Telehealth Jobs | Credenza

Care Manager RN, Behavioral Health in 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.

Wellness/Longevity Nurse Practitioner / Physician Assistant (Full-time)

OrangeTwist Newport Beach, CA

$90 - $150 / hour

We want people to look + feel amazing. “Look good feel good” isn’t just a cute phrase around here. We make it happen, in real life, every single day. It’s all about innovation, personalization, and connection. No two people are ever alike, and neither are their treatments. We have high standards. Our treatments are curated from nothing but the best. We believe chic and high-end should still be friendly and approachable. This is OrangeTwist. Your treatment shop. 24 locations and growing 7 different types of treatments in 1 shop Our current eNPS (Employee Net Promoter Score) score of 75—Exceptional, world-class score— Extremely high employee's satisfaction and loyalty, showcasing a strong and positive work culture. We are seeking an experienced, client-focused Physician Assistant (PA-C) or Nurse Practitioner (NP) to serve as the clinical lead for our Wellness & Longevity Program. This provider will be the central point of care for clients seeking peptide therapies and, as the program expands, Hormone Replacement Therapy (HRT). The Wellness & Longevity PA/NP will conduct comprehensive client intakes and clinical assessments, determine clinical appropriateness for treatment, prescribe therapies within their scope of practice, and develop individualized treatment plans. As the primary prescribing provider for the Wellness & Longevity Program, this individual will create comprehensive care plans that are executed by the center's providers, ensuring a coordinated, personalized client experience from evaluation through ongoing treatment. This role is instrumental in maintaining clinical excellence, ensuring client safety, and delivering exceptional outcomes within a collaborative, concierge-style wellness practice. Location: Remote, Need to live in California or Texas Schedule: 5 days a week, minimum 4 weekend days a month Compensation: Total compensation of $90-$150 hourly, based on performance What You Will Do: Clinical Assessment & Treatment Planning Serve as the primary clinical provider for the Wellness & Longevity Program. Conduct comprehensive client consultations, medical history reviews, and clinical assessments. Evaluate clients for peptide therapies and, as services expand, Hormone Replacement Therapy (HRT). Order, review, and interpret laboratory testing and diagnostic evaluations. Determine client eligibility for treatment based on clinical findings, laboratory results, and health goals. Prescribe peptide therapies, hormone replacement therapy, and other wellness treatments within the provider's scope of practice and applicable state regulations. Develop individualized treatment plans that guide each client's care throughout the program. Educate clients on recommended therapies, expected outcomes, potential risks, and lifestyle modifications that support long-term wellness. Care Coordination & Clinical Leadership Serve as the central point of prescribing and clinical decision-making for the Wellness & Longevity Program. Create comprehensive treatment plans that are implemented by the center's providers during ongoing client care. Collaborate with physicians, nurses, and other clinical team members to ensure seamless execution of prescribed treatment plans. Monitor client progress through follow-up visits and laboratory review, modifying treatment plans as clinically indicated. Ensure continuity of care and maintain high standards of documentation, client safety, and regulatory compliance. Program Development Assist in developing and refining standardized clinical protocols for peptide therapies and hormone optimization. Support the implementation and growth of new longevity and regenerative medicine services. Stay current on emerging research and evidence-based practices in longevity medicine, peptide therapies, hormone optimization, and preventive health. Participate in quality improvement initiatives and help establish best practices for client outcomes. Qualifications: Valid State license to practice as a Physician Assistant Valid State license to practice as a Registered Nurse and Nurse Practitioner DEA registration required. Minimum 2 years experience in functional medicine, integrative medicine, anti-aging medicine, wellness, longevity, endocrinology, weight management, or regenerative medicine. Minimum 2 years experience prescribing peptide therapies and/or Hormone Replacement Therapy. Strong clinical assessment, diagnostic, and treatment planning skills. Excellent communication and client education abilities. Ability to practice independently within state scope and collaborative practice requirements. Proficiency in interpreting comprehensive laboratory panels. Perks Forward-thinking, transparent, and inclusive company culture Competitive salary, incentive plan, generous paid time off, sick time, and paid holidays Comprehensive benefits package including medical, dental & vision insurance 401k employee contributions, FSA, and dependent care options Continuing education with our own University Employee referral bonus program, employee resource groups, and professional development All benefits dependent on role and eligibility We’re accepting applications on an ongoing basis and will continue reviewing candidates until the role is filled. All candidate email communication will be done through an @orangetwist.com email address. If you ever receive communication regarding a job posting from an entity that does not match that or seems concerning, please contact Recruiting@orangetwist.com. OrangeTwist is a leading national Aesthetic treatment with a mission to make our clients look + feel amazing. OrangeTwist is “your treatment shop for body, face, and skin,” offering curated treatments including Botox + fillers, CoolSculpting, HydraFacial, lasers, micro-needling, skin and scalp care, and more. We recognize that the key to success lies in valuing the minds, experiences and perspectives of people from all walks of life. OrangeTwist is proud to value diversity and be an equal opportunity employer. Pursuant to the San Francisco Fair Chance Ordinance and the Los Angeles Fair Chance Initiative for Hiring, we will consider for employment qualified applicants with arrest and conviction records. OrangeTwist is an E-Verify employer. GDPR & CCPA disclosure notice here.

Care Manager - RN (ACM)

Astrana Health Houston, TX

$80,000 - $94,000 / year

Care Manager - RN (ACM) Department: HS - ACM Employment Type: Full Time Location: 19500 HWY 249, Suite 570 Houston, TX 77070 Compensation: $80,000 - $94,000 / year Description We are looking for a compassionate and experienced Care Manager - RN to join our Houston team. In this role, you will provide comprehensive care management and coordination for members across the continuum of care, partnering with providers, interdisciplinary teams, and community resources to improve clinical outcomes, enhance quality of care, and support members with complex medical, behavioral, and psychosocial needs. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Care Management & Coordination Conduct comprehensive health assessments, including medical, behavioral, and social determinants of health (SDOH). Develop, implement, and evaluate individualized care plans based on member needs, goals, and risk level. Coordinate care across multiple settings, including inpatient, outpatient, and community-based services. Facilitate transitions of care, including hospital discharge planning and post-discharge follow-up. Clinical Oversight Utilize clinical expertise to identify gaps in care, potential risks, and opportunities for early intervention. Monitor member progress and adjust care plans accordingly. Provide education to members and caregivers regarding disease management, medications, and treatment plans. Apply evidence-based guidelines and best practices in care management. Utilization Management & Cost Containment Support appropriate utilization of healthcare services to ensure cost-effective care delivery. Collaborate with utilization management teams to reduce avoidable hospitalizations and emergency department visits. Identify high-risk members and implement strategies to improve outcomes and reduce healthcare costs. Collaboration & Communication Partner with physicians, specialists, behavioral health providers, and community agencies to coordinate care. Serve as a liaison between members, providers, and health plan resources. Participate in interdisciplinary team meetings and case conferences. Maintain effective communication to ensure continuity of care. Quality & Compliance Ensure timely and accurate documentation in accordance with regulatory, CMS, and organizational requirements. Support quality improvement initiatives, including HEDIS, STAR ratings, and other performance measures. Maintain compliance with accreditation standards and internal policies. Member Engagement Conduct outreach to engage members in care management programs. Promote self-management and adherence to treatment plans. Address barriers to care, including social, economic, and cultural factors. Qualifications Bachelor of Science in Nursing (BSN) preferred; Associate degree in Nursing required Texas RN unrestricted active license At least 2 years of clinical nursing experience (case management, acute care, medical group, health plan, or managed care preferred) Certifications & Licensure Active, unrestricted Registered Nurse (RN) license Strong clinical background must be familiar with developing care plans and assessments Experience with Microsoft Office Word Understanding of regulatory standards (CMS, NCQA, etc.). Ability to assess and manage complex clinical and psychosocial situations Excellent communication, collaboration, and critical-thinking skills Proficiency in electronic health records (EHR) and care management documentation systems Ability to manage multiple priorities in a fast-paced environment You'll be a great for the role if: Able to work independently and make independent decisions Ability to work prioritize and multi-task Excellent written and verbal communication skills Maintain courteous professional attitude when working with internal and external customers Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements Environmental Job Requirements and Working Conditions This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. The office is located at 19500 HWY 249, Suite 570 Houston, TX 77070. This position requires up occasional travel for onsite visits or team meetings. The target pay range for this role is between $80,000 - $94,000 annually. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Care Partner - Medical Assistant

BayCare Health System Tampa, FL

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence. The Care Partner-Medical Assistant Responsibilities Include Works collaboratively with the Licensed Practical Nurse (LPN) Care Partner to review patient chart data, identify open Healthcare Effectiveness Data and information Set (HEDIS) gaps and facilitates gap closure. Partners with BayCare Medical Group (BMG) physicians and office medical staff to ensure gaps are addressed and closed. Performs telephonic outreach to patients to discuss needed care, assess and document barriers to accessing medical services and support care coordination efforts for Population Health Services Organization (PHSO). Places standing orders for open quality gaps in accordance with BMG policy to facilitate timely gap closures. Position Details Location: Hybrid Status: Full time; 40 hours per week Schedule: Monday - Friday; days. Times may vary. Weekend Requirement: No On Call: No Education Required High School Diploma or Equivalent (GED) Experience Required 1 year experience Medical Assistant Benefits Benefits (Health, Dental, Vision) Paid time off Tuition reimbursement 401k match and additional yearly contribution Yearly performance appraisals and team award bonus Community discounts and more Equal Opportunity Employer Veterans/Disabled

Nurse Practitioner / Physician Assistant

Planned Parenthood of Greater Texas Mesquite, TX

Overview The official job title for this position at PPGT is “Clinician”. The Clinician provides comprehensive reproductive healthcare services to patients at Planned Parenthood of Greater Texas (PPGT). Works as part of the Health Services team in collaboration with Health Services and other team members to meet the clinical needs of patients as outlined in affiliate protocols. Orders, interprets, and records results of clinical tests and consults with supervising physicians as needed. Prescribes medications and makes recommendations for other forms of treatment, including contraception. The Clinician is part of the medical services team providing sexual and reproductive healthcare as outlined in affiliate protocols. Provides services by telehealth and/or in-person visits including: history review, health education, physical exam, counseling, diagnosis, and treatment according to protocols. The Clinician works in partnership with management, Health Services and Chief Operating and Medical Services Officer (COMSO) to provide the highest quality of patient care and excellent patient experience. Participates as a member of a team providing confidential, quality healthcare services, allowing patients to maintain a sense of dignity, trust and safety. There is a dual reporting structure for clinicians. Clinicians report directly to the Health Services Regional Director and clinical supervision is provided by the Director of Clinical Services. Performs duties to ensure productivity expectations, patient satisfaction, customer service, and compliance standards are maintained. Supports the organization’s strategic plan and workplace inclusion initiatives. Abides by the organization’s mission in performing job duties. Demonstrates an understanding and commitment to PPGT’s culture of quality, safety and risk awareness. Responsibilities • Performs physical examinations with special emphasis on the reproductive system including breast examinations, pelvic/genital, cancer screening tests, diagnosis of sexually transmitted infections (STIs), and other types of more specialized services or procedures as may be indicated by medical policy or protocols (e.g. gender affirming hormone therapy-GAHT). • Orders, and interprets diagnostic studies as indicated and permitted by medical protocols. Performs lab testing per Clinical Laboratory Improvement Amendments (CLIA) regulations and according to PPGT’s lab manual or manufacturer’s directions. • Provides patient care according to all Medical Standards and Guidelines and/or the specific direction of a supervising physician. Consults with organization COMSO or designee when deviates from PPGT Medical Standards and Guidelines (MS&Gs). • Provides relevant health instruction and education to include family planning, sexual counseling, and principles of health promotion • and maintenance. • Documents exam findings and other clinical aspects of direct patient care into the medical record accurately. • Codes billable services accurately based on medical record documentation using accepted practices, i.e. Evaluation and Management (E&M), Current Procedural Terminology (CPT) and diagnosis codes (ICD-10). • Ensures conformity with the policies and procedures of the affiliate, Texas Medical Practice Act, Physician Assistant Licensing Act, Texas Nurse Practice Act, and rules promulgated under those acts. • Recognizes ethical, legal, and professional issues inherent in providing care to health center patients throughout the life cycle. • Initiates and monitors appropriate follow-up according to PPGT Medical Standards and Guidelines on all abnormal test results and referrals. • Remains well informed about current contraceptive technology and reproductive and sexual healthcare issues. • Develops and maintains a collaborative working relationship with the Health Center Manager and support staff resulting in a team effort in meeting center goals. • Develops a level of time management that is conducive to seeing 3-4 clinician visits per hour meeting productivity goals and expectations. • Takes an active role in managing patient satisfaction by practicing patient centered care and providing exemplary customer service to patients. • Responds to medical emergencies as provided in the medical protocols and is responsible for maintenance of emergency box • May assist in supervising and participating in the orientation and proctoring of new clinicians. • Administers, supplies, or prescribes medications/devices, including injections, per delegated orders of the Pharmacist-in-charge and the Chief Medical Officer as outlined in The Manual of Medical Standards and Guidelines and Pharmacy Manual and as per Title 22, Part 11, Chapter 22 of the Texas Administrative Code. • Maintains an active Prescriptive Authority Agreement which is reviewed with authorizing physician annually. Holds Quality Assurance and Improvement meetings and chart reviews as required by the PAA between the authorizing physician and the clinician. • Has unrestricted access to patient protected health information (PHI) on paper and electronic forms health records for purposes of treatment, payment, and/or healthcare operations. The use of a patient’s protected health information should be limited to information needed for the specific task that is being performed or requested by the individual patient. Disclosure of any patient information must be for purposes of treatment, payment or healthcare operation OR must be accompanied by a valid patient authorization. Must adhere to minimum necessary rule. • Embraces the organization’s In This Together customer service standards and uses them with internal and external customers, every person, every time. • Duties and responsibilities may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing. Qualifications Minimum Education Master’s degree (or equivalent) and certification in specialty as a Family Nurse Practitioner (FNP), Women’s Health Nurse Practitioner (WHNP), Certified Nurse Midwife (CNM), Primary Care Nurse Practitioner, or Physician Assistant (PA). Minimum Experience Experience as a Nurse Practitioner, Nurse Midwife, or Physician Assistant in reproductive healthcare or women’s health strongly preferred. In the absence of advance practice experience, candidates must have direct patient care experience (in addition to clinical rotation/externship/internship hours) such as a RN, LVN, Medical Assistant, laboratory technician in a supervised clinical setting such as: hospital, ambulatory surgery center, clinic, nursing home or other related medical setting (excluding home care). Required Licenses or Certifications License to practice as an Advanced Practice Nurse with prescriptive authority in the State of Texas or License to practice as a Physician Assistant by the Texas Medical Board. Must be able to obtain and maintain appropriate licenses listed above and appropriate national certification (NCC, AMCB, AANP, ANCC, or NCCPA) and basic cardiopulmonary resuscitation (CPR) BLS certification course taught by the either American Heart Association (AHA) or American Red Cross (ARC). Agency Standards Must have excellent computer skills with knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Internet. Must have the willingness and ability to adapt to change including advances or new technology. Must have excellent customer service skills and be committed to providing the highest level of customer satisfaction. Other PPGT is an equal opportunity employer. We strictly prohibit unlawful discrimination of any kind, including discrimination on the basis of age; race, color, ancestry, national origin, or ethnicity; citizenship status; sex or gender; gender identity or gender expression or transgender status (including the individual's actual or perceived sex and the individual's gender identity, self-image, appearance, behavior, or expression); sexual orientation (including actual or perceived heterosexuality, homosexuality, bisexuality and asexuality); mental or physical disability; AIDS, AIDS Related Complex, or HIV status; perception of risk of HIV infection; or association with individuals who are believed to be at risk; religion or creed; genetic information; pregnancy status, including related medical conditions; marital status; past, current, or prospective service in the uniformed services; or any other basis protected by law. We are a drug-free and tobacco-free workplace. Applicants have rights under the Federal Employment Laws. To view these notices, please click on the following links: Family and Medical Leave Act (FMLA) poster: Equal Employment Opportunity (EEO) poster; and Employee Polygraph Protection Act (EPPA) poster. Required Knowledge, Skills, and Abilities • Must be able to work all health center hours of operation including evenings and weekends. • Performance of job duties in a health center and/or virtual telehealth environment as defined by position requirements. • Must be able and willing to travel to other locations as needed to provide clinician coverage to centers. • Bilingual in Spanish/English desired. • Demonstrates continued competency in meeting educational and professional standards. • Ability to adhere to the medical protocols of the organization and Planned Parenthood Federation of America (PPFA). • Ability to think strategically and achieve organization’s goals relating to position. • Ability to adhere to the compliance and regulatory requirements pertaining to position. • Possess effective analytical skills. • Strong organizational skills and ability to multi-task. • Ability to manage details and complexity, to handle a variety of tasks simultaneously and to work under pressure. • Ability to exercise initiative, sound judgment, and problem-solving techniques in the decision-making process. • Ability to effectively use organization’s computer systems. • Skilled in verbal and written communications. • Be discreet and safeguard confidential information. • Possess integrity and compliance – can be relied upon to act ethically. • Ability to provide effective, equitable, understandable, and respectful quality care and services that are responsive to the diverse cultural health beliefs and practices, preferred language, health literacy and other communication needs. • Ability to work effectively as a team member. • Ability to lead, manage, direct, and motivate diverse groups of people and possess the skills to delegate and supervise subordinates. • Organizational Awareness: Demonstrates a comprehensive awareness of the impact and implications of decisions and actions on other areas (departments or clinics) within the organization. • Industry Awareness: Remains aware PPFA accreditation standards and of the reproductive health environment’s regulatory compliance requirements. Understands how accreditation standards, regulatory agencies, funding, the external marketplace and competitive environment drives change within the organization. • Work Management: Effectively manages time as a resource; establishes realistic priorities; schedules own time and activities effectively; gives balanced focus and attention to appropriate long- and short-term priorities. Develops action plans and budgets; leverages technology; anticipates obstacles; establishes check points and monitors progress. • Recovery Skills: Responds effectively and acknowledges responsibilities when clients (internal or external) experience problems or mistakes; rectifies the situation to restore client satisfaction; seeks information and collaborates with others to take action to implement permanent fixes. Maintains stable performance and emotions when faced with opposition, pressure, and or stressful conditions. • Interpersonal Sensitivity: Acts in a way that indicates understanding and accurate interpretation of others’ concerns, feelings, strengths and limitations. Uses interpersonal understanding to shape one’s own response. • Building Relationships: Shows genuine interest in others’ needs and opinions; establishes rapport; earns the confidence and trust of others; demonstrates consistency between words and actions; delivers on commitments. • Adaptability or Flexibility: Responds with flexibility to shifting priorities and changing work situations; recovers quickly from problems and setbacks; develops new skills to remain competitive. Adapts easily to change, sees the merits of differing positions, and adapts own positions and strategies in response to new information or changes to a situation. • Coping with Demands of the Position: Uses effective problem solving while working under stress, high volume of work demands and/or time demands; regularly meets deadlines. • Exemplify the organization’s In This Together values: We Tend to the Team; We Respect and Honor All People; We Jump In; We Try and We Learn; We Care for our Business; and We Return to our Mission. Essential Physical Requirements/Working Conditions Must be able to bend, stoop, kneel, crouch, reach, and grasp. Must be able to stand, particularly for sustained periods of time. Must be able to move about on foot to accomplish tasks, such as moving from one work site to another. Must be able to push/pull. Must be able to work primarily with fingers such as picking, pinching, or typing. Must be able to perceive attributes of objects such as size, shape, temperature or texture by touching with skin, particularly that of fingertips. Must be able to communicate effectively. Will have substantial movements of the wrists, hands, and/or fingers. Must be able to lift and/or exert up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or negligible amount of force constantly to move objects. Subject to hazards including a variety of physical conditions such as proximity to moving mechanical parts, moving vehicles, electrical current, or exposure to infectious diseases. Must be able to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices. Health Center environment.

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.

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.

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)

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)

Network Pricing Consultant - Remote PST/MST/CST

UnitedHealthcare Phoenix, AZ

$72,800 - $130,000 / year

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. This opportunity is all about complexity and meaningful impact. You will play a key role in accurately and effectively pricing our provider network across the West Region markets, including Arizona, Nevada, Utah, and Idaho. Success in this role requires strong analytical thinking, creativity in interpreting contract structures, and the ability to leverage available resources to develop accurate and reliable pricing. As a Network Pricing Consultant, you will support and validate Provider Network (hospital, physician, ancillary facilities, etc.) contracting and unit cost management activities through financial modeling, analysis, and reporting. You will conduct unit cost and contract valuation analysis to support negotiations and unit cost management strategies, while managing unit cost budgets, targets, and performance reporting. Challenge can often be its own reward, but why settle for challenge alone when you can also be supported, mentored, and developed in a fast-paced and impactful career? With UnitedHealth Group, you can expect all of the above, every day. Here's your opportunity to combine analytical expertise and collaborative problem-solving as you strike the balance between health care costs and resources. In this role, you'll ensure that health care contracts are priced accurately and fairly for all involved, backed by the resources and stability of a Fortune 5 leader. While this role primarily supports West Region markets, you'll enjoy the flexibility to work remotely from anywhere in the U.S. For hires residing in the Minneapolis or Washington, D.C. areas, on-site work is required at least four days per week. Primary Responsibilities Support network pricing strategies and tactics in collaboration with local network field leaders and network managers Analyze financial impact of provider contracts Evaluate financial impact of corporate initiatives and external regulations Review payment appendices and develop options for various contracting approaches and methodologies Communicate financial impact findings and insights to stakeholder groups Conduct financial and network pricing modeling, analysis, and reporting Provide mentorship and engage in detailed peer review activities Perform unit cost and contract valuation analysis to support network contracting and unit cost management strategies Lead large and complex analytical projects to support key business objectives Influence pricing strategies and rate development by identifying opportunities or safeguarding favorable structures Collaborate with Network Management to strategize rates or contract methodologies Review competitive analysis to determine appropriate provider pricing You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications Undergraduate degree in Math, Statistics, Finance, Economics, or related field 4+ years of analytical experience 3+ years of experience with provider payment methodologies and healthcare products Experience presenting to internal or external stakeholders Financial impact analysis and data manipulation skills Advanced proficiency in Microsoft Excel Demonstrated ability to interpret financial modeling results and develop forecasts Demonstrated ability to manage multiple projects simultaneously Demonstrated ability to research and solve problems independently Preferred Qualifications Experience with advanced statistical functions for financial modeling Experience with various payment methodology types Knowledge of commercial, Medicare, and Medicaid PPO/HMO revenue and expense patterns Solid interpersonal, collaboration, negotiation, and communication abilities All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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.

Clinical Triage Specialist, LPN - Gen Surg, Wt Mgmt, ENT - Access Center

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), LPN - Access Center will compassionately deliver an exceptional patient experience providing the first level of clinical triage resources to patients. The CTS-LPN is responsible for using medical training judgment in answering/returning patient calls related to direct care provided by the practices. This includes following a protocol established for the appropriate triage and escalation of medical questions/concerns. 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 first level of clinical triage for patient and staff issues, and provides clinical advice based on clinical protocols, procedures, and escalation paths. Escalates patient concerns to CTS (RN) or Clinical Triage Supervisor to better assist patients with complex clinical concerns. Manages and responds to electronic patient messages whenever not answering inbound patient calls, and uses clinical judgment to prioritize, escalate, 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. 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 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: Graduate of an accredited nursing program. Active LPN 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: Two years of experience in a healthcare setting is required; customer service experience in a contact center is strongly 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.

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)

After Hours + Weekends Telehealth Nurse Practitioner (OH)

CareMed Kenton, OH

CAREMED HEALTH SOLUTIONS REMOTE POSITION Company Description CareMed Health Solutions is a facility-based team of medical providers who provide medical services to patients living in long term care facilities. We strive to give quality care to residents while working together with the facility to carry out the best care possible. While an interdisciplinary care team to provide medical care to patients in long term care facilities, you will have the opportunity to impact in a positive way the life and wellbeing of the elderly population. We are currently seeking Nurse Practitioners to telemedicine services to patients living in long-term care facilities. NP ROLE AND RESPONSIBILITIES: · Provide primary and preventative care for long-term care patients residing in skilled nursing facilities. · Manage Residents with acute changes in condition. · Prescribe appropriate medications, including controlled substances in accordance with State law. · Order, review, and/or follow-up with treatments and diagnostic testing. · Communicate with the nursing home staff on a regular and as needed to discuss changes in condition. · and/or the care plan. NP QUALIFICATIONS AND EDUCATION REQUIREMENTS · Current, unrestricted NP license. · Board Certification. · DEA licensure. · Clinical background in adult, family, or geriatric specialties. · Experience working in a long-term care setting. · Ability to work with an EMR. · Ability to manage patients with advanced illness and multiple chronic conditions. · Ability to work within an interdisciplinary care team to coordinate patient care.

Remote RN - Internal Medicine (must reside within 60 miles)

Sanford Health Bismarck, ND

$29.50 - $44.50 / hour

Careers With Purpose Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Facility: 5th Broadway Clinic Location: Bismarck, ND Address: 515 E Broadway Ave, Bismarck, ND 58501, USA Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $29.50 - $44.50 Pay Info: $20,000 Sign on Bonus Department Details Our Internal Medicine team provides comprehensive, patient-centered care for adults, focusing on the prevention, diagnosis, and management of acute and chronic conditions. As a Nurse in our clinic, you will play a key role in supporting providers and ensuring a positive patient experience. Daily tasks include coordinating care across specialty and primary care teams and maintaining accurate documentation and follow clinical protocols and quality standards. This role is the best of both worlds having face to face collaboration and local flexibility to be fully remote after a 6 month in-clinic orientation. ✅Must reside within 60 miles of Bismarck, ND ✅ Monday - Friday 8:00a-5:00pm ✅$20,000 Sign on bonus ✅Experience is credit to wage range Great opportunity for those looking to advance and create efficient workflow for staff and patients. Come join a great team in a fast paced environment! Job Summary The Registered Nurse (RN) is responsible for utilizing the nursing process (assessment, diagnosis, outcomes/planning, implementation and evaluation) to provide individualized nursing care to patients. Responsible for the coordination of care, patient assessment, patient education, triage, and various other nursing interventions. Collaborates with other inter-professional colleagues, including physicians, to plan, implement and evaluate care. Demonstrates competency and practices within the full scope of nursing expertise/knowledge and utilizes appropriate age and population specific standards as designated in their assigned clinical setting. Functions within the scopes and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of practice and licensure. The Sanford Professional Nursing Practice recognizes the Scope and Standards of Practice and the Code of Ethics for Nurses with Interpretive Statements as published by the American Nurses Association as the foundation of nursing care delivery and professional conduct. Qualifications Graduate from an accredited nursing program preferred, including, but not limited to, American Association of Colleges of Nursing (AACN), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Bachelor’s Degree in nursing preferred. Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific licensure, competencies and certifications. Benefits Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits . Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org . Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment. Req Number: R-0266008 Job Function: Nursing Featured: No

After Hours + Weekends Telehealth Nurse Practitioner (OH)

CareMed Columbus, OH

CAREMED HEALTH SOLUTIONS REMOTE POSITION Company Description CareMed Health Solutions is a facility-based team of medical providers who provide medical services to patients living in long term care facilities. We strive to give quality care to residents while working together with the facility to carry out the best care possible. While an interdisciplinary care team to provide medical care to patients in long term care facilities, you will have the opportunity to impact in a positive way the life and wellbeing of the elderly population. We are currently seeking Nurse Practitioners to telemedicine services to patients living in long-term care facilities. NP ROLE AND RESPONSIBILITIES: · Provide primary and preventative care for long-term care patients residing in skilled nursing facilities. · Manage Residents with acute changes in condition. · Prescribe appropriate medications, including controlled substances in accordance with State law. · Order, review, and/or follow-up with treatments and diagnostic testing. · Communicate with the nursing home staff on a regular and as needed to discuss changes in condition. · and/or the care plan. NP QUALIFICATIONS AND EDUCATION REQUIREMENTS · Current, unrestricted NP license. · Board Certification. · DEA licensure. · Clinical background in adult, family, or geriatric specialties. · Experience working in a long-term care setting. · Ability to work with an EMR. · Ability to manage patients with advanced illness and multiple chronic conditions. · Ability to work within an interdisciplinary care team to coordinate patient care.

Nurse Practitioner Licensed in Florida

Pharmko Tampa, FL

CCM/RPM The medical assistant works in collaboration and continuous partnership with chronically ill patients and their family/caregiver(s), clinic/hospital/specialty provider and staff, and community resources in a team We are seeking a full-time, bilingual, and remote Medical Assistant (MA) to join our rapidly growing team at Preventel Health performing Chronic Care Management and Remote Patient Monitoring (RPM) by telephonically delivering health and wellness calls to assigned patients. Responsibilities: Remotely providing basic patient coaching and care to improve patient outcomes. Coaching and educating patients on improving their Chronic Conditions, preventive care and physician directives Updating and managing patient care plans based on assessment of patients’ needs and physician directives Schedule appointment scheduling on behalf of physicians Telephone outreach to English and Spanish-speaking patients Facilitate CCM program enrollment Facilitate RPM- remote patient monitoring enrollment Monitor patients outcomes Clear explanation of the benefits of chronic care management Patient eligibility verification Concise and accurate documentation Cultivate and support the primary care providers with timely communication, inquiry follow-up, and integration of information into the care plan regarding transitions-in-care and referral · Serve as the contact point, advocate, and information resource for patients and their care team. · Work with patients to plan and monitor health and social needs · Develop a care plan with the patient, family/caregiver(s) and provider · Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner and facilitate changes as needed · Create ongoing process for patients and family/caregiver(s) to determine and request the level of care coordinates support they desire at any given point in time Requirements: Medical Assistant certification Fluent in Spanish Knowledgeable using Excel spreadsheets Computer with internet COMPENSATION: Based on a base plus incentive model.

Health Coach - (CMA or LPN) - CIN - PGH Region - Hybrid

Allegheny Health Network Pittsburgh, PA

Company Allegheny Health Network Job Description GENERAL OVERVIEW As a member of the health care team, assists with population health management through patient outreach and coordination of care, participates in the clinical visit to assist the provider, and provides self-management support to patients. Demonstrates leadership by communicating effectively, developing others, building and maintaining relationships, and guiding effective teams and work groups. Also mentors others within the team with office functions to support patient care and office operations. Follows all established protocols, policies, procedures and standardized work flows. Leads in managing data so that patients are effectively treated. Essential Responsibilities Actively participates in population health outreach through identification of patients with gaps in care through use of analytic tools and patient registries. Contacts patients and facilitates closing gaps in care. (10%) Ensures pre-visit planning is completed by performing chart and data reviews in advance of patient visit and preparing for patient arrival by identifying items that need addressed during visit. (10%) Demonstrates expanded rooming protocol by assisting the provider in addressing care gaps with the patient and appropriately activating standing orders. (10%) Accurately performs clinical transcription during the patient encounter by documenting elements of the clinical visit under direct supervision of the provider and assisting with computerized provider order entry under direct supervision of the provider. (10%) Uses a motivational interviewing approach to coach patients toward self-management, self-efficacy, and activation. Engages the patients to assess current state, collaboratively set goals, and review the after-visit summary. Instructs the patient on condition management, behavioral support, and addresses emotional demands of having a chronic condition. Reinforces the clinical care plan and follows up for ongoing activation. (10%) Performs registry and quality data review and conducts population outreach to close gaps in care. (10%) Oversees the identification of high risk patients and facilitates complex care management referrals. Works collaboratively with care team nurses to provide care coordination to rising risk patients. (10%) Reviews and assesses with care team members to achieve population health management goals, to improve patient access to care and to reduce avoidable emergency department visits. (10%) Cleans and sterilizes instruments per established standards. Ensures adequate inventory of medical supplies. Ensures all patient treatment areas are stocked with appropriate supplies using established inventory standards. (10%) Performs in-house testing following established standards and policies. (10%) Performs other duties as assigned or required. Qualifications Minimum Current State of PA LPN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) OR Medical Assistant Certification. Completion of an accredited course of study in medical assisting or two years of relevant experience. CPR certification. Act 34 Criminal Background Clearance Certificate Act 33 Child Abuse Clearance Certificate Act 73 FBI Fingerprinting Criminal Background Clearance Certificate Preferred High school diploma or equivalent. Disclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Nurse Practitioner Licensed in Florida

Pharmko Orlando, FL

CCM/RPM The medical assistant works in collaboration and continuous partnership with chronically ill patients and their family/caregiver(s), clinic/hospital/specialty provider and staff, and community resources in a team We are seeking a full-time, bilingual, and remote Medical Assistant (MA) to join our rapidly growing team at Preventel Health performing Chronic Care Management and Remote Patient Monitoring (RPM) by telephonically delivering health and wellness calls to assigned patients. Responsibilities: Remotely providing basic patient coaching and care to improve patient outcomes. Coaching and educating patients on improving their Chronic Conditions, preventive care and physician directives Updating and managing patient care plans based on assessment of patients’ needs and physician directives Schedule appointment scheduling on behalf of physicians Telephone outreach to English and Spanish-speaking patients Facilitate CCM program enrollment Facilitate RPM- remote patient monitoring enrollment Monitor patients outcomes Clear explanation of the benefits of chronic care management Patient eligibility verification Concise and accurate documentation Cultivate and support the primary care providers with timely communication, inquiry follow-up, and integration of information into the care plan regarding transitions-in-care and referral · Serve as the contact point, advocate, and information resource for patients and their care team. · Work with patients to plan and monitor health and social needs · Develop a care plan with the patient, family/caregiver(s) and provider · Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner and facilitate changes as needed · Create ongoing process for patients and family/caregiver(s) to determine and request the level of care coordinates support they desire at any given point in time Requirements: Medical Assistant certification Fluent in Spanish Knowledgeable using Excel spreadsheets Computer with internet COMPENSATION: Based on a base plus incentive model.

RN Triage Nurse

Anchor Health CA

Anchor Health is looking for a compassionate RN Triage Nurse (Full-Time) to join a strong supportive team of professionals that provide hospice/palliative care. Position Purpose: Under the general supervision of the Nurse Manager, the Triage Nurse is responsible for patient triage via the nurse phone line and Call Center agents, in collaboration with Clinic Administrators, providers, and other departments. The Triage Nurse provides quality patient care in compliance with local, state, and federal regulations, as well as accreditation standards. Principal Responsibilities: Responds to triage calls on the nurse phone line, assessing patient needs and providing appropriate guidance. Manages inquiries on the pharmacy phone line, ensuring timely and accurate responses. Conducts patient assessments over the phone Determines urgency based on a telephone assessment and the patient’s medical history in the electronic medical record (EMR). Utilizes clinical decision-making tools, including algorithms that replicate physician logic, to guide scheduling decisions. Escalates high-risk cases involving symptoms such as chest pain, abdominal pain, or severe headaches, ensuring immediate ER referral or ambulance coordination. Provides home care guidance to patients who do not require emergency services. Maintains thorough documentation of consultations and treatments in the NextGen Electronic Health Record system. Coordinates appointments for non-emergency patients and consults with physicians as necessary. Acts as a resource for patient inquiries when designated as "Ask a Nurse," addressing routine questions such as vaccination schedules. Serves as a clinical resource and role model for nursing staff, promoting best practices. Manages workload effectively, prioritizing tasks and completing them promptly. Assists with medical chart reviews and compiles data for audits and reports. Supports policy development, collaborating with the Managing Nurse to establish nursing protocols and procedures. Ensures clear, concise, and accurate triage documentation. Provides patient education, offering guidance on self-care and medical conditions. Communicates professionally with staff, consultants, patients, families, and the community. Resolves conflicts proactively, improving patient satisfaction through timely responses. Participates in team meetings, training sessions, and planning discussions as needed. Performs additional duties as assigned to support clinical operations. Requirements: Licensed by the State of California as a Registered Nurse. Current BLS certification from the American Heart Association or the American Red Cross. At least one year of experience in an ambulatory care setting. Excellent verbal and written communication skills, including strong organizational, detail-oriented, and interpersonal skills. Proficiency in computer skills and word processing. Employee Benefits: At Anchor Health, we believe in taking care of those who take care of others. If you work 30+ hours per week, you’ll enjoy competitive pay and a robust benefits package that includes: Medical, Dental, Vision Paid time off (vacation, sick leave) 401(k) Short- and long-term disability plans (LTD/STD). Life insurance policy REMOTE position

Nurse Practitioner Licensed in Florida

Pharmko Orlando, FL

CCM/RPM The medical assistant works in collaboration and continuous partnership with chronically ill patients and their family/caregiver(s), clinic/hospital/specialty provider and staff, and community resources in a team We are seeking a full-time, bilingual, and remote Medical Assistant (MA) to join our rapidly growing team at Preventel Health performing Chronic Care Management and Remote Patient Monitoring (RPM) by telephonically delivering health and wellness calls to assigned patients. Responsibilities: Remotely providing basic patient coaching and care to improve patient outcomes. Coaching and educating patients on improving their Chronic Conditions, preventive care and physician directives Updating and managing patient care plans based on assessment of patients’ needs and physician directives Schedule appointment scheduling on behalf of physicians Telephone outreach to English and Spanish-speaking patients Facilitate CCM program enrollment Facilitate RPM- remote patient monitoring enrollment Monitor patients outcomes Clear explanation of the benefits of chronic care management Patient eligibility verification Concise and accurate documentation Cultivate and support the primary care providers with timely communication, inquiry follow-up, and integration of information into the care plan regarding transitions-in-care and referral · Serve as the contact point, advocate, and information resource for patients and their care team. · Work with patients to plan and monitor health and social needs · Develop a care plan with the patient, family/caregiver(s) and provider · Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner and facilitate changes as needed · Create ongoing process for patients and family/caregiver(s) to determine and request the level of care coordinates support they desire at any given point in time Requirements: Medical Assistant certification Fluent in Spanish Knowledgeable using Excel spreadsheets Computer with internet COMPENSATION: Based on a base plus incentive model.

Nurse Practitioner Licensed in Florida

Pharmko Tampa, FL

CCM/RPM The medical assistant works in collaboration and continuous partnership with chronically ill patients and their family/caregiver(s), clinic/hospital/specialty provider and staff, and community resources in a team We are seeking a full-time, bilingual, and remote Medical Assistant (MA) to join our rapidly growing team at Preventel Health performing Chronic Care Management and Remote Patient Monitoring (RPM) by telephonically delivering health and wellness calls to assigned patients. Responsibilities: Remotely providing basic patient coaching and care to improve patient outcomes. Coaching and educating patients on improving their Chronic Conditions, preventive care and physician directives Updating and managing patient care plans based on assessment of patients’ needs and physician directives Schedule appointment scheduling on behalf of physicians Telephone outreach to English and Spanish-speaking patients Facilitate CCM program enrollment Facilitate RPM- remote patient monitoring enrollment Monitor patients outcomes Clear explanation of the benefits of chronic care management Patient eligibility verification Concise and accurate documentation Cultivate and support the primary care providers with timely communication, inquiry follow-up, and integration of information into the care plan regarding transitions-in-care and referral · Serve as the contact point, advocate, and information resource for patients and their care team. · Work with patients to plan and monitor health and social needs · Develop a care plan with the patient, family/caregiver(s) and provider · Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner and facilitate changes as needed · Create ongoing process for patients and family/caregiver(s) to determine and request the level of care coordinates support they desire at any given point in time Requirements: Medical Assistant certification Fluent in Spanish Knowledgeable using Excel spreadsheets Computer with internet COMPENSATION: Based on a base plus incentive model.

Virtual Nurse-RN/ Virtual Nursing

Premier Health Partners Dayton, OH

Position: Virtual Nurse-RN Department: Virtual Nursing Facility: Premier System Support Shift: Full-time 7:00am-7:30pm/ 72 Hours Per Pay This is not a remote work from home position* The Virtual Clinical Nurse is a registered nurse (RN) who works remotely from a centralized location and partners with the bedside nurses and advocates for patients/families/significant others to provide physical, emotional, and spiritual support which impacts patient outcomes in a safe environment. The Virtual RN functions in a versatile role that demonstrates professionalism and promotes excellence and autonomy in the practice of Nursing. The Virtual RN utilizes the nursing process in conjunction with evidence-based principles to care for a diverse caseload of patients within the department scope of service. The Virtual RN collaborates with, and guides care delivered by the inter-professional team. The Virtual RN will perform task that may include admissions, discharges, patient education, rounding on patients, performance improvement, etc. The Virtual RN is accountable for compliance with the Ohio Nurse Practice Act, Nursing Code of Ethics, and applicable regulatory standards. Education Minimum Level of Education Required: Associate degree Additional Requirements Type of degree: Graduation from an accredited school of nursing. Area of study or major: Nursing Preferred educational qualifications: BSN Preferred; BSN Completion or Professional Certification may be required. Position specific testing requirement: N/A Licensure/Certification/Registration Valid Ohio RN license Experience Minimum Level of Experience Required: 3 - 5 years of job related experience Prior job title or occupational experience: N/A Prior specific functional responsibilities: N/A Preferred Experience Other experience requirements: N/A Knowledge/Skills Must be able to multitask with constant interruptions while maintaining a pleasant demeanor. Basic computer knowledge Strong organization skills Effective interpersonal and communication skills

RN

Telehealth

2 months ago

Registered Nurse - Call Center Advice RN

Virginia Garcia Memorial Health Center Hillsboro, OR

At Virginia Garcia Memorial Health Center, we honor all members of our community and acknowledge the dignity of each person we serve. Our purpose is to provide high-quality, comprehensive primary health care to the communities of Washington and Yamhill counties with a special emphasis on migrant and seasonal farm workers and a view to removing barriers to health care. We strive to provide an environment that welcomes and values the people we employ and serve. If you are unsure whether you meet all the required qualifications for this role but are interested and passionate about this potential position, we encourage you to apply. Job Summary: The Call Center Advice Nurse (CCAN) provides clinical advice and support over the phone to patients calling our call center. The CCAN utilizes their clinical background and critical thinking skills to assess symptoms, offer guidance on self-care, and determine the appropriate level of care needed, potentially referring them to other healthcare professionals or facilities like the Emergency Department (ED). This role works collaboratively with the Call Center, but practices independently to assist patients and uses evidence-based telephone triage nursing protocols and their nursing experience and judgment to provide guidance on a wide range of care concerns. Position allows for a hybrid schedule of four (4) ten-hour days per week with remote work up to three (3) days per week, negotiated based on performance and successful completion of the 150-day probationary period and orientation. Remote work is expected during interruptions to clinic services due to inclement weather or other emergencies. Hybrid or remote work requires adequate Wi-Fi and private space to care for patients and properly store any confidential materials. Laptop and peripheral equipment will be provided. Essential Duties and Responsibilities: • Provide triage assessment over the phone utilizing the nursing process, making both independent and collaborative decisions to advise patients. • Utilize telephone interpretation services to meet the needs of patients where appropriate. • Provide high-quality customer service and a clinically appropriate and timely experience for patients calling the VGMHC Call Center. • Coordinate care services for follow-up with the Emergency Department (ED) and internal and external departments/clinics based on patient needs. • Perform patient education, including explaining to the patient the triage disposition, treatment plan (including use of medications and their effects and side effects if appropriate), infection control (if indicated), and preventative techniques to lower the risk of future disease or accident. • Offer patients guidance on self-care, medication management, and preventative measures based on clinical protocols. • Identify care gaps and problem-solve with patients to schedule appropriate appointments with their care team. • Update on-call providers as needed on the changing needs of complex, high-risk patients. • Document all interactions with patients and others involved in the care of the patient, accurately, timely, and efficiently in the Electronic Health Record (EHR). • Communicate problems or concerns immediately to the supervisor to prevent delayed or inappropriate care decisions. • Maintain up-to-date knowledge and skills in professional, clinical, and system VGMHC areas. • Perform other duties as assigned. • Handle protected health information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) HIPAA Requirements: The CCAN will use PHI to answer patient questions about their medical problems or plan of care, to triage and schedule appointments for urgent medical problems, to relay information from the health care providers to the patient. Applying the minimum necessary rules of HIPAA, the designated record sets to which this employee will have access include scheduling, demographics, and view only patient account information in the practice management system, and the complete medical record, including confidential sections. Knowledge, Skills and Abilities Required: • Relevant nursing experience that utilizes the nursing process and assessment skills, in person or over the phone. • Strong ability to accurately elicit information, determine existing health problems and evaluate current symptoms without the advantage of a physical patient assessment required. • Strong critical thinking skills and clinical judgment. Flexible and adaptable to daily needs. • Proficiency in English, written and spoken language required. Proficiency in Spanish (or another 2nd language on the VG language list) preferred. The person hired for this role will need to pass a language proficiency test to qualify for a bilingual pay differential. • Commitment to providing quality health care to all. • Demonstrated commitment to working with patients and staff from a wide range of ethnic, economic, cultural, and social backgrounds. Education and Experience Required: • Current Oregon RN License • Two (2) years’ minimum experience with telephone or in-person nurse triage required, 3-5 years of experience preferred. Physical Requirements: Percentage of time spent • Standing: 5% • Walking: 5% • Sitting: 90% • Lifting/Carrying: 0% Equipment Used: • Office Equipment o Computer o Telephone, fax, copier, scanner • Medical equipment - The medical equipment listed provides examples of the clinical data you will be reviewing and analyzing in your role. You may not be expected to physically operate this equipment on a regular basis. o Pulse oximeter o O2 tank o Blood pressure equipment o Glucometer o EKG o Fetal monitor o Other emergency equipment as ordered • Electronic Software o Electronic Health Record EHR (Epic OCHIN) o ClearTriage Other Equipment and Requirements (for remote work): • Computer or laptop (provided by VGMHC IT) • Telephone (May be provided by VGMHC IT or calls can be routed through the laptop) • High-speed wired Internet service • Private home office Immunization: Staff members must meet immunization requirements as stated in VGMHC’s immunization policy and state and federal guidelines. Job descriptions represent a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHC’s Mission. VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status, or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes fairness in placement, promotion, transfer, rate of pay, and termination.

Virtual Registered Nurse (RN), On-Site, PRN, Days

Mary Washington Healthcare Stafford, VA

Start the day excited to make a difference…end the day knowing you did. Come join our team. Job Summary: The Virtual Registered Nurse (VRN) is responsible for providing professional nursing care with collaboration from the bedside nurse through two-way audio/visual technology and performing assessments of vital signs and monitoring data through specialized software. The VRN position provides professional direct patient nursing care to a diverse patient population. Besides conducting nursing assessments, assisting with exams and treatment and maintenance of medical records, this position assists in coaching and mentoring department staff in areas of clinical and professional practice. The VRN position offers high level contributions at the bedside, unit, service line, and across the healthcare system. Responsibilities for this position may include but are not limited to leading unit and shared governance activities, serving as charge nurse, assessing unit needs related to practice and improvement opportunities, serving as a clinical resource for both unit and hospital staff, and coordinating unit and hospital-wide education in partnership with management. The Level II Competent Registered Nurse is clinically able to care for patients. The Level II MWHC nurse demonstrates the ability to collaborate with the healthcare team to improve the quality of care in the designated clinical area by incorporating research and implementing evidenced-based knowledge into practice. The Level II Competent Registered Nurse assumes the accountability and responsibility as a professional nurse for providing total, comprehensive, continuous, and patient-centered care for an assigned group of patients. The RN is responsible for the delivery of patient care through the nursing process of assessment, diagnosing, planning, implementation, and evaluation. Essential Functions & Responsibilities: Assess and care for patients by leveraging video conferencing to complete virtual nursing rounds. Provide patients with virtual health assessments, treatment solutions, and follow-up from the Virtual Command Center. Create, implement, and monitor care plans in collaboration with other care teams. Develop, update, and communicate plan of care, including discharge, in partnership with the patient, family and interprofessional health care team. Prioritize care based on the patient's needs, abilities, and preferences. Advocate on patient/family's behalf to identify and resolve clinical and ethical concerns. Collaborate with interprofessional health care team to facilitate patient throughput efficiently to meet organizational goals. Develop and implement effective patient teaching strategies based on learning needs; use appropriate resources, incorporating planning for care after discharge. Evaluate the patient's comprehension and adapt teaching methods accordingly. Anticipate/prevent and recognize/resolve early declines in patient condition and emergent situations. Recognize, determine a plan of action, and respond to situations, such as Rapid Response/CERTs, and emergency codes. Contribute to development of service line and hospital standards and guidelines. Contributes to staff development by coaching to support the growth of nursing staff in meeting identified goals. Provide oversight for student/new employee preceptorships. Foster identification and implementation of innovative solutions to improve patient care or unit operations such as reduction of hospital readmissions or other department-specific measures by leading and/or participating in unit projects and shared governance activities. Lead initiatives to improve quality and safety scores on the unit and hospital scorecards, through peer-to-peer accountability, reporting near misses and identifying solutions by collaborating with the interprofessional team. Serve as the clinical resource. Develop and disseminate, as appropriate, informational/educational resources and programs designed to improve quality and professional practice. Document in Electronic Medical Record each encounter with clinical staff. Ensure that reporting is in place to demonstrate program outcomes and support performance improvement activities. Other duties as assigned. Practice Standards for a Level II Registered Nurse: In the MWHC Practice Standards, a Level II Registered Nurse is outlined in the following areas of: Exemplary Professional Practice Standards Structural Empowerment Practice Standards Transformational Leadership Practice Standards New Knowledge, Innovations, and Improvement Practice Standards Essential Functions & Responsibilities: Direct and coordinate nursing care, including oversight of licensed and unlicensed personnel in any assigned or delegated tasks using the nursing process and interdisciplinary teamwork to achieve desired patient outcomes. Coordinate involvement of the patient, family and health team members in patient care, including patient/family teaching and discharge planning. Communicate and coordinate the plan of care and other pertinent information to/from other health care team members. Assist Leadership to define standards of excellence for patient care; participate in improvement of patient care services. Participate in, contribute to and integrate performance improvement into care delivery and participate in quality improvement activities. Participate in orientation of new permanent and temporary staff members. Act as point of contact on hospital and departmental policies and procedures to nurses and other health team members. Participate in daily operational activities necessary for safe patient/staff environment. Provide input to the Nurse Manager regarding unit needs. Participate in unit, departmental and hospital committees for formulation of nursing and hospital policies and procedures. Qualifications Required Graduate of an accredited nursing program and has experience as a Registered Nurse. Valid RN License from Virginia or reciprocal compact state. BSN is preferred; all Registered Nurses with an Associate's Degree in Nursing will be required to obtain their BSN within five years of hire. (Effective March 2014) Three (3) years acute care nursing experience. AHA BLS Provider CPR. Computer skills and dexterity required for data entry and retrieval of information. Effective verbal and written communication skills and the ability to present information clearly and professionally Proficient with Windows-style applications, various software packages specific to role and keyboard Preferred American Nursing Credentialing Center (ANCC)-recognized certification in applicable specialty area As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status. ‎ Required Physical Requirements: Constant (67-100% of workday) walking, standing, use of arms and hands; frequent (34-66% of workday) bending, stooping, kneeling, and squatting; ability to lift 35 lbs.; ability to push and pull 20 lbs.; auditory and visual skills to include color determination; ability to work in confined spaces; ability to reach above/overhead. Mental Requirements: Possesses critical thinking and analytical skills. Ability to multi-task. Ability to communicate effectively and collaborate with a multi-disciplinary team. Capacity to cope with difficult situations. Ability to tolerate irregular hours including evenings, nights, and weekends. Environmental Requirements and Exposure Hazards: Potential risk of exposure to radiation and toxic chemicals. Potential for exposure to bloodborne pathogens; must be able to wear appropriate personal protective equipment. “It is the policy of Mary Washington Healthcare to provide reasonable accommodations to qualified individuals with a disability who are applicants for employment or Associates.” ‎