Telehealth Jobs | Credenza

Utilization Management Program Manager-RN

Summary Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together. This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin Our Ideal Candidate Will Have The Following Experience Health plan utilization management Medicare and Medicaid rules and regulations and health plan benefit structure and policy. Data analysis to include reporting results and developing improvement plans Quality Management experience in a healthcare setting Occasionally JOB SUMMARY/PURPOSE Executes program(s) that meet the needs of the organization, employees and/or customers. Plans, initiates, oversees execution of all elements for assigned program(s). Leads the development, implementation and management of assigned program(s) and associated projects. Oversees process from planning to completion. Works with multiple internal teams, vendors, clients. Responsible for explaining, training, and mentoring the entire organization on the program. Collaborates with SHS system experts to ensure focus, alignment, and best practices for the program. EXPERIENCE/EDUCATION/QUALIFICATIONS Current unencumbered Oregon RN License required within 90 days of hire. BSN preferred. Master's degree in a related field preferred. One (1) year clinical nursing experience plus four (4) years health plan utilization management experience required. Experience or training in the following required: Health care delivery systems and/or managed care patients. Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced). Experience in the following preferred: Team leadership. Case management. Medicare and Medicaid rules and regulations and health plan benefit structure and policy. KNOWLEDGE/SKILLS/ABILITIES Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management. Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner. Critical thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions. Communication and team building - Lead effectively with excellent verbal and written communication. Delegates and initiates/manage cross-functional teams and multi-disciplinary projects. PHYSICAL DEMANDS Rarely (1 - 10% of the time) (11 - 33% of the time) Frequently (34 - 66% of the time) Continually (67 - 100% of the time) CLIMB - STAIRS LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs LIFT (Knee to chest: 24"-54") 0 - 20 Lbs LIFT (Waist to Eye: up to 54") 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds BEND FORWARD at waist KNEEL (on knees) STAND WALK - LEVEL SURFACE ROTATE TRUNK Standing REACH - Upward PUSH (0 - 20 pounds force) PULL (0 - 20 pounds force) SIT CARRY 2-handed, 0 - 20 pounds ROTATE TRUNK Sitting REACH - Forward MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist

RN Triage Nurse

Anchor Health Petaluma, 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

RN Triage Nurse

Anchor Health Petaluma, 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

Case Manager - Registered Nurse - Southeast Region

CVS Health FL

$60,522 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. Required Qualifications Candidates must live in the Southeast Region (States Include- FL, GA, AL, MS, NC, SC, TN, AR, LA) Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence 3+ years clinical practical experience with preference in the following areas: diabetes, Congestive Heart Failure (CHF), Chronic Kidney Disease (CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members 2+ years case management, discharge planning and/or home health care coordination experience 2+ years of experience with Microsoft Word, Excel, and Outlook Preferred Qualifications Previous work from home experience in a healthcare related field Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills Ability to work independently Certified Case Manager National professional certification (CRC, CDMS, CRRN, COHN, or CCM) Efficient and effective computer skills including navigating multiple systems and keyboarding Education Associate's Degree in Nursing or Nursing Diploma (REQUIRED) Bachelor's Degree in Nursing (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 05/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Transfer Center and Virtual Care RN

Renown Health Reno, NV

Position Purpose The Transfer Center & Virtual Care RN provides leadership, accountability, and comprehensive nursing services to ensure optimal patient care, resource utilization, and seamless patient flow. This role is challenged with facilitating patient flow into and within the healthcare system by collaborating with Renown leadership, clinical staff, unit staff, providers and transfer center personnel, along with coordinating patient care across the continuum, from admission through discharge, and ensuring effective two-way communication between the medical staff, referring physicians, and other healthcare team members. In collaboration with members of the bedside interdisciplinary healthcare team, participates in the multidisciplinary plan of care for patients, and ensuring effective quality and cost-efficient outcomes. Must demonstrate competence in a fast paced, stressful environment due to demands from multiple sources. In this unpredictable environment, the individual must possess the ability to organize, prioritize and reprioritize shift priorities as needed. Nature and Scope This role performs various RN functions within the RTOC, including Transfer Center RN and Virtual Care RN. The position involves facilitating patient transfers, managing virtual care, and ensuring smooth patient flow across Renown Health. Transfer Center RN: Coordinates incoming and outgoing patient transfers, ensuring seamless communication between care teams, facilities, and physicians while utilizing a strong knowledge of acute care and patient treatment. While operating as the RTOC Charge Nurse, this role also takes on leadership responsibilities in patient flow management, ensuring optimal placement and transfer processes, and collaborating with healthcare teams to meet safety and compliance standards. Virtual Care RN: Provides telehealth services, including virtual assessments, documentation, and patient education, using advanced systems to support multidisciplinary care teams and patients. This position does provide direct patient care. Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications Requirements - Required and/or Preferred Name Description Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Appropriate education to obtain and maintain State of Nevada Registered Nurse licensure. Bachelor of Science degree in Nursing preferred. Experience Minimum three years of RN experience in an acute patient care setting in medical/surgical, Emergency Department or critical care. Nurses with five or more years’ experience preferred. License(s) Ability to obtain and maintain a State of Nevada Registered Nurse license. Certification(s) Ability to obtain and maintain an Acute-Care Virtual Nurse Certification within three (3) years of hire. Computer / Typing Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Care Manager, LPN (Eastern Time Zone)

Curana Health

Care Manager, LPN (Eastern Time Zone) Location US-Remote ID 2026-3441 Category Nursing Position Type Full-Time At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com. Summary The Care Manager delivers telephonic care management for Curana patients enrolled in a Value-Based Care Program such as but is not limited to Advanced Primary Care Management (APCM) or Chronic Care Management (CCM). These patients often have complex, emerging health risks, or recent care transitions. Working with Curana Providers and the interdisciplinary team, the Care Manager supports quality, cost-effective care. Essential Duties & Responsibilities Patient and Caregiver Support Review electronic health records (EHR) to identify gaps in care for patients residing in a Long-term Care Nursing Facility. Review and approve initial and ongoing health questionnaires completed by a member of the care management team. Serve as a health coach to educate patients and/or caregivers about their disease process. Develop patient-centered care plans. Educate patients and their durable medical power of attorney (DPOA) on the benefits of APCM or CCM. Provider Support Support quality gap closure through clinical discovery. Schedule Provider visits for at-risk patients Coordinate with the Transitional Care Manager to schedule patient visits and inform the TCM nurse if a patient is discharged to acute or SNF. Ensure orders, referrals, and prior authorizations are facilitated by the virtual care support team. Escalate abnormal diagnostic test results to Curana providers. Communication Support Communicate patient health updates to the Curana providers. Communicate treatment plans and health updates to the patient’s caregiver in an effective and caring manner. Primary liaison between the provider and administrative support team. Other duties as assigned Qualifications Exhibits knowledge of pathophysiology and accepted treatment protocols for common health diagnoses (i.e., diabetes, chronic heart failure, chronic obstructive pulmonary disease). Ability to analyze patient records to identify gaps in care and report to the provider. Ability to work in a remote environment that is free of distractions. Proficient computer skills and ability to adapt to various technology platforms. Excellent written communication skills. Demonstrated experience in the usage of clinical data to guide decision making. Must have the ability to function independently and as a member of the interdisciplinary care team. Required Education and Experience Must hold an active, unrestricted compact LPN license. Ability to obtain additional state licenses, as needed 2+ years of experience in nursing is required. Care settings may include inpatient, outpatient, or skilled nursing facilities. Preferred Education and Experience Case Management experience CCM certification (strongly preferred) Experience working with Electronic Health Records Travel Requirements: 100% remote position requires a reliable high-speed internet connection. We’re thrilled to announce that Curana Health has been named the 147 th fastest growing, privately owned company in the nation on Inc. magazine’s prestigious Inc. 5000 list. Curana also ranked 16 th in the “Healthcare & Medical” industry category and 21 st in Texas. This recognition underscores Curana Health’s impact in transforming senior housing by supporting operator stability and ensuring seniors receive the high-quality care they deserve. Options ApplyApply Submit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances. The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment. *The company is unable to provide sponsorship for a visa at this time (H1B or otherwise). Application FAQs Software Powered by iCIMS www.icims.com

Nurse Practitioner - Virtual Practice Support - Full Time - Experienced Preferred

Advocate Aurora Health New Berlin, WI

$51.05 - $76.60 / hour

Department: 01223 AMG WI Department of Digital Medicine - Virtual Practice Support Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: M-F 8a-5p (34 patient contact hours weekly including 6 hours admin per week) Pay Range $51.05 - $76.60 MAJOR RESPONSIBILITIES Clinical responsibilities: Assesses, diagnoses, and determines/alters treatment and management plans appropriate for age, acuity and clinical condition. This includes ordering, performing, and interpreting appropriate diagnostic studies and prescription of pharmacologic and non-pharmacologic interventions and therapies. Manages conditions based on clinical indication, evidence-based care, cost effectiveness, and assessment of risks/benefits and alternatives. Provides health promotion, disease prevention and disease management counseling and education of patients and families. Manages patients as part of an interdisciplinary team and within scope of practice. Seeks physician or other healthcare team member consultation or referrals as appropriate. Escalates need for more emergent or specialized care when necessary. Maintains accurate, complete, concise, and timely documentation in the electronic medical record. Substantiates and submits professional services consistent with compliant coding and billing practices. Facilitates consistent, coordinated care and clear communication among all members of the healthcare team and/or health or community agencies. Performs office or hospital procedures in accordance with specialty practice, competency and granted privileges (where applicable). Other responsibilities: Participates in quality, safety, and peer review initiatives/performance activities, organizational and/or departmental meetings and committees, peer review, and workgroups as necessary. Participates in education and/or onboarding of new team members, students, and other health care professionals. Seeks experiences to maintain and develop clinical and professional skills and advance the profession within and outside of the organization. Maintains standards of productivity, access, face-to-face time, and quality metrics to ensure optimal, safe and timely patient care delivery. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards. MINIMUM EDUCATION AND EXPERIENCE REQUIRED License/Registration/Certification Required: Active RN, and APRN/APRN-FPA/APNP or other APRN license(s) in state(s) of practice, AND Active national board certification in area of clinical practice and populations served, AND Active DEA registration prior to hire, AND If Illinois practice: active Illinois Controlled Substance License prior to hire, AND Active BLS and/or ACLS, PALS, NRP as required by clinical practice prior to or within 6 months of hire Education Required: Master’s Degree in Nursing Experience Required: No experience required KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED Demonstrated high level of clinical proficiency, and excellent decision-making skills. Demonstrated ability to work independently and as an effective member of a health care team. Demonstrated ability to adapt to evolving technology and proficiency with the electronic medical record. Excellent communication skills. Ability to effectively collaborate with and establish/build relationships with others. Proven organizational skills and ability to prioritize effectively. PHYSICAL REQUIREMENTS AND WORKING CONDITIONS Must be able to stand, walk, bend, stoop, and twist continuously throughout the workday. Must have functional speech, vision, touch, and hearing. Must be able to: Lift up to 50 lbs from floor to waist. Lift up to 20 lbs over the head. Carry up to 40 lbs a reasonable distance. Operate all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Behavioral Health Sr Clinical Admin Nurse RN

UnitedHealthcare Phoenix, AZ

$60,200 - $107,400 / 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. The Senior Clinical Administrative Nurse is an outreach‑intensive role in which the nurse spends approximately 90% of the workday on the phone attempting engagement with membership. Using clinical expertise, the nurse conducts structured outreach to engage members, assess needs, and introduce available clinical services in support of organizational engagement goals. In addition to outbound outreach, the role supports members and their covered families with health care system navigation and care coordination. Acting as a clinical liaison, the nurse collaborates with members, caregivers, medical providers, and internal and external clinical teams to facilitate coordinated, efficient care using a clinically informed and operationally driven approach. Success in this role requires comfort spending most of the workday on the phone, sustained outbound calling, efficiency in member engagement, and the ability to balance clinical assessment with operational productivity expectations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities Provide members with tools and educational support to navigate the health care system and manage health concerns effectively and cost efficiently Assist members with adverse determinations, including support through the appeals process Educate members on the use of UMR internet based wellness tools and resources Educate and guide members regarding behavioral health and substance use disorder (BHSUD) services Provide ER steerage and education on appropriate emergency department utilization and alternative levels of care Conduct outreach to members to provide pre admission counseling Conduct outreach to members and caregivers to support discharge planning Track all activities and maintain complete documentation to support customer reporting Accept referrals through designated processes; collaborate in evaluating available services and coordinate required medical care and community referrals Comply with all policies, procedures, and documentation standards across applicable systems, tracking mechanisms, and databases Contribute to treatment plan discussions Perform other duties as assigned Candidate must be willing to work weekdays 11:00 am - 8:00 PM CST, including Saturdays 8:00 am - 5:00 PM CST 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 Current and unrestricted RN compact license Ability to obtain additional state licensure as needed 2+ years of acute nursing experience 2+ years of behavioral health nursing experience Basic computer proficiency (ie MS Word, Outlook) Proven ability to function independently and responsibly with minimal supervision Preferred Qualifications Bachelor's degree in nursing 2+ years of case management experience Telephonic nursing experience CCM 2+ years managed care experience Critical care, pediatric, med-surg and/or telemetry experience Utilization management experience Adverse Determination experience Telecommute experience Soft Skills Demonstrated excellent verbal and written communication skills Excellent customer service orientation Proven team player and team building skills Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment 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 $60,200 to $107,400 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.

Bilingual Pediatric Registered Nurse

Imagine Pediatrics

$40 - $47 / hour

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

Case Manager RN

CVS Health AZ

$60,522 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This Case Manager RN position is 100% remote, no travel is expected with this position. Normal Working Hours: Monday through Friday, 8 hour shift between 7am to 5pm Arizona time The Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members from our Federal Plans. The Case Manager is responsible to evaluate the medical needs of the member in order to facilitate and promote the member’s overall wellness. The Case Manager develops a proactive course of action to address issues presented to enhance the member's short and long term outcomes. Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. Conduct comprehensive clinical assessments. Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services. Advocate for patients to the full extent of existing health care coverage. Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency. Identify and escalate quality of care issues through established channels. Provide an expected very high level of customer service. Utilize assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change. Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Required Qualifications Must have active, current and unrestricted RN licensure in state of residence and have the ability to be licensed in all non-compact states. Must be willing and able to work Monday through Friday, 8 hour shift between 7am to 5pm Arizona time Must live in either PST, MST, or Arizona Time zones 3+ years of clinical practice experience required 1+ years of experience utilizing MS Office suites Preferred Qualifications Case management experience preferred Case Manager Certification Education Associate's degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 05/17/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Care Manager (RN)

Molina Healthcare Long Beach, CA

$30.37 - $59.21 / hour

JOB DESCRIPTION Job Summary 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). • Valid Compact RN License • Valid California RN license • Valid Illinois RN license (or ability to obtain) • Strong background with high risk Obstetrics 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: $30.37 - $59.21 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Care Coordinator-RN

Renown Health Reno, NV

Position Purpose This position provides face to face, virtual or telephonic care. Collaborates with their team members both clinical and non-clinical. Coordinates services provided for patients with chronic, or behavioral health/chemical dependency needs across the lifespan to improve the quality of care and satisfaction. Identifies social determinants of health and clinical symptomology needing intervention and works within the framework of the IDT to build a longitudinal plan of care and satisfy goals. Nature and Scope This position shall coordinate all components of Care Coordination services to provide for individual patients’ health care needs thorough the continuum of care. This includes Care Coordination which involves deliberately organizing patient care activities and sharing information among all the participants concerned with a patients care to achieve safer, and more effective care. This means patients’ needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient. The Care Coordinator will follow the Renown policies and procedures. The Care Coordinator will follow the Care Coordination Model of Care and Standard work as defined by CMSA. The scope includes potential for cross training within the department Care Coordination roles to cover for departmental vacations, illness and vacancies. Position Will Be Responsible For The Following Strong interpersonal communication skills both verbal and written. Remains productive and offers help and support to team members. Collaborate with the patient, family, providers and team members to develop a patient centered Plan of Care and support patient with self-management goals. Coordinates alternative community resources to include Home Health Care, REMSA, Durable Medical Equipment, Social Determinants and Community Partners to promote and assist the patient to have a safe environment of their choice and in alignment with the patient. Facilitate, problem solve with patients, families, providers and other health care professionals to effectively resolve patient care issues. Understands how to navigate Care Coordination process of Assessment, Planning, Goal Setting, Intervention, and Evaluation with the ability to utilize these components to provide for the individual health care needs and promote positive outcomes (quality). Helps with transitions of care and organizes medical information. Knowledge of applicable regulatory requirements and community resources Knowledge of continuous quality improvement process. Philosophy consistent with the corporate culture of Renown Health Initiates, updates and revises: Assessments, Patient Outreach Encounter documentation and Longitudinal Plan of Care within the Health Planet module in Epic Ability to document in the MIDAS system any grievances, complaints, or compliments identified. May be responsible for other duties as assigned. This position may be patient facing, in person, e-visits, home visit, virtual or telephonic. Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications Requirements - Required and/or Preferred Name Description Education: Must have working-level knowledge of the English language, including reading, writing, and speaking English. Appropriate education to obtain and maintain Registered Nursing licensure in the State of Nevada. Experience One year experience as an RN preferred. License(s) Applicants with Care Management or Home Health experience preferred. Valid State of Nevada or California driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria (excludes 200373). Ability to obtain and maintain a State of Nevada RN license at time of hire. Required for this position Fingerprints must be able to pass Nevada Division of Public and Behavioral Health (DBPH) background checks upon hire and every 5 years per State of Nevada Revised Statue (NRS 449.123) to remain in this position. Certification(s) Utilization or Case Management Certification desirable. Computer / Typing Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Care Manager (RN) - Washington, Utah and Nevada

Molina Healthcare Long Beach, CA

$30.37 - $59.21 / hour

JOB DESCRIPTION Job Summary 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). • Valid Compact RN License • Valid California RN license • Valid Illinois RN license (or ability to obtain) • Strong background with transition of care 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: $30.37 - $59.21 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Care Manager (RN) - CA State License AND Compact

Molina Healthcare Long Beach, CA

$30.37 - $59.21 / hour

JOB DESCRIPTION Job Summary 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). • Valid Compact RN License • Valid California RN license • Valid Illinois RN license (or ability to obtain) • Strong background with transition of care 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: $30.37 - $59.21 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Wooster Heart Group Phone Triage RN

Bloomington Medical Services Wooster, OH

$24.24 - $43 / hour

Job Title: BMS RN – Phone Triage Nurse Department: Bloomington Medical Services Reports to: Practice Manager FLSA Status: Non-Exempt (Hourly) Job Summary: The Phone Triage Nurse serves as a critical clinical resource within Bloomington Medical Services, responsible for managing high-volume patient communications, performing clinical assessments via telephone, and coordinating timely, appropriate patient care. This role ensures safe, efficient patient access to providers through prioritization, education, and care coordination. In addition to primary triage responsibilities, this position functions as a flexible clinical team member and may be deployed to support in-office clinical operations as needed. The RN is expected to maintain competencies consistent with other clinical staff and assist with direct patient care duties during staffing needs, call-offs, or high-volume periods. Primary Duties/Responsibilities – Telephone Triage: Perform comprehensive patient assessments via telephone using clinical judgment and established protocols Determine urgency and appropriate level of care (emergent, urgent, routine) Provide clinical advice, education, and follow-up instructions to patients and caregivers Manage and respond to high-volume incoming calls, patient portal messages, and refill requests Coordinate care with providers, nurses, and ancillary departments to ensure timely patient management Document all patient interactions accurately in the EMR Communicate test results and provider recommendations to patients Identify and escalate high-risk or complex patient concerns appropriately Facilitate referrals, procedures, and follow-up appointments as indicated Monitor and track patient outcomes and follow up as needed Secondary Duties/Responsibilities – Clinical Support (as needed): Support in-office clinical operations during staffing shortages or increased patient volume Room patients, obtain vital signs, and update medical histories Assist providers during examinations and procedures Administer medications, perform phlebotomy, and provide wound care Prepare patients for tests and procedures Reinforce patient education and discharge instructions Maintain exam room readiness and ensure proper sterilization of equipment Administrative/Operational Responsibilities: Maintain confidentiality of all patient information in accordance with HIPAA Assist with scheduling, referrals, pre-authorizations, and care coordination tasks Monitor and respond to patient portal communications Collaborate with clinical, clerical, and provider teams to support efficient workflows Participate in quality improvement initiatives and workflow optimization efforts Education and Experience: Current Registered Nurse (RN) License required Clinical nursing experience, with triage experience preferred Proficiency with EMR systems (e.g., Meditech Expanse preferred) Strong clinical judgment, communication, and organizational skills Ability to work in a fast-paced, high-volume environment and adapt to changing priorities Key Expectations: Demonstrates flexibility to support both triage and direct patient care functions Maintains competency across all core clinical skills required within the practice Acts as a collaborative team member contributing to patient safety, access, and overall operational efficiency This position is primarily scheduled Monday through Friday, 8:00 AM – 4:30 PM. Alternative scheduling options may be considered based on candidate preference and operational needs, including a four-day workweek (4 x 10-hour shifts). Flexible scheduling is intended to support recruitment and retention while ensuring consistent patient access and coverage. This position is budgeted for 36–40 hours per week based on operational needs. The standard schedule is Monday through Friday, 8:00 AM – 4:30 PM. Alternative scheduling options may be considered to support recruitment and retention, including a four-day workweek (4 x 9-hour shifts or 4 x 10-hour shifts), while maintaining appropriate coverage for patient access and triage operations.

Nurse Practitioner - National After-Hours Team - part time

Curana Health

Nurse Practitioner - National After-Hours Team - part time Location US-Remote ID 2026-3112 Category Provider Position Type Part-Time At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com. Summary At Curana Health, we are committed to supporting the health, dignity, and comfort of residents in senior living communities. Our National After-Hours Call Team plays a vital role by providing compassionate telephonic care and clinical direction during evenings, nights, weekends, and holidays—ensuring that residents receive timely, high-quality support without unnecessary transfers. In this work-from-home role, you’ll deliver after-hours care virtually (primarily by phone) to aging residents across multiple states. This position offers both autonomy and purpose—you’ll be the trusted voice and clinical partner helping residents and facility staff during critical times, making an immediate impact in the lives of older adults. In this position the provider must be comfortable managing high call volumes and performing at least 30% telehealth visits, including evaluation of acute changes, falls, and controlled substance visits. Providers must be able to manage multiple calls independently while providing care across several states. Essential Duties & Responsibilities Serve as the first line of support for residents and facility staff after-hours, providing direction and medical care over the phone. Use Curana’s telephonic platform to take and place calls, coordinating care between facilities, hospitals, and clinics. Deliver high-quality, cost-effective care to patients—addressing acute, chronic, and behavioral health needs in collaboration with physicians and specialty providers. Perform comprehensive assessments and document encounters accurately and thoroughly in the EMR, ensuring compliance with CMS requirements. Apply Curana’s clinical protocols and practice guidelines to support safe, effective treatment in place whenever possible. Participate in mandatory education and training to stay current with standards of care. Scheduling & Hours: While shift times can vary, we provide coverage to skilled nursing and senior living facilities on weeknights from 5pm- 8am local time, continuous coverage from Friday at 5pm to Monday at 8am. Holiday coverage is also provided beginning at 5pm of the end of the last business day to 8am of the resumption of business hours. Availability and Coverage expectations for this role Weeknight shifts between 5pm and 8am Every other weekend coverage both Saturday and Sunday for 12 hour day shifts. Overnight and holidays are required for all After Hours Call Team Members, 2 holidays per year required for part time Holiday scheduling is completed at the beginning of the year for advanced planning Qualifications Education and Experience: Master's Degree as a Nurse Practitioner Current unrestricted NP license in Pennsylvania and New York and/or Michigan required. Active or willingness to obtain licensure within 30 days is required for the District of Columbia, Maryland, Virginia, and West Virginia Nurse Practitioner national certification as ANP, FNP, or GNP Ability to obtain DEA licensure / Prescriptive Authority Background in acute and chronic disease management Clinical background in adult, family, or geriatrics 3+ years of experience as a NP Ability to gain a collaborative practice agreement, if applicable in your state(s) Ability to work scheduled shifts in accordance with scheduling policies Proficient computer skills including the ability to document medical information with written and electronic medical records Preferred Qualifications: Experience working in a nursing home, or with seniors in an acute care facility Understanding of Geriatrics, Chronic Illness, and acute disease management Understanding of Advanced Illness and end of life discussions Ability to develop and maintain positive customer relationships Adaptability to change We’re thrilled to announce that Curana Health has been named the 147 th fastest growing, privately owned company in the nation on Inc. magazine’s prestigious Inc. 5000 list. Curana also ranked 16 th in the “Healthcare & Medical” industry category and 21 st in Texas. This recognition underscores Curana Health’s impact in transforming senior housing by supporting operator stability and ensuring seniors receive the high-quality care they deserve. Options ApplyApply Submit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances. The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment. *The company is unable to provide sponsorship for a visa at this time (H1B or otherwise). Application FAQs Software Powered by iCIMS www.icims.com

Registered Nurse (RN) - National After-Hours Team - part time - compact license

Curana Health

Registered Nurse (RN) - National After-Hours Team - part time - compact license Location US-Remote ID 2026-3481 Category Provider Position Type Part-Time At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com. Summary An RN functions as part of the National After-Hours Team (NAHT), and reports to the NAHT Director of Clinical Operations (DCO) or Clinical Team Lead (CTL). The RN performs activities that fall within the RN scope of practice. This role works in close collaboration with all of the team members and may support multiple providers. The RN works under the direction of the provider, and activities are delegated to the RN by the provider or the DCO/CTL. The RN understands and supports the NAHT models of care including the varying settings including Skilled-Nursing Facilities, Short Term Rehab, Assisted Living Facilities and Independent Living Communities. Essential Duties & Responsibilities The NAHT RN is responsible for providing telephonic care and direction to members and facility staff during various overnight, weekend, and holiday hours. This role is responsible for the delivery of medical care services to a pre-designated group of enrollees in the Southwest Region, including, but not limited to AL, AZ, AR, CO, KY, LA, MS, NM, TN, TX, CA and NV. In this home-based role you will provide afterhours virtual (primarily telephonic) care for aging residents in various settings. This excellent opportunity affords an autonomous role bringing enormous satisfaction in the care and comfort of our aging population. Scheduling & Hours: This is a part time, work from home position requiring various shift coverage with a mix of weeknights, weekend, and holiday coverage. While shift times can vary, we provide coverage to members on weeknights from 5pm- 8am local time, continuous coverage from Friday at 5pm to Monday at 8am. Holiday coverage is also provided beginning at 5pm of the end of the last business day to 8am of the resumption of business hours. Availability and Coverage expectations for this role While shift times can vary, we provide coverage to members on weeknights from 5pm- 8am local time, continuous coverage from Friday at 5pm to Monday at 8am. Holiday coverage is also provided beginning at 5pm of the end of the last business day to 8am of the resumption of business hours. Availability and Coverage expectations for this role Weeknight shifts between 5pm and 8am Every other weekend coverage for 12-hour day shifts 10am-10pm CDT both Saturday and Sunday.. Weeknight Overnight coverage and holidays are required for all RNs, 2 holiday shifts (12 hours) per year required for part time. Holiday scheduling is completed at the beginning of the year for advanced planning Primary Responsibilities : Care Coordination Assist the provider/team with various care coordination activities to support the role of the NAHT APPs Telephonic triage of incoming calls and voicemails to determine the correct level of care. Responsible for collaborating with the nursing facility, APPs, and community members to identify and respond to changes in condition. Assist the provider/team with inbound and outbound communications for members including addressing handoffs, telephonic assessments, and acuity follow-ups. Team Support Assist in the coordination of the follow up of members in the ER. Participate in the onboarding of new clinical staff under the direction of the DCO/CTL; the RN may coordinate onboarding activities and participate in other orientation activities under the direction of the DCO/CTL. Documentation Document all clinical information, telephonic assessments, and activities in the appropriate documentation tool. RN to APP Hand Off One entry by the RN and one responding entry by the APP should be recorded in the appropriate documentation tool. RN is responsible for escalating appropriate calls to the NAHT APP. Use of RN mini soap note for acute change in condition calls escalated to APP. Use of the fall mini soap note for reported falls, escalate to APP. Qualifications Current unrestricted compact RN license (AL, AZ, AR, CO, KY, LA, MS, NM, TN, & TX). Candidates must be able to apply for California (CA) and Nevada (NV) RN licenses within the first month of employment and be willing to obtain additional state licenses as needed within a 30-day timeframe. 3+ years of clinical experience in a hospital, acute care, home health/hospice, direct care, or case management position. Dedicated space for home office set up. Access to high speed internet services Computer/typing proficiency to enter and retrieve data in electronic clinical records. Proficient with Microsoft Word, Outlook, and Excel. Strong problem solving skills. Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Ability to flex with change and perform positively and efficiently in production driven environment. Preferred Qualifications : Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs Experience triaging calls Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances. The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment. *The company is unable to provide sponsorship for a visa at this time (H1B or otherwise). We’re thrilled to announce that Curana Health has been named the 147 th fastest growing, privately owned company in the nation on Inc. magazine’s prestigious Inc. 5000 list. Curana also ranked 16 th in the “Healthcare & Medical” industry category and 21 st in Texas. This recognition underscores Curana Health’s impact in transforming senior housing by supporting operator stability and ensuring seniors receive the high-quality care they deserve. Options ApplyApply Submit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances. The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment. *The company is unable to provide sponsorship for a visa at this time (H1B or otherwise). Application FAQs Software Powered by iCIMS www.icims.com

UM/ECM - RN Reviewer HP

Cook Children's Health Care System Fort Worth, TX

Location: Calmont Operations Building Department: Utilization Shift: First Shift (United States of America) Standard Weekly Hours: 40 Summary: Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP. Additional Information: Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP. Education/Education: Associate degree of Nursing required, BSN preferred. Minimum of five (5) years clinical experience. 2 years utilization management or case management experience required. Strong skills in the following areas : Oral and written communication; Critical thinking; Organization and time management; Customer service. Certification/Licensure: Current unrestricted Registered Nurse licensure in the State of Texas. About Us: Cook Children's Health Plan Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise. Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

UM/ECM - RN Reviewer HP

Cook Children's Health Care System Fort Worth, TX

Location: Calmont Operations Building Department: Utilization Shift: First Shift (United States of America) Standard Weekly Hours: 40 Summary: Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP. Additional Information: Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP. Education/Education: Associate degree of Nursing required, BSN preferred. Minimum of five (5) years clinical experience. 2 years utilization management or case management experience required. Strong skills in the following areas : Oral and written communication; Critical thinking; Organization and time management; Customer service. Certification/Licensure: Current unrestricted Registered Nurse licensure in the State of Texas. About Us: Cook Children's Health Plan Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise. Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

Case Manager, Registered Nurse

CVS Health LA

$54,095 - $116,760 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Work Expectations Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Candidate must have functioning internet access that is sufficient to support work responsibilities Required Qualifications Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager – Registered Nurse (CM RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Candidate must have functioning internet access that is sufficient to support work responsibilities Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 05/21/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Case Manager - Registered Nurse (EST)

CVS Health PA

$60,522 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences to benefit overall medical management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Required Qualifications Candidate must be based in the Eastern Time Zone (US) 3+ years clinical practice experience Candidate must have an active and unrestricted Compact Registered Nurse (RN) License in the state of residence Candidate must be willing and able to obtain additional state licensure as needed Preferred Qualifications Bilingual English/Spanish Managed care experience CCM Certification Education Associate's Degree in Nursing (REQUIRED) Bachelor's Degree in Nursing (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) License in the state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 05/21/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

RN Case Manager Advanced (IKC-CA)

DaVita Kidney Care El Segundo, CA

$41 - $55 / hour

Posting Date 04/20/2026 601 Hawaii St, El Segundo, California, 90245-4814, United States of America The DaVita IKC position can be telephonic based, field based, or a combination of both telephonic and field. Field based positions require home offices and travel to dialysis centers in designated geographic area. Telephonic positions that are remote will require home offices. DaVita Integrated Kidney Care (DaVita IKC) is an the integrated care division of DaVita Inc. working on DaVita’s vision to provide integrated care to all ESRD patients, who are some of the most medically complex and vulnerable patient populations in the US. Our more than 600 dedicated nurses, care coordinators, nurse practitioners (NPs) and business professionals integrate and manage care for more than 20,000 patients with late-stage chronic kidney disease (CKD) and end stage renal disease (ESRD) across the US each month. We’ve proven that integrating care achieves the triple aim of improved patient quality of life, better outcomes and lower total cost of care. What sets DaVita IKC apart is that we not only provide great care management but we start with our heart with our patients and each other. We focus on creating both a great experience for our patients and a special place to work for our teammates. We’re on a mission to revolutionize kidney care, with a vision of making integrated care the standard of care for all renal patients. To help us achieve our vision, we’re investing extensively in developing both our model of care and our team. When you join DaVita IKC, you're joining a compassionate team committed to quality patient care. Through our commitment to training, growth and quality we consistently achieve superior clinical outcomes while giving teammates the opportunity to excel in an award-winning environment that enables them to thrive both professionally and personally. Qualifications for the Shining Star for our DaVita IKC Registered Nurse are: A.D.N degree from accredited school of nursing required; B.S.N preferred; Current Registered Nurse (RN) license in the state of practice required Continuing education credits maintained as required by state of practice required Minimum of five (5) years’ experience in clinical nursing required Minimum of three (3) years’ experience in renal nursing preferred Demonstrated knowledge and understanding of data and managing to clinical, financial, and patient satisfaction outcomes Demonstrated experience and effectiveness in change agent role Demonstrated knowledge and understanding of CQI techniques Previous experience in healthcare performance coaching required Certified Nephrology Nurse (CNN) or Certified Case Manager (CCM) preferred Current CPR certification required Ability to modify personal practice patterns to adapt to new / electronic processes and increased productivity expectations as it pertains to Capella implementation Current driver’s license in state employed with positive driving record and able to meet requirements of insurance coverage required Basic computer skills and proficiency in MS Word and Outlook required Functional proficiency with DaVita specific clinical software programs, including Capella, required within 90 days of employment Home office with internet connectivity at minimum of 1MB upload and 1MB download speed required Join us as we pursue our vision "To Build the Greatest Healthcare Community the World has Ever Seen." What We’ll Provide: More than just pay, our DaVita Rewards package connects teammates to what matters most. Teammates are eligible to begin receiving benefits on the first day of the month following or coinciding with one month of continuous employment. Below are some of our benefit offerings. Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out Support for you and your family: Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita’s online training platform StarLearning. At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. This position will be open for a minimum of three days. The Wage Range for the role is $41.00 - $55.00 per hour. For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.

Case Manager - Registered Nurse

CVS Health SC

$54,095 - $116,760 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Work Expectations Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Required Qualifications Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager – Registered Nurse (CM RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 05/20/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Case Manager Registered Nurse - UAS NY Certified

CVS Health New York, NY

$66,575 - $142,576 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: Registered Nurse (RN) – Quality Review You will be responsible for conducting quality checks on completed member assessments within the New York Long Term Services and Supports (LTSS) program. This role ensures all assessments meet program requirements, regulatory standards, and the UAS-NY Certification guidelines. The RN reviews assessments for accuracy, completeness, clinical appropriateness, and compliance, providing feedback and guidance to support high-quality, consistent assessment outcomes. Working collaboratively with assessment staff, quality teams, and leadership, the RN serves as a clinical subject matter expert, helping to uphold program integrity, support continuous quality improvement, and ensure members’ needs are accurately captured to support appropriate service planning and authorization. Required Qualifications: Active RN License in the State of New York UAS Certification for New York 3 or more years’ experience in MLTC(Managed Long Term Care) 3 or more years’ experience in performing UAS NY Assessments Preferred Qualifications: Certified Case Manager (CCM) certification Strong problem‑solving and decision‑making skills Working knowledge of medical terminology Comfortable using digital systems and documentation platforms Ability to interact tactfully and professionally with staff, members, and community partners Demonstrated ability to handle sensitive and confidential information responsibly Strong judgment in weighing options to determine the most appropriate clinical and operational decisions Experience working effectively within culturally diverse clinical environments Education and License Requirements: Bachelor's Degree in Nursing (BSN) New York Registered Nurse License, Active and unencumbered UAS -NY Certification Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 05/17/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Case Manager Registered Nurse

CVS Health AZ

$60,521.99 - $129,615 / year

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. RN Case Manager (Remote) 100% Remote | Full-Time | EST Business Hours We’re seeking a compassionate and experienced RN Case Manager to join our remote care team. In this role, you’ll collaborate with members telephonically and occasionally face‑to‑face to assess needs, coordinate care, and promote overall health and wellness. This is a fully remote position —candidates may live in any state and must be available to work Monday–Friday, 9:00 AM–5:30 PM EST for a scheduled 8‑hour shift. Weekends and holidays may be required based on the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis. What You’ll Do Assess, plan, and coordinate care to support member health and wellness Develop proactive care plans to improve short‑ and long‑term outcomes Review clinical data (assessments, claims, etc.) and connect members to available programs and resources Apply clinical judgment to address complex medical and social needs Engage members using strong interviewing and communication skills Ensure compliance with regulatory and company case management standards What We’re Looking For Required Active, unrestricted RN license in your state of residence Willingness to obtain additional state licenses (company‑paid) 3+ years of acute care RN experience (medical, surgical, ICU, pediatrics, case management, or discharge planning) Comfortable working with multiple systems/screens simultaneously Private, distraction‑free home workspace with high‑speed internet Preferred Compact RN license 1+ year of case management experience Certified Case Manager (CCM) Strong customer service and telephonic communication skills Proficiency with Microsoft Office (Word, Excel, PowerPoint) Additional Details Education: Associate Degree in Nursing required (BSN preferred) Schedule: Occasional weekend/holiday on‑call (currently volunteer‑based) Travel: Less than 5% for meetings, trainings, or licensure requirements If you’re passionate about remote nurse case management and making a meaningful impact on member care, we’d love to hear from you. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 05/02/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.