Technology has changed our world in more ways than can be counted, and one of the more profound changes is our ability to work from just about anywhere. This includes providing virtual healthcare services to the public. If you’re looking to make a switch from in-person caregiving, start exploring remote nursing jobs.
There are many different types of work-from-home nursing jobs available. To streamline your search, you can look for positions by license type:
IntelyCare can help you find a great remote nursing job that fits your needs.
Enjoy Better Work-Life Balance With Remote Nurse Jobs
One of the main benefits of remote jobs for nurses is the improved work-life balance they offer. There’s no commute, which cuts down on travel costs in addition to preserving your precious time — not to mention taking a bit of stress off your shoulders. Some work-from-home nurse jobs even feature flexible schedules, which allow you to choose when you start and end your day. If you’re raising a family or caring for a loved one, you’ll appreciate these kinds of perks that you just don’t get when working on-site.
Remote Nursing Jobs Can Boost Your Career
This is extremely obvious, but it’s worth pointing out anyway: If you work in traditional full-time jobs or part-time jobs in a facility, you have to live nearby. Your career development is limited to the jobs available in your geographic area.
Remote nurse jobs are located all over the country, and in many nursing specialties, which means a reliable internet connection can turn you into a candidate for any job that interests you. If you’re not finding opportunities for advancement with your current employer, take a look at what’s being offered in remote nurse positions.
Tailor Your Resume and Cover Letter for Virtual Nursing Jobs
Before you apply to a remote nurse job, take a good look at the job ad to see what the list of requirements looks like. The items toward the top of the list are typically the most important. Pick out the keywords you see and incorporate them into your nursing resume.
For example, if the ad mentions that a candidate must have “exceptional communication skills” and “solid problem solving abilities,” include the phrases in your resume to show that you’ve gained competency in those skills.
Use your cover letter to expound on these topics. Let the reader know how you successfully used those particular soft skills in your previous jobs. By aligning your qualifications to the needs of the role, you’re showing an employer that you’d be a great fit for the job.
Interviewing for Remote Jobs for Nurses
One of the key traits an employer will be looking for in remote workers is emotional intelligence. You can demonstrate this skill during a job interview by being properly prepared. Review common nursing interview questions and practice delivering thoughtful responses. Just because work-from-home nursing jobs aren't in person doesn’t mean you can afford to take liberties.
Find Remote Nursing Jobs That Work for You
If you’re ready to work from the comfort of your own home, start searching IntelyCare for a great remote nurse job that piques your interest and fits your needs. Want more career help? Learn how we can match you with great nursing jobs all over the country.
This is a remote role. CircleLink Health is looking for passionate, tech savvy ILLINOIS registered nurses to work remotely and serve patients enrolled in Medicare’s Chronic Care Management Program. In this part time role (requires about 20 to 25 hours per week, depending on caseload), an RN Care Coach will be assigned a group of patients that they will be following and calling each month. In these monthly calls the Care Coach will provide education, coordinate care, close preventive care gaps, and coach on strategies for self-management to keep patients out of the hospital. This Role Requires Precision, Discipline, and Accountability The Care Manager role is not a step back from bedside nursing — it’s a step into a more complex, structured, and performance-driven environment. To succeed, you must bring more than clinical knowledge: ✅ Excellent documentation skills — Your charting must be complete, timely, and accurate. ✅ Strong time management — Case tasks must be prioritized and closed on schedule. ✅ Ownership of outcomes — Each case is closely tracked for quality, compliance, and effectiveness. Expectations are high, and performance is regularly reviewed. This is not a role where details can be missed or timelines pushed — we need professionals who take initiative, stay organized, and consistently deliver. If you’re ready for a challenging, fast-paced environment where your work is held to high standards and makes a real difference, we encourage you to apply. Key Responsibilities: Utilize our specialized care management software to call a full caseload of Medicare patients with two or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made Connect the patient with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc. Conduct Transitional Care Management activities to high-risk patients discharged from the hospital and the ER to reduce unnecessary readmissions. Close care gaps by encouraging preventive care measures, i.e. annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc. Fluent in English Self-directed, able to work independently with little supervision while meeting performance metrics Passion for nursing and improving patient outcomes Good with technology and eager to learn and use new software Excellent organizational and time management skills Strong communication and telephonic skills Strong critical thinking and problem-solving skills Education and Experience: Current, unrestricted Illinois RN license is required. Proficiency with EHRs (electronic health records) and web-based applications 3 or more years' experience as a Registered Nurse Preferred Education and Experience: Case Management or Chronic Disease Management experience preferred Certified Diabetes Educator desired, but not required Experience with Motivational Interviewing or other behavior change communication techniques is a plus. Scheduling and Other Requirements Must have a STRONG internet-connected computer. Equipment is NOT provided by the company. A minimum of 20 hours of day time availability per week is required. You will commit to your own schedule using our software. This is a 1099 contract position with no end date. Care Coaches are responsible for their own equipment, taxes and insurance. Compensation: Compensation is paid at the rate of $15.00 per initial clinical encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call and the patient has 20 minutes or more of time in their chart timer. Ex: If in one hour you called and spoke with 2 patients and spent 20 minutes with each of them, your pay for that hour would be $30.00 ($15.00/pt reached x 2). Pay Timing: *Your first check will be paid monthly via direct deposit, 40 days after the last day of the month of service. This is due to the time it takes Medicare to process reimbursements. All other checks after the first one will be deposited about 30 days after the last day of the month of service.* Fraud Alert: CircleLink Health has identified fraudulent emails sent from @joincirclelinkhealth.team, which is NOT affiliated with our company. Official CircleLink emails come only from @circlelinkhealth.com. Please report any suspicious messages to info@circlelinkhealth.com. About CircleLink Health: CircleLink Health is a company of passionate clinicians, technologists and businesspeople tackling the $600B problem of preventable chronic and post-acute complications. We’re building a world-class Care Management platform to enable providers while accelerating the shift to preventative care instead of status quo reactive care. Learn more about us here.
Nurse Practitioner - National After-Hours Team - Full Time - PA, NY and/or MI Licensed Location US-Remote ID 2025-2717 Category Provider 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 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. 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 for 10-12-hour shifts covering both day and night shifts Overnight and holidays are required for all After Hours Call Team Members 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 the state you reside and ability to obtain in other required locations within 60 days 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
Nurse Practitioner - National After-Hours Team - Full Time - PA, NY and/or MI Licensed Location US-Remote ID 2025-2717 Category Provider 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 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. 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 for 10-12-hour shifts covering both day and night shifts Overnight and holidays are required for all After Hours Call Team Members 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 the state you reside and ability to obtain in other required locations within 60 days 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
Become a part of our caring community and help us put health first Humana is looking for a Field Care Manager, Behavioral Health to join the IL Medicaid team. In this position, you will report to the Manager, Care Management and connect with members both face-to-face and telephonically. The Field Care Manager serves as the primary point of contact, providing integrated care to ensure members receive timely, high-quality, and coordination services that meet their needs. You will employ a variety of strategies, approaches, and techniques to manage a member's health issues and resolve barriers that hinder effective care. Using a holistic, person-centered approach, you will enhance behavioral health outcomes, reduce care gaps and support Illinois' FIDE population through comprehensive, integrated behavioral health care management. Position Responsibilities: Utilize high-quality, evidence-based behavioral health services through personalized care coordination, crisis intervention, peer support, and strong collaboration with medical and behavioral health providers. Provide comprehensive, integrated support to members experiencing behavioral health conditions, including children, adolescents, adults with serious mental illness (SMI) and serious emotional disturbance (SED), Substance Use Disorders (SUD) and justice-involved members. Engage members in their own communities, meeting them face-to-face whenever possible to build trust and facilitate meaningful care coordination. Coordinate behavioral health and medical services, ensuring appropriate provider engagement and adherence to treatment plans. Improve member's health literacy while simultaneously addressing health related social needs to positively impact member's healthcare outcomes and well-being. Serve as the driver of the member's interdisciplinary care team (ICT), overseeing care planning, transitions, and service delivery. Facilitate ICT meetings, ensuring communication among providers, Service Coordinators, and Care Management Extenders. Proactively support transition of care efforts. Will work with autonomy but reach out when support is needed. Collaborate with internal departments, providers, and community-based organizations to link to appropriate services and create a seamless, culturally competent care experience that respects the members' preferences and needs. Follow processes and procedures to ensure compliance with regulatory requirements by the Illinois Department of Human Services (IDHS), Center for Medicare and Medicaid Services (CMS) and the National Committee on Quality Assurance (NCQA). Use your skills to make an impact Required Qualifications This role is regionally based and candidates must reside in the south or southwest Chicago, IL area. Active Illinois licensed LCSW, LMFT or LCPC (No supervisees or provisional licenses) 2+ years of post-degree clinical experience in behavioral health setting. Case management experience working with complex SMI, SUD, SED population. Ability to travel to region-based facilities and homes for face-to-face assessments. Ability to use a variety of electronic information applications/software programs including electronic medical records. Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel. Valid driver's license, car insurance, and reliable transportation. Preferred Qualifications Case Management Certification (CCM) 3+ years of in-home assessment or care coordination experience. Experience working with Medicare, Medicaid and dual-eligible populations Field Case Management Experience Knowledge of community health and social service agencies and additional community resources Previous managed care experience Bilingual Additional Information Workstyle: This is a remote position that will require you to travel. Travel: Up to 75% of the time for collaboration and face-to-face meetings and field interactions with staff, providers, members, and their families. Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Central Standard Time (CST). This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,500 - $97,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Become a part of our caring community and help us put health first The SDOH Social Determinates of Health (Care Management Support Professional) contributes to administration of care management. The individual in this role provides non-clinical support to the assessment and evaluation of enrollees' needs and requirements to achieve and maintain an optimal wellness state by guiding enrollees and their families toward and facilitate interaction with resources appropriate for the care and wellbeing. This role's work assignments are mostly straightforward and of moderate complexity. Position Responsibilities Find community-based support to meet enrollees' housing, transportation, food insecurity, education, and employment needs, in addition to other SDOH needs. Support Care Managers and Community Health Workers to find appropriate community housing resources and to address additional SDOH needs. Liaise among Humana Care Managers, providers, and community-based organizations to coordinate referrals for enrollees to community-based services and programs and to foster integrated efforts among all parties. Handle calls from Enrollee Services for callers who require resources and who are not participating in Care Management; can refer enrollee to Care Management after initial resource assistance. Assist with health screening process, unable to reach efforts, conduct non-clinical surveys, and offer Care Management services, as needed. Serve as a key knowledge source for community services and information for enrollees and other Humana associates. Implement community assessments to identify community resource gaps. Monitor enrollee compliance with their care plan and provide motivational interviewing to support medication and treatment adherence. Support enrollees' self-management skills through the provision of culturally appropriate health education and health coaching Attend Humana community events to connect with enrollees and provide education on care management services. Build and maintain relationships with providers and community resources to support enrollee identification and referrals. Use your skills to make an impact Required Qualifications Must reside in Oklahoma, Occasional travel to office for staff meetings, training, etc. Minimum two (2) years prior experience working with community housing resources, community health agencies/social service agencies (Area Agency on Aging, DME providers, Meal on Wheels etc.) Minimum 1-year professional experience. Intermediate to Advanced knowledge of Microsoft Office Suite to include Word, Excel, and PowerPoint Decision making skills regarding own work approach/priorities, and work assignments, standards, and resources. Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders. Ability to multi-task and work in a very fast-paced environment Preferred Qualifications: Associate degree Experience with behavioral change, health promotion, coaching and wellness. Bilingual preferred (Spanish, Native Tribal, Vietnamese, or other) Additional Information WAH Internet Statement To ensure Home or Hybrid Home/Office employees', the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Benefits Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including: Health benefits effective day 1 Paid time off, holidays, volunteer time and jury duty pay Recognition pay 401(k) retirement savings plan with employer match Tuition assistance Scholarships for eligible dependents Parental and caregiver leave Employee charity matching program Network Resource Groups (NRGs) Career development opportunities HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $45,400 - $61,300 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Become a part of our caring community and help us put health first The Care Manager Nurse 2 works primarily in a telephonic environment. The nurse assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state. The nurse guides members/families toward and facilitates interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. You will report to the Manager, Care Management. Additionally, you will be in a field role and will require up to 25% travel visiting members or facilities within the state of South Carolina. The Care Manager Nurse 2 employs a variety of strategies and techniques to manage a member's physical, environmental and psycho-social health issues. Medicaid population experience preferred. Identify and resolve barriers that hinder care. Ensure patient is progressing towards desired outcomes by monitoring patient care through assessments and evaluations. Create member care plans. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Use your skills to make an impact Required Qualifications Unrestricted Current Licensed Registered Nurse (RN) in the state of South Carolina or a compact license with no active disciplinary action Must live in the state of South Carolina 3 or more years of clinical acute care experience 1 or more years case management, care coach, or care coordination Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook Preferred Qualifications Bachelor's degree Medicaid or Managed care experience Experience with case management, discharge planning and patient education for adult acute care Certified Case Manager (CCM) Additional Information Workstyle: Remote Work at Home with Field requirements Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Location: South Carolina Work Schedule: Monday - Friday; 8:00 AM - 5:00 PM Eastern Time Travel: 25% Work at Home Guidance To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information TB This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Driving Statement: This role is part of our company's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. Medicaid Mileage Reimbursement We provide mileage reimbursement for work-related travel. Eligible mileage includes: Travel from your home to your first work location of the day. Travel between client or assignment locations during the workday. Travel from your final work location back to your home. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
It's more than a career, it's a calling. WI-REMOTE Worker Type: Regular Job Summary: Oversees and manages the daily operations and activities of the regional Clinical Documentation Improvement (CDI) program. Promotes consistent and standardized operations and documentation across the network. Builds and maintains productive inter/intra departmental and vendor work relationships to optimize operations. Job Responsibilities and Requirements: PRIMARY RESPONSIBILITIES Manages the daily operations and resources of assigned Clinical Documentation Improvement (CDI) team, including the development and monitoring of strategic operating goals, objectives, and data analysis; and report operational performance, justification, and/or corrective action. Provides on-going support of CDI with extensive collaboration with physicians, nursing, coding, quality, and leadership. Facilitates improvements to clinical documentation through chart review and educational training sessions (with CDI Educator), which could be performed onsite, with physicians and/or other clinical professionals. Initiates corrective actions to resolve any problem areas identified between CDI and any other areas of the organization. Collaborates with CDI educator for regional education. Provides ongoing clinical documentation management program education for new staff, including new clinical documentation registered nurses, physicians, nurses, and allied health professionals. Participates in the direction and education of all phases of the clinical documentation process. Supports and implements technologies designed to improve and/or ensure the accurate depiction of clinical services, patient’s severity of illness, and risk of mortality. Conducts audits on CDI reviews against quality, coding, and mortality. Provides feedback to staff and CDI educator and director. Reports monthly CDI metrics regarding KPIs and staff productivity. Strengthens technical coding practices and clinician documentation by reviewing patient records with flagged complications to ensure coding accurately reflects the patient’s clinical course and complexity to validate accurate risk-adjustment for administrative metrics used in government incentive/penalty programs. Collaborates with interdisciplinary teams including physicians, nurse practitioners, physicians assistants, and the department managers for revenue integrity, coding and data quality, case management and health information management. Demonstrate leadership and management skills to promote effective and efficient review of physician documentation and the medical record. Communicates with assigned regional/ministry physician leaders. Participates in monthly medical management meetings to report CDI metrics and act as subject matter expert for inquiries. Recruits, engages, develops, leads, and manages assigned staff. Performs other duties as assigned. EDUCATION Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE Two years' acute hospital experience or surgical area as a clinical nurse Three years' clinical documentation specialist Two years' demonstrated progressive leadership experience PHYSICAL REQUIREMENTS Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc. Frequent keyboard use/data entry. Occasional bending, stooping, kneeling, squatting, twisting and gripping. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Rare climbing. REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Missouri Division of Professional Registration State of Work Location: Oklahoma Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services Work Shift: Day Shift (United States of America) Job Type: Employee Department: 8746010033 Sys Clinical Documentation Improvement Scheduled Weekly Hours: 40 Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. Upfront Tuition Coverage : we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status , or any other characteristic protected by applicable law. Click here to learn more.
Become a part of our caring community and help us put health first The Field Care Manager, Behavioral Health 2 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Field Care Manager, Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Field Care Manager, Behavioral Health (Care Manager, Behavioral Health) employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. In this role you will report to the Manager of Care Managementand be part of the Medicaid Care Management Team. In this role you will: •Conducts telephonic and in-person assessments to evaluate members’ needs, guiding members and their families toward appropriate resources to support optimal wellness. •Continuously monitors member progress through ongoing assessments and evaluations to ensure achievement of desired health outcomes. •Develops individualized care plans based on comprehensive assessments, aligning with departmental and organizational strategies. •Collaborates with healthcare providers and community resources to facilitate quality, cost-effective care and support. •Ensures members receive necessary services and supports across Behavioral Health, Physical Health, Social Determinants of Health, and value-added benefits. •Coordinates with the transdisciplinary care team, including at minimum the Primary Care Provider (PCP), to manage transitions of care. •Documents and submits incident reports as required. Use your skills to make an impact Required Qualifications Field Care Manager, Behavioral Health must meet one of the following: •An active, unrestricted LA Licensed Masters Clinical Social Worker (LCSW), OR •LA Licensed Professional Counselor (LPC) OR •LA Licensed Marriage Family Therapist (LMFT) OR •LA Licensed Addiction Counselor (LAC) OR •Active, unrestricted Louisiana Registered Nurse (RN) license with at least three years of experience in behavioral health. Field Care Manager, Behavioral Health must meet all the following: •2+ years or more of experience working as a behavioral health professional •Experience with behavioral change, health promotion, coaching and/or wellness •Proficient in using electronic information systems and Microsoft Office tools (Word, Outlook, Excel) to document, communicate, and collaborate effectively with internal partners and members. •Demonstrates strong keyboard and web navigation skills, provides clear narrative documentation, and builds rapport through exceptional communication and interpersonal abilities. •Must reside and perform work in the state of Louisiana and willing to travel to see members up to 75% of the time Preferred Qualifications •Experience supporting patients telephonically •Experience working in Community Mental Health or as part of a crisis response team or Assertive Community Treatment (ACT) team, and substance use disorder treatment •Experience working with both children and adults •Bilingual Language in both English and Spanish or Creole Bilingual (English/Spanish) - Bilingual Language in both English and Spanish or Creole– Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages. Workstyle: Combination remote work at home and onsite/home member visits Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM, over-time may be requested to meet business needs and requires approval. Screening: This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Travel, Driver's License, Transportation, Insurance: Must be willing to travel at least 75% of the time within a 30-40 mile radius of your assigened Region , to conduct field visits with members in your assigned area. Travel requirements may vary based on member tier level. This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. Mileage reimbursement is provided for work-related travel. Eligible mileage includes: •Travel from your home to your first work location of the day. •Travel between client or assignment locations during the workday. •Travel from your final work location back to your home. Work At Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: •At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required. •Satellite, cellular and microwave connection can be used only if approved by leadership. •Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. •Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. •Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Additional Information *Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level. Job Summary You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, manage denials and appeals. Your job is to handle claim denials from all insurance companies, addressing various reasons. SALARY The pay range for this position is $40.35 (entry-level qualifications) - $62.52 (highly experienced) The specific rate will depend upon the successful candidate’s specific qualifications and prior experience Essential Functions of the Role You receive rejected healthcare claims from financial office or provider. You appeal until resolution following guidelines. Reviewing medical records is important. Verify care levels, admissions, and hospitalizations. Evaluate stay duration and discharge planning. You will contribute to improving processes and protocols by identifying opportunities for enhancement and earnestly participating in their implementation. By closely examining denial trends, you will categorize them based on impacts like diagnosis, type and procedural variations amongst others. You will record denial data and appeal findings in an electronic system. The system helps study denial trends and assess appeal outcomes. Key Success Factors Awareness and knowledge of nursing procedures and patient care standards. Excellent ability in problem-solving and critical thinking. Highly capable of clear communication, both spoken and written. Capability to engage meaningfully with varied groups of people. Ability to carefully observe patients' condition changes and communicate effectively with nursing staff and providers. Belonging Statement We believe that all people should feel welcomed, valued and supported. Qualifications Associate degree. A minimum of (2) two years of relevant work experience is preferred. Applicants should be registered nurses. Clinical Experience: Five (5) or more years of clinical experience preferred with a strong ability to analyze medical records and support medical necessity.
It's more than a career, it's a calling. WI-REMOTE Worker Type: Regular Job Summary: Manages assigned program(s) to meet business objectives. Job Responsibilities and Requirements: PRIMARY RESPONSIBILITIES Develops program goals and infrastructure to align with defined business strategy. Manages program through creating program plans, management tools and reporting capabilities. Leads cross-functional teams and ensures resources are assigned to meet program goals. Recommends program budget and monitors and adjusts plan as resource requirements change. Communicates and documents program quality outcomes and progress metrics. Addresses and resolves project issues to ensure goals remain on track. Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's Scope of Service. As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations. Works in a constant state of alertness and safe manner. Performs other duties as assigned. EDUCATION Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE Five years' registered nurse experience with demonstrated progressive leadership responsibility PHYSICAL REQUIREMENTS Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc. Frequent keyboard use/data entry. Occasional bending, stooping, kneeling, squatting, twisting and gripping. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Rare climbing. REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Nurse (RN) - Missouri Division of Professional Registration Or Registered Nurse (RN) Issued by Compact State State of Work Location: Oklahoma Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services Work Shift: Day Shift (United States of America) Job Type: Employee Department: 8741000033 Clinical Education Scheduled Weekly Hours: 40 Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. Upfront Tuition Coverage : we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status , or any other characteristic protected by applicable law. Click here to learn more.
Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this remote in Tennessee. The schedule for this role is 3x12s, 12-hour shifts (5:00am-5:00pm, 7:00am-7:00pm, 11:00am-11:00pm, and 7:00pm-7:00am). What You'll Do: As an Acute Care Registered Nurse on Imagine’s acute care team, you will be part of a team that is focused on delivering acute virtual care to patients in markets nationwide. In the role of an Acute Care Registered Nurse, you will: Provide professional and friendly proactive care for our patients. Utilize standard triage protocols to accurately assess and provide a disposition for clinical issues using our platform. Perform virtual nursing assessments as needed Embed a family centered care philosophy in care delivery. Demonstrate knowledge and expertise in nursing assessment and triage. Recognize and collaborate with acute care providers, patient and family in planning and implementing care. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Perform other duties as needed. How You Qualify & What You Bring: First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need: Graduate with a bachelor's in nursing from an accredited university required Multistate Compact Licensed RN required 4+ year's experience in pediatric nursing required 1-2 years' experience in a Pediatric ED/Urgent Care required Virtual care experience preferred What We Offer (Benefits + Perks) The hourly rate for this position ranges from $44-48 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We’re guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this remote in New Jersey. The schedule for this role is 3x12s, 12-hour shifts (5:00am-5:00pm, 7:00am-7:00pm, 11:00am-11:00pm, and 7:00pm-7:00am). What You'll Do: As an Acute Care Registered Nurse on Imagine’s acute care team, you will be part of a team that is focused on delivering acute virtual care to patients in markets nationwide. In the role of an Acute Care Registered Nurse, you will: Provide professional and friendly proactive care for our patients. Utilize standard triage protocols to accurately assess and provide a disposition for clinical issues using our platform. Perform virtual nursing assessments as needed Embed a family centered care philosophy in care delivery. Demonstrate knowledge and expertise in nursing assessment and triage. Recognize and collaborate with acute care providers, patient and family in planning and implementing care. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Perform other duties as needed. How You Qualify & What You Bring: First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need: Graduate with a bachelor's in nursing from an accredited university required Multistate Compact Licensed RN required 4+ year's experience in pediatric nursing required 1-2 years' experience in a Pediatric ED/Urgent Care required Virtual care experience preferred What We Offer (Benefits + Perks) The hourly rate for this position ranges from $44-48 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We’re guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Nurse Practitioner - National After-Hours Team - part time - PA and NY Licensed Location US-Remote ID 2026-3188 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 (12 hours shifts) 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 required. Active or willingness to obtain licensure within 30 days is required for the District of Columbia, Michigan, 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
Responsibilities A professional nurse is an individual accountable for the care of a group of patients. The Registered Nurse (RN) focuses on safe effective patient and family centered care, customer satisfaction and quality outcomes. The RN is responsible for assisting in maintaining a financially stable unit, promoting his/her own development with an emphasis on evidence based practice and education supported by a Practice Governance framework. The RN supervises licensed and non-licensed staff members. Applying the caring processes of the Kristin M. Swanson Model of Care, the RN has the responsibility to assess, develop, implement and evaluate the plan of care. The RN focuses on patient and family comforts, education and satisfaction. The RN applies his/her educational and professional experiences in the delivery of quality care and mentoring/precepting staff. Discover a healthcare career designed with you in mind at Norton Healthcare. Whether you are an upcoming New Graduate RN pursuing an ADN or BSN or are an Experienced RN , the Norton Healthcare team will walk you through career opportunities and pathways. We invite you to learn more about what it means to be a part of the Norton Healthcare family through our interactive Zoom information sessions: For New Graduate RNs, click here to sign up for a zoom session. As an employee, you will have access to a variety of programs to enhance your experience and well-being, including learning and career growth opportunities, an employee wellness program, employee resource groups, and volunteer opportunities. You may be eligible for some of our programs: Tuition Assistance to aid with school costs. Relocation Assistance to help you make the Louisville Metropolitan or Southern Indiana area your new home. Commuter Program for those who don’t need or want to move to start a great career. Encompass Program: Supports new graduate nurses during transition from the role of student to practicing nurse, helping them gain confidence and develop professional relationships in the process. Employee Referral Incentive to support your networking and help others join our team. Comprehensive Benefits to choose from to support your needs. Norton Clinical Agency to offer experienced nurses competitive hourly pay for taking assignments as needed across our organization. Retention Incentive Program: Designated Units may qualify for additional incentive payments. Qualifications Required: No experience required for full-time or part-time positions. If PRN, must have one year of RN/LPN experience in an inpatient, acute-care setting. Diploma or Associate Nursing Registered Nurse (IN)
Company : Allegheny Health Network Job Description : This is a remote/work from home role but preferred candidates will live within 50 miles of the Pittsburgh or Erie region. GENERAL OVERVIEW: Improves the overall quality and completeness of medical documentation; facilitates enhancements to clinical documentation through extensive interaction with physicians, nursing staff, case managers, other patient caregivers, and medical records coding staff to ensure that the appropriate reimbursement is received for the level of service rendered to all inpatients; ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes; educates all members of the patient care team on an ongoing basis. ESSENTIAL RESPONSIBILITIES: Facilitate appropriate clinical documentation through concurrent, prospective, and retrospective medical record review (30%) Facilitate modifications to clinical documentation through extensive interaction with physicians, nurses and ancillary staff based on knowledge of coding and HCC guidelines, documentation strategies, and clinical documentation requirements (25%) Work collaboratively with coding professionals to assure documentation of diagnoses and comorbidities are a complete reflection of the patient's clinical status and care (10%) Formulate credible clinical documentation clarifications to improve clinical documentation (10%) Educates all internal customers on compliant documentation responsibilities, coding, and reimbursement issues, as well as performance improvement methodologies (15%) Performs other duties as assigned or required (10%) QUALIFICATIONS: Minimum High school/ GED Bachelor's Degree in Nursing OR Relevant experience and/or education as determined by the company in lieu of bachelor's degree 5 years in a nursing role Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Preferred Experience in Clinical Documentation Integrity (CDI) Experience in Coding Knowledge of ICD 10 and HCC coding guidelines Knowledge of Electronic Medical Record (Epic) Knowledge of Encoder (3M 360 Encompass) Excellent communication skills Critical thinking skills Certified Coding Specialist (CCS) Certified Outpatient Clinical Documentation Improvement Specialist (CCDS-O) Certified Clinical Documentation Improvement Specialist (CCDS) Certified Clinical Documentation Improvement Professional (CDIP) Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $30.10 Pay Range Maximum: $48.54 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Responsible for obtaining insurance precertification/recertification, functioning as a liaison with third party payers, communicating clinical information to the insurance companies as requested, addressing and resolving any actual or potential denials, and functioning as a member of the care coordination team. ESSENTIAL RESPONSIBILITIES: Obtains or ensures acquisition of appropriate pre-certifications/authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party payer guidelines. (30%) Obtains or facilitates acquisitions of urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements. (30%) Documents, monitors, intervenes/resolves, and reports clinical denials/appeals and retrospective payer audit denials; collaboratively formulates plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor, and third party payers, etc. (30%) Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental/commercial payer guidelines.(5%) Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies.(5%) Communicates telephonically and electronically with the outpatient providers in an effort to enhance the continuum of care. Assumes responsibility for AHN required continued education and own professional growth. Performs other duties as assigned or required. QUALIFICATIONS: Minimum Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Nationally recognized Care Management Certification within 5 years of start date (3 years for currently employed UR's) 2-3 years nursing experience with 1 year in Utilization Management Preferred Experience in case management, discharge planning and/or the application of InterQual criteria Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $30.10 Pay Range Maximum: $48.54 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice
The Telephonic Critical Support Nurse supports a busy 24/7 clinical call center, responding to a wide variety of incoming calls from patients, clinicians, referral sources, and hospitals. The team provides support for chronic therapies, including Home Infusion Therapy, and handles after-hour calls for all divisions of Accredo Health Group Specialty Pharmacies. Key Responsibilities: Triage incoming calls from patients, clinicians, hospitals, and other sources. Intervene to address life-threatening medication interruptions. Guide patients, caregivers, and clinicians through assessment of potential disruptions in medication administration, including pump malfunction, central line problems, and patient error. Troubleshoot issues with infusion devices, answer infusion access questions, and provide therapy support. Coordinate communication between patients, caregivers, pharmacists, nurses, hospital staff, and physicians. Ensure timely provision of products and supplies. Contact appropriate personnel as needed and document transactions in patients’ electronic charts. Maintain up-to-date knowledge of all services, products, and resources provided by Accredo, incorporating new product and service information. Identify trends and needs within the scope of customer/client contact. Qualifications: Registered Nurse (RN) with multistate license in good standing, with ability to obtain licensure in all 50 states. Valid RN license in state of primary residence. Compact license required. Bachelor of Nursing degree (BSN) preferred. Minimum of 5 years of relevant RN experience in critical care or home infusion. Ability to work the shifts listed above. Proficiency with Microsoft Office software (Outlook, Word, Excel, PowerPoint, OneNote). Understanding of legal and regulatory issues. Ability to compile data and statistics. Strong customer service focus and ability to counsel patients. Ability to develop and maintain a cross-section of networks. Strong oral and written communication and organizational skills. Schedule Information: Shift will be four 10 hour days. Schedule will vary. Days off will vary week-to-week Must be flexible to work adjusted hours for team PTO coverage Evening, overnight, and weekend shifts include a shift differential All shifts include every third weekend and some holidays About Accredo: Accredo, Evernorth Health Services' specialty pharmacy, serves patients with complex and chronic health conditions, including PAH, Immune Deficiencies, Hereditary Angioedema, Lysosomal Storage Disorders, Blood Disorders, Parkinson's, and many others. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 33 - 56 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here . About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Date Posted: 2026-03-19 Country: United States of America Location: Florida - Remote WHY JOIN FCS At Florida Cancer Specialists & Research Institute, we believe our people are our strength and we invest in them. In addition to having a positive impact on the people and communities we serve, associates benefit from significant professional opportunities, career advancement, training and competitive wages. Offering competitive salaries and comprehensive benefits packages to include tuition reimbursement, 401-K match, pet and legal insurance. A LITTLE BIT ABOUT FCS Since 1984, Florida Cancer Specialists & Research Institute & Research Institute (FCS) has built a national reputation for excellence. With over 250 physicians, 220 nurse practitioners and physician assistants and nearly 100 locations in our network. Utilizing innovative clinical research, cutting-edge technologies, and advanced treatments, we are committed to providing world-class cancer care. We are recognized by the American Society of Clinical Oncology (ASCO) with a national Clinical Trials Participation Award, FCS offers patients access to more clinical trials than any private oncology practice in Florida. Our patients have access to ground-breaking therapies, in a community setting, and may participate in national clinical research studies of drugs and treatment protocols. In the past five years, the majority of new cancer drugs approved for use in the U.S. were studied in clinical trials with FCS participation prior to approval. Through our partnership with Sarah Cannon, we are one of the largest clinical research organizations in the United States. Often, FCS leads the nation in initiating research studies and offering ground-breaking new therapies to patients. Come join us today! SUMMARY: The LPN Nurse Navigator will assist the RN with the management of patient caseloads to ensure timely access to care and removal of barriers to treatment. PRIMARY TASKS AND RESPONSIBILITIES: Assist patient and family in the coordination of care and management of a patient's individual health needs throughout the care continuum. Assist the RN with the management of patient caseloads by providing prompt response to telephone inquiries and other issues of a clinical nature as directed. Address barriers to care for patient, caregiver, or family needs to achieve optimal patient outcomes. Assist high risk patients with the goal of minimizing Emergency Department and inpatient readmission. Provide patient-centered, individualized ongoing education, resources, and referrals to internal and external resources. Works as an integral team player and is expected to adhere to and abide by the rules and regulations set forth by the Florida State Board of Nursing. Additional tasks as needed to support the team EDUCATION/CERTIFICATIONS & LICENSES: A valid Licensed Practical Nurse multistate or Florida single-state licensure is required EXPERIENCE: Three (3) years of LPN experience Oncology experience preferred. CORE COMPETENCIES, KNOWLEDGE/SKILLS/ABILITIES: Strong organizational skills Ability to prioritize and reprioritize quickly Strong written communication skills Strong telephonic communication skills Ability to work autonomously and with a virtual team in a remote work environment Proficient in Microsoft Word, Excel, and Outlook Possess high-level critical-thinking skills VALUES: Patient First – Keeping the patient at the center of everything we do Accountability – Taking responsibility for our actions Commitment & Care – Upholding FCS vision through every action Team – Working together, one team, one mission Expectations for all Employees Every FCS employee is expected to regularly conduct themselves in a professional and respectful manner, to comply with all labor laws, workplace policy, and workplace practices. Employees are expected to bring issues of any form of workplace harassment, discrimination, or other potential improprieties to the attention of their management or the human resources department. #LI-TW1 SCREENINGS – Background, drug, and nicotine screens Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. All offers of employment at Florida Cancer Specialists & Research Institute are contingent upon clear results of a thorough background screening. Additionally, as a condition of employment, FCS requires all new hires to receive various vaccinations, including the influenza vaccine, barring an approved exemption. In addition, FCS is a drug-free workplace, and all new hires will be subject to drug/ nicotine testing. Medical Marijuana cards are not recognized. EEOC Florida Cancer Specialists & Research Institute (FCS) is committed to helping individuals with disabilities to participate in the workforce and ensure equal opportunity to compete for jobs. If you require an accommodation to submit a resume for positions at FCS, please email FCS Recruitment ( Recruiter@FLCancer.com ) for further assistance. Please note this email address is intended to request an accommodation as part of the application process. Any other correspondence will not receive a response. FCS is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status. Click HERE to access the Florida Agency for Healthcare Administration
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ***This is a fully remote position; however, candidates must reside in the state of New York and maintain active New York State (NYS) RN licensure to be considered. The standard work schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m., with the potential for weekend coverage based on business needs.*** Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires graduation from an accredited school of nursing or a Bachelor’s degree in Nursing (BSN), along with 2–4 years of related nursing experience. A minimum of 2 years of acute care experience is required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: NYS RN Licensure Strongly Preferred Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required For Health Net of California: RN license required RN - Registered Nurse - State Licensure and/or Compact State Licensure For State of Nevada required *Must be licensed in Nevada. Location: Position is remote. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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 Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. • Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care • Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs • Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. • Typical office working environment with productivity and quality expectations. • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. • Sedentary work involving periods of sitting, talking, listening. • Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. • Effective communication skills, both verbal and written Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CST zones Education Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Become a part of our caring community and help us put health first Why Humana? At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we've got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future. Promoting a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and succeeds in part because every person can bring their whole self to work to make an impact. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths. About Humana Healthy Horizons Humana Healthy Horizons is more than a health plan. We're human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states enable partnerships with state and local governments, community-based organizations, and national partners that commit to removing barriers to helping people achieve their best health. Humana Healthy Horizons is seeking Care Manager Assistants with decisions typically focused on interpretation of area or department policy and methods for completing assignments. These individuals work within defined parameters to identify work expectations and quality standards, with some discretion over prioritization and timing. The Care Manager Assistant follows standard policies and practices that allow opportunity for interpretation. POSITION RESPONSIBILITIES: Contribute to Care Management administration. Provide nonclinical support to the assessment. Evaluate Enrollees' needs and requirements to achieve or maintain optimal wellness. Perform varied activities and moderately complex administrative, operational, and customer support assignments. Perform computations and typically work on semi-routine assignments. Use your skills to make an impact JOB DESCRIPTION: Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Work within defined parameters to identify work expectations and quality standards but have some latitude over prioritization/timing. Follow standard policies that allow for some opportunity for interpretation/deviation. REQUIRED QUALIFICATIONS: 1+ years administration support experience in the healthcare industry 1- 3 years of Microsoft technical experience in Word, Excel, Outlook and an ability to troubleshoot and resolve general technical difficulties. Ability to multi-task and work in a fast-paced environment MUST RESIDE IN OKLAHOMA PREFERRED QUALIFICATIONS: Associate's degree ADDITIONAL INFORMATION: Workstyle: This is a remote position Core Workdays & Hours: Typically, Monday – Friday 8:00am – 5:00pm CST WAH Internet Statement To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $39,000 - $49,400 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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 Supports comprehensive coordination of medical services through composition and auditing of approval, extensions, and denial letters. Promotes and supports quality effectiveness of the healthcare services. Maintains accurate and complete documentation to meet risk management, regulatory, and accreditation requirements. Promotes communication, both internally and externally to enhance effectiveness of medical management services. Training Schedule-9am-6pm Monday-Friday Perm Schedule-9am-8pm Thursday - Sunday Required Qualifications - Must have active, current, and unrestricted RN license in the state of residence -1+ years of clinical experience - Must be willing and able to work occasional holiday and weekends depending on business needs Preferred Qualifications 1+ years as a RN - Utilization management experience - Managed care experience - Must be a team player - Good communication skills - Good grammar and syntax - Ability to multi-task - Schedule flexibility Education Associates degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $32.01 - $68.55 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/25/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Centene is hiring a Remote Clinical Review Nurse – Prior Authorization to support our Duals team . The ideal candidate will have experience reviewing outpatient services , with a background in one or more of the following areas: Imaging services Durable Medical Equipment (DME) Home Health Care Elective inpatient services Multi-State nursing license This role is responsible for conducting clinical reviews for prior authorization requests in accordance with medical necessity guidelines, regulatory requirements, and company policies. This is a remote position with standard business hours, Monday through Friday, 8:00 AM–5:00 PM. Candidates must reside and work within the Mountain or Pacific time zones. This role may also require flexibility for weekend, holiday, and on-call coverage. An alternative schedule of Sunday through Thursday, 9:00 AM–6:00 PM may be required based on business needs. Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required Pay Range: $27.02 - $48.55 per hour Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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 Supports comprehensive coordination of medical services through composition and auditing of approval, extensions, and denial letters. Promotes and supports quality effectiveness of the healthcare services. Maintains accurate and complete documentation to meet risk management, regulatory, and accreditation requirements. Promotes communication, both internally and externally to enhance effectiveness of medical management services. Required Qualifications - Must have active, current, and unrestricted RN license in the state of residence -1+ years of clinical experience - Must be willing and able to work Monday through Friday, 11:00am to 7:00pm EST - Must be willing and able to work occasional holiday and weekends depending on business needs Preferred Qualifications - Utilization management experience - Managed care experience - Must be a team player - Good communication skills - Good grammar and syntax - Ability to multi-task - Schedule flexibility Education Associates degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $32.01 - $68.55 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/25/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
