred Requirements: BSN Management experience with two years supervisory. Certification in specialty area of practice preferred. License/Certification: PACU: ACLS required or must obtain within six months of hire, PALS preferred. ACLS. #LI-AL2 Organization Description Abrazo West Campus is recognized for providing exceptional, comprehensive care to patients in West Valley communities. The 200-bed acute care hospital offers advanced services, including the da Vinci Xi surgical platform, Level I Trauma Center, Loop-X system, orthopedics, obstetrics and cardiovascular care. Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: http://www.uscis.gov/e-verify The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. 2603012996
RN Utilization Review Telehealth Other
Devoted Health

Clinical Guide Part A: Utilization Management Nurse

Devoted Health
$85,000 - $95,000 / year
Job Description Schedule: The weekly schedule choice is either Monday - Friday 10am-7pm EST OR Tuesday - Saturday 9am-6pm EST A bit about this role: The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient, behavioral health, and/or post-acute authorization review in alignment with CMS and Medicare Advantage regulations. Reviews medical records to evaluate the medical necessity and appropriateness of requested inpatient and/or post-acute services in accordance with established clinical criteria and CMS guidelines. Your Responsibilities and Impact will include: Review Medical Records: Conduct prospective (pre-service), concurrent, and retrospective utilization review to evaluate medical necessity, appropriate level of care (Inpatient vs. Observation), and post-acute services in accordance with established clinical criteria and CMS guidelines. Evaluate Treatment Plans: Assess the appropriateness, timing, and setting of requested services, ensuring alignment with medical necessity criteria and Medicare Advantage requirements. Recommend alternative levels of care when clinically appropriate. Inpatient & Behavioral Health Review: Perform initial, concurrent, and discharge reviews for inpatient and behavioral health admissions. Ensure admission status accuracy and regulatory compliance with CMS timeliness (TAT) standards. Post-Acute Review: Conduct initial authorization and concurrent review for post-acute services (SNF, LTACH, ARU, Home Health), evaluating ongoing medical necessity and appropriate length of stay. Issue NOMNC when coverage criteria are no longer met. Medical Director Collaboration: Refer cases that do not meet criteria to the Medical Director for secondary review and final determination. Prepare clinical summaries and coordinate peer-to-peer (P2P) discussions. Manage authorization reopen requests as appropriate. Resource Stewardship: Monitor utilization of inpatient and post-acute services to promote appropriate resource use while maintaining high-quality, member-centered care. Regulatory & Documentation Compliance: Maintain accurate, defensible documentation of all determinations. Ensure adherence to CMS regulations, Medicare Advantage requirements, and internal compliance standards. Required skills and experience: Unrestricted RN license with a minimum of 4 years of clinical experience. Minimum 3 years of Utilization Management or Inpatient UR experience within a health plan or hospital setting. Strong knowledge of CMS regulations and Medicare Advantage requirements. Experience preparing cases for Medical Director review Able to work in a fast paced environment that is constantly evolving. Desired skills and experience: Experience with AI/LLM Certified in InterQual #LI-Remote #LI-DS1 Salary Range: $85,000-$95,000 / year The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and vision plan with low or no premium Generous paid time off $100 monthly mobile or internet stipend Stock options for all employees Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience. Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
RN Pediatric Telehealth Other
Imagine Pediatrics

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 reside in Tennessee, Missouri, Louisiana or Illinois. 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. Bachelors in nursing from an accredited university required. 5+ years of pediatrics experience required Outpatient (primary care and/or subspecialty), home health, complex care, pediatric ICU, emergency medicine, etc. strongly preferred 1+ years' experience in care coordination or case management experience preferred Bilingual Spanish preferred 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.
RN Telehealth Full-time
MUSC

In-Basket Registered Nurse – Neurosurgery - MUSCP

MUSC Mount Pleasant, SC
Job Description Summary The Registered Nurse, Phone Triage for Neurosurgery, reports to the RN Manager. Under general supervision, the RN Phone Triage Nurse provides individualized, goal directed patient care to families and patients at the competent level utilizing the principles and practices of the nursing process; delivers safe and effective care and interacts with other members of the health care team to achieve desired results and outcomes. Functions as a cohesive member of the team, facilitating patient care and treatment through telephone and electronic encounters. The duties include but are not limited to: respond to callers health information inquires (via telephone and internet) and facilitate referrals; provide verbal/printed health information; provide nursing triage for all ages of patients using established guidelines and direct callers to the most appropriate level of care. Demonstrates excellent customer service skills and behaviors. Entity Carolina Family Care, Inc. (CFC) Worker Type Employee Worker Sub-Type​ Regular Cost Center CC004079 CFC COMM PM&R Mt. Pleasant Community PM&R CC Pay Rate Type Hourly Pay Grade Health-27 Scheduled Weekly Hours 40 Work Shift Job Description Provides phone triage and response within scope of practice. Provides patient instruction that results in increased understanding and improved outcomes during phone triage. Responsible for development of personal, professional and leadership skills that enhance overall unit operations and efficiency. Utilizes the nursing process to facilitate phone triage activities. Additional Job Description Required Minimum Training and Education : Associate's Degree A minimum of three (3) years of work experience as a Registered Nurse. Preferred Training and Education: Bachelor of Science in Nursing. EMR and phone triage experience, or Neurosurgery experience. Required Licensure, Certifications, Registrations : Licensure as a Registered Nurse by the South Carolina Board of Nursing or a compact state. Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification. Physical Requirements: Continuous requirements are to perform job functions while standing, walking and sitting. Ability to bend at the waist, kneel, climb stairs, reach in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions. Ability to be qualified physically for respirator use, initially and as required. Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors. Frequently lift, lower, push and pull and/or carry objects weighing 50 lbs (+/-) unassisted, exert up to 50 lbs of force, lift from 36” to overhead 25 lbs. Infrequently work in dusty areas and confined/cramped spaces. Preferred Knowledge, Skills and Abilities: Considerable knowledge of complex medical terminology and advanced disease processes. Considerable knowledge of the cost factors in delivering patient care. Ability to instruct and direct paraprofessional nursing personnel. Ability to establish and maintain satisfactory working relationships with other employees and service areas. Ability to appropriately respond to emergency situations. If you like working with energetic enthusiastic individuals, you will enjoy your career with us! The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
RN Med-Surg Telehealth Full-time
Tennova Healthcare

Registered Nurse Medsurg Tele

Tennova Healthcare Concord, TN
Job Summary The Registered Nurse (RN) provides patient-centered care through the nursing process of assessment, diagnosis, planning, implementation, and evaluation. This role is responsible for coordinating and delivering high-quality care based on established clinical protocols and physician/provider orders. The RN collaborates with physicians, nurses, and other healthcare professionals to ensure effective patient care and desired outcomes, while maintaining a supportive and compassionate environment for patients and their families. Essential Functions Coordinates and delivers high-quality, patient-centered care in accordance with organizational policies, protocols, and the nursing process. Conducts thorough patient assessments and documents findings accurately, reporting changes in condition to the appropriate care team members. Utilizes knowledge of human growth and development to provide age-appropriate care and education. Administers prescribed medications, monitors for side effects, and documents administration in accordance with standards of practice. Assists physicians during procedures within the scope of documented competency and skill level. Collaborates with the healthcare team to develop, implement, and evaluate individualized care plans based on patient assessments and needs. Responds to medical emergencies and participates in life-saving interventions, such as CPR and code team activities, as appropriate. Advocates for the rights and needs of patients, ensuring their voices are heard and respected in care planning and delivery. Provides patient and family education on medical conditions, treatment plans, and post-discharge care, ensuring understanding and adherence to instructions. Implements and adheres to infection control protocols to prevent the spread of healthcare-associated infections. Monitors and operates medical equipment (e.g., IV pumps, monitors, ventilators) as needed for patient care and safety. Promotes patient safety by adhering to National Patient Safety Goals and maintaining a clean, safe environment for patients and staff. Participates in audits, chart reviews, and compliance checks to ensure adherence to standards of practice and regulatory requirements. Demonstrates responsible decision-making in planning, delegating, and providing care based on patient needs and organizational policies. Documents patient care and education thoroughly and promptly in the medical record. Engages in professional development to maintain clinical competency and understanding of current nursing standards and regulations. Participates in performance improvement initiatives, including data collection and process development, to enhance patient outcomes and care delivery. Telemetry RN: Using telemetry equipment to track heart rhythms (EKG), blood pressure, oxygen saturation, and other vital signs. Analyzes telemetry data to identify trends, abnormalities, and potential problems, and reports these findings to physicians. Provides direct patient care, including medication administration, wound care, and patient education, with a focus on cardiac health. Recognizes and responds to emergencies, such as cardiac arrest, and implements appropriate interventions. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications 0-2 years of experience in a clinical nursing role or student clinical rotations in an acute care setting required Knowledge, Skills and Abilities Strong knowledge of the nursing process and clinical nursing practices. Ability to perform thorough patient assessments and communicate findings effectively. Proficient in administering medications and monitoring for side effects. Effective communication and interpersonal skills to collaborate with interdisciplinary teams. Strong organizational skills and attention to detail in documenting patient care. Knowledge of safety standards, infection control, and quality improvement initiatives. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required BCLS - Basic Life Support required ACLS - Advanced Cardiac Life Support preferred PALS - Pediatric Advanced Life Support preferred NRP - Neonatal Resuscitation preferred Refer to facility or unit-specific guidelines for additional requirements.
RN Psych Telehealth Full-time
Molina Healthcare

Care Manager RN, Behavioral Health in Miami, FL

Molina Healthcare Miami, FL
$26 - $42 / hour
JOB DESCRIPTION We are seeking RNs in the Miami area with BH experience who are passionate about supporting pediatric members and delivering high-quality care. Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). #LI-AC1 #PJHS3 #HTF To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26 - $42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
RN Psych Telehealth Full-time
Molina Healthcare

Care Manager RN, Behavioral Health, Multiple Areas in Florida

Molina Healthcare FL
$26 - $42 / hour
JOB DESCRIPTION We are seeking RNs in the Miami area with BH experience who are passionate about supporting pediatric members and delivering high-quality care. Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). #LI-AC1 #PJHS3 #HTF To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26 - $42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
RN Psych Telehealth Full-time
Molina Healthcare

Care Manager RN, Behavioral Health, Multiple Areas in Florida

Molina Healthcare Miami, FL
JOB DESCRIPTION We are seeking RNs in the Miami area with BH experience who are passionate about supporting pediatric members and delivering high-quality care. Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). #LI-AC1 #PJHS3 #HTF To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $26 - $42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
RN Telehealth Part-time
St. Luke's University Health Network

Virtual Acute Care Registered Nurse (RN), Part Time Nights

St. Luke's University Health Network Allentown, PA
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Registered Nurse Virtual Response Center utilizes proactive technology and software to remotely monitor patients to assist the bedside clinical care teams in making real time decisions in the delivery of care for patients. Responsible for remotely monitoring all patients within the Network and in-home settings where Epic, Masimo, Patient Safety Net, etc. are utilized. Notifies nursing and providers of any clinical concerns in a timely manner to facilitate real time, proactive clinical decision making and compliance with protocols. JOB DUTIES AND RESPONSIBILITIES: Utilizes clinical assessment skills and available technology to assist the bedside clinical team in timely identification of potential patient clinical deterioration Demonstrates competence in the predictive analytic model and articulates understanding of each type of alert to include Sepsis Time Zero, Deterioration Index, etc Documents precisely in Epic the outcome of each encounter with clinical staff Partners with bedside nurses/clinicians effectively to inform, coach and support onsite nurses/clinicians, cultivating a therapeutic team approach. Clearly articulates reasons for the communication and interventions to clinical staff Formulates collaborative and individualized plan of care and identifies expected patient outcomes, using the nursing process Effectively communicates to VRC team members through formal handoffs including patient concerns to the oncoming staff Functions as a professional role model and resource person providing guidance to co-workers Maintains responsibility for own professional development through active participation in in-services and/or continuing education programs Complies with established chain of command for work-related problems Participates in identifying unit needs and support unit goals and objectives PHYSICIAL AND SENSORY REQUIREMENTS: Requires sitting up to eight hours per day. Routinely use upper extremities; occasionally to lift items up to 10 pounds. Stoop, bend, and reach above shoulder level regularly. Hearing is required, being sharp and alert. General, near and peripheral visions are all required. EDUCATION: Registered Professional Nurse with current license to practice in the state of Pennsylvania. TRAINING AND EXPERIENCE: Minimum of 2 years of recent direct inpatient clinical experience. Strong technical aptitude and knowledge of healthcare information systems preferred. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
RN Telehealth Part-time
St. Luke's University Health Network

Virtual Acute Care Registered Nurse (RN), Part Time Evenings

St. Luke's University Health Network Allentown, PA
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Registered Nurse Virtual Response Center utilizes proactive technology and software to remotely monitor patients to assist the bedside clinical care teams in making real time decisions in the delivery of care for patients. Responsible for remotely monitoring all patients within the Network and in-home settings where Epic, Masimo, Patient Safety Net, etc. are utilized. Notifies nursing and providers of any clinical concerns in a timely manner to facilitate real time, proactive clinical decision making and compliance with protocols. JOB DUTIES AND RESPONSIBILITIES: Utilizes clinical assessment skills and available technology to assist the bedside clinical team in timely identification of potential patient clinical deterioration Demonstrates competence in the predictive analytic model and articulates understanding of each type of alert to include Sepsis Time Zero, Deterioration Index, etc Documents precisely in Epic the outcome of each encounter with clinical staff Partners with bedside nurses/clinicians effectively to inform, coach and support onsite nurses/clinicians, cultivating a therapeutic team approach. Clearly articulates reasons for the communication and interventions to clinical staff Formulates collaborative and individualized plan of care and identifies expected patient outcomes, using the nursing process Effectively communicates to VRC team members through formal handoffs including patient concerns to the oncoming staff Functions as a professional role model and resource person providing guidance to co-workers Maintains responsibility for own professional development through active participation in in-services and/or continuing education programs Complies with established chain of command for work-related problems Participates in identifying unit needs and support unit goals and objectives PHYSICIAL AND SENSORY REQUIREMENTS: Requires sitting up to eight hours per day. Routinely use upper extremities; occasionally to lift items up to 10 pounds. Stoop, bend, and reach above shoulder level regularly. Hearing is required, being sharp and alert. General, near and peripheral visions are all required. EDUCATION: Registered Professional Nurse with current license to practice in the state of Pennsylvania. TRAINING AND EXPERIENCE: Minimum of 2 years of recent direct inpatient clinical experience. Strong technical aptitude and knowledge of healthcare information systems preferred. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.
RN Telehealth Full-time
L.A. Care Health Plan

Clinical Policy Nurse RN II

L.A. Care Health Plan Los Angeles, CA
$88,854 - $142,166 / year
Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Clinical Policy Nurse RN II is responsible for analytical research, trending, and assessment based on legislation, regulatory and accreditation requirements that impact claims, Utilization Management (UM) department and healthcare services policies. Reviews and analyzes clinical financial data to assess the effectiveness of existing and proposed policies to identify opportunities for improvement, cost containment, and quality enhancement. This position plays a key role in translating regulatory impacts into operational strategies and works collaboratively with internal and external stakeholders to ensure clinical policies support safe, effective, and compliant care delivery. Assists in development of policies and programs that improve health outcomes and target Fraud, Waste and Abuse (FWA). This position works cross functionally with other departments to develop end to end operational strategies of policy content and roll out timeframes. The Clinical Policy Nurse II serves as a liaison to ensure the ongoing maintenance of clinical coding for the authorization matrix. Duties Assess federal, state, and local legislation, regulatory guidance, and health care policies to identify potential impacts on clinical practice, reimbursement and organizational operations that impact healthcare services policies. Review and interpret clinical, utilization, and financial data to identify trends, opportunities for policy improvement and cost-savings. Research, develop, and evaluate clinical and health policy designed to improve patient outcomes, detect and mitigate Fraud, Waste, and Abuse (FWA), and streamline organizational processes. Monitor the implementation of health programs, clinical initiatives, and community action plans to assess effectiveness, compliance, and impact on patient outcomes. Collaborate with internal stakeholders to evaluate utilization trends and anomalies and contribute to policy development aimed at improving efficiency and compliance identified during risk assessments. Prepare analytical reports, summaries, and analyses assessing policy performance, regulatory impact, and communicate insights and recommendations to stakeholders to drive evidence-based policy and impacted outcomes. Present findings, recommendations, and action plans to key stakeholders. Participate in work groups related to healthcare services clinical policies and procedures including efforts to improve department processes, as needed. Perform other duties as assigned. Duties Continued Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing Experience Required: At least 5 years of experience in Clinical Nursing. At least 3 years of experience with Medi-Cal and Medicare in a managed care environment. Experience in performing and creating clinical documentation. Experience in regulatory compliance for a health plan. Preferred: Experience with active participation in state regulatory audits such as Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), and/or National Committee for Quality Assurance (NCQA) audits. At least 1 year of experience in clinical health services policies with a managed care plan. Skills Required: Demonstrated strong reporting skills by preparing clear, concise reports and presentations that communicate findings and performance. Working knowledge of clinical policies. Strong analytical and critical thinking skills with the ability to interpret regulatory requirements and legislation. Ability to translate regulatory requirements into auditable tools. Ability to perform independent research on complex medical topics. Excellent verbal and written communication skills. Strong problem solving and team building skills. Ability to work independently with strong self-direction. Advanced proficiency in Microsoft Word, Excel, and PDF documentation tools. Ability to work effectively with diverse teams in cross-functional work groups. Ability to multitask, re-prioritize tasking, and streamline day-to-day operations. Strong organizational and time-management skills. Preferred: Advanced skills in assessing clinical policy deficiencies through literature searching and clinical research analysis based on the best available evidence. Understanding of the managed care industry and market conditions. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)
RN Telehealth Full-time
L.A. Care Health Plan

Clinical Policy Clinical Coder RN II

L.A. Care Health Plan Los Angeles, CA
$102,183 - $163,492 / year
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Clinical Policy Clinical Coder RN II is responsible for analyzing, interpreting, and operationalizing medical and utilization management policies to ensure accurate coding, appropriate authorization requirements, compliant claims processing, and effective utilization oversight. This position serves as a key clinical and coding resource, translating medical policy requirements into diagnosis, procedure, and service code logic, including determining which codes require prior authorization. Conducts in-depth research and analysis of legislation and regulatory requirements, clinical outcomes, utilization, claims, and financial data to identify utilization trends, fiscal risk, and opportunities for policy enhancement and cost containment. This position works cross-functionally with internal teams to ensure policies are codified, consistently applied, and monitored through reporting and data analysis. This position collaborates closely with internal stakeholders and external entities to support standardized benefit administration, effective program implementation, and organizational compliance with state, federal, and accreditation requirements. Duties Translate approved clinical policies and utilization management criteria into clear, codified claims rules and system logic to support accurate claims adjudication. Develop, revise, and recommend clinical policies and internal utilization management criteria when standard clinical guidelines are insufficient to support appropriate decision-making based on codified claim rules. Assess the downstream claims impact of new or revised clinical policies prior to implementation and recommend configuration updates to mitigate operational or financial risk. Participate in validation of claims configuration changes to ensure policies are applied correctly and consistently across all lines of business. Monitor post-implementation claims activity to identify configuration issues, unintended denials, or payment discrepancies related to clinical policy application. Support remediation of claims configuration defects by identifying root causes and coordinating corrective actions with internal teams. Participate in and lead specialty and cross-functional workgroups and committees focused on healthcare services clinical policies, utilization management processes, strategic initiatives, policy governance, operational alignment, and continuous improvement efforts. Ensure timely dissemination of accurate and consistent policies and procedures across departments. Promote collaboration, engagement, and a positive work environment while supporting departmental initiatives and team-based activities. Manage assigned projects from concept through implementation, ensuring timelines, quality standards, and deliverables are met. Analyze and interpret medical and utilization management policies to identify applicable diagnosis, procedure, and service codes and determine authorization, pre-payment, or post-payment review requirements. Define and maintain code lists that require prior authorization or other utilization management controls based on clinical evidence, regulatory guidance, utilization trends, and financial risk. Duties Continued Collaborate with internal teams to ensure authorization requirements and coding logic are accurately configured in authorization and claims systems based on authorization matrix requirements. Support accurate claims processing by validating codified authorization and policy requirements are correctly applied and aligned with approved medical policies. Provide clinical and coding recommendations to support the development, revision, and implementation of new or updated medical and utilization management policies. Investigate and resolve coding and authorization related issues, including claim denials, coding edits, authorization discrepancies, and policy interpretation questions. Review and assess claims edits, authorization matrixes, and coding rules to identify root causes of errors or inconsistencies and recommend corrective actions. Ensure coding, authorization requirements, and claims-related guidance align with medical necessity criteria, benefit structures, and applicable state, federal, and regulatory requirements. Develop, review, and maintain reporting related to authorization required codes, approval and denial rates, utilization patterns, claims payment outcomes, and policy effectiveness. Prepare reports, summaries, and presentations and communicate findings, recommendations, and action plans to internal and external stakeholders. Analyze claims, authorization, and utilization data to identify trends, measure policy impact, and recommend opportunities for policy refinement, cost containment, or reduction of administrative burden. Monitor post-implementation performance of authorization-required codes and recommend additions, removals, or modifications to authorization requirements based on regulatory thresholds and utilization outcomes. Perform other duties as assigned. Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing Experience Required: At least 8 years of experience in Clinical Nursing. At least 3 years of experience with Medi-Cal and Medicare in a managed care environment. Experience in performing and creating clinical documentation. Experience in regulatory compliance for a health plan. Experience with medical coding systems. Preferred: At least 1 year of experience in editing and writing clinical health services policies within a managed care health plan. Skills Required: Proficient with clinical policy through skills in literature searching and clinical research analysis based on the best available evidence. Working knowledge of clinical policies. Working knowledge of CPT/HCPC codes and claims. Ability to translate regulatory requirements into auditable tools. Ability to perform independent research on complex medical topics. Excellent verbal and written communication skills. Strong analytical, problem solving, and team building skills. Ability to work independently with strong self-direction. Advanced proficiency in Microsoft Word, Excel, and PDF documentation tools. Ability to work effectively with diverse teams in cross-functional work groups. Ability to multitask, re-prioritize tasking, and streamline day-to-day operations. Ability to identify discrepancies, assess risk, and recommend actionable solutions. Knowledge of medical coding systems, including ICD-10-CM, CPT, and HCPCS, and their application in authorization and claims environments. Strong organizational and time-management skills. Preferred: Advanced skills in assessing clinical policy deficiencies through literature searching and clinical research analysis based on the best available evidence. Proficient in claims configuration, including claims adjudication workflows, configuration of claims edits and rules, and the translation of clinical and utilization management policies into system-based claims logic to support accurate, compliant payment outcomes. Understanding of the managed care industry and market conditions. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Licenses/Certifications Preferred Certified Professional Coder (CPC) Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)
RN Telehealth Full-time
United Health Services (NY)

Registered Nurse

United Health Services (NY) Johnson City, NY
$33.63 - $50.45 / hour
Position Overview As an extension of the providers care team, the Remote RN is responsible for providing telephone communication and assessment of patient's needs. This requires the application of a variety of procedures, policies, and/or precedents relating to both the standards and procedures of the nursing profession and those established by UHS. The remote nurse provides communication and advice and follow-up education consistent with the patient's age and cultural needs. The remote nurse responds to patient's inquiries, prioritizing responses and routing urgent situations to the appropriate provider. The remote nurse maintains accurate and appropriate documentation and follows patient privacy in accordance with HIPAA and UHS policies and procedures while working from a secure, private remote location. Primary Department, Division, or Unit: UHS Heart and Vascular Institute Johnson City Primary Work Shift: Day Regular Scheduled Weekly Hours: 40 Compensation Range: $33.63 - $50.45 per hour, depending on experience ----- Education/Experience Minimum Required: Graduate of an accredited school of registered Nursing. At a minimum of one (1) years’ experience in a health care setting with evidence of having obtained proficiency in those areas emphasized in the Registered Nurse curriculum. Annual Health Assessment required if the RN is working “in person” at any UHS location. Preferred: Bachelor’s degree in nursing Previous telephone triage experience. Previous experience in a walk-in/primary care/specialty care office setting. Knowledge of Joint Commission, NYS Department of Health, CMS and Article 28 standards. Working knowledge of Microsoft Word, Excel and PowerPoint programs. License/Certification Minimum Required: Current NY State RN license Preferred CPR certification must be maintained if the RN will be working “in person” at any UHS location ----- Why You’ll Love Working at UHS At United Health Services (UHS), we believe every connection—to patients, to purpose, to each other—makes a difference. That’s why we’re intentional about supporting our team in ways that go beyond the job. Whether through meaningful benefits, personal growth, or fun along the way, we’re here to help you thrive in work and life. A Culture of Connection – We support each other like family and create space for every voice to be heard. Engagement Councils, peer recognition, and initiatives like Walk in my Shoes for senior leaders are just a few ways we foster belonging and collaboration. Outside of work, we stay connected through team events like trivia, trunk-or-treat, volunteer days, our staff choir, or seasonal celebrations. Comprehensive Benefits for Life & Family – We offer medical, dental, and vision coverage starting the first of the month after hire for employees working 24+ hours/week. With flexible plan options and coverage tiers, you can choose what fits your life best. Additional perks include discounted childcare through Bright Horizons and voluntary benefits like pet insurance, legal services, and identity theft protection. ​ Well-Being & Financial Security – From day one, PTO starts accruing so you can take time to recharge. We support your long-term wellness with a 403(b) retirement plan and company match, flexible spending accounts, access to financial advisors, and up to $400/year in wellness rewards. When life gets tough, we’re here with 24/7 EAP counseling, virtual mental health support, a food pantry, PTO donation program, and professional attire through the Classy Closet. ​ Growth That Moves with You – With access to 100,000+ online courses, leadership programs, tuition reimbursement, clinical ladders, and internal mobility, we help you grow wherever your passion leads. We also continuously review compensation to ensure market competitiveness and internal equity, so you can feel confident your work is valued and rewarded fairly. ​ A Place to Call Home – Located in New York’s Southern Tier, UHS offers more than a career—we offer a lifestyle. Enjoy four-season recreation, affordable living, top-rated schools, minor league sports, craft brews, a close-knit community, and more, all within reach of the Finger Lakes, the Catskills, and major Northeast cities. ----- About United Health Services United Health Services (UHS) is a locally owned, not-for-profit healthcare system in New York’s Southern Tier comprising four hospitals, long-term care and home care services, and physician practices in Broome and surrounding counties. UHS provides healthcare and medical services for two-thirds of the region’s population, produces $1.3 billion a year in total economic impact, and boasts a workforce of more than 6,300 employees and providers. At UHS, our work is guided by our Values of Compassion, Trust, Respect, Teamwork, and Innovation. Whether you provide direct patient care or support behind the scenes, you are part of a shared purpose: to improve the health and well-being of the communities we serve. Every employee plays a meaningful role in fulfilling our mission—we’d love for you to consider joining us! United Health Services is an Equal Opportunity Employer. ----- United Health Services, Inc. and the members of the UHS System neither are affiliated with, sponsored, endorsed nor approved by, nor otherwise associated with, Universal Health Services, Inc. (NYSE: UHS), UHS of Delaware, Inc. nor their affiliates, which can be found at www.uhsinc.com.
RN Telehealth Full-time
L.A. Care Health Plan

Lead Customer Solution Center Appeals and Grievances RN

L.A. Care Health Plan Los Angeles, CA
$102,183 - $163,492 / year
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Lead Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for all lines of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved Customer Service to L.A. Care’s (LAC) membership. This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines. Leads and works closely with assigned team daily. This position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and project completion. Duties Review and process complex and/or escalated clinical A&G cases. Analyze the patient medical records, clinical documentation, and insurance policies to determine medical necessity. Prepares and reviews A&G files for submission to providers and internal departments. Work with other departments to ensure all aspects of a case are appropriately managed. Conduct targeted and random clinical case audits to ensure that all regulatory and departmental guidelines, policies, procedures, and standards are met. Work closely with the leadership team to create and/or modify Desk Level Procedures and recommend enhancements to process and procedures. Assist the Clinical Supervisors in identifying deviations in performance and process changes are implemented to redirect performance to acceptable levels. Recommend and implement resolutions, new processes, and/or process improvement. Provide accurate and timely written statistical reports that include historical and/or current data to aid in projecting or evaluating compliance status. Identify and analyze trends in appeals and grievances to find the root cause of denials. Duties Continued Check, verify and ensure that all clinical A&G cases are processed accurately and within established timelines to meet or exceed member satisfaction goals and regulatory (CMS, DMHC, DHCS, NCQA), Health and Safety Code and company compliance. Maintain documentation of all communications in the A&G system to ensure thorough tracking of case status. Lead the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training, and feedback on performance to department management. Work closely with management to review performance and quality standards on an ongoing basis. As well as motivational programs needed to achieve regulatory standards. Act as a back-up to the Supervisor in leading meetings and handling escalations as required. Perform other duties as assigned. Education Required Associate's Degree in Nursing for Registered Nurses Education Preferred Bachelor's Degree in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting, At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment. At least 1 year of leading a process, program, or staff experience. Preferred: Clinical acute experience. Skills Required: Extensive knowledge of healthcare regulations and managed care guidelines Demonstrated ability to provide recommendations towards resolution. Strong critical thinking and problem-solving abilities to assess complex clinical cases and evaluate medical necessity. Ability to communication, conflict resolution, and motivational skills. Ability to work independently and closely with a team in a collaborative and interactive environment. Ability to adjust to changing circumstances within the team. Good verbal and written communication skills. Preferred: Strong project management skills with the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and occasional flexibility in hours/shift in critical situations and work on-call. This position requires handling various caseloads and flexibility to adapt to changing priorities, which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned. Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)