RN Case Manager – MLTC (Bilingual highly preferred) – Hybrid (4 days remote)

Job Summary:

The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member’s health needs while promoting quality cost effective outcomes.

Essential Functions:

• Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status.
• Authorizes covered services and coordinates care regardless of payer.
• Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
• Works with member/family to maintain the most independent living situation possible
• Assesses, plans and provides continuous care management across all venues of care, including hospital, sub-acute, long-term and home settings.
• Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria.
• Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs.
• Collaborates with the primary care physician and Inter-Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
• Ensures appropriate, safe plan for members’ discharge from their plan.
• Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.
• Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
• Responds to members’ requests in the designated timeframes and completes Initial Adverse Determinations (IAD) as indicated
• Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharges planners, and formulates appropriate plan of care.
• Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in person recertification notes.
• Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members’ needs.
• Perform any other job related duties as requested.

Education and Experience:

• Associates degree in Nursing from an accredited nursing program required
• Bachelor’s degree in Nursing preferred
• Three (3) years of experience as a registered nurse required
• Clinical experience in geriatrics and/or managed long-term care experience preferred
• Experience using multiple languages may be required based on operational needs

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
• Ability to communicate effectively with a diverse group of individuals
• Ability to multi-task and work independently within a team environment
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
• Adhere to code of ethics that aligns with professional practice
• Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
• Strong advocate for members at all levels of care
• Strong understanding and sensitivity of all cultures and demographic diversity
• Ability to interpret and implement current research findings
• Awareness of community & state support resources
• Critical listening and thinking skills
• Decision making and problem-solving skills
• Strong organizational and time management skills
• Bilingual speaking and writing skills are preferred

Licensure and Certification:

• Current, unrestricted Registered Nurse licensure in the state of New York required
• Case Management Certification preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Up to 25% (regular) travel may be required to travel to different locations, including homes, offices, or other public settings, to perform work duties

Compensation Range:
$100,000 – $115,000.. We takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

#AC1
#ACP

SPECIALTIES:

Case Management (CM)

The Case Manager is a Registered Nurse in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a care plan that will ensure quality medical care for the member population serviced by ProgenyHealth. The Case Manager for Maternity program will focus on empowering the member to support optimal wellness while advocating for necessary medical services.
Requirements
Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.
Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures.
Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care.
Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits.
Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc.
Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care.
Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care.
Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member.
Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.

Qualifications

Registered Nurse (RN) with a current, unrestricted compact license is required.
College degree is preferred.
Scheduled hours will be in central, mountain or pacific time zone.
Three or more years of experience in a Case Management role is required.
Previous experience in a maternity management program preferred.
Three or more years of clinical experience in OB/L&D or related area is required.
CCM certification required within the timeframe specified by company policy.
Experience with data entry into a database or EHR required. Must be computer literate.
Excellent communication skills and organizational ability are required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks.
Must demonstrate accuracy in spelling and documentation.
Demonstrated strength in working independently as well as collaboratively within a team.
Must have excellent interpersonal skills, telephone etiquette, and maintain positive communication at all times.
Must have commitment to excellence in customer service.

Benefits

Some of the benefits we offer our team are:

Paid Time Off
Paid Parental Leave
Medical, dental, vision benefits
401K with company match
Short- and Long-Term Disability
Group Life Insurance
Tuition reimbursement
Professional development opportunities

SPECIALTIES:

Case Management (CM)

e primary location for this remote in New Jersey.
The schedule for this role is 3x12s, 12-hour shifts (5:00am-5:00pm, 7:00am-7:00pm, 11:00am-11:00pm, and 7:00pm-7:00am).

What You’ll Do:

As an Acute Care Registered Nurse on Imagine’s acute care team, you will be part of a team that is focused on delivering acute virtual care to patients in markets nationwide. In the role of an Acute Care Registered Nurse, you will:

Provide professional and friendly proactive care for our patients.  
Utilize standard triage protocols to accurately assess and provide a disposition for clinical issues using our platform.
Perform virtual nursing assessments as needed
Embed a family centered care philosophy in care delivery.  
Demonstrate knowledge and expertise in nursing assessment and triage.
Recognize and collaborate with acute care providers, patient and family in planning and implementing care.  
Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. 
Perform other duties as needed.
How You Qualify & What You Bring:

First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need: 

Graduate with a bachelor’s in nursing from an accredited university required
Multistate Compact Licensed RN required
4+ year’s experience in pediatric nursing required
1-2 years’ experience in a Pediatric ED/Urgent Care required
Virtual care experience preferred
What We Offer (Benefits + Perks)

The hourly rate for this position ranges from $44-48 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks:

Competitive medical, dental, and vision insurance
Healthcare and Dependent Care FSA; Company-funded HSA
401(k) with 4% match, vested 100% from day one
Employer-paid short and long-term disability
Life insurance at 1x annual salary
20 days PTO + 10 Company Holidays & 2 Floating Holidays
Paid new parent leave
Additional benefits to be detailed in offer

What We Live By

We’re guided by our five core values:

Our Values:

Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future.
Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments.
Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale.
Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve.
One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together.

SPECIALTIES:

Telehealth

The primary location for this remote in Tennessee.
The schedule for this role is 3x12s, 12-hour shifts (5:00am-5:00pm, 7:00am-7:00pm, 11:00am-11:00pm, and 7:00pm-7:00am).

What You’ll Do:

As an Acute Care Registered Nurse on Imagine’s acute care team, you will be part of a team that is focused on delivering acute virtual care to patients in markets nationwide. In the role of an Acute Care Registered Nurse, you will:

Provide professional and friendly proactive care for our patients.  
Utilize standard triage protocols to accurately assess and provide a disposition for clinical issues using our platform.
Perform virtual nursing assessments as needed
Embed a family centered care philosophy in care delivery.  
Demonstrate knowledge and expertise in nursing assessment and triage.
Recognize and collaborate with acute care providers, patient and family in planning and implementing care.  
Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. 
Perform other duties as needed.
How You Qualify & What You Bring:

First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need: 

Graduate with a bachelor’s in nursing from an accredited university required
Multistate Compact Licensed RN required
4+ year’s experience in pediatric nursing required
1-2 years’ experience in a Pediatric ED/Urgent Care required
Virtual care experience preferred
What We Offer (Benefits + Perks)

The hourly rate for this position ranges from $44-48 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks:

Competitive medical, dental, and vision insurance
Healthcare and Dependent Care FSA; Company-funded HSA
401(k) with 4% match, vested 100% from day one
Employer-paid short and long-term disability
Life insurance at 1x annual salary
20 days PTO + 10 Company Holidays & 2 Floating Holidays
Paid new parent leave
Additional benefits to be detailed in offer

What We Live By

We’re guided by our five core values:

Our Values:

Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future.
Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments.
Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale.
Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve.
One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together.

SPECIALTIES:

Telehealth

You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members.
You will report into the Associate Director, Clinical.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $39.28 – $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
Actively reach out to members undergoing difficult health challenges and develop care plans
Proactively reach out to hospital case managers to assist with discharge planning
Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures.
Compliance with all applicable laws and regulations
Other duties as assigned
Requirements:

Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
Ability to obtain additional state licenses to meet business needs
2+ years of clinical experience to include payer, hospital, outpatient or community based care management
1+ years of experience in Care Coordination and Navigation
Bonus points:

CCM Certification
Bilingual in Spanish and/or creole reading, writing, speaking
BSN
Working knowledge of Milliman Guidelines

SPECIALTIES:

Case Management (CM)

This is a remote work from home role anywhere in the US with virtual training.
American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

Key Responsibilities

This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.

Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.

Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.

Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.

Utilizes case management processes in compliance with regulatory and company policies and procedures.

Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.

Identifies and escalates member’s needs appropriately following set guidelines and protocols.

Need to actively reach out to members to collaborate/guide their care.

Perform medical necessity reviews.

Required Qualifications

5+ years’ experience as a Registered Nurse with at least 1 year of experience in a hospital setting.

The AHH RN Case manager position requires the nurse to support members across multiple states. A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across participating states with one license. Nurses residing in non‑compact states must hold an individual, state‑specific RN license for each state they support.

1+ years’ experience documenting electronically using a keyboard.

1+ years’ current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience.

Preferred Qualifications

1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care.

1+ years’ experience in Utilization Review.

CCM and/or other URAC recognized accreditation preferred.

1+ years’ experience with MCG, NCCN and/or Lexicomp.

Bilingual in Spanish preferred.

Education

Diploma or Associates Degree in Nursing required.

BSN preferred.

Anticipated Weekly Hours

40
Time Type

Full time
Pay Range

The typical pay range for this role is:

$54,095.00 – $155,538.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

SPECIALTIES:

Case Management (CM)

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Typical office working environment with productivity and quality expectations.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Sedentary work involving periods of sitting, talking, listening.
Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written
Required Qualifications
– 2+ years of experience as a Registered Nurse in adult acute care/critical care setting

– Must have active current and unrestricted RN licensure in state of residence

– Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours

Preferred Qualifications
– 2+ years of clinical experience required in med surg or specialty area
– Managed Care experience preferred, especially Utilization Management

– Preference for those residing in MNT or CST

Education

– Associates Degree in Nursing required

– Bachelors in Science and Nursing preferred

Anticipated Weekly Hours

40
Time Type

Full time
Pay Range

The typical pay range for this role is:

$29.10 – $62.32
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

SPECIALTIES:

Utilization Review & Management (UR/UM)

Anticipated End Date:
2026-03-20
Position Title:

Telephonic RN Nurse Case Manager I – AmeriBen
Job Description:

Telephonic RN Nurse Case Manager I – AmeriBen

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours: Monday thru Friday 8 am to 5 pm (local time)

AmeriBen is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, including medical management.

The Telephonic Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.

How you will make an impact:

Ensures members understand benefits and assist in access of services appropriate to their health needs.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan through actions based on assessments including providing education, facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and other health professionals on the development of care management treatment plans.
Assists in problem solving for members and providers related to access to care, vendors, claims or service issues, etc.
Minimum Requirements:

Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted compact RN license in your home state.
Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Capabilities, Skills and Experiences:

Strong clinical background in hospital setting, i.e. Med Surg, ER, ICU, Critical Care
Ability to talk, type and critically think at the same time.
Demonstrates critical thinking skills when interacting with members.
Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
Ability to manage, review and respond to emails/instant messages in a timely fashion.
Excellent collaboration, communication and teamwork skills.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $70,560 to $115,920

Locations: Illinois, Maryland, Minnesota, New Jersey, Nevada

In addition to your salary, Elevance Health 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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Exempt
Workshift:

1st Shift (United States of America)
Job Family:

MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

SPECIALTIES:

Case Management (CM)

Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.
Primary Duties and Responsibilities

Conducts admission concurrent and retrospective case reviews to meet hospital objectives of high-quality patient care in the most efficient way
Strives to meet the department goals adheres to organizational policies procedures and quality standards. Complies with rules and regulations set forth by the governmental and accrediting agencies.
Collaborates with medical staff physician advisor social workers and other ancillary hospital disciplines to meet patients’ health care needs in the most cost-effective way.
Performs patients’ medical record reviews document pertinent information and communicate with third party payors in a timely fashion to ensure proper hospital reimbursement and eliminate unnecessary denials.
Implements strategies to avoid potential denials by communicating with all the key stakeholders including attending physician.
If necessary non-coverage ABN MOON letters and other appropriate documents as per organizational governmental and accrediting organizations policies and regulations.
Actively participates in IDRs Length of Stay and other meetings as per hospital policies.
Identifies potential risks pertaining to patients’ care and communicates with appropriate hospital discipline including risk management quality safety and infection control.
Serves as a resource to the health care team by educating the health care team through in-services staff meetings and formal educational settings in areas of utilization management.
Demonstrate current knowledge of State and Federal regulatory requirements as it pertains to the utilization review process.
Identifies dynamics of neglect/abuse and reports to the appropriate in-house departments and governmental agencies.
Minimal Qualifications
Education

Associate’s degree in Nursing required
Bachelor’s degree in Nursing preferred
Experience

3-4 years Experience in an acute care setting required
2 years experience in case management insurance ultilization review or related preferred
Licenses and Certifications

RN – Registered Nurse – State Licensure and/or Compact State Licensure in the District of Columbia or the State of Maryland depending on work location required
CCM – Certified Case Manager preferred
Knowledge Skills and Abilities

Excellent problem-solving skills and ability to exercise independent judgment.
Business acumen and leadership skills.
Strong verbal and written communication skills with ability to effectively interact with all levels of management internal departments and external agencies.
Working knowledge of various computer software applications.

This position has a hiring range of

USD $89,065.00 – USD $162,801.00 /Yr.
Sidnie
Registered Nurse

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In addition to your salary, MedStar Health offers a comprehensive healthcare package (including medical, dental and vision subject to eligibility requirements) and other benefits. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by MedStar Health.  MedStar Health is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The hiring range is the range MedStar Health, in good faith, believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on work experience, education and/or skill level, etc. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in MedStar Health’s sole discretion unless and until paid and may be modified at MedStar Health’s sole discretion, consistent with the law.

SPECIALTIES:

Utilization Review & Management (UR/UM)

Your future role at a glance Department: Case Management
Schedule: Part time, Days
Hospital: Ascension St Thomas
Location: Remote
      ****Tennessee RN license is required.

How you’ll make an impact in this role
Provide health care services regarding admissions, case management, discharge planning and utilization review.

Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
Provide case management and/or consultation for complex cases.
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Assess and coordinates discharge planning needs with healthcare team members.
May prepare statistical analysis and utilization review reports as necessary.
Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
What minimum qualifications you’ll need
Licensure / Certification / Registration:

Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current home state license for multi-state license recognition “Compact State” obtained prior to hire date or job transfer date required.
Education:

Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
What additional requirements you’ll need
#UM2026

Life at Ascension: Where purpose meets opportunity
Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.

SPECIALTIES:

Utilization Review & Management (UR/UM)

Employment Type: Full time
Shift:
Day Shift
Description:
RN – Internal Medicine Office

FULLY REMOTE
If you are looking for an RN II position in an Internal Medicine Office, this could be your opportunity. Here at St. Peter’s Health Partner’s, we care for more people in more places.

Position Highlights:
Quality of Life: Where career opportunities and quality of life converge
Advancement: Strong orientation program, generous tuition allowance and career development
Work/Life: Monday – Friday

What you will do:
The Registered Professional Nurse has the responsibility and accountability to utilize the nursing process to diagnose and treat human responses to actual or potential problems of individuals or groups. The Registered Professional Nurse works within and contributes to an environment where the St. Peter’s Healthcare Services mission is actualized, patient outcomes are achieved, and professional practice is realized.

Responsibilities:
Brings patient to exam room, takes appropriate vital signs and documents in electronic medical record.
Review and update medication list to ensure accurate and complete list in electronic medical record (EMR) available for provider review and submission.
Complete referrals and tracks patients’ compliance.
Review prescriptions electronically and send prescriptions to providers for review and submission.
Obtains patient consent for procedures as directed by provider.
Performs pre-visit planning and reviews quality metrics.
Retrieves telephonic clinical information from patients who call into the office.
Monitors task list and completes tasks assigned by provider in a timely manner based on urgency.
Educates patients regarding medication, testing procedures and home care techniques.
Ensure proper labeling, handling and documentation for patient specimens.
Follow up with patient regarding test results based on advice given by provider.
Maintains a clean and safe work environment including disinfecting patient care areas and equipment.
In conjunction with other nursing colleagues, maintains the medical supply cabinet and drug cabinet.
Uses the electronic medical record to communicate effectively.
Performs quality assurance duties as assigned.
Provides a clinical visit summary (Patient Plan) to patient as requested including educational materials.
Participates in daily Patient Care huddles as appropriate.
Works cooperatively with all colleagues to ensure quality patient care at all times.
Performs other duties as assigned.

What you will need:
Associates or Bachelor’s degree in Nursing preferred
HS Diploma/equivalent required
Current unencumbered NYS RN license
Basic Life Support certification
6 months previous RN experience
Must be able to lift 20 lbs.

Pay Range: $36.00 – $47.52

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.

SPECIALTIES:

Case Management (CM), Triage