Nurse remote jobs

Mercy Hospital Jefferson Where Nurses Come to Grow! Are you interested in opportunities at Mercy Jefferson? Apply today, and let's chat about how we can match you with the perfect role! Available Oppurtunities: (*please apply here to discuss current unit openings*) Acute Rehab (ARU) Progressive Care Unit (PCU) Medical A (Med2) Medical B (Neuro) Surgical Unit Experienced RN Incentives: Up to $10,000 Sign-On Bonus Based on Unit No Contract Required! ASN to BSN Bridging Program to assist in obtaining your BSN (up to $16,000). BSN to MSN Bridging Program to assist in obtaining your BSN (up to $16,000). New RN Incentives: $5,000 Sign-On Bonus Based on Unit No Contract Required! RN Loan Forgiveness Program to aide in paying off your RN student loan debt. Up to $370 per month directly towards loan payments ($20,000 cap). Must start with Mercy within 12-months of graduation. We offer many other great benefits and perks, including: Shift Differential Pay Annual Merit increases based on performance Tuition Reimbursement up to $2,000 for continuing education Health/Dental/Vision available after day one Annual contribution of $100 per month to eligible co-workers enrolled in the Dependent Care FSA Paid parental leave for new parents 401k with employer match Paid PTO for volunteering Competitive salary Future career growth! Free parking We’re a Little Different: Mercy Hospital Jefferson is a 251-bed acute care facility located in Festus, Mo., providing 24-hour emergency room care and a full range of diagnostic, preventive and restorative health care services. Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.” We’re bringing to life a healing ministry through compassionate care. At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We’re expanding to help our communities grow. Join us and be a part of it all. What Makes You a Good Match for Mercy? Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and unafraid to do a little extra to deliver excellent care – that’s just part of our commitment. If that sounds like a good fit for you, we encourage you to apply. Qualifications: Required Education: Nursing Degree from an accredited school License: current RN license in our state or can be obtained within 90 days Certifications: Basic Life Support certification through the American Heart Association or can be obtained within 90 days NOTE: one or more of the certifications below may be required based on the position/unit hired to, or acquisition of certification within department required timeframe If you would like to connect with the Recruiter for more information before applying, please contact Breana Balthasar at **************************. Mercy has determined this is a safety-sensitive position. The ability to work in a constant state of alertness and in a safe manner is an essential function of this job.

Virtual Clinical Nurse (RN) - onsite inpatient role Doctors Community Medical Center, Lanham, MD PRN/Supplemental - Day/Evening shift (M-F, 10:00am-7:30pm or 1:00pm-10:30pm, rotating weekends) Contributes to the provision of high-quality, cost-effective healthcare as a provider of direct and indirect patient care and by effective of the health care team. Functions as a competent member of the health care team. Essential Job Duties: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: 1. Clinical Decision Making/Judgment Demonstrates clinical nursing knowledge and skill based upon the needs of the patient population. Demonstrates the ability to apply the nursing process effectively in the care of culturally diverse patients and families. Demonstrates the ability to utilize all applicable laws, policies, standards, guidelines and evidence-based practice in the provision of patient/family care. Organizes and reprioritizes patient care activities based on subtle and overt and/or environmental changes. Consistently and thoroughly assesses patients to collect data and identify learning needs according to established standards and policies. Utilizes a systematic, continuous and complete analysis of assessment data to develop individualized problem lists for assigned patients. Develops and individualizes a plan of care for each patient in accordance with established standards, appropriate prioritization of problems/needs, and mutually agreed upon goals. Efficiently implements the patient's plan of care in accordance with applicable standards, policies, procedures and guidelines. Demonstrates clinical proficiency in patient education and nursing practice related to medication administration, medication side effects, pain management, drains, wounds, ostomy care, post-operative care, and other specific skills as needed for virtual clinical care. Continuously evaluates the effectiveness of the plan(s) of care, making revisions and recommendations based on analysis of patient responses to interventions. 2. Nurse-Patient Family Relationships Demonstrates the ability to assess the patient's/family's learning needs, readiness to learn, learning style, and presence of barriers to learning. Demonstrates the ability to develop, implement and evaluate teaching plans for patient populations in accordance with applicable standards. Demonstrates the ability to apply knowledge of growth and development across the life span to the care of patients. Provides virtual patient care to patients and families in a culturally, developmentally and ethically appropriate manner. Plans of care address the physical, psychosocial, spiritual, social determinants of health, and learning needs of the patient/family. 3. Clinical Scholarship Participates in Quality reviews or initiatives. Participates in QI, CPI, and risk management activities at the unit, department, or organizational level. Collaborate with healthcare team to ensure effective quality care delivery Supports the use of evidence-based guidelines and organizational policies and procedures to promote safe patient care and a safe practice environment. Enhance the patient experience by utilizing appropriate communication, providing patient centered care, and collaborating with the care team to ensure patient concerns are addressed. 4. Clinical Leadership Promotes shared governance by actively participating in Luminis Health Nursing Practice committees. Participates in the education and/or orientation of new staff. Delegates patient care activities as appropriate; evaluates delegated activities for expected patient care outcomes. Employs real time computer documentation when completing patient record. Participate in daily dyad rounds with physician, nurse, and other care team members. Utilize the appropriate resources to ensure patient centered quality care is provided. 5. Role Specific Responsibilities Provide nursing care to the adult medical patients ranging in age from 18 years to the elderly. Demonstrates the ability to utilize various forms of technology to effectively deliver appropriate nursing care and patient education to desired population. Demonstrates the ability to utilize telemetry as an assessment tool and manage the patient care. Identifies and treats in conjunction with the primary care team the following nursing diagnoses that frequently occur in the medical population: Activity intolerance Impaired adjustment Impaired physical mobility Pain Self-care deficit Alteration in elimination Potential for impaired gas exchanges in pulmonary system Increased risk for impaired skin integrity Increased risk for infection Ineffective Coping Enhance the patient experience by utilizing appropriate communication, providing patient centered care, and collaborating with the care team to ensure patient concerns are addressed. Educational/Experience Requirements: Graduate of an accredited school of nursing Bachelor of Science in Nursing (BSN) or higher nursing degree preferred. Adheres to the credentialing requirements of Luminis Health as stated in the nursing bylaws for Luminis Health Anne Arundel Medical Center (AAMC) and/or Luminis Health Doctor's Community Hospital (DCH). Five years current clinical nursing experience in specialty Required License/Certifications: Current licensure as a registered nurse by the Maryland Board of Nursing BLS - American Heart Association Healthcare Provider certification Working Conditions, Equipment, Physical Demands: Physical Demands - Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work. The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act. The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary. Luminis Health Benefits Overview: Medical, Dental, and Vision Insurance Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year) Paid Time Off Tuition Assistance Benefits Employee Referral Bonus Program Paid Holidays, Disability, and Life/AD&D for full-time employees Wellness Programs Eligible for shift differentials/OT Employee Assistance Programs and more *Benefit offerings based on employment status

Our client, a Global Fortune 50 organization and one of the world's largest distributors of Health care systems, medical supplies & Pharmaceutical products, seeks an accomplished Clinical Oncology RN - Remote. *** TITLE: Clinical Oncology RN - Remote *** WORK LOCATION: Remote Role / Client Location: 9950 Woodloch Forest Drive, The Woodlands TX 77380 *** DURATION: 6 months+ Contract with high possibility of extension *** WORK SCHEDULE: 8am-5pmCST M-F Pay Rate: $35.00/hr. - $40.00/hr. (depending upon experience) RESPONSIBILITIES: Accurately and effectively conduct electronic medical record abstraction into the electronic data capture tool. Complete quality, accuracy and/or inter-rater reliability testing as requested in a timely manner. Abide by all HIPPA and associated patient confidentiality requirements. QUALIFICATIONS / REQUIREMENTS: Education: High School diploma. Must be an oncology RN and have >5 years of oncology experience. Must have 2+ years of electronic medical record chart abstraction experience. Must be proficient in navigating through EMR databases. Clinical experience/pharmaceutical experience; prefer experience in performing chart abstractions in oncology setting, academic or research experience helpful. Excellent computer skills including MS Word, MS PowerPoint, MS Excel, MS Outlook Must have high speed internet access. I'd love to talk to you if you think this position is right up your alley, and assure a prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you. Recruiter Name: Lalit Malgotra Title: Sr. Business / Professional Recruiter Email ID: ****************************** Company Overview: Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally; as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients' businesses forward. Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws

Trinity Health FirstChoice is seeking a travel nurse RN Virtual Care for a travel nursing job in Boise, Idaho. Job Description & Requirements Specialty: Virtual Care Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel This an On-site and Inpatient role, requiring a minimum of 8 years of Med Surg Tele or PCU and Cardiac Acute Care hospital experience. What you'll need to qualify: • 8 years of recent Med/Surg Tele or PCU experience in an acute care hospital • Current BLS and ACLS • Knowledge of Cerner • RN license in the state you wish to work. • Cannot hold a concurrent position at a Trinity Health facility. POSITION PURPOSE This unique model offers a new virtual role for the experienced nurse to care for patients, coordinate complex care and provide mentoring to early career nurses. Bedside nurses also benefit from having an RN mentor for support in patient care. You will be working virtually in the monitor room and view the patients on video. You will be doing things such as admissions, discharges, fall prevention documentation, stroke documentation, calling physicians, scheduling appointments, assisting new nurses (via video), skin assessments, etc. ESSENTIAL FUNCTIONS Experienced RNs are eligible for the onsite vRN role, allowing them to care for patients in a less physically demanding environment. Virtual RNs provide mentoring and support for bedside nurses. This is critical for early career nurses to feel engaged and have a fellow nurse help them navigate care questions or concerns. Allows experienced nurses to transition to a role that maximizes their expertise, while supporting desire for a change in physicality of work. Care Partners (LPN/LVN, CNA, NA) have access to two RNs for patient care. Care partners are an integral part of the Virtual Connected Care team addressing routine patient care needs appropriate to their license. Trinity Health FirstChoice Job ID #KTN-03252025-D. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN Virtual Care Onsite About Trinity Health FirstChoicePremium pay FirstChoice offers a rewarding career with significant premium pay and flexible scheduling to fit your life. FirstChoice healthcare travel professionals fill critical positions when unforeseen or unplanned circumstances occur; or, when there is a position open due to an extended leave-of-absence. You'll get to experience a variety of practice settings while traveling within your local region or traveling nationally - your choice! Healthcare travel professionals, join us in caring for our community, we can't do it without you. FirstChoice exclusively supports facilities within the Trinity Health system meaning you will have a consistent experience between job sites. Your training at one site will apply to other sites within the region and will minimize the time you are spending outside of patient care. We understand that there has been a fundamental shift in the nursing position in recent years and like any other employee, nurses want more options and flexibility in their careers. FirstChoice provides you with both along with the comfort and security of one employer. Benefits of Being a FirstChoice healthcare travel professional: Premium pay Choose your own travel adventure-work in a variety of practice settings Wide range of assignments available Housing and meal stipend Minimum Qualifications/Requirements of a FirstChoice Nurse: Registered nurse with a license in the state(s) you will work Minimum of 2 years, depending on specialty area Cannot hold a concurrent position at a Trinity Health facility Trinity Health is a leading not-for-profit Catholic health system with 92 hospitals and hundreds of primary, specialty and continuing care centers across the United States. Benefits Employee assistance programs 403b retirement plan Discount program

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Inpatient Review Nurse assists patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Assures that services are provided at the most appropriate, cost effective level of care needed to meet the patient's medical needs while maintaining safety and quality. GENERAL DUTIES / RESPONSIBILITIES: 1. Performs reviews of inpatients with complex medical and social problems. 2. Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient's primary care physician. 3. Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting. 4. Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on acceptable evidence-based guidelines used by AHC. 5. Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities. 6. Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary. 7. Communicates and collaborates with IPA/MG as necessary for effective management of Members. 8. Assigns and provides daily oversight of the activities and tasks of the CCIP Coordinator. 9. Records communications in EZ-Cap and/or case management database. 10. Arranges and participates in multi-disciplinary patient care conferences or rounds. 11. Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure. 12. Monitors for any over utilization or underutilization activities. 13. Generates referrals as appropriate to the QM department. 14. Enters data as necessary for the generation of reports related to case management. 15. Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management. 16. Performs other duties as assigned. Minimum Requirements: Experience: • Required: Minimum (3) years' general case management skills. Minimum (2) years' experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay: including review of diagnosis and length of stay. Minimum (2) consecutive years related experience in a managed care setting as an inpatient case manager • Preferred: Experience with a senior population. Education: • Required: Successful completion of an accredited Licensed Vocational Nursing Program • Preferred: Associates or Bachelors Degree Specialized Skills: • Required: Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Excellent critical thinking skills related to nursing utilization review Knowledge of Medicare Managed Care Plans Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. • Preferred: Knowledge and experience in complex / catastrophic case management preferred Licensure: • Required: Must have and maintain an active, valid, and unrestricted RN license in California (Non-Compact) Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1 While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear. 2 The employee is frequently required to reach with hands and arms 3 The employee is occasionally required to climb or balance and stoop, or kneel 4 The employee must occasionally lift and/or move up to 20 pounds. 5 Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. Pay Range: $77,905.00 - $116,858.00 Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.

Remote/Hybrid Triage Nurse - Danville Health Center Northern Counties Health Care is seeking a compassionate and skilled Registered Nurse (RN) to join our team as a Triage Nurse for Danville Health Center. This position will begin on-site for training; after which it can transition to a hybrid schedule with up to three remote days per week. The ideal candidate will assess patients' conditions over the phone, respond to requests for medical treatment, determine illness severity, review and refill medications, and address other patient health concerns. This role requires excellent communication skills, clinical judgment, and the ability to remain calm under pressure. Key Responsibilities: Conduct initial assessments of patients' symptoms and medical history. Provide medical advice and guidance to patients via phone or virtual platforms. Prioritize patient needs based on the severity of their condition. Collaborate with healthcare providers to ensure appropriate patient care. Document patient information accurately and efficiently in the Electronic Medical Record (EMR). Adhere to all legal and ethical standards of nursing practice. Requirements: Valid Registered Nurse (RN) license. Minimum of three years of nursing experience in an ambulatory care setting. Excellent assessment and communication skills. Ability to make quick and accurate clinical judgments. Proficiency in EMR systems and ability to work efficiently in a remote setting. Benefits: Health, Vision, and Dental Insurance Long-Term & Short-Term Disability Life Insurance Paid Parental Leave 403b Retirement Plan Generous Earned Time Accrual If you are an experienced Registered Nurse looking for a flexible hybrid or remote opportunity while providing essential patient care, we encourage you to apply! Northern Counties Health Care is an equal opportunity employer dedicated to diversity and inclusion.

Position: Part-Time, Non-Exempt, 5-20 hours per week Reports to: Forensic Nurse Expert II Supervisory responsibilities: None About the Company Godoy Medical Forensics Incorporated, originally founded in 2009 with one nurse, has evolved into a prominent consulting company boasting a diverse team of experts, including physicians, toxicologists, and Registered Nurses (RNs) from various backgrounds. With a wide-ranging scope, we offer expert opinions in numerous forensic areas, including but not limited to sexual assault, child abuse, gunshot wounds, assault, DUI, and homicide cases. We are retained by both the prosecution and the defense, with a significant portion of our cases coming from defense attorneys. Join us as we continue to expand our influence in the field of forensic nursing and expert consultation. Job Overview The Forensic Nurse Expert - SANE Specialty provides expert opinions and professional reports to attorneys in criminal and civil matters. The Forensic Nurse Expert - SANE Specialty is expected to represent the company in a manner that is professional and reputable. Essential functions Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions. Case review - The nurse will be required to review pertinent discovery in criminal and civil matters, provide verbal consultation with attorneys and offer opinions including, but not limited to, those that relate to medical conditions, traumatic injuries, and medication affects. Written reports - The nurse must be capable of writing professional reports, citing credible resources and produce a product that is free of grammatical mistakes and plagiarism. Testimony - The nurse must be willing to provide testimony in-person and remotely. The nurse must be willing to travel 1-2 times per month, with limited notice, including out of state, with full compensation for travel and travel time. Other Duties Sales/Marketing - The nurse may be asked to deliver presentations and exhibit at conferences for lead generation and company growth and development. Other tasks may include preparation of chronologies, locating and screening experts, and general assistance of other staff. Please note this job description is not designed to cover or contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Required Education, Experience and Skills Current IAFN SANE certification in either Adult/Adolescent or Pediatrics. Continually meet the continuing education/recertification requirements to maintain IAFN SANE certification in either Adult/Adolescent or Pediatrics. Ongoing and actively performing SANE exams in a clinical setting. Minimum of 5 years of clinical experience. Registered Nurse license that is current and free of any negative history. Bachelor's Degree in Nursing or related field. Spoken Communication - Fluent in English, with clear articulation and professional delivery. Written Communication- Written reports must be high quality, fluent and free of grammatical errors or plagiarism. Public Speaking - Must be comfortable with public speaking and able to deliver a presentation or testimony without outward signs of anxiety. Preferred Education and Experience Other specialized education, training and experience in forensic areas including, but not limited to child abuse, strangulation, gunshot wounds or homicide. It is desirable that the SANE FNE obtain a second specialty area as per the requirements set by Godoy Medical Forensics. It is highly recommended that the nurse obtain a Certification in Forensic Nursing, and start that program within six (6) months of employment. Emergency Room, Trauma, or ICU experience. Testimony experience. Public speaking experience. Additional Eligibility Requirements Professional attire during client interactions, both in and out of the courtroom, is required. This includes conservative jewelry and minimal fragrances. Tattoos must be able to be concealed when professional courtroom attire or speaking engagements are required. Clean background check, including criminal record. Access to high-speed internet connection in work environment Physical Demands: Sitting/Standing/Walking: Must be able to sit at computers for long periods of time. Standing and walking may be required. Speaking/Hearing: Ability to effectively communicate with co-workers and clients. Vision: Must be able to see details on computer screen and read printed materials. What We Offer • 401K w/Employer Match • 11 Paid Holidays, plus 1 Floating Holiday • Paid Sick Leave • Paid Vacation • Remote Work Environment • Opportunity for Growth and Leadership Development • Onboarding Includes on the Job Training and Mentorship. • Family-oriented Business Culture with Reasonable Flexibility • Tuition Reimbursement Godoy Medical Forensics, Inc. provides equal employment opportunities to all employees and applicants for employment.

Thank you for your interest in working for our Company. Recruiting the right talent is crucial to our goals. On April 1, 2024, 3M Healthcare underwent a corporate spin-off leading to the creation of a new company named Solventum. We are still in the process of updating our Careers Page and applicant documents, which currently have 3M branding. Please bear with us. In the interim, our Privacy Policy here: *************************************************************************************** continues to apply to any personal information you submit, and the 3M-branded positions listed on our Careers Page are for Solventum positions. As it was with 3M, at Solventum all qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Description: 3M Health Care is now Solventum At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers' toughest challenges, we pioneer game-changing innovations at the intersection of healh, material and data science that change patients' lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue. We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you. The Impact You'll Make in this Role As an Inpatient Consultant you will have the opportunity to tap into your curiosity and collaborate with some of the most innovative and diverse people around the world. Here, you will make an impact by: Validation and application of software modules relating to coding and training Collaborating with the coding and clinical team members and external clients includes content creation. Assist in presenting clinical and coding concepts to various hospitals and/or organizations and implementing and supporting Clinical Documentation Integrity programs in multiple facilities Leading audit tasks of medical record coding, documentation, compliance and DRG assignment Participating in relevant corporate programs/initiatives and ensuring professional, quality and security standards are complied with while performing assigned duties and complying with corporate policies and procedures while acting in a manner consistent with 3M's values and ethical standards Your Skills and Expertise To set you up for success in this role from day one, Solventum requires (at a minimum) the following qualifications: Bachelor's Degree or higher (completed and verified prior to start) and seven (7) years of experience as a coding professional or clinical experience OR High School Diploma/GED (completed and verified prior to start) and eleven (11) years of experience as a coding professional or clinical experience AND In addition to the above requirements, the following are also required: RHIT OR CCS certification with five (5) years of clinical coding experience or Five (5) years of CDI experience Ability to travel up to 50% Additional qualifications that could help you succeed even further in this role include: Master's degree in HIM, Nursing, or other healthcare clinical background (completed and verified prior to start) from an accredited institution Valid RN License with five (5) years acute care experience and recognized CDI credential from ACDIS (CCDS) or AHIMA (CDIP). Experience with telecommuting, working with EMRs and other electronic tools with current chart auditing skills Knowledgeable in 3M HIS software portfolio (360 Encompass) Proficient Microsoft Word, Excel and PowerPoint and other Microsoft Office programs and excellent verbal, written, presentation, analytical and organizational skills For current employees, internal transfer restrictions may not apply. For more details, contact your local recruiter/HR team. Work location: Remote USA Travel: May include up to 50% travel domestically Relocation Assistance: Not authorized Must be legally authorized to work in country of employment without sponsorship for employment visa status (e.g., H1B status). Supporting Your Well-being Solventum offers many programs to help you live your best life - both physically and financially. To ensure competitive pay and benefits, Solventum regularly benchmarks with other companies that are comparable in size and scope. Applicable to US Applicants Only:The expected compensation range for this position is $119,076 - $145,537, which includes base pay plus variable incentive pay, if eligible. This range represents a good faith estimate for this position. The specific compensation offered to a candidate may vary based on factors including, but not limited to, the candidate's relevant knowledge, training, skills, work location, and/or experience. In addition, this position may be eligible for a range of benefits (e.g., Medical, Dental & Vision, Health Savings Accounts, Health Care & Dependent Care Flexible Spending Accounts, Disability Benefits, Life Insurance, Voluntary Benefits, Paid Absences and Retirement Benefits, etc.). Additional information is available at: *************************************************************************************** of this position include that corporate policies, procedures and security standards are complied with while performing assigned duties. Solventum is committed to maintaining the highest standards of integrity and professionalism in our recruitment process. Applicants must remain alert to fraudulent job postings and recruitment schemes that falsely claim to represent Solventum and seek to exploit job seekers. Please note that all email communications from Solventum regarding job opportunities with the company will be from an email with a domain *****************. Be wary of unsolicited emails or messages regarding Solventum job opportunities from emails with other email domains. Please note, Solventum does not expect candidates in this position to perform work in the unincorporated areas of Los Angeles County.Solventum is an equal opportunity employer. Solventum will not discriminate against any applicant for employment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status. Please note: your application may not be considered if you do not provide your education and work history, either by: 1) uploading a resume, or 2) entering the information into the application fields directly. Solventum Global Terms of Use and Privacy Statement Carefully read these Terms of Use before using this website. Your access to and use of this website and application for a job at Solventum are conditioned on your acceptance and compliance with these terms. Please access the linked document by clicking here, select the country where you are applying for employment, and review. Before submitting your application you will be asked to confirm your agreement with the terms.

Reports to: Chief Executive Officer and/or Training Director Scope of work: Provides monitoring and clinical skills training & exposure to nurse practitioner and physician assistant students. Education: M.D. from accredited University or Medical School Completion of a Psychiatric Residency Program Experience: Has experience in mental health services Has medical license within the U.S. Responsibilities: Provide monitors and proctors nurse practitioner and physicians assistant students in psychiatric services Provides feedback and training on clinical skills development with NP and PA students

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

Hi. We're Hummingbird. We're elevating patient access so patients can get healthcare how, when, and where they need it. We partner with healthcare systems to transform how patients access care, enabling their providers to focus on what matters most - caring for patients. By managing patient access as a technology-enabled service, we help health systems stabilize costs and improve patient experience while creating good jobs that attract and retain talent in the industry. Our team of experts is obsessed with the connection between the people, processes, and technology that make healthcare organizations hum. Join us and help build the healthcare experience we want for our communities, our families, and ourselves. Summary As an RN Agent at Hummingbird, you'll provide high-quality, efficient, and compassionate care to patients via telephone triage. This includes assessing patient needs, offering clinical advice, and ensuring appropriate follow-up care that follows client-specific clinical guidelines, policies, and processes. In this role, you will work under moderate supervision as you develop proficiency, conducting work of increasing complexity and contributing to team objectives and outcomes Responsibilities Compensation: The hiring range is $30.43 - 32.72 - 35.00 USD per hour, based on experience, less statutory deductions. Work Location: This is a work-from-home position. You must work from a private location within the United States with consistent, high-speed internet service. Travel: Work from home. There may be optional travel for company events. FLSA Status: Non-Exempt Benefits Eligible: Yes People Manager: No Telephone Triage Answer inbound telephone calls promptly and direct callers efficiently, adhering to defined service level agreements (SLAs) and quality metrics. Verify and document patient information, adhering to HIPAA regulations. Using Epic's Nurse Triage module, perform clinical assessments and provide appropriate medical advice following client-specific clinical guidelines, policies, and processes. Determine the urgency of patient symptoms and direct patients to the appropriate level of care. Identify patient needs, clarify information, and provide solutions or alternatives using appropriate tools and resources. Document patient interactions accurately in the electronic health record (EHR) system. Escalate complex inquiries to senior agents or supervisors as necessary. Clinical Decision-Making Use clinical knowledge and judgment to prioritize and manage patient care needs, following client-specific clinical guidelines, policies, and processes. Identify and address potential health risks and escalate cases to appropriate providers when necessary. Coordinate with team members and clinic teams to ensure accurate and efficient scheduling, patient communication, and comprehensive care. Customer Service Excellence Address and resolve customer service issues promptly and professionally, ensuring patient satisfaction while maintaining patient confidentiality and adhering to HIPAA regulations. Communicate effectively with supervisors and team leads, following established protocols and guidelines. Maintain high standards of service quality by following best practices, actively participating in training, and continuously seeking improvement. Team Engagement Actively support team initiatives, contributing to a culture of trust and transparency. Complete ongoing training to maintain competency in existing and changing workflows. Share insights and support team goals. Collaborate with non-clinical and clinical colleagues to enhance overall performance and understanding of appropriate situations for nurse triage. Suggest practical solutions to improve patient access services. Embrace continuous learning and professional development opportunities. Required & Desired Skills Required Skills and Experience 2+ years of clinical nursing experience, preferably in an emergency, telephonic triage, or critical care setting. Current, unrestricted RN license in the state of North Carolina. Strong clinical assessment and decision-making skills via telephone. Strong customer service skills including the ability to handle challenging situations with patience and professionalism. Basic computer literacy and troubleshooting skills. Ability to type 50 WPM with accuracy. Strong communication skills, both written and verbal. Ability to adhere to established clinical protocols and guidelines. Ability to multitask and prioritize tasks in a fast-paced environment. Ability to work collaboratively in a team setting. Comfortable working in a remote work environment. Desired Skills and Experience Current Compact State Nursing License or eligibility for licensure in a compact state. Previous telephone triage or contact center experience is highly desirable. Familiarity with contact center software and technology. Prior experience using Epic's electronic health records (EHR) software. The Hummingbird Approach We value a team that brings diverse perspectives and experiences to the work we do. While there are many ways to do this, people who are successful at Hummingbird: Lead with Respect by valuing kindness and working to actively foster an environment of inclusion and respect. Embrace Growth and seek out learning and growth for themselves and support those around them in their growth journey. They bring curiosity and an openness to innovation to all their interactions. Bring a Win Together mentality by approaching conflict directly, listening carefully, and seeking to understand. They problem-solve with the goal of finding successes, not trade-offs, for all involved. Equal Opportunity Statement Hummingbird Healthcare is an equal opportunity employer committed to diversity and inclusion. We do not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected characteristic. We value the talents of individuals from all backgrounds and actively seek a diverse workforce. Our mission is to provide a fair and inclusive recruitment process for everyone, and reasonable accommodations are available to any applicant who may need them. Please reach out to talent@hummingbird.healthcare to request accommodations and we'd be happy to chat.

Available! Inspire Hospice is seeking a dedicated part-time Remote Triage Nurse to join our team. This role is perfect for individuals passionate about providing exceptional end-of-life care from the comfort of their own home. Position: Remote Triage Nurse Schedule: Part-time; Saturdays and Sundays, 8 AM to 8 PM Compensation: $25 per hour Key Responsibilities: Provide phone-based triage, assessing patient needs and offering appropriate guidance. Utilize our electronic medical records system to review patient histories and ensure accurate documentation. Work collaboratively with our care team to ensure a comprehensive support system for our patients. Manage patient calls with a focus on responsiveness and compassion. Requirements: Must possess a current Georgia RN license. Residency in Georgia is required. Prior experience in hospice, palliative, or end-of-life care. Access to high-speed internet and a private, HIPAA-compliant workspace. Proficiency in technology with strong keyboard skills and the ability to navigate multiple software applications. Ability to work efficiently in a fast-paced environment. Ideal Candidate Will: Demonstrate excellent communication skills and empathetic patient interactions. Have a strong background in critical care or similar fast-paced medical settings. Be highly organized and capable of multitasking effectively. Benefits: Remote work arrangement to eliminate commuting and maximize work-life balance. Competitive hourly wage. Be part of a mission-driven organization that values compassion and quality care. Apply Now: If you are committed to making a difference in the lives of patients and looking for a fulfilling role that offers flexibility, please apply to join our dynamic team at Inspire Hospice.

Available! Inspire Hospice is seeking a dedicated part-time Remote Triage Nurse to join our team. This role is perfect for individuals passionate about providing exceptional end-of-life care from the comfort of their own home. Position: Remote Triage Nurse Schedule: Part-time; Saturdays and Sundays, 8 AM to 8 PM Compensation: $25 per hour Key Responsibilities: Provide phone-based triage, assessing patient needs and offering appropriate guidance. Utilize our electronic medical records system to review patient histories and ensure accurate documentation. Work collaboratively with our care team to ensure a comprehensive support system for our patients. Manage patient calls with a focus on responsiveness and compassion. Requirements: Must possess a current Georgia RN license. Residency in Georgia is required. Prior experience in hospice, palliative, or end-of-life care. Access to high-speed internet and a private, HIPAA-compliant workspace. Proficiency in technology with strong keyboard skills and the ability to navigate multiple software applications. Ability to work efficiently in a fast-paced environment. Ideal Candidate Will: Demonstrate excellent communication skills and empathetic patient interactions. Have a strong background in critical care or similar fast-paced medical settings. Be highly organized and capable of multitasking effectively. Benefits: Remote work arrangement to eliminate commuting and maximize work-life balance. Competitive hourly wage. Be part of a mission-driven organization that values compassion and quality care. Apply Now: If you are committed to making a difference in the lives of patients and looking for a fulfilling role that offers flexibility, please apply to join our dynamic team at Inspire Hospice.

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

Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must have strong skills with organization, multitasking, problem solving, and using clinical judgment. Candidates with proficient knowledge of MS Office, PEGA, QNXT, MCG is highly preferred. Further details to be discussed during our interview process. This is a remote position. Illinois & Wisconsin RN compact licensure required Work hours: Monday- Friday: 8:30am -5:00pm. Central Time. Along with every 8 weeks Friday coverage is from 9 to 5:30pm CST for 2 weeks. Job Duties Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing. Identifies and reports quality of care issues. Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience Documents clinical review summaries, bill audit findings and audit details in the database Provides supporting documentation for denial and modification of payment decisions Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. Reviews medically appropriate clinical guidelines and other appropriate criteria with Medical Directors on denial decisions. Supplies criteria supporting all recommendations for denial or modification of payment decisions. Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. Provides training and support to clinical peers. Identifies and refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. JOB QUALIFICATIONS Graduate from an Accredited School of Nursing REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: Minimum 3 years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review. Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience Familiar with state/federal regulations REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: Active, unrestricted State Registered Nursing (RN) license in good standing. PREFERRED EDUCATION: Bachelors's Degree in Nursing or Health Related Field PREFERRED EXPERIENCE: Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other healthcare certification. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

, however, candidates must reside in the State of TX or State of IL is a contract for about 9 months. Pay: $41/hour RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended For Medical Necessity, Contract Interpretation, Pricing; And To Initiate And/Or Respond To Correspondence From Providers Or Members Concerning Medical Determinations. Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation. Awareness of claims processes and claims processing systems. PC proficiency to include Microsoft Word and Excel and health insurance databases. Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings. Organizational skills and prioritization skills. :Registered Nurse (RN) with unrestricted license in state. 3 years clinical experience. Needs to be able to navigate MCG and Medical policies with the reviews.

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. JOB QUALIFICATIONS (Required): Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company. Knowledge of medical terminology and procedures. Verbal and written communication skills. JOB QUALIFICATIONS (Preferred): MCG or InterQual experience Utilization management experience LOCATION: REMOTE in Texas (Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties). POSITION: 6-month assignment SALARY: $38 - $40 hourly HOURS PER WEEK: 40 HOURS PER DAY: 8

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. The UR RN specializes in examining medical records and developing concise and pertinent clinical reviews to support authorization obtainment, avoid payment denial, and optimize reimbursement. The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. The Utilization Management Case Manager is responsible for performing the initial and concurrent Utilization Reviews on all patients admitted or placed in outpatient status with observation services. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Current unencumbered RN license in state of residency, West Virginia or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). EXPERIENCE: 1. Three (3) years of healthcare clinical experience. PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion within three (3) years of hire. EXPERIENCE: 1. Medical Management for Medicare and/or Medicaid populations. 2. Utilization Management experience. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Assure effective communication of medical necessity to the applicable payor. 2. Reviews, assesses, and evaluates clinical information used to support Utilization Management (UM) decisions based on medical record documentation. 3. Facilitates professional communication to ensure the authorization process is completed in a patient centered manner with adherence to quality and timeline standards. 4. Reviews medical records and compiles concise and pertinent clinical reviews. 5. Collaborates with UR coordinators, clinical appeals, and physician advisors to prevent and manage concurrent denials. 6. Advocates for the patient and hospital with insurance companies to optimize reimbursement and hospital stay coverage 7. Collaborates with other members of the interdisciplinary team as outlined in the system UM Plan 8. Provides timely and comprehensive documentation of clinical reviews and payor communication. 9. Maintains working knowledge of payor requirements. 10. Communicates concurrent denials to appropriate team members in a timely fashion. 11. Provide highly effective reconsideration clinicals to payors in order to prevent denials 12. Liaise with hospital case management as necessary and appropriate 13. Maintains effective and efficient processes for determining appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. 14. Maintains knowledge and understanding of applicable federal regulations and Conditions of Participation. 15. Actively participates in process improvement initiatives, working with a variety of departments and multidisciplinary staff. 16. Effectively and efficiently manages a diverse workload in a fast-paced, rapidly changing regulatory environment. 17. Identify delays in treatment or inappropriate utilization and serves as a resource 18. Coordinates communication with physicians and collaborates to ensure appropriate patient status. 19. This individual identifies, develops, and provides orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis. 20. Consistently demonstrate ability to serve as a role model and change agent by promoting the concept of teamwork and the revenue cycle process continuum of high performing teams. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office work which includes sitting for extended periods of time. 2. Must have reading and comprehension ability. 3. Visual acuity must be within normal range. 4. Must be able to communicate effectively. 5. Must have manual dexterity to operate keyboard, fax machines, telephones and other business equipment. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office work which includes sitting for extended periods of time. 2. Maintains confidential home office space 3. Required weekends and holidays as assigned SKILLS & ABILILTIES: 1. Effective verbal and written communication skills. 2. Strong interpersonal skills. 3. Strong attention to detail. 4. Knowledge of medical terminology required. 5. Knowledge of third party payers required. 6. Ability to use tact and diplomacy in dealing with others. 7. Working knowledge of computers. 8. Excellent customer service and telephone etiquette Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 553 SYSTEM Utilization Review

Utilization Review Nurse - LTSS (Contract-to-Perm) Location: Remote however Candidates must reside in one of the following states: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY, OH, TX, UT, WA, or WI Schedule: Monday-Friday | 8:00 AM - 4:30 or 5:00 PM EST Pay Rate: $42.00 per hour + Full Health Benefit Plan Offered Contract-to-Hire Opportunity Join a Mission-Driven Managed Care Organization This is your chance to join one of the nation's most respected Managed Care Organizations, known for its commitment to delivering high-quality, cost-effective healthcare to underserved populations. With a culture of compassion and innovation, this organization is recognized for prioritizing patient outcomes and creating opportunities for professional growth across the country. Position Overview The Utilization Review Nurse (LTSS) supports the Utilization Management team and is responsible for reviewing long-term services and supports (LTSS) provider requests, primarily by evaluating clinical documentation to ensure appropriateness of care, cost efficiency, and compliance with state and federal regulations. The role plays a critical part in ensuring members receive the right care at the right time, particularly under Virginia Medicaid guidelines. Key Responsibilities Review LTSS provider service requests against case management documentation Conduct prior authorization and concurrent reviews in accordance with clinical guidelines and organizational policy Complete reviews within turnaround time (TAT) expectations Identify member eligibility, applicable benefits, and appropriate levels of care Collaborate with internal care teams, including Behavioral Health and Long-Term Care Refer cases to medical directors when needed for clinical decision-making Participate in staff meetings and cross-functional collaboration Provide mentorship to new team members as assigned Maintain documentation standards, compliance, and productivity benchmarks Ensure HIPAA and regulatory compliance at all times Requirements Active, unrestricted RN license in Virginia or Compact State (required) Completion of an accredited Registered Nursing program 0-2 years of clinical practice experience (hospital, utilization management, or case management preferred) Experience with LTSS highly preferred Familiarity with Virginia Medicaid is a strong plus Knowledge of InterQual, Milliman, or other medical necessity tools Experience with NCQA standards and utilization review policies Comfortable working independently in a fully remote environment Strong written/verbal communication and organizational skills Proficient with Microsoft Office products; experience with clinical systems a plus Work Environment & Schedule 100% Remote Candidates must be available to work EST business hours This is a contract-to-permanent position with the opportunity to grow within a mission-driven team that values clinical excellence, accountability, and member advocacy.