NURSE FERN HAS A LIVE CE COMING UP ON 5/15 ***For the first time we are offering this CE as a stand alone outside of the traditional membership. AI is rapidly advancing and we want more nurses to have the basics.
The APPLY link will take you to the sign up page for this event.

This 1 hour CE course will be taught live on 5/15.
The recording will be available within 24 hours of the presentation.

Objectives:

1. Describe the fundamental concepts of artificial intelligence, machine learning, and generative AI as they relate to healthcare.
2. Apply examples of artificial intelligence to nursing practice, including patient care, documentation, and clinical decision support.
3. Evaluate the risks, limitations, and ethical considerations of artificial intelligence use in nursing practice, including bias, hallucinations, and data privacy.

Presenter: Michelle Hamland, DNP, RN, NI-BC

Number of CEs: 1

Additional Benefits:

-Learn how AI is used in healthcare
-Add relevant CEs to your resume
-Interview for roles with the confidence you understand the basics of AI
-Volunteer for unit-based AI task forces! (like ambient AI nurse influencers)

This class will be taught live on 5/15/26 @ 1100 PT/1400 ET, the recording and quiz to claim your CE certificate will be available 24 hours after the presentation. 

Since we offer CEs that count towards license renewal, your employer may reimburse you for the membership. But you may need to ask first!

*Nursing Professionals will earn contact hours through Debriefing the Front Lines, Inc. for attending select education in the membership. ​Debriefing the Front Lines, Inc.​ is an accredited provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation. Provider approved by the Kansas Board of Registered Nursing, Provider # LT0308-0621.

Join Silverado Hospice CA Regional and be part of a nationally recognized team ranked in the top 10 nationwide by Fortune Magazine’s Best Workplaces in Aging Services™. Since 1997, Silverado has been delivering exceptional care to individuals with neurodegenerative conditions and those facing life-limiting illnesses through our Hospice services. We’re a certified Great Place to Work® and proud to offer competitive pay, benefits, and growth opportunities.
We’re hiring a Regional Triage Nurse (RN) – a skilled and compassionate professional who provides telephonic triage, clinical oversight, and coordination of after-hours care across multiple hospice sites. This role is essential to ensuring timely, high-quality care for patients and families during critical moments.

Be a Difference-Maker with a Hospice Care Leader

You lead with clinical expertise, empathy, and strong communication skills. You thrive in a mission-driven environment and are passionate about supporting patients and families while ensuring smooth coordination of care.

What You’ll Be Doing

Oversee and assign on-call/after-hours RN runners for supported hospice sites
Provide telephonic assessments and implement appropriate interventions based on patient’s terminal diagnosis and reported symptoms
Collaborate with attending physicians, Medical Directors, and interdisciplinary hospice teams
Utilize EMR systems (HCHB workflow) as assigned
Act as liaison with patients, families, and healthcare professionals while maintaining confidentiality and dignity
Qualifications

Active RN licenses in good standing in both California and Texas
Minimum of 1 year RN experience, including at least 1 year in end-of-life care
Certification as a Hospice and Palliative Nurse (CHPNA) preferred but not required
Must clear criminal background check, physical, and drug screening
Valid driver’s license, good driving record, and reliable transportation required
Willingness to travel to patient locations as needed
Ability to work outside regular hours depending on business needs
Why Choose Silverado?

Fortune Magazine Best Workplace in Aging Services™
Certified Great Place to Work®
Strong internal mobility
Schedule: Monday – Friday 5:00pm – 12:00am, Saturday and Sunday

#LI-AH1

Anticipated pay range
$52—$56 USD
Silverado offers the following benefits to eligible employees:

401(k) matching
Health, Dental and Vision Insurance
Flexible Spending Account (FSA)
Paid time off
Tuition reimbursement and professional development assistance
Referral program
Other amazing benefits such as Pet Insurance, Auto and Home Insurance and Discount Programs!
* Silverado does not accept candidates from outside recruiters or agencies for this role. *

California Employees: For roles requiring driving, the driving requirement has been deemed essential to the performance of this role due to specific business necessity. Supporting documentation is maintained by Silverado and is available for review upon request to ensure compliance with California law.

To view California Consumer Privacy Act (CCPA) information, please visit this page: https://www.silverado.com/legal-disclaimers/#Consumer-Privacy-Act-Disclosure

Employment offers are contingent on background check, drug screening, physical, and TB testing (if applicable).

Silverado uses E-Verify to confirm work authorization with both the Social Security Administration and the Department of Homeland Security

EOE/M/F/D/V  

SPECIALTIES:

Triage

RN Medicare Compliance-Proactive Reduction Outreach PRIMARY PURPOSE:  To perform initial and ongoing clinical assessment through provider outreach, specialized document review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations.
Uses specialized knowledge to assess the needs of the individual case and creates customized correspondence for any applicable providers that will provide the clarity needed to proceed with the preparation of the Medicare Set-Aside.
Proactively and strategically plans and executes outreach activities with providers for each case via telephone, email, and fax, adhering to best practice guidelines.
Reviews and analyzes completed documentation from providers to ensure accuracy, completeness, adherence to quality assurance standards.
Measures interventions to determine the outcome of the clinical assessment involvement to include efficacy of response, financial, and client satisfaction; maintains accurate record of management including costs, savings.
Articulates and effectively documents clear and concise information with handling planner, specialist, client, and supervisor while maintaining client’s privacy and confidentiality; adheres to ethical, legal, accreditation and regulatory standards.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.
QUALIFICATIONS

Education & Licensing
Bachelor’s degree from an accredited college or university preferred.  Active unrestricted RN license issued in a state or territory of the United States required.

Experience

Four (4) years of related experience or equivalent combination of education and experience required.

Skills & Knowledge

Excellent oral and written communication skills, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Ability to create and complete comprehensive, accurate and constructive written reports
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

TAKING CARE OF YOU BY

We offer a diverse and comprehensive benefits package including:
Three Medical, and two dental plans to choose from.
Tuition reimbursement eligible.
401K plan that matches 50% on every $ you put in up to the first 6% you save.
4 weeks PTO your first full year.
NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $60,000 – $65,000/year.  A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.  They are not intended to constitute a comprehensive list of functions, duties, or local variances.  Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you’re excited about this role but your experience doesn’t align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

SPECIALTIES:

Quality

**Fern note – post shows as 6+ months old but re-shared by hiring team as active recruitment.
Position Overview:

We are in search of a Nurse Navigator to join our dynamic healthcare team within the innovative setting of a startup. In this role, the Nurse Navigator will operate primarily in a remote capacity, offering indispensable assistance to patients as they navigate intricate healthcare systems. We require a candidate with robust clinical expertise, exceptional communication abilities, and a heartfelt dedication to patient well-being. Acting as a guiding beacon through their healthcare journey, the Nurse Navigator holds a pivotal position in ensuring patients receive the precise care and support they require.

By championing patient advocacy and fostering a culture of cost-conscious care, the Nurse Navigator becomes a catalyst for positive transformation. This transformative impact extends to enhancing patient outcomes, streamlining care delivery, and furthering our mission of delivering top-tier healthcare services at optimal value.

We are seeking a Nurse Navigator who embodies adaptability and agility, embracing change and uncertainty as catalysts for personal and professional development. With resilience and flexibility, the Nurse Navigator adeptly navigates the ever-evolving healthcare landscape, harnessing technological advancements, and aligning with organizational objectives to drive innovation and foster continuous improvement.

Key Responsibilities:

Patient Advocacy: Serve as a primary point of contact and advocate for patients navigating the healthcare system remotely.
Care Coordination: Collaborate with healthcare providers, specialists, and other stakeholders to coordinate patient care effectively.
Communication: Maintain clear and timely communication with patients, caregivers, and healthcare professionals via phone, email, and teleconferencing platforms.
Documentation: Ensure accurate and thorough documentation of patient interactions and their plan of care in our proprietary app.
Resource Referral: Facilitate referrals to preferred providers, community resources, and additional healthcare services as needed.
Compliance: Adhere to all relevant healthcare regulations, policies, and protocols, ensuring compliance with HIPAA and other privacy laws.
Professional Development: Stay updated on current healthcare trends, best practices, and evidence-based guidelines through ongoing education and training.

Qualifications:
Registered Nurse (RN) License: Active and unrestricted RN license in the state of Wisconsin.
Clinical Experience: Minimum of 2 years of clinical experience in a healthcare setting, preferably in areas such as medical-surgical, primary care, or case management.

Computer Proficiency: Proficiency in using electronic health record (EHR) systems, Microsoft Office Suite, and other relevant software applications.
Passion for the Mission: Alignment with the mission, values, and goals of the startup. A genuine passion for making a positive impact in healthcare and improving patient outcomes is motivating and fosters dedication to the organization’s mission.
Communication Skills: Excellent verbal and written communication skills, with the ability to effectively interact with diverse patient populations and healthcare professionals.
Critical Thinking: Strong critical thinking and problem-solving abilities, with the capacity to assess complex healthcare situations and find appropriate options for the patient based on their health plan.
Empathy and Compassion: Demonstrated empathy, compassion, and sensitivity to patients’ emotional and psychological needs.
Time Management: Excellent organizational and time management skills, with the ability to prioritize tasks and manage multiple responsibilities efficiently.
Entrepreneurial Spirit: A mindset that thrives on innovation, creativity, and risk-taking. Ability to think outside the box and contribute ideas to drive the growth and success of the startup.
Resourcefulness: Ability to accomplish goals with limited resources and find creative solutions to overcome constraints. Making the most of available tools, technologies, and networks is essential.
Collaborative Mindset: Willingness to work collaboratively with cross-functional teams, share knowledge, and contribute to a supportive and inclusive work culture. Collaboration and teamwork are vital for success in a startup setting.
Fast Learner: Rapidly acquire new skills, knowledge, and industry insights to keep pace with the evolving needs of the startup. Being a quick learner enables individuals to adapt to changing requirements and contribute effectively to the team.
Customer-Centric Approach: Commitment to understanding and meeting the needs of customers or end-users. Prioritizing customer satisfaction and feedback drives product improvement and business growth in a startup.

Preferred Qualifications:

Bilingual Skills: Proficiency in multiple languages, particularly Spanish
Previous Navigation Experience: Prior experience in patient navigation, care coordination, or case management roles is advantageous.
Advanced Microsft Office Proficiency: The ability to create presentations and analyze data is a plus.
Working Conditions:

This is a remote position, requiring a reliable internet connection and a quiet workspace conducive to telecommuting.
Flexible work hours may be necessary to accommodate patient needs and schedule variations.
Some travel and on-site meetings are required
Benefits:

Competitive salary
Membership to a Direct Primary Care practice of your choice
Healthcare stipend
Dental & FSA benefit options
Opportunity for professional growth and advancement within a rapidly growing startup.
A collaborative and supportive work environment with a focus on innovation and creativity.
Join us in our mission to transform healthcare and make a positive impact on the lives of businesses and individuals in Wisconsin. If you’re passionate about sales, healthcare, and driving meaningful change, we want to hear from you! Apply now to join our dynamic team.

Self Fund Health is an equal opportunity employer.

Note: This job description is intended to convey information essential to understanding the scope of the position and is not an exhaustive list of skills, efforts, duties, responsibilities, or working conditions associated with it. Responsibilities may be subject to change based on organizational needs and the evolution of the healthcare landscape.

SPECIALTIES:

Case Management (CM)

Why North Memorial Health?

At North Memorial Health, you’re part of an inclusive health team that is rooted in our values: Advocate Courageously, Rally Together, Respect Uniqueness and Create Impact. Empathy and care are at the heart of North’s culture which is designed to actively support each team member’s wellbeing and growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person. Together, we empower patients to achieve their best health.

Our health system encompasses two hospital locations in Robbinsdale and Maple Grove as well as a network of 23 clinics which includes 13 primary clinics, 6 specialty clinics, 4 urgent care/urgency centers and emergency care offerings covering five counties. Our Robbinsdale Hospital, established in 1954, is a 385-bed facility recognized as the top Level 1 Trauma center for 25 years, as well as serving as a Level II pediatric trauma center. Our Maple Grove Hospital was established in 2009, is a 134-bed facility recognized as a top hospital in the state for Women and Children Care, with a Level III NICU, and is the largest Family Birth Center in the state (~5,000 deliveries per year and over 60,000 babies delivered). Both have been named to the 2022 Fortune/Merative 100 Top Hospitals® list, 2023 Women’s Choice Award Best Hospitals list.

Benefits the North Way!

As North Memorial Health is a non-profit organization you are eligible for the Public Student Loan Forgiveness program. Most part-time and all full-time positions are eligible for benefits.

Health & Welfare Benefit Packages
401k Retirement Match or Pension Plan, based on workgroup eligibility
Generous Paid Time Off (PTO) Plans
Adoption Reimbursement up to $3000 per child
Child Care Discount Program with New Horizon 10% off weekly childcare tuition
Education/Tuition Reimbursement
24/7 Fitness Center Access for all benefit eligible team members
Commitment to Diversity, Equity & Inclusion

At North Memorial Health we recognize that the strength of our team lies in our diversity and make every effort to embrace the unique contributions and experiences of each person on our team. We strive to ensure that everyone feels like they are a valuable part of our community, with initiatives that reinforce our belief in diversity, equity, and inclusivity, to promote a workforce that enables authenticity, as we want to be our best when providing effective services to our patients. We acknowledge and celebrate the unique traditions, backgrounds, languages, beliefs, and customs of our community, and want everyone to feel welcome. Through our DE&I initiatives we hope to dispel myths, assumptions, and acts of implicit bias.

About this position

The Care Access Nurse Line Nurse uses the nursing process in coordinating all aspects of care for patients. The Nurse applies telephonic communication with and/or regarding an established patient or non-North Memorial established patient in which the Nurse utilzes medically approved nursing protocols to determine urgency of the customer’s needs, and appropriate level of care; clinical judgement; and clinical care coordination.The Nurse works towards providing clinical support and coordination to all North Memorial Health Programs. The Nurse maximizes the customer’s health outcomes by utilizing standard protocols in triaging, coordinating, and communicating patient care needs. The Nurse executes the Standards of Nursing Practice including: assessment; nursing diagnosis; outcome identification; planning, implementation; and evaluation.The Nurse will provide education, advice, and facilitate communication between patients and North Memorial Health providers, clinics, and departments. At all times, the Nurse helps to foster a team-based, supportive, and collaborative care and work environment, including documenting within the electronic medical record. The scope of practice includes the care of neonates, infants, pediatrics young adults, and older adults throughout the life cycle.

Requirements

Education

• Graduate from an accredited school of Nursing  

Experience

Experience
• 3+ years of nursing experience in a hospital, acute care or clinic setting required.
• Experience with EPIC Electronic Health Record preferred.
– Must live in MN or WI to be considered for this role

Knowledge, Skills and Abilities
• Typing test minimum 40+ WPM required.
• Skilled in Microsoft Word, Excel, and Outlook email or similar email software
• High speed internet required (unable to support satellite internet)
• Ability to provide telephone nursing assessment of the actual or potential health needs of an individual and provide nursing care such as teaching, counseling, case finding and referral to other health resources and evaluates these actions.
• Ability to react calmly and effectively in emergency situations.
• Knowledge of drugs and their indication, contraindications, dosing, side effects and proper administration.
• Knowledge of nursing theory and practice.
• Knowledge of patient evaluation and triage procedures.
• Ability to listen, observe, assess, and record symptoms, reactions, and progress.
• Ability to balance, prioritize work in a rapidly changing environment.
• Works well independently in addition to being skilled in interdisciplinary collaboration.
• Demonstrates effective written and oral communication.  

Licensure/Certification

• Current licensure as RN in State of Minnesota

The North Memorial Health System is dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role, but your past experience doesn’t perfectly align with every qualification listed, we encourage you to apply anyway. You may still be the right candidate for this or other roles.

SPECIALTIES:

Triage

Located in the heart of Washington, we enjoy open skies, snow-capped mountains, and the lakes and rivers of the high desert. We are the proud home of orchards, farms, and small communities. Confluence Health actively supports the communities we serve and their quality of life through our community support program and through our individual efforts as involved community members.

Full Time Employees of Confluence Health receive a wide range of benefits in addition to compensation.

Medical, Dental & Vision Insurance
Flexible Spending Accounts & Health Saving Accounts
Paid Time Off
Generous Retirement Plans
Life Insurance
Long-Term Disability
Gym Membership Discount
Tuition Reimbursement
Employee Assistance Program
Adoption Assistance
Shift Differential
For more information on our Benefits & Perks, click here!

Summary

This position has the option to work virtually. Must reside in the state of WA, OR, ID, WI, FL, MT, TX, AZ, VA, AL, TN.

The CDS is responsible for facilitating a thorough, complete and accurate patient health record which will secure the correct reimbursement for resource utilization, the highest quality measures and outcomes, superior communication between providers, and ultimately high patient satisfaction. Travel may be required to outlying clinics. Work is conducted remotely, in the hospital and/or in the clinic.

Position Reports To: Director of Quality Analytics

Essential Functions

Ability to learn and develop the skills necessary to perform clinical documentation reviews using the tools provided.

Perform accurate and timely record review.

Recognize opportunities for documentation improvement.

Formulate clinically credible documentation clarifications.

Effectively communicate opportunities for clarification to providers in a way that secures complete and accurate documentation.

Effective and appropriate communication with providers, the clinical documentation and coding teams, and others that fosters collaboration and trust.

Timely follow-up on all clarification requests.

Participate in Task Force meetings.

Manage multiple priorities.

Adhere to established clinical documentation rules, processes and workflows.

Apply critical thinking, problem solving, and deductive reasoning skills to complex clinical and interpersonal situations.

Understand and communicate differences between IPPS and OPPS and how they impact DRGs and ICD-10 code assignment.

Able to process multiple sources of information simultaneously while maintaining clarity of thought and purpose.

Required to maintain active Basic Life Support (CPR) certification.

Performs other duties as assigned.
Demonstrate standards of behavior and adhere to the Code of Conduct in all aspects of job performance at all times.

Qualifications

Required:

Recent 2 years acute care experience, preferably ICU, PCU or strong Med/Surg.
Current licensure in the state of Washington (RCW 18.88) or licensure through Multistate Nurse Licensure Compact (SSB 5499).
Must successfully pass an on-line clinical knowledge assessment (provided by Confluence Health) with 70% or greater.
Extensive knowledge of pathophysiology, disease processes and associated care-pathways.
Basic computer skills; familiarity with Microsoft software programs.
Desired:

BSN.
5 years acute care experience
Experience in organizational, analytical, and writing skills.
ACDIS or other national CDI certification.
Knowledge of CMS and regulatory environment.

Physical/Sensory Demands

O = Occasional, represents 1 to 25% or up to 30 minutes in a 2 hour workday.

F = Frequent, represents 26 to 50% or up to 1 hour of a 2 hour workday.

C = Continuous, represents 51% to 100% or up to 2 hours of a 2 hour workday.

Physical/Sensory Demands For This Position:

Walking – C
Sitting/Standing – C
Reaching: Shoulder Height – O
Reaching: Above shoulder height – O
Reaching: Below shoulder height – O
Climbing – O
Pulling/Pushing: 25 pounds or less – O
Pulling/Pushing: 25 pounds to 50 pounds – O
Pulling/Pushing: Over 50 pounds – O
Lifting: 25 pounds or less – O
Lifting: 25 pounds to 50 pounds – O
Lifting: Over 50 pounds – O
Carrying: 25 pounds or less – O
Carrying: 25 pounds to 50 pounds – O
Carrying: Over 50 pounds – O
Crawling/Kneeling – O
Bending/Stooping/Crouching – O
Twisting/Turning – C
Repetitive Movement – C
Working Conditions:

Work is done throughout a specific clinical/reception area of the building. Some work areas may be small, crowded, and confined. Job requires both working closely with others and working alone. Hours can vary from a normal schedule and overtime may be required. Stressful working conditions do exist.
Job Classification:

FLSA: Non-Exempt
Hourly/Salary: Hourly
Physical Exposures For This Position:

Unprotected Heights – No
Heat – No
Cold – No
Mechanical Hazards – No
Hazardous Substances – No
Blood Borne Pathogens Exposure Potential – Yes
Lighting – Yes
Noise – No
Ionizing/Non-Ionizing Radiation – No
Infectious Diseases – Yes

SPECIALTIES:

Clinical Documentation Integrity (CDI)

We are building a high-performing clinical review operation to support documentation and compliance for durable medical equipment (DME), starting with surgical dressings.
This role sits at the intersection of clinical judgment and operations. You will utilize our internal software and your clinical background to evaluate patient documentation against structured coverage criteria, identify gaps, and produce clear, standardized review outputs at high throughput.

This is not a traditional bedside or case management role. Success in this role requires attention to detail, comfort with structured workflows, and the ability to operate efficiently at scale.

What You’ll Do
Review patient charts and documentation against defined coverage criteria

Work with internal AI software that enables review productivity

Apply structured processes to determine documentation sufficiency

Identify missing or inconsistent documentation and flag appropriately

Produce clear, standardized written summaries of review outcomes

Meet daily throughput and quality targets (e.g., reviews/day, QA pass rates)

Incorporate feedback from QA and continuously improve accuracy and speed

Collaborate with product team to refine software over time

What You’ll Bring: The Skills and Experience You’ll Leverage
Required:

Active RN license (BSN preferred but not required)

2+ years of clinical experience OR prior utilization review / documentation review experience

Extremely strong attention to detail

Fast learning rate of new concepts

Ability to follow structured workflows and apply rules consistently

Comfort working in a high-throughput, metrics-driven environment

Strong written communication skills

DME, Medicare regulations/surgical dressing reviews preferred but not required

The Rewards & Reality: Compensation, Benefits & Logistics
Meaningful Compensation: $70,000-$90,000 base salary

Comprehensive Health & Wellness: We cover 100% of your health insurance premium and provide access to high-quality dental and vision insurance plans for you and your dependents.

Plan for the Future: We offer a 401(k) plan to help you save for your future. At this time, the company does not offer a 401(k) match.

Career Growth: You’ll have opportunities for rapid career advancement in a company that’s at a major inflection point. We want you to grow with us.

Work Environment & Location:

This is a remote position.

Please note that at this time, we are not able to provide visa sponsorship for this position. All candidates must be authorized to work in the United States.

Our Pledge for an Equitable Future
At Verse Medical, our mission is to deliver equitable, hospital-quality care to everyone, regardless of their background or where they live. We can only achieve this if our own team reflects the diversity of the patients we serve. We are committed to building a workplace where everyone feels a sense of belonging, where their contributions are valued, and where they can do their best work. We embrace diversity of all kinds: race, gender, age, religion, identity, experience. We are actively working to build a more inclusive and equitable world, starting from within our own walls. We are an equal opportunity employer.

We are also committed to providing a positive and accessible interview experience. If you require any accommodations to participate in our process, please contact us at recruiting@versemedical.com.

SPECIALTIES:

Utilization Review & Management (UR/UM)

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Responsible for completing telephonic comprehensive nursing assessments, creating care plans, participating in interdisciplinary team meetings, evaluating patient care needs, and coordinating care and benefits.

Delegates tasks as needed to professionals and para-professional employees. Coordinates activities and works closely with clinicians and staff to maintain efficient department functions and ensure the successful operation of the department. Responsible for performing operational duties as required under the supervision of the site administrator or designee. Familiar with the Model of Care and NCQA guidelines.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. This role manages patients within the California market and must be able to work PST business hours.

Primary Responsibilities:

Meets telephonically with patients, patients’ families, and caregivers as needed to discuss care and treatment plan
Outreaches patients after a hospital discharge to ensure post discharge needs are met
Consults with the physician and other team members to ensure that the care plan is successfully implemented
Uses protocols and pathways in line with established disease management and care management programs to optimize clinical outcomes and minimize unnecessary institutional care
Monitors and coaches patients using motivational interviewing techniques and behavioral change to maximize self-management
Oversees provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
Works in coordination with the care team and demonstrates accountability with patient management and outcome
Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when
applicable
Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families
Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals
Participates actively in Monthly Care Management Department meetings and daily huddles
Documents pertinent patient information and Care Management Plan in Electronic Health Record
Coordinates care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies
Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports
Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions
Adheres to departmental policies and procedures. Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Participates in training all new care managers

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:

Graduation from an accredited school of nursing
Active, unrestricted Registered Nurse license through the State of California
1+ years of experience in a clinical setting or care Management
Intermediate level experience in Microsoft products including word, excel, and outlook
Ability to work PST business hours

Preferred Qualifications:

Bachelor of Science in Nursing, BSN
Telehealth certification
3+ years of experience working in acute care
1+ years of care management, utilization review or discharge planning experience
HMO experience
Ability to type 45 wpm

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

SPECIALTIES:

Case Management (CM)

The Case Management Supervisor leads a team of case managers and/or health coaches who manage active case files. This role is responsible for team performance, quality, and customer satisfaction through the delivery of high-quality case management and coaching services. The supervisor partners across internal teams and external stakeholders (customers, providers, vendors, and claims payors) to support business initiatives and resolve service delivery issues.
Key Responsibilities

Lead, coach, and develop direct reports (case managers, coaches, and other clinical team members) through regular performance discussions, feedback, and career development planning.

Monitor and manage performance against established key performance indicators (KPIs), quality standards, and applicable accreditation requirements (e.g., URAC, NCQA).

Drive operational excellence by using available tools and resources to improve service delivery, outcomes, and team effectiveness.

Collaborate with matrix partners to develop work plans, remove barriers, and take corrective actions to meet objectives.

Serve as an escalation point for service delivery concerns; support customer meetings, presentations, and audits as needed.

Participate in projects, work groups, and committees; communicate progress, risks, and outcomes to leadership.

Minimum Qualifications

Active, unrestricted Registered Nurse (RN) license in a U.S. state or territory.

Two (2) years of full-time equivalent direct clinical care experience.

If directly supervising the case management process for three (3) years, holds a URAC-recognized case management certification

Preferred Qualifications

Experience leading teams in clinical operations, care management, or healthcare services (1–2 years preferred).

Strong knowledge of case management and coaching programs.

Excellent written and verbal communication skills, with the ability to present information to diverse audiences.

Demonstrated ability to build collaborative relationships across internal teams and external partners.

Experience supporting or participating in client meetings, presentations, and audits.

Proficiency with Microsoft Word, Excel, and PowerPoint for reporting and presentations.

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 annual salary of 92,100 – 153,500 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.

SPECIALTIES:

Case Management (CM)

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.  We provide:
Comprehensive health benefits that start day 1
Student Loan Repayment Assistance & Reimbursement Programs
Family-focused benefits  
Wellness incentives
Ongoing mentorship, development, and leadership programs  
And more

**Every other weekend requirement**

Description
Job Summary: The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR Specialist will perform timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. Primary duties and responsibilities: Operational Support: 1. Conducts thorough medical necessity reviews to assist with determining appropriate patient class designation. 2. Performs timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. 3. Performs appropriate and accurate initial, admission (episode day one) and concurrent utilization reviews as guided by InterQual Criteria and UR Department workflows on all observation, inpatient, and extended recovery admissions as required based on Emory Healthcare’s Utilization Management Plan and the UR Department¿s processes. 4. Ensures that all InterQual reviews are supported with provider team documentation and/or clinical data. 5. When appropriate, the UR Specialist will utilize the UR Department’s Severity of Illness/Intensity of Service template to document the medical necessity of the admission or continued stay. 6. While conducting utilization reviews, will identify any Avoidable Delays and accurately document the delay(s) based on the workflow. 7. Follow the UR Department¿s denial workflows as appropriate. 8. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. Compliance: 1. Will identify and complete Medicare Outpatient Observation Notices (MOON), Medicare Change of Status Notice (MCSN), Condition Code 44s and Medicare Hospital Issued Notices of Non-Coverage (HINNs) for Medicare beneficiaries as appropriate. 2. Ensures compliance with all state of Georgia and Federal regulatory requirements as designated in Emory Healthcare’s Utilization Management Plan. 3. Maintains all required annual competencies, metrics, and fully participate and engage in department process improvements. Collaboration: 1. Responsible for timely communication to the provider team and interdisciplinary team as it relates to patient class designation and medical necessity of an admission or continued stay on individual patient basis based on UR Department workflows. 2. In a team effort, the UR Specialist will work closely with the UR Department’s Case Management Authorization Specialist IP to ensure that authorized days and patient actual LOS are reconciled to ensure appropriate reimbursement for services provided. 3. Responsible for communicating medical necessity denials for in-house patients to the Medical Director of UR, and when designated to the provider team. 4. Serves as a resource to the provider team, Interdisciplinary Care Team, and patient to explain external UR regulations. 5. Provides effective and efficient proactive communication to internal and external customers. 6. Assists in collaborative efforts with the Case Management Department, Revenue Cycle, Physician Advisors, and other required departments. Additional Responsibilities: 1. Ability to multi-task in a fast-paced environment while efficiently handling multiple priorities and ensuring deadlines are met. 2. Performs other duties and tasks as assigned. Travel: Less than 10% of the time may be required. Work Type: This position is a remote position outside traditional office, often from home or another remote setting.

Minimum Qualifications: Education – Associate degree in nursing. Experience – Minimum of 5 years of recent acute hospital experience or a minimum of two years of previous utilization review experience. Licensure – Must have a valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board. Skills – Must meet all quality and productivity expectations and successfully complete yearly competencies. Preferred Qualifications: Education – Bachelor’s degree in Nursing strongly preferred. Certification – Case Management certification preferred. Skills – InterQual Level of Care Criteria experience. Previous utilization review experience strongly preferred.

PHYSICAL REQUIREMENTS: Occasional to frequent sitting. Close eye work (computers, typing, reading, writing).

ENVIRONMENTAL FACTORS: Remote position.

Additional Details
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week’s advance notice is preferred.

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SPECIALTIES:

Utilization Review & Management (UR/UM)

Applies the nursing process to plan and implement the care of patients, including patient and family education and continuum of care planning. Effectively communicates pertinent patient/family information to the health care team. Collaborates in establishing patient goals and evaluates progress to ensure effective outcomes. Furthers professional growth by engaging in learning activities according to the Board of Nursing standards. .

About The Position: The person in this position will work remotely to call patients within 48 hours of discharge from Vanderbilt Psychiatric Hospital to follow up on things like appointments, problem solve issues, barriers to discharge, etc. The RN in this position with collect data, identify trends and report out to leaders. They will also forward feedback and concerns to the appropriate parties.

Shift: Primary business hours with some flexibility

What you’ll Need:

RN License for TN or compact License
1 Year of RN experience
Graduate of an accredited program

The hiring team is seeking candidates local to the Nashville area for an occasional on-site meeting if needed and would prefer RN candidates with at least two years of nursing experience. The hiring team would also prefer candidates with prior psych nursing experience.

KEY RESPONSIBILITIES

Collaborates in establishing the plan of care, coordinates and implements care delivery while anticipating patient care needs across the continuum.
Analyzes comprehensive information pertinent to the patient’s care and management to determine nursing diagnosis.
Continually utilizes the nursing process to evaluate patient’s progress towards goals and applies appropriate interventions to ensure effective outcomes.
Employs strategies to promote health and a safe and healthy environment.
The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES

Care Planning (Novice): Demonstrates ability to anticipate resource needs, identify distinct tasks, set priorities, schedule activities, meet deadlines, and organize work within areas of direct responsibility. Competently handles multiple assignments often simultaneously by prioritizing work into manageable and measurable units. Ability to adapt to changes to patient care and area needs with minimal disruption and loss of productivity. Follows up to assure problems and issues are resolved.
Nursing Patient Education (Novice): Possesses sufficient fundamental proficiency in providing patient education in practical applications of moderate difficulty.
Nursing Patient Assessment & Evaluation (Novice): Possesses sufficient fundamental proficiency to successfully demonstrate the ability to assess and evaluate patients in practical applications of moderate difficulty. Conducts primary care patient interviews and physical examinations. Demonstrates sufficient acumen to recognize problems, ask questions and to contact the patient’s primary care provider and other members of the healthcare team. Has experience in gathering pertinent clinical data that aid in referral, treatment, or other primary care pathways.
Evidence-Based Practice (Novice): Possesses sufficient fundamental proficiency to successfully search for evidence to answer clinical questions. Generally works under the direction of others while accomplishing assignments.
Our Nursing Philosophy:  

We believe highly skilled and specialized nursing care is essential to Vanderbilt University Medical Center’s mission of quality in patient care, education and research. We believe nursing is an applied art and science focused on helping people, families and communities reach excellent health and well-being.

As a Vanderbilt University Medical Center employee, you make a difference to our patients and their families by bringing compassion and care to those in need of hope and healing. Please see our current employee benefits offered:

Affordable High Quality Health Plan Options
Dental and /or vision plan
403 (b) retirement plan
Paid Time off (flex PTO)
Tuition Reimbursement and adoption assistance (maximums applied)
Short-Long term disability
Subsidized backup childcare
And many more… Ask us about our current inpatient nursing supplemental Pay Program!
Achieve the Remarkable:

Learn more about VUMC Nursing here.

Core Accountabilities:

Organizational Impact: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance. Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment. Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area. Team Interaction: Provides informal guidance and support to team members.
Core Capabilities :

Supporting Colleagues:- Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas.- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.- Communicates Effectively: Recognizes group interactions and modifies one’s own communication style to suit different situations and audiences. Delivering Excellent Services:- Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.- Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees’ effectiveness. Ensuring High Quality: – Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.- Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. – Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: – Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.- Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation:- Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.
Position Qualifications:

Responsibilities:

Certifications:

LIC-Registered Nurse – Licensure-Others
Work Experience:

Relevant Work Experience

Experience Level:

1 year
Education:

Graduate of an approved discipline specific program
This role offers the opportunity to make a meaningful impact within Vanderbilt Health, supported by a comprehensive benefits package which may include health, disability, retirement and/or wellness offerings to enhance your well-being and professional growth.

Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity.  EOE/Vets/Disabled.

SPECIALTIES:

Case Management (CM)