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Chronic Care Manager (LPN) Fully Remote Sweeten Health (via Phamily) We are seeking a compassionate and patient-centered Licensed Practical Nurse (LPN) to join our care team as a Chronic Care Manager. This fully remote position plays a key role in supporting patients with chronic conditions by providing proactive, ongoing care coordination and education. Ideal candidates are highly organized, strong communicators, and committed to making a difference in patients day-to-day lives. Position Details: Position Type: Full-time, 40 hours/week Schedule: MondayFriday, no evenings or weekends Compensation: $22.00/hour (non-negotiable starting rate) Work Environment: Fully remote (see tech requirements below) Qualifications: Active LPN license (required) Own Windows-based computer with webcam (tablets/iPads not supported) Reliable home Wi-Fi connection Previous remote work experience preferred Strong interpersonal and organizational skills Benefits: Paid Time Off (PTO) & Paid Holidays Fully remote role with weekday-only schedule 401(k) eligibility after 1 year of full-time employment Key Responsibilities: Conduct comprehensive patient assessments to develop individualized care plans Collaborate with interdisciplinary care teams, including hospitals and primary care providers Monitor patient health status and facilitate follow-up care Educate patients and families about self-management, medications, and available resources Maintain accurate and timely documentation in compliance with regulatory standards Advocate for patient needs and coordinate services to ensure continuity of care Application Requirements: To be considered, applicants must: Acknowledge the starting rate is $22/hour Confirm use of a personal Windows computer with webcam (no tablets/iPads) PIddfd21df4f77-25***********0

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We serve the Commonwealth of Massachusetts in partnering with onsite audits and projects. We have collaborative team scheduling and there is an occasional opportunity for remote work based on business needs. For the role there will be no weekends, no holidays, and no on-call work. If you are located in Massachusetts, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Audit entire medical record for accuracy of the coding on the MDS/ MMQ to support payment to the nursing facility Discuss Patient Care specifics with peers or providers in overall patient care and benefits Communicate clinical findings and present rationale for decisions to medical professionals and members at the appropriate level for understanding Review the entire medical record for accuracy, and appropriate clinical treatment Communicate findings of audits to client, and community as needed Education of findings with community, identifying plans for correction Comply with HIPAA guidelines related to Personal Health Information (PHI) when communicating with others Leverage experience and understanding of disease pathology to review chart/clinical information, ask appropriate questions, and identify appropriate course of care in a given situation Perform medical chart review that includes a review of current and prior patient conditions, documents, and evaluations, and relevant social and economic situations to identify patients' needs Research and identify information needed to review assessment for accuracy, respond to questions, or make recommendations Apply knowledge of pharmacology and clinical treatment protocol to determine appropriateness of care Work collaboratively with peers/team members and other levels or segments within Optum, UHC, or UBH (e.g. Case Managers, Field Care Advocates) to identify appropriate course of action (e.g. Appropriate care, follow up course of action, make referral) Required to travel within geographic territory 75% of the time and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite) You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Undergraduate degree or 4+ years of equivalent nursing experience Current unrestricted RN nurse license in Massachusetts MDS certification OR ability to obtain and provide proof prior to start date Experience working within medical insurance and/or healthcare industries Experience analyzing inventory, researching, identifying, and resolving issues Experience with defining and managing processes within a team Proficient in Microsoft Office Proficient written and verbal skills Ability to travel within geographic territory 75% of the time and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite) Preferred Qualifications: Recent long-term care MMQ, MDS, staff development or management experience (in long-term care) Experience trouble shooting issues for users within teams, IT and or business partners Proven knowledge of Medicaid and Medicare benefit products including applicable state regulations Demonstrated knowledge of applicable area of specialization Demonstrated knowledge of Massachusetts DPH guidelines Demonstrated knowledge of computer functionality, navigation, and software applications *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Job Type: Full-time, 1099 position OnSite Medical House Calls is seeking a Nurse Practitioner to join our growing team! This position will be traveling and delivering primary care to patients in Anne Arundel, Queen Annes and Baltimore Counties that are home-bound. At OnSite Medical, we bring primary care right to where our patients call home. The nurse practitioner will provide comprehensive care to patients diagnosing and treating acute or chronic health conditions. Nurse Practitioner/NP Job Education and Experience Requirements: Active State NP license AANP or ANCC board-certified as ANP, AGNP, FNP Current BLS certification Active CDS Active DEA 12 months experience as an NP Prior Home Health Nursing/house call experience, a plus but not required Job Types: Full-time, Contract Salary: $109,417.02 - $200,000.00 per year Benefits: 401(k) Medical specialties: Primary Care Standard shift: Day shift Weekly schedule: Monday to Friday Work setting: Outpatient License/Certification: Certified Nurse Practitioner (Required) Work Location: On the road Flexible work from home options available.

This RN position involves providing acute, in-home care for patients requiring advanced assessment, technical procedures, teaching, and decision-making skills. Work schedule is 80% FTE with day/evening shifts, every other weekend, holiday rotation, and on-call responsibilities with a one-hour response time within a 30-mile radius of Madison, WI. Responsibilities include performing assessments, managing IVs, lab draws, medication administration, wound care, remote monitoring, and virtual visits, collaborating with an interdisciplinary team to ensure high-quality patient care. Requires relevant acute or home health experience, RN licensure in WI, CPR/BLS certification, and current driver's license with insurance and background check. Offers flexible scheduling, wellness programs, acuity-based staffing, professional growth opportunities, and recognition for nursing excellence. Strong emphasis on diversity, equity, and inclusion, encouraging applications from diverse backgrounds and identities.

pThis is a contract assignment that will start right away and end on June 28th 2024/p pbr//p pspan style="font-size: 16px;"span Remote in TX/span/span/p pbr//p pspan style="font-size: 16px;"span Must Live in TX/span/span/p pbr//p pspan style="font-size: 16px;"br/span SUMMARY DESCRIPTION:/spanbr/span RN or LPN with clinical experience and will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications./spanbr/br/span JOB REQUIREMENTS:/spanbr/span• Degree, Diploma or Certificate from a school of nursing with clinical experience./spanbr/span• Licensed in the State of Illinois/spanbr/span• Knowledge of medical terminology/spanbr/span• Data entry and/or typing experience./spanbr/span• Clear and concise written and verbal communication skills./spanbr/span• PC proficiency to include Word, Excel and Lotus Notes./spanbr/span• Auditing experience preferred./spanbr/br/span DUTIES AND RESPONSIBILITIES:/spanbr/span• Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines./spanbr/span• Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors./spanbr/span• Identify and report abstraction errors and provide measure re-education with for the abstractor./spanbr/span• Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s)./spanbr/span• Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results./spanbr/span• Maintains productivity level as determined by the HEDIS Coordinator/QI Department./spanbr/span• Maintain compliance with all HIPPA and patient confidentiality requirements./spanbr/span• All other duties as assigned./span/span/p pspan style="color: #32363a; font-size: 16px;" /span/p pspan style="color: red; font-size: 16px;" /span/p

Job Title: Clinical Review Registered Nurse Why work at OpTech? OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at ***************** SUMMARY: * Our Client is looking for a Clinical Review Registered Nurse to support operations within its Utilization Management team. * This is a full-time (40 hours, M-F) remote opportunity for a 1-3 month duration with potential to extend as needed. * This position executes utilization management processes to ensure the delivery of medically necessary and appropriate, cost-effective and high-quality care through the performance of clinical reviews. * Reviews requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization. * Identifies questionable cases and refers to superior or a medical director for review. * There is no travel required for this role. RESPONSIBILITIES: * This position executes utilization management processes to ensure the delivery of medically necessary and appropriate, cost-effective and high-quality care through the performance of clinical reviews. * Reviews requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization * Identifies questionable cases and refers to superior or a medical director for review * Perform related duties as required or directed PRIMARY RESPONSIBILITIES: * Conduct clinical reviews of all prior approval, post service reviews, customer service and claim requests * Determine adequacy of clinical elements of clinical information submitted * Determine essential elements of clinical information for decision-making and request same as appropriate * Make determinations based on medical policy, evidence-based guidelines, and medical necessity * Communicate directly with requesting providers to obtain additional clinical information as needed in order to make utilization management decisions. * Review late and out of network prior approval / referral authorizations for appropriateness and make determination on benefit level based on medical necessity * Provide timely and accurate review for procedure/service appropriateness, reconsideration, and appeals based on Rule 9-03, DRF, and NCQA Standards * Perform monthly audits related to prior approval processes as well as weekly guidelines to confirm medical necessity and appropriateness of reviewed services * Use sound clinical judgment along with appropriate review criteria and practice guidelines to confirm medical necessity and appropriateness of reviewed services * Provide support to Provider Relations and Provider Reimbursement in regard to clinical issues relating to new procedure, coding, pricing and provider communications * Provide appropriate and timely referrals to the medical director. Identify and report any potential quality of care of services issue to the medical director. * Perform timely case review information, case entry and updates to case file in the appropriate systems * Participate in medical policy committee including research and development of policies and collaboration with participating provider * Assist in review of health service delivery and utilization and cost data * Determine through clinical review members that would potentially benefit from case management. Initiate referrals to triage to assess these members for effective case management intervention * Determine and interpret member eligibility, coverage and available benefits. Contribute to member and provider satisfaction within program and organization * Assist the claims payer in accurate adjudication of care management approved services as needed QUALIFICATIONS: * RN with Vermont License required * Also open to candidates who have a compact license * BSN desired * 5-7 years of clinical practice required * 1-3 years of insurance related experience desired * Must be willing to participate in on-going CEU training Top 3 Required Skills/Experience: * Subject Matter Expertise: * Strong knowledge base in health care delivery systems, health insurance, medical care practices and trends, regulatory and accreditation agencies/standards, and provider network management * Strong knowledge of all Plan products and services benefits that effect clinical decision making * Strong knowledge of clinical nursing practice * Computer Skills: * Proficient in all Microsoft Office applications * Proficient in CPT, HCPCS coding and ICD-10 diagnosis codes * Proficient in specialized computer applications preferred including SalesForce Health Cloud, Acuity, Microsoft CRM, Onbase (or similar document mgt system), Jira * Analytical Skills: * Strong analytical skills, including statistical data analysis Required Skills/Experience - The rest of the required skills/experience. Include: * Communication Skills - Strong written and oral communication skills * Interpersonal Skills - Strong interpersonal skills * Organizational Abilities - Strong organizational skills * 5 - 7 years of clinical practice required Preferred Skills/Experience - Optional but preferred skills/experience. Include: * 1- 3 years of insurance related experience desired * Willing to participate in required on-going CEU training Education/Certifications - Include: * Licensed RN ; BSN desired; Licensed in compact state desired Supervision Received - Discretion and Judgment: * Is expected to regularly use discretion and judgment to make decisions without approval such as planning projects, analyzing accounts, solving problems, or improving processes. Nature of Duties: * Primary duties are non-manual in nature (i.e., call handling, accounting) Focus of Work: * Primary duties are directly related to general business operations (nearly all of Our Clients) Knowledge Requirements: * Ability to perform the job duties requires sue of advance knowledge acquired by a lengthy course of study and/or instruction. Physical Demands in Performing Essential Job Functions (amount of time): This section is to comply with the Americans with Disabilities Act (ADA): * Stand - 1/3 * Walk - 1/3 * Talk to hear - 2/3 * Sit - 2/3 * Reach with hands and arms - 1/3 * Push/pull - 1/3 * Stoop, kneel, crouch or crawl - 1/3 * Fine dexterity - 1/3 to 2/3 * Repetitive use of hands - 2/3 * Visual activity - 2/3 * Aural acuity - 2/3 The above is intended to describe the general contents and requirements of work being performed by people assigned to this position. Nothing in this position description of Our Client's right to assign or reassign duties and responsibilities to this position at any time. OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. *************************************************

Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. Perform concurrent and retrospective reviews of medical records to ensure accurate documentation of patient care. Educate healthcare providers on the importance of accurate and complete clinical documentation. Utilize clinical knowledge and expertise to identify opportunities for documentation improvement. Ensure compliance with regulatory requirements and guidelines. Participate in multidisciplinary team meetings to discuss documentation improvement strategies. Provide feedback to healthcare providers on documentation practices and areas for improvement. Maintain up-to-date knowledge of clinical documentation standards and best practices. Responsibilities * Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. * Perform concurrent and retrospective reviews of medical records to ensure accurate documentation of patient care. * Educate healthcare providers on the importance of accurate and complete clinical documentation. * Utilize clinical knowledge and expertise to identify opportunities for documentation improvement. * Ensure compliance with regulatory requirements and guidelines. * Participate in multidisciplinary team meetings to discuss documentation improvement strategies. * Provide feedback to healthcare providers on documentation practices and areas for improvement. * Maintain up-to-date knowledge of clinical documentation standards and best practices. Qualifications * Registered Nurse (RN) with a current license from any state. * Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) certification. * Certified Coding Specialist (CCS) certification if they have the CCDS 2 certification. * Minimum of 3 years of clinical nursing experience. * Strong knowledge of clinical documentation standards and regulatory requirements. * Excellent communication and interpersonal skills. * Ability to work collaboratively with healthcare providers and multidisciplinary teams. * Proficiency in electronic health record (EHR) systems. Additional Skills * Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) certification. * Certified Coding Specialist (CCS) certification if they have the CCDS 2 certification. Work Environment Fully remote role. Schedule: Monday-Friday 9am-5pm with potential for flexibility as long as 40-hour weeks are maintained. Pay and Benefits The pay range for this position is $70000.00 - $120000.00/yr. Health, Vision, Dental, 401k If we find a local candidate (CT RN license in CT, they will receive Middlesex Health Benefits, If we find someone national w/o CT RN License then they will receive benefits through 3rd party organization- Mindlance (have been told this is very expensive so they prefer local). Have all the benefit info in a PDF when needed Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on May 9, 2025. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

pJob description/ppstrong Telemedicine -NP or PA- Remote for Part-time for Dermatology amp; Primary Care Experience/strong/pp Callondoc in Dallas, TX is seeking a part-time remote nurse practitioner/physician assistant to join our team. Candidates must have dual experience in strongprimary care and dermatology. /strong/ppstrong REQUIRED:/strong/ppstrong 2-year contract- Due to licensing providers in additional state licenses. /strong/ppstrong Must be residing in any the following states:/strong/pullistrong Maryland, Florida, Illinois, Kentucky, Louisiana, Missouri, New Jersey, New York, Ohio,Tennessee, California, Texas, Georgia, Mississippi. /strong/li/ulpbr//ppstrong Please follow this link to apply/strong/ppstrong************* talenthr. io/callondoc/telemedicine-np-or-pa-remote-for-part-time-for-dem-primary-care-experience/17/strong/ppbr//pp Medical provider must have strong Dermatology and Primary care experience (more than 2years of experience)/strong. This is a remote part-time position for an independent contractor/pul li We are looking for an energetic mid level with both strong Dermatology and Primary care experience/strong /li listrong Must be flexible to work night shifts (6pmCST-midnight)/strong/li listrong Shifts required- evening shifts-Fridays 6pmCST-midnight and alternating weekends 6pmCST-midnight/strong/li li Paid Training/li /ulp Work Location:/pulli Remote/li/ulp Salary:/pulli$55. 00-$60. 00 per hour/li/ulp Medical specialties:/pul listrong Dermatology/strong/li listrong Primary care/strong/li /ulp Job Type: Part-time/pp Pay: $55. 00 - $60. 00 per hour/pp Expected hours: Part-time/pp Work Location: Remote/pp Job Type: Part-time/ppbr//pp Pay: $55. 00 - $60. 00 per hour/ppbr//pp Expected hours: 20 - 25 per week/ppbr//pp Medical Specialty:/pulli Dermatology/li/ulp Application Question(s):/pulli Required- Did you follow and complete your application and questions? ************* talenthr. io/callondoc/telemedicine-np-or-pa-remote-for-part-time-for-dem-primary-care-experience/17/li/ulp Work Location: Remote/p

Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected duration. Performs leadership role on team when implementing new tools or case management programs/initiatives. Manages own caseload and coordinates all assigned cases. Supports and provides direction to more junior professionals. Works autonomously, only requiring "expert" level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license required. **Job Description** **Position Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical knowledge to assess inpatient admission level of care, treatment plan and goals, identified gasps or risk for readmission or complications and any barriers to discharge. + Establishes patient centric goals and interventions to meet the member's needs while inpatient and post inpatient stay. + Interfaces with facility, member, family, and other healthcare team members as well as internal matrix partners. + Balances business needs with patient advocacy. + Builds solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers. **Summary description of position:** + Plans, implements and evaluates appropriate health care services in conjunction with the physician treatment plan. + Handles more complex, high acuity cases and /or account sensitive cases. + Performs prospective, concurrent and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services including DME (durable medical equipment). + Ensures that inpatient case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. + Excellent time management, organization and negotiation skills. Strong research and analytical skills. Ability to assess complex issues, recommend changes and resolve problems. Knowledge of managed care preferred. + Works independently, receiving direction from manager or team leader for new or unprecedented situations. + Manages own caseload and coordinates all assigned cases. + Acts as a resource to others. + Utilizes Cigna's approved guidelines and tools to rigorously assess the clinical status of the member, the level of care and the services the member is receiving as clinically appropriate covered services. + Anticipates care needs along the continuum of inpatient and outpatient services and facilitates coordination across the network of providers, participants and caregivers to assure timely discharge/transfer to an alternate level of care. + Consults with manager and medical director to resolve any issues related to delay of services or barriers to discharge in a timely manner. **Major responsibilities and desired results:** + Develops and defines a structured working relationship with key partners in inpatient facilities to support regular, effective communication and exchange of information in order to manage the member's needs in compliance with all Federal/State/Facility contract and internal Cigna requirements. + Retrieves active daily census each morning and prioritizes cases for impact. + Access the approved Cigna guidelines for inpatient review and directs communication with the facility to elicit clinical information and facilitate discharge planning. + Identified all cases appropriate for inpatient case management interventions, initiates and discusses options for discharge planning with the facility, provider, vendor, member and/or family and documents interactions and outcomes related to those actions. + Identify and build effective relationships with a network of community, government, and knowledge resources. Maintain information on those resources and share with peers as appropriate. + Act as liaison and patient advocate between account, participant, family, physician(s) and facilities/agencies. Take appropriate action to ensure participant and practitioner satisfaction within benefit constraints. + Develop a participant centered plan for short term and long term objectives, including time frames for follow up. Utilize available internal and community resources in development of plan. Involve all appropriate parties (member, physician, providers, employers, etc) to determine case results/outcomes. + Provide information and resources as appropriate to empower participants to take an active role in care, treatment and cost decisions. + Implement, coordinate, monitor and evaluate the plan on a systematic, ongoing, appropriate basis. + Negotiate price and quality care levels, intensity and durations of services. + Document findings and continue to anticipate needs, determine benefit coverage status and communicate proactively to participant and members of treatment team. + Identifies new referrals for complex and specialty CM programs and coordinates transition to appropriate CM when necessary. + Identifies and elevates potential quality of care issues to Cigna's Quality representatives for follow up determination. + Works to identify gaps in care and resolution of those identified and prevention of future gaps in care. + May be required to participate in customer and auditor visits. + Participates in special projects as deemed necessary. + Other duties as required and related to this role. **Minimum requirements:** + Active unrestricted Registered Nurse (RN) license in state or territory of the United States. + Ideal candidate must reside in California **Preferred requirements:** + Bachelors degree a plus + 3 years clinical experience in inpatient or managed care setting + Demonstrated ability to anticipate, plan, coordinate and organize. + Knowledge of community, state and federal resources. + Possession of a valid driver's license, proof of insurance, good driving record and reliable transportation. + Strong skills in teamwork, negotiation, conflict management, problem solving, and effective decision making. + Experience in medical management and case management in a managed care setting or hospital is highly desirable. + Ability to assess complex issues, recommend changes and resolve problems. + Strong computer knowledge and abilities. + Knowledge of managed care products and strategies. + Ability to work within changing business environment and balance business needs with patient advocacy. + Experience managing multiple projects in a fast paced matrix driven environment. + Effective at negotiation, teamwork and cooperative relations with diverse internal and external stakeholders. 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 30 - 50 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. We want you to be healthy, balanced, and feel secure. That's why 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) with company match, 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, visit Life at Cigna Group . **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 require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _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._

divdivdivdivdivdivp id="is Pasted" style='margin-top:12.0pt;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'strongspan style='font-family:"Times New Roman",serif;color:black;'Join the Team at Concierge Home Care - Where Care Changes Lives!/span/strong/pp style='margin-top:12.0pt;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'span style='font-family:"Times New Roman",serif;color:black;'At Concierge Home Care, we believe in the power of home health care to change lives-for patients and team members alike. Our mission, “Caring for people who care for people,” is the foundation of who we are and what we do. Guided by our values-em Integrity, Caring, Quality, Service, Innovation, and Team/em-we are dedicated to delivering compassionate, high-quality care that empowers patients to heal in the comfort of their own homes./span/pp style='margin-top:12.0pt;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'span style='font-family:"Times New Roman",serif;color:black;'Since we opened our doors in 2015, Concierge Home Care has grown to serve over 57 counties across Florida, offering incredible opportunities for growth and career advancement./span/pp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'strongspan style='font-family:"Times New Roman",serif;'Location:/span/strong/pp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'span style='font-family:"Times New Roman",serif;'This position is strongu FULLY REMOTE/u/strong, serving patients in Northeast, FL, and surrounding areas. Hours include strong Friday-Monday/strong./span/pp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'strongspan style='font-family:"Times New Roman",serif;'Your Role as a Clinical Manager, RN:/span/strong/pul style="list-style-type: disc;"lispan style='font-family:"Times New Roman",serif;'Supervise home health services to ensure patients receive high-quality care as prescribed by physicians./span/lilispan style='font-family:"Times New Roman",serif;'Review clinical documentation to ensure compliance with Medicare, Federal, Insurance, and Company guidelines./span/lilispan style='font-family:"Times New Roman",serif;'Follow and enforce Agency policies and procedures to set a strong example for the team./span/lilispan style='font-family:"Times New Roman",serif;'Maintain compliance with accepted professional standards, principles, and Standard Operating Procedures./span/lilispan style='font-family:"Times New Roman",serif;'Stay up to date on all relevant guidelines, policies, and protocols to support quality care./span/li/ulp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'strongspan style='font-family:"Times New Roman",serif;'Qualifications:/span/strong/pul style="list-style-type: disc;"lispan style='font-family:"Times New Roman",serif;'An unencumbered Florida Nursing License (required)/span/lilispan style='font-family:"Times New Roman",serif;'Valid driver's license, auto insurance, and reliable transportation (required)/span/lilispan style='font-family:"Times New Roman",serif;'Two years of experience as an RN in acute care, med/surge, ICU, or ER settings (required)/span/lilispan style='font-family:"Times New Roman",serif;'One year of experience in skilled, geriatric home health care strongwith proficiency in Medicare OASIS documentation/strong (required)/span/lili id="is Pasted"span style='font-family:"Times New Roman",serif;'strongu One year of experience in a supervisory/clinical manager role/u/strong in a Medicare-certified Home Health Care agency span id="is Pasted" style='font-family:"Times New Roman",serif;'(required)/span/span/li/ulp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'strongspan style='font-family:"Times New Roman",serif;color:black;'Why Choose Concierge Home Care?/span/strong/pp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'span style='font-family:"Times New Roman",serif;color:black;'Whether you're new to home health or an experienced professional, you'll have access to the tools and support needed to excel./span/pp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'span style='font-family:"Times New Roman",serif;color:black;'You'll also be part of a team that values collaboration and autonomy. While you'll have the independence to manage your role, you'll never be without the support of experienced clinical supervisors and a dedicated team focused on delivering exceptional care./span/pp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;'span style='font-family:"Times New Roman",serif;color:black;'And when it comes to what we offer, we've got you covered:/span/pul style="list-style-type: disc;"listrongspan style='font-family:"Times New Roman",serif;color:black;'Professional Development: /span/strongspan style='font-family:"Times New Roman",serif;color:black;'Ongoing training, mentorship opportunities, and support for career development./span/lilispan style='font-family:"Times New Roman",serif;color:black;'strong Compensation:/strong $80,000-$90,000/span/lilistrongspan style='font-family:"Times New Roman",serif;color:black;'Comprehensive Benefits:/span/strongol style="list-style-type: circle;"lispan style='font-family:"Times New Roman",serif;color:black;'Enjoyem three weeks of PTO and annually increases to four weeks after five years./em/span/lilispan style='font-family:"Times New Roman",serif;color:black;'Earn emquarterly bonuses based on individual and team performance./em/span/lilispan style='font-family:"Times New Roman",serif;color:black;'Plan for the future with our em 401(k) options/em./span/lilispan style='font-family:"Times New Roman",serif;color:black;'Employee Assistance Program (EAP), pet insurance, legal assistance, and employee referral bonuses./span/lilispan style='font-family:"Times New Roman",serif;color:black;'Health, dental, vision, and HSA options./span/lilispan style='font-family:"Times New Roman",serif;color:black;'Mileage reimbursement or company vehicle (per company policy)./span/lilispan style='font-family:"Times New Roman",serif;color:black;'Data plan reimbursement./span/li/ol/li/ulp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;text-align:center;'strongspan style='font-family:"Times New Roman",serif;color:black;'Take the First Step/span/strong/pp style='margin-top:12.0pt;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;text-align:center;'emspan style='font-family:"Times New Roman",serif;color:black;'Join Concierge Home Care and make a meaningful impact! Apply today to begin an exciting and rewarding career where care truly changes lives./span/emstrongspan style='font-family:"Times New Roman",serif;color:black;' /span/strong/pp style='margin-top:12.0pt;margin-right:0in;margin-bottom:12.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:"Cambria",serif;text-align:center;'stronguspan style='font-family:"Times New Roman",serif;'************************************************************************** /div

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: This will be a generic IC profile for any clinician that is contracted to work with Corro. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. At CorroHealth our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. Status - Independent Contractor (Part-Time/Flexible) (20 hours per week min.) **Must complete and pass a technical and inpt clinical assessment. (link to be sent) ** JOB SUMMARY: As a Denial Management Appeals Clinician, you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor. You will perform retrospective clinical case reviews and draft appeals that focus on establishing the Medical Necessity of the services performed, both Inpatient and Outpatient. Essential Duties and Responsibilities: Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials. Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process. Minimum Qualifications & Competencies: RN or MD degree with strong clinical knowledge - Active unrestricted clinical license in at least one state within the United States. Minimum of 5 years recent acute-care hospital experience, preferred. Minimum of 2 years Utilization Review / Case Management experience within the last 5 years. Managed care payor experience a plus in either Utilization Review, Case Management or Appeals. Must have excellent attention to detail, written communication skills and be computer proficient. Work will be assigned on an as-needed basis. It will consistent and weekly for the next several months at least. As such, Consultant will receive a queue assignment/ report a) on Tuesday each week with a due date of the end of the business day the following Thursday and b) on Friday each week with due date of the end of the business day the following Monday. Consultant must provide a minimum of 20 hours per week and not exceed 40 hours per week unless approved by manager. Consultant shall be paid monthly as follows: Training: $45 an hour Meetings: $45 an hour for meetings attended (prorated for actual time spent) Written Appeals: $45 / completed written Inpatient appeal letter, $25 / completed written Outpatient appeal letter PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Careage Home Health is Hiring a RN!! Come and work with us!! We offer a supportive and caring team environment as well as competitive wages and benefits. $10,000 Hiring Bonus!!! Serving Thurston County $47-$57 / DOE Mileage reimbursement @ IRS Rate Must have RN license, exp. Home Health experience is preferred. Full Time $10,000 Bonus Payout as follows: $2,500 pay out at 6mths, $2,500 at 12mths, $2,500 at 18 mths, and $2,500 at 24mths of successful Full time Employment Employee Benefits We offer a comprehensive benefits package for full-time employees: Medical, Dental, Vision, and Life & AD&D Insurance, voluntary STD, LTD, 401k with employer match, 16 days Paid Time Off and holidays, WA & CA Paid Sick Leave and discretionary bonuses. For a complete list of employee benefits, please visit careage.com/careers Why work with us? Our employees are more than just coworkers - they are family - just like our patients! Working at Careage Home Health, you will be provided ample opportunities to grow both personally and professionally. You will also be working alongside individuals who share the same passion and commitment to providing exceptional healthcare, service, and life enrichment to our patients. Our culture is one that encourages, supports, and celebrates our diversity and looks to expand and build it constantly. Join us! About Careage Home Health Careage Home Health provides at-home care for patients that reside within King, Pierce, and Thurston Counties in Washington State. Our team of caregivers, nurses, and therapists work with the guidance and collaboration of the patients' medical team to provide the services needed for their recovery. For more information, visit CareageHomeHealth.com About Careage Careage is a leading provider of senior-focused construction, management, and health care services throughout the United States. They are committed to providing exceptional services to a wide variety of clients, including hospitals, medical clinics, skilled nursing, and post-acute rehabilitation facilities, Assisted Living Communities, Memory Care centers, and retirement communities. For more Careage news, go to *************** A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Clinical Services/Clinical Manager via physician orders. This position supervises and coordinates the care provided by LPN's and CNA's assigned to the RN-CM's patients. Provides feedback to Director of Clinical Services regarding performance of supervised LPN's and CNA's. Summary of Responsibilities Provides services in accordance with the plan of care. Makes the initial evaluation visit and regularly reevaluates the patient's nursing needs. Initiates the plan of care and necessary revisions. Provides those services requiring substantial specialized nursing skills. Initiates appropriate preventive and rehabilitative nursing procedures. Prepares clinical and progress notes for each patient visit and summaries of care conferences on his/her patients in a timely manner as per Agency policy. Coordinates services. Informs personnel of changes in the condition and needs of the patient. Counsels the patient and family/significant others in meeting nursing and related needs. Participates in and presents in-service programs. Understands and adheres to established Agency policies and procedures. Processes orders and notifies physician of patient needs and changes in condition. Completes certification/recertification orders and discharge summaries. Determines the amount and type of nursing needed by each individual patient. Refers and coordinates care to Physical Therapist, Speech Language Pathologist, Occupational Therapist and Medical Social Worker those patients requiring their specialized skills. Supervises and teaches other nursing personnel in the RN-CM's team. Conducts patient care conferences on patients assigned to his/her care. Participates in peer review and Quality Assessment and Performance Improvement as assigned. Requirements Current Registered Nursing license in Washington state. BLS Certification One (1) year of nursing experience is preferred. Home Health experience, preferred. Ability to travel within a specific region of Olympia and surrounding Thurston County, required. Valid driver's license and insured, reliable vehicle, required.

JOIN THE WORLD LEADER IN PROACTIVE HEALTHCARE Americans are demanding a better way to take control of how they feel and how long they'll live. Over the next decade over one trillion dollars will flow from traditional sick-care to proactive health programs. As the largest longevity medicine program in the world, Lifeforce is accelerating the shift towards more personalized, effective, and empowering healthcare. Founded in collaboration with clinical and scientific leaders from Cleveland Clinic, Mass General Hospital, and Harvard Medical School, Lifeforce combines everything needed to safely track and optimize how your body is functioning now and in the decades ahead. Comprehensive diagnostics, hands-on clinical experts, certified health coaches, and customized supplement, pharmaceuticals, and lifestyle protocols - all accessed from your home at the price of a gym membership. We are looking for a Clinical Registered Nurse who is passionate about delivering exceptional, high-quality healthcare. The ideal candidate will have experience in clinical triage, functional medicine, hormone optimization, and/or longevity medicine. If you excel in dynamic environments, thrive in communication, and love building meaningful connections with patients, this role is for you! We are seeking someone who is excited about making a tangible difference in people's lives. This position represents an amazing opportunity for forward-thinking RNs who are eager to learn and grow their own skill set while delivering a best-in-class member experience. As a Lifeforce clinical teammate, you will work alongside our physicians and health coaches to ensure our members receive best-in-class care. DUTIES & RESPONSIBILITIES Develop a deep understanding of our nutraceutical and pharmaceutical offerings Deep knowledge of Hormone based therapy prescriptions Deep knowledge of GLP-1 therapy Support member care Provide education on Lifeforce prescribed medications, side effects, and compliance Instruction on administering subcutaneous and intramuscular injections Update and send RXs to clinicians Troubleshoot RX orders Clinical Operations Liaison between customer service team and the clinical team Manage clinical triage questions Evaluate member concerns and escalate to the clinical team as necessary Collaborate with customer service teams to communicate clinical updates Member Advocacy: Proactively check-in with members on behalf of the clinical or customer service team Core Competencies: Being willing and able to use evolving technologies needed to deliver care as well as communicate both with members and team members internally Leveraging strong verbal and written communication skills and being excited to continue to develop these skills as needed to improve member outcomes Putting the outcome and experience of the member at the forefront of your care while never compromising the use of safe, Lifeforce-approved medical protocols Having genuine interest in our members, being empathetic to their concerns and meeting them where they're at Being able to meet quality and productivity standards that will be clearly communicated to you and reviewed regularly with your manager YOU'LL LOVE THIS JOB IF You are dedicated to improving the quality of life of members by providing above-and-beyond, personalized, patient-centered support. You are passionate about performance optimization, nutrition, health, and wellness. You are dedicated to supporting safe, research-backed protocols, nutraceuticals and pharmaceuticals. You have a growth mindset when it comes to medicine and are willing and eager to learn new approaches. You want to be able to work remotely while still providing stellar care and making an impact on member's lives. You enjoy working in a fluid, start-up environment and are invigorated by being a part of something new, even if it means frequent changes for the better. You value collaboration and feedback, both receiving and sharing in an effort to continuously improve our care, products and technology. You have a positive attitude and are willing and able to adapt if something doesn't go according to plan. You have a strong sense of self-accountability and you know you'll be able to deliver on agreed-upon commitments. You are organized, on-time and always present yourself in a professional manner. YOU SHOULD GET IN TOUCH IF You are an RN or BSN You have unrestricted licenses to practice in multiple states or Nurse Licensure Compact. You have experience with GLP-1, Statins, Hormone Replacement Therapy (HRT) treatments. You possess a strong knowledge and/or interest in learning about more functionally-minded approaches to care. You are interested in a fully-remote role. You are willing to work at least 40 hours per week consistently, including weekends (flexible). You have a strong interest and passion for wellness, fitness and nutrition. You have strong time management skills and can work independently with minimal supervision. You have experience working in Zendesk, preferred You are willing to have your time be split between phone calls, email communications and SMS communications, as needed. You are someone who can quickly acquire proficiency with the necessary technology, including computers, software applications, phone systems, etc. You are someone with excellent interpersonal, verbal, and written communication skills. You thrive in a team environment, with the ability to excel in a fast-paced atmosphere and successfully collaborate with diverse groups at all levels of the organization when needed. WHAT WE OFFER Full time 40hrs/wk Company provided computer and other required equipment Generous benefits package including Healthcare, Dental, Vision, Life Insurance, and Wellness Care Complimentary Lifeforce Membership for Full Time Employees Unlimited PTO 12 Paid Company Holidays Paid training 100% remote working environment $68,000 - $72,000 a year Please note that job scams are on the rise. If you are contacted for this role, it will be from a team member with an email address domain *******************. Our company does not use Microsoft Teams and will never ask you to disclose your banking information. #LI-remote

Department: Status: Full time Benefits Eligible: Yes Hours Per Week: 32 Schedule Details/Additional Information: Schedule: Part-time, either 3 (10 hour) shifts or 4 (8 hour) shifts. Day/pm hours available. Every third weekend and holiday rotation. **Candidate MUST have 2+ years' acute care experience (ED, Urgent Care, ICU and some Med/Surg will be considered) is required within the last 4 years to be considered.** Due to complex requirements, remote work is NOT permitted from the following states: CA, CO, CT, HI, MA, MD, MN, NJ, MY, OR, RI, VT, WA Schedule: Part time position (30 or 32 hours) start times mornings 8a,9a or 10a, PMs 12p, 1p, 2p or later 8 hour or 10 hour shifts are available for different shifts MUST be available to work every 3rd weekend and holiday rotation Major Responsibilities: Uses the nursing process and guidance of established protocols to assess the needs of the patient telephonically including the patient, guardian, or family in the conversation when necessary. Determines most appropriate level of care needed, provides detailed education, establishes a plan of care including interventions, and communicates follow up instructions to the patient. Escalates and collaborates with the appropriate on call provider when additional guidance is needed. Prioritizes patient interactions by acuity and need considering all available information and resources. Applies evidence-based practice to deliver patient care. Implements strategies to reduce patient risk and increase patient safety. Assesses patient and family readiness to learn and individualizes the approach as necessary. Works collaboratively to develop strategies to meet the learning needs of the patient and family. Supports shared governance activities and initiatives to improve processes and patient outcomes. Participates in department quality/process improvement initiatives aimed at enhancing the patient care experience. Participates in professional activities which contribute to personal professional development and the development of others. Seeks opportunities to be taught, coached, and mentored. Attends required meetings/educational programs and completes annual competencies in a timely manner. Demonstrates effective communication, feedback, and conflict resolution skills. Promotes collaboration with clinicians and other healthcare team members to coordinate patient-centered care. Promotes a culture of safety through identifying threats to patient safety and intervening to prevent patient harm. Reports patient safety events and near misses in a timely manner. Seeks to identify potential safety issues and assists in the implementation of corrective action. Applies ethical decision making, demonstrates respect and understanding for peers, and other clinical disciplines. Participates as an effective member of the patient care team to formulate an integrated, unbiased, individualized approach to care. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret appropriate information needed to identify each patient's requirements relative to his/her age specific needs and provide the care advice/disposition outlined in the departments policies, procedures, and protocols. Schedules appointments with emphasis on making the appointment in correlation to the recommended end point of the protocol used. Collaborates with other health care team members to coordinate medical and nursing management of patient care, including procedures and medication refills. Accurately maintains and updates the patient's clinical records according to agency, State and Federal guidelines. Documents all call encounters utilizing the patient's Electronic Medical Record at the time of the call. Communicates information relating to the patient's physical and psychological status to the physician, Advanced Practice Clinician and/or additional members of the interdisciplinary team as appropriate. Provides pertinent and concise reports describing patient's response to medical and nursing plans of care. Participates in team meetings and works on special projects/tasks as assigned by leadership. Participates in the ongoing development of comprehensive health information resources, system and operational efficiencies and resources. Assists in interpreting department policies and procedures and advises staff on procedural changes. Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices. Education Required: Associate's Degree (or equivalent knowledge) in Nursing. Experience Required: Typically requires 2+ years' of acute care experience, preferably within the last 4 years (ED, Urgent Care, ICU and some Med Surg will be considered). Knowledge, Skills & Abilities Required: Critical thinking skills necessary to independently determine and prioritize the needs of patients using sound judgment and strong problem-solving skills. Knowledge of a variety of healthcare specialties, including levels of care, symptom identification and proven treatment recommendations. Ability to incorporate past experience with established protocols. Excellent verbal communication skills demonstrating empathy, respect, restatement, open-ended questions, active listening and diplomacy with a diverse customer population. Ability to develop rapport and maintain positive, professional relationships with a variety of patients, staff and physicians. Proven ability to independently organize and prioritize work, managing multiple priorities and maintaining a flexible schedule in a fast paced, dynamic customer service environment. Excellent customer service and follow-up skills including the ability to stay calm during stressful situations. Demonstrated proficiency as a technology user with computers, internet, desktop software packages and multiple-line telephone systems. Ability to converse with customers/patients while researching and documenting calls on multiple systems. Knowledge of documentation techniques for communication Physical Requirements and Working Conditions: Required stable and secure internet connection Must have functional vision, touch, speech, and hearing. Required sitting a majority of the workday. Operates all equipment necessary to perform the job. Must have quiet space to make and receive phone calls Ability to lift 15 lbs. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Pay Range $34.90 - $52.35 Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Full time Shift: First Shift (Days - Less than 12 hours per shift) (United States of America) Hours per week: 40 Job Information Exemption Status: Non-Exempt Provides professional nursing care for clinic patients following established standard and practices. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson's Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization. Education Qualifications Bachelor's Degree Bachelor's of Science in Nursing (BSN) Preferred Experience Qualifications 1 year Nursing experience. Preferred Skills and Abilities Skill in applying and modifying the principles, methods and techniques of professional nursing to provide on-going patient care. (Required proficiency) Skill in establishing and maintaining effective working relationships with patients, medical staff and the public. (Required proficiency) Ability to maintain quality control standards. (Required proficiency) Ability to react calmly and effectively in emergency situations. (Required proficiency) Licenses and Certifications Registered Nurse - KSBN Required What you will do Triage of all incoming phone calls by evaluating the physical and psychosocial health status of patients. Follows nursing protocols and guidelines for answering and directing calls. Record and reports patient's condition and reaction to drugs and treatments to interdisciplinary team. Provide instruction to patients/family regarding treatment. Maintains and reviews patient records, charts, and other pertinent information. Oversee appointment bookings and ensure preferences are given to patients in emergency situations. Arranges for patient testing and admissions. Refill prescribed medications per standing orders. Clarify medication orders and refills to pharmacies as directed by providers. Perform medication prior authorizations as needed by providing needed clinical information to insurance. Maintain timely flow of patient to include scheduling of follow up appointments if needed. Working of in-basket medication refill requests for providers. Provide education to patient and family on medications, treatments and procedures. Record and report patient's condition and reaction to drugs and treatments to interdisciplinary team, reviewing patient records and other pertinent information. Ensure patients receive appointments that align with triage disposition and that maintain timely flow of patients. Coordinate patient testing, referrals, and admissions Work collaboratively with on-site staff to provider coordinated patient care Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Not Patient Facing Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail's Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually. Remote Work Capability Full-Time Scope No Supervisory Responsibility No Budget Responsibility No Budget Responsibility Physical Demands Balancing: Rarely less than 1 hour Carrying: Rarely less than 1 hour Eye/Hand/Foot Coordination: Occasionally 1-3 Hours Feeling: Rarely less than 1 hour Grasping (Fine Motor): Occasionally 1-3 Hours Grasping (Gross Hand): Rarely less than 1 hour Handling: Rarely less than 1 hour Hearing: Occasionally 1-3 Hours Kneeling: Rarely less than 1 hour Sitting: Frequently 3-5 Hours Standing: Rarely less than 1 hour Stooping: Rarely less than 1 hour Talking: Frequently 3-5 Hours Walking: Rarely less than 1 hour Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment. Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.

Job Description Now Hiring - Registered Nurse (RN) – Remote Nurse Triage & Clinical Support Schedule: Full time Salary: Starting at $30 per hour Who We are: At Call 4 Health, we’re not just a company—we’re a mission born from a personal journey. Over 27 years ago, our founder, Joe Pores, turned a deeply personal loss into a vision for better healthcare communication. Inspired by his experience as a caregiver for his terminally ill mother and the challenges of after-hours healthcare, Joe founded Call 4 Health to ensure no patient or family feels unsupported "After my mother’s passing, I vowed to create a service where patients and their families are heard, valued, and cared for. That promise became Call 4 Health." – Joe Pores, Founder & CEO Job Summary: Are you ready to make an impact from the comfort of your home? As a Registered Nurse (RN) with Call 4 Health, you’ll serve as a vital connector between patients and healthcare providers. In this remote role, you’ll provide triage, clinical support, and care coordination, ensuring patients receive the attention and guidance they deserve. From managing Electronic Health Records (EHR) to delivering empathetic, expert advice, you’ll be at the forefront of transforming healthcare interactions. What You’ll Do: Respond to patient inquiries via phone or portal using Schmitt-Thompson telephone triage protocols. Document interactions with precision within client EHRs or Call 4 Health systems. Provide clinical assessments and ensure seamless care coordination. Process medication refills, coordinate post-discharge care, and manage critical result notifications. Collaborate with providers, facilities, and agencies to meet patient needs efficiently. Monitor Remote Patient Monitoring (RPM) data, educate patients on chronic conditions, and encourage adherence to care plans. Assist with clinical trials by screening patients and delivering essential education. Offer exceptional service to hospitals, nursing homes, funeral homes, and public agencies. Embrace additional responsibilities to support patients and your team. What You’ll Need: Bachelor’s or Associate’s in Nursing. 2-4 years of full-time clinical RN experience in areas like ER, Urgent Care, ICU, or Home Health. Previous telephone triage experience with electronic systems and multiple EHR platforms. Active eNLC license required (additional licenses a plus). Multistate license required. What You’ll Need for Remote Success A quiet, dedicated workspace with reliable high-speed internet. Why Join Call 4 Health? Be part of a mission-driven team that prioritizes patient care. Make a meaningful difference in the lives of patients every day. Benefit from a supportive work culture that values your contributions and encourages growth. Experience the variety and pace of a dynamic healthcare environment. What’s In It For You: Join a mission-driven team committed to improving patient outcomes. Work remotely while making a tangible difference in patients’ lives. Enjoy a supportive, growth-focused environment that celebrates your contributions.

As a top cancer care provider in Florida, Orlando Health Cancer Institute is a comprehensive, multidisciplinary cancer program consisting of six treatment sites and more than 10 practice locations that serve the region's adult oncology needs. Specializing in more than 200 types of cancer, an expert team of medical professionals providespersonalized care with the most state-of-the-art technologies, such as advanced radiation and proton therapies, and bone marrow transplant and cellular therapy. Through a robust research program, the institute also supportsphysician involvement in numerous research studies and clinical trials that give patients access to innovative diagnosis, treatment and symptom management options. In addition to being accredited by the Commission on Cancer, a program of the American College of Surgeons, Orlando Health Cancer Institute has earned accreditations and certifications in several areas - including medical oncology and hematology/oncology, radiation oncology, cellular therapy, rectal cancer, and breast care - from the respective accrediting organizations, and recently wasnamed in the 2023 Becker's Hospital Review "60 Hospitals and Health Systems with Great Oncology Programs" list. Orlando Health Cancer Institute is part of the Orlando Health system of care, which includes 24 award-winning hospitals and ERs, 9 specialty institutes, 14 urgent care centers, 100+ primary care practices and more than 60 outpatient facilities that span Florida's east to west coasts and beyond. Collectively, we honor our 100-year legacy by providing care for more than 142,000 inpatient and 3.9 million outpatient visits each year. Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not just something we say, it's our promise to you. Collaborates with the assigned clinical team to identify patients most likely to benefit from care coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management, and preventive care services. *Work location 3090 Caruso Court, Suite 50 Orlando Fl. 32806 Work hour are Monday - Friday 8:00 AM - 4:30PM* Responsibilities Essential Functions • Takes the lead in ensuring the continuity and consistency of care across the continuum (inpatient, emergency and ambulatory care/outpatient) to ensure integrated delivery across all settings to include the facilitation, comprehensive discharge planning (in the hospital), and follow-up care (as an outpatient). • Develops an effective working relationship with the Patient and Family Counselors/Social Workers and the Utilization Review Nurses to engage the patient/family to collaborate, advocate, and problem solve to support and enhance their functional ability, while ensuring an appropriate and timely discharge plan. • Monitors progress towards discharge plans daily, need to alter discharge plan due to change in patient condition, and family needs with a priority placed on those patients at highest risk for complication, admission, or readmission. • Educates patients (& families) with chronic illness about evidence-based standards of care to include self-management strategies. • Identifies support needs for patients and their families, develops action plan(s), and provides creative guidance in initiating and overcoming any self-management strategies. • Educates patients and families about the health care system and facilitates relationship building between the various settings. • Ensures patients have access to prescriptions, durable medical equipment (DME), and other services as identified. • Contributes to problem solving within the team through communication, collaboration, data collection, obtaining consensus, and evaluating outcomes of treatment options to include tracking patient progress toward care plan goals and revising the care plan as indicated. • Advocates for patients in order to optimize their health care needs including but not limited to: safety, physical, and legal and financial well-being. • Refers patients to education regarding the healthcare delivery and reimbursement systems, prescription drug programs, health & wellness programs, community agencies, public and private organizations, housing options, and other services as appropriate. • Works with available IT resources (i.e. Phytel, Crimson) to facilitate registry reporting and maintenance of specified patient populations to improve disease outcome measures through evidence-based guidelines and the implementation of clinical decision support tools, referral and test tracking, and preventive medicine reminders. • Participates in clinical outcome measurement to include the identification of strategies that promote population health. • Ensures patient safety in the performance of job functions to include the implementation of policies, procedures, and standards to support assigned duties. • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards. • Maintains compliance with all Orlando Health policies and procedures. Other Related Functions • Possesses excellent analytical and team building skills, as well as the ability to prioritize and work independently. • Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served though knowledge of the principles of growth and development over the life span. • Demonstrates awareness of medical/ legal issues, patient rights, and compliance with standards of regulatory and accrediting agencies. Qualifications Education/Training • Effective July 1, 2024: New Hires and team members moved into this job and/ or transferring departments must have obtained a Bachelor of Science in Nursing (BSN) degree. Licensure/Certification • Maintains current license as an RN in the State of Florida. • Maintains current BLS/ healthcare provider. Experience Three (3) years of direct clinical experience with an emphasis on the population to be served in the assigned area. Education/Training • Effective July 1, 2024: New Hires and team members moved into this job and/ or transferring departments must have obtained a Bachelor of Science in Nursing (BSN) degree. Licensure/Certification • Maintains current license as an RN in the State of Florida. • Maintains current BLS/ healthcare provider. Experience Three (3) years of direct clinical experience with an emphasis on the population to be served in the assigned area. Essential Functions • Takes the lead in ensuring the continuity and consistency of care across the continuum (inpatient, emergency and ambulatory care/outpatient) to ensure integrated delivery across all settings to include the facilitation, comprehensive discharge planning (in the hospital), and follow-up care (as an outpatient). • Develops an effective working relationship with the Patient and Family Counselors/Social Workers and the Utilization Review Nurses to engage the patient/family to collaborate, advocate, and problem solve to support and enhance their functional ability, while ensuring an appropriate and timely discharge plan. • Monitors progress towards discharge plans daily, need to alter discharge plan due to change in patient condition, and family needs with a priority placed on those patients at highest risk for complication, admission, or readmission. • Educates patients (& families) with chronic illness about evidence-based standards of care to include self-management strategies. • Identifies support needs for patients and their families, develops action plan(s), and provides creative guidance in initiating and overcoming any self-management strategies. • Educates patients and families about the health care system and facilitates relationship building between the various settings. • Ensures patients have access to prescriptions, durable medical equipment (DME), and other services as identified. • Contributes to problem solving within the team through communication, collaboration, data collection, obtaining consensus, and evaluating outcomes of treatment options to include tracking patient progress toward care plan goals and revising the care plan as indicated. • Advocates for patients in order to optimize their health care needs including but not limited to: safety, physical, and legal and financial well-being. • Refers patients to education regarding the healthcare delivery and reimbursement systems, prescription drug programs, health & wellness programs, community agencies, public and private organizations, housing options, and other services as appropriate. • Works with available IT resources (i.e. Phytel, Crimson) to facilitate registry reporting and maintenance of specified patient populations to improve disease outcome measures through evidence-based guidelines and the implementation of clinical decision support tools, referral and test tracking, and preventive medicine reminders. • Participates in clinical outcome measurement to include the identification of strategies that promote population health. • Ensures patient safety in the performance of job functions to include the implementation of policies, procedures, and standards to support assigned duties. • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards. • Maintains compliance with all Orlando Health policies and procedures. Other Related Functions • Possesses excellent analytical and team building skills, as well as the ability to prioritize and work independently. • Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served though knowledge of the principles of growth and development over the life span. • Demonstrates awareness of medical/ legal issues, patient rights, and compliance with standards of regulatory and accrediting agencies.

Employment Type: Part Time Shift: Nights, 7pm - 7:30am The licensed Registered Nurse (RN) plans & provides professional nursing services & standards of practice in accordance with level of experience & education, state board of nursing & established policies & procedures. The RN integrates the art, science, leadership & knowledge of the nursing clinical practice through relationship-centered, compassionate, ethical & respectful direct / indirect care. What you will Do: * The Virtual Registered Nurse (RN) is a member of the Nursing Care Team and is responsible for collaboration, communication & facilitation of optimal provision of care through a computerized &/or digital platform supporting daily management of care. * Responsible for the assessment, planning, implementation, coordination, monitoring & evaluation of the patient's plan of care from admission to discharge. * Utilizes clinical knowledge, critical thinking skills & the principles of case management & adult education to coordinate, implement & support the plan of care. * Ensures a seamless, effective, efficient transition of care across the continuum. * Responsible for monitoring quality metrics specific to the department & ensuring complete & accurate documentation in the patient record. * Performs the roles: 1) mentor; 2) clinician; 3) educator; 4) consultant/collaborator; and 5) navigator. Hours/Schedule: Part Time, 48hrs in pay period, 7pm - 7:30am Minimum Qualifications: * Graduation from an accredited professional school of nursing. * Valid RN licensure authorized in the applicable state(s) of practice/employment. * Baccalaureate Degree in the Science of Nursing (BSN) degree from an accredited school of nursing. Specialty credentialing & educational degree according to clinical nursing practice specialty area. * Valid driver's license where required by assignment. * Minimum eight (8) years of experience in health condition management, which must include adult condition management. Electronic Medical Record (EMR) experience. Position Highlights and Benefits: * MercyOne Nurses Rock Scholarship - loan repayment for ADN or BSN * Education Assistance offered * Effective Day 1 Benefit Package (Medical, Dental, Vision, and more) for positions 16 hours per week or greater * Competitive wages; including weekend and night differentials * Generous paid time off program * Retirement Savings program with employer match starting on Day 1 Ministry/Facility Information: MercyOne North Iowa Medical Center provides expert health care to 15 counties. MercyOne North Iowa Medical Center is a 342 bed, regional referral teaching hospital in Mason City, Iowa. MercyOne New Hampton Medical Center is an 11 bed, rural access hospital in New Hampton, Iowa. Our service area spans 15 counties across northern Iowa and southern Minnesota. We serve a population over 260,000. With more than 3,000 colleagues and a medical staff of almost 500 physicians and allied health professionals, MercyOne North Iowa Medical Center is the largest employer in the region. MercyOne Medical Group - North Iowa is part of Iowa's largest multispecialty clinic systems. In north Iowa, our clinics are made up of more than 25 primary care, pediatric, internal medicine and specialty clinics. Legal Information All offers are contingent upon the successful completion of references, background checks, pre-employment physical, drug screen and post offer exam. EEO Employer F/M/Veteran/Disabled In compliance with the ADA Amendments Act (ADAAA), VEVRAA, and Section 503, should you have a disability and would like to request an accommodation in order to apply for a currently open position with MercyOne North Iowa Medical Center, please call Human Resources at ************** or email us at ********************************* Our Commitment to Diversity and Inclusion Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Must be willing to travel to the Asheville Office if needed . GENERAL STATEMENT OF JOB The Clinical Risk Management Registered Nurse (CRM-RN) provides clinical physical health expertise in Quality Management (QM) to support provider oversight and performance improvement activities. As part of Clinical Quality, the CRM-RN engages in day-to-day provider monitoring, clinical reviews, and the management of critical incidents to identify problematic practices and adverse clinical risk trends. The CRM-RN advises on the incident reporting process, facilitating the communication of trends to leadership teams and internal committees, thereby supporting the oversight of quality, safety, and improvement. Additionally, the CRM-RN collaborates with QM Operations and Quality teams to reduce member harm. Serving as a team member within QM, the CRM-RN aims to mitigate risks and ensure high-quality care within the healthcare environment. The CRM-RN provides expert consultation on clinical risk management to ensure the highest quality of care in a dynamic healthcare environment. The CRM-RN identifies problematic practices and adverse clinical risk trends, collaborating with the appropriate operations teams to mitigate or eliminate risks to member safety. The CRM-RN diligently works to identify circumstances and opportunities that pose risks to members, taking proactive measures to prevent or control these risks. Additionally, the CRM-RN communicates and collaborates with leadership to develop strategies for risk minimization, identify risk reduction interventions, and promote member safety. ESSENTIAL JOB FUNCTIONS Quality Management and Provider Performance Improvement Oversight: Provide clinical physical health expertise in Quality Management to support provider oversight and other quality-related activities. Offer expertise in monitoring physical health provider records and reviewing providers in relation to DHHS priority quality measures (e.g., opioid misuse, tobacco cessation, pregnancy intendedness, birth outcomes, diabetes prevention, hypertension). Assist in the development and implementation of processes and protocols aimed at improving member outcomes. Collaborate with leadership to develop tools and programs that support the organization's goals. Efficiently complete Clinical Quality monitoring activities to assess provider quality against best practices and compliance with rules, regulations, and service definitions, while maintaining the integrity of the review process. Review and evaluate medical and/or behavioral service outcomes by applying clinical expertise and administrative policy knowledge. Maintain current clinical, contract, and policy knowledge, applying it appropriately as part of the monitoring and oversight process. Generate Reports of Findings and Results Letters to address review outcomes and identified quality issues. Implement monitoring systems to enhance the performance of contracted providers within the Vaya Health Network and improve member outcomes. Develop innovative interventions to address and identify treatment gaps within the Vaya Health Network of contracted providers. Engage in direct intervention and education with providers regarding healthcare delivery system quality interventions. Complete tracking and monitoring systems as required by regulatory requirements, accreditation standards, policies and procedures, protocols, and contractual obligations. Serve as a subject matter expert (SME) in physical health and quality improvement for team members and external stakeholders. Participate in desk reviews and on-site reviews as needed. Assist in the preparation and execution of external regulatory and accreditation reviews as required. Collaborate with internal teams and external stakeholders to develop quality solutions when opportunities for improvement are identified. Review reports and data to identify trends and patterns impacting service quality and delivery and develop solutions to address non-compliances. Critical Incident Oversight: Serves as the primary clinical Subject Matter Expert (SME) for incidents. Utilizes a high degree of judgment, prioritization, problem-solving, and decision-making skills to conduct comprehensive reviews of quality-of-care incidents. Provides clinical support for the Critical Incident Review Committee (CIRC) process, including initial clinical triage of incident reports to ensure a consistent flow of incidents and the implementation of immediate performance improvement interventions as needed. Leads and directs daily critical incident review prioritization activities. Identifies and gathers necessary documents for critical incident review and remediation. Collaborates with the Chief Medical Officer (CMO) and/or Deputy CMO as part of the CIRC process and case disposition, as needed or requested. Completes provider technical assistance and post-clinical activities following CIRC meetings. Offers guidance and consultation on clinical risk management issues, policies, procedures, and practices from a risk management perspective. Special Projects and Committee Involvement: Assist Quality Management (QM) Leadership with special projects and assignments directly related to quality assurance and provider monitoring, and lead such projects as assigned. Collaborate with the Quality Management leadership team on departmental projects. Represent Vaya Health on internal committees as assigned. Participate in external committees and workgroups as assigned. Attend NCDHHS Department meetings as needed or assigned to stay informed and maintain a current knowledge base of performance metrics and local, state, and federal requirements. Provide ongoing staff development and support as requested to assist the department in fulfilling its responsibilities. Collaborate with the Quality Director and Medical Operations to implement Patient Safety principles across the organization and provider network. KNOWLEDGE, SKILL & ABILITIES Demonstrates comprehensive knowledge of rules, regulations, and contractual standards related to behavioral health and medical performance methods and practices, with a focus on improving member outcomes, providing technical assistance, and implementing plans of correction. Possesses in-depth understanding of the treatment and service needs of members, with skills in assessing strengths and needs, developing treatment plans, and implementing medical and clinical services. Exhibits strong organizational skills and attention to detail, capable of independently managing multiple tasks efficiently. Demonstrates flexibility, adaptability, accountability, and self-governance. Utilizes problem-solving, negotiation, and conflict resolution skills to balance the needs of internal and external customers. Effectively negotiates with teams, providers, and other departments to address issues of concern. Self-motivated and able to work effectively with a diverse range of individuals, teams, providers, and departments to address issues of concern. Maintains a positive, solution-focused attitude and the ability to adapt to changing priorities. Possesses highly effective communication skills, capable of presenting information across various audiences and responding to questions from internal and external stakeholders. Exhibits excellent decision-making abilities based on relevant facts and established processes to determine appropriate actions during quality reviews and follow-up. Demonstrates exceptional interpersonal and leadership skills, able to work both autonomously and as part of a team, exercising sound judgment and problem resolution skills. Respects and works effectively with individuals from diverse ethnicities, cultures, and abilities, establishing respectful relationships and partnerships. Proficient in Microsoft Office products (e.g., Word, Excel, Outlook). Knowledgeable in CPT, ICD, and HCPCS coding.