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JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. KNOWLEDGE/SKILLS/ABILITIES We are seeking a candidate with a WA state RN licensure to support the Washington State Plan. Candidates with knowledge of the criminal justice system, or carceral facility knowledge/work experience are highly preferred. Candidates must have previous case management, discharge planning or care coordination experience. Bilingual candidates that speak fluent Spanish are encouraged to apply to support our diverse communities. Further details to be discussed during our interview process. Remote position Work schedule: Monday- Friday: 7:30am- 4:30pm PST. RN WA licensure required • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment., • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals., • Conducts face-to-face or home visits as required., • Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly., • Maintains ongoing member case load for regular outreach and management., • Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members., • Facilitates interdisciplinary care team meetings and informal ICT collaboration., • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts., • Assesses for barriers to care, provides care coordination and assistance to member to address concerns., • 25- 40% local travel required., • RNs provide consultation, recommendations and education as appropriate to non-RN case managers., • RNs are assigned cases with members who have complex medical conditions and medication regimens Required Education Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred. Required Experience 1-3 years in case management, disease management, managed care or medical or behavioral health settings. Required License, Certification, Association Active, unrestricted State Registered Nursing (RN) license in good standing. Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. Preferred Education Bachelor's Degree in Nursing Preferred Experience 3-5 years in case management, disease management, managed care or medical or behavioral health settings. Preferred License, Certification, Association Active, unrestricted Certified Case Manager (CCM) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. #PJHS Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. KNOWLEDGE/SKILLS/ABILITIES • Follows member throughout a 30-day program that starts at hospital admission and continues through transitions from the acute setting to other settings, including nursing facility placement and private home, with the goal of reduced readmissions., • Ensures safe and appropriate transitions by collaborating with hospital discharge planners, as well as with hospitalists, outpatient providers, facility staff, and family/support network, as needed or at the request of member., • Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required., • Works with participating ancillary providers, public agencies, or other service providers to make sure necessary services and equipment are in place for a safe transition., • Conducts face-to-face visits of all members while in the hospital and home visits of high-risk members post-discharge., • Coordinates care and reassesses member's needs using the Coleman Care Transitions Model recommended post-discharge timeline., • Educates and supports member focusing on seven primary areas (ToC Pillars): medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and or Home and Community-based Services, and advance directives., • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts., • Assesses for barriers to care, provides care coordination and assistance to member to address concerns., • Facilitates interdisciplinary care team meetings and informal ICT collaboration., • RNs provide consultation, recommendations, and education as appropriate to non-RN case managers., • RNs are assigned cases with members who have complex medical conditions and medication regimens., • RNs will conduct medication reconciliation when needed. JOB QUALIFICATIONS Required Education Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing preferred. Required Experience 1-3 years hospital discharge planning or home health. Required License, Certification, Association • Active, unrestricted State Registered Nursing (RN) license in good standing., • Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. CALIFORNIA State Specific Requirements: Must be licensed currently for the state of California. California is not a compact state. Preferred Education Bachelor's Degree in Nursing Preferred Experience 3-5 years hospital discharge planning or home health. Preferred License, Certification, Association Active, unrestricted Transitions of Care Sub-Specialty Certification and/or Certified Case Manager (CCM) **Work schedule :M - F Pacific Business Hours Candidates can live anywhere in the USA but must work PACIFIC hours. California or West Coast USA Residents preferred **Remote, no travel required. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $30.37 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Looking for a RN that has a current active unrestricted license This a remote role and can sit anywhere within the United States. Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. Job Duties • Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing., • Identifies and reports quality of care issues., • Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience, • Documents clinical review summaries, bill audit findings and audit details in the database, • Provides supporting documentation for denial and modification of payment decisions, • Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care., • Reviews medically appropriate clinical guidelines and other appropriate criteria with Medical Directors on denial decisions., • Supplies criteria supporting all recommendations for denial or modification of payment decisions., • Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals., • Provides training and support to clinical peers., • Identifies and refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. JOB QUALIFICATIONS Graduate from an Accredited School of Nursing REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: • Minimum 3 years clinical nursing experience., • Minimum one year Utilization Review and/or Medical Claims Review., • Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience Active, unrestricted State Registered Nursing (RN) license in good standing. PREFERRED EDUCATION: Bachelors’s Degree in Nursing or Health Related Field PREFERRED EXPERIENCE: Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other healthcare certification. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job DescriptionCompany Description WHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. Join us as we put healthcare on a better path!! Job Description As a registered nurse with an Illinois nursing license, you will work remotely to enhance the quality of member management, maximize both satisfaction and cost effectiveness, and assist in navigating the health care system as a collaborative health partner in their health care team. As an RN Case Manager, the RN will work closely with client and members alike to promote wellness, problem-solve, and assist members in realization of their personal health-care related goals. This role includes telephonic member and provider outreach, data collection and analyzation, reporting, clinical review, medical and behavioral health assessments, and documentation in compliance with Federal/State regulation, NCQA standard, and company policies and procedures. This position is part of the Value Based Care Services team. WHAT YOU’LL BE DOING • Pulling, sorting, and analyzing data to determine member eligibility for the Population Health management Program., • Coordinating and providing care that is timely, effective, equitable, safe, and member-centric while following HMO processes., • Managing case assignments which includes outreach, documentation, monitoring for case progression, and case closure., • Meeting reporting and documentation standards while engaging in collaborative meetings with department staff and clients., • Assisting members in reaching wellness and health-autonomy by addressing barriers, social determinants, member motivators, and psychosocial issues., • Helping members make informed decisions by educating them on navigation through the HMO and healthcare spectrum while promoting quality and cost-effective interventions and outcomes., • Supporting operational aspects of the division to meet the organization’s customer requirements and satisfaction., • Maintaining confidentiality related to all computer programs, medical records, and data., • Participation in QM/UM Committee Meetings including material preparation, minutes, data collection, and analysis, reporting, and follow-up tasks which may require in-person attendance., • Rotation in off-hour/weekend calls if applicable., • Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Practice Act., • Other responsibilities as assigned and per any changes in annual program requirements. Qualifications WHAT YOU'LL NEED TO HAVE • Current IL Registered Nurse License (State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2-year license renewal cycle)., • Minimum of five years of experience in a variety of health care settings., • Highly experienced in Case Management and Chronic Condition Management., • Knowledge of utilization review, quality improvement, managed care, and/or community health., • Previous remote and/or telephonic work experience., • Basic knowledge of case management principles, healthcare management, and reimbursement components, with experience in motivational interviewing., • Excellent clinical judgment, as well as highly skilled in verbal and written communication., • Strong organizational. problem solving, and time management skills necessary., • Ability to ensure timely completion of projects and assignments., • Ability to prioritize and react based on rapidly changing business needs., • Must have ability to work independently and remotely with multi-tasking skills for fast paced workflows., • Must possess software knowledge including word processing and spreadsheets, computer skills including MS Word, Excel, Access, PDF, Outlook, etc., • Experience navigating multiple EMR’s., • Certification in Case Management preferred but not required Additional Information The salary range for this role is between $80,000.00 and $85,000.00 ALIVE with Purpose: How We Thrive at Guidehealth At Guidehealth, our values come to life in everything we do. • We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike., • Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare., • With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve., • At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member., • And through Empathy in Action, we build stronger connections with those who count on us. All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include: • Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs., • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered., • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution., • Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected., • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times., • Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals., • Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need. The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications. OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment. OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager. REMOTE WORK TECHNICAL REQUIREMENTS Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.

RNs provide consultation, recommendations and education as appropriate to non-RN case managers. We are seeking a candidate with a WA state RN licensure to support the Washington State Plan. Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

An active RN License in the state of application. RN experience in a health care setting. Notice for Job Applicants Residing in California.

RNs are assigned cases with members who have complex medical conditions and medication regimens RNs conduct medication reconciliation when needed. RNs provide consultation, recommendations and education as appropriate to non-RN case managers. Required License, Certification, Association Active, un

This caring hospice organization recognizes the significance of each precious, end-of-life journey. We are seeking a talented Hospice Registered Nurse (RN) Case Manager for. The Hospice Registered Nurse (RN) Case Manager plans, organizes and directs hospice care and is experienced in nursing, with e

RNs provide consultation, recommendations and education as appropriate to non-RN case managers. Assesses for barriers to care, provides care coordination and assistance to member to address concerns. RNs are assigned cases with members who have complex medical conditions and medication regimens.

Admissions Registered Nurse (RN). An active RN License in the state of application. RN experience in a health care setting.

RNs provide consultation, recommendations and education as appropriate to non-RN case managers. We are seeking a candidate with a WA state RN licensure to support the Washington State Plan. Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

An active RN License in the state of application. RN experience in a health care setting. Notice for Job Applicants Residing in California.

They will also, educate the patient, circulating nurse and/or scrub nurse, and potentially RN first assistant or operating room director.

Hospice Registered Nurse (RN) Case Manager. This caring hospice organization recognizes the significance of each precious, end-of-life journey. We are seeking a talented Hospice Registered Nurse (RN) Case Manager for.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

An active RN License in the state of application. RN experience in a health care setting. Notice for Job Applicants Residing in California.

They will also, educate the patient, circulating nurse and/or scrub nurse, and potentially RN first assistant or operating room director.

An active RN License in the state of application. RN experience in a health care setting. Notice for Job Applicants Residing in California.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

Notice for Job Applicants Residing in California. Admissions Registered Nurse (RN). An active RN License in the state of application.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

Current Registered Nurse (RN) licensure (in good standing) in the state(s) of practice with.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

Assesses for barriers to care, provides care coordination and assistance to member to address concerns. Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may conduct medication reconciliation as needed.

Travel Registered Nurse RN Cardiovascular Intensive Care Unit CVICU at OneStaffMedical summary:. Cardiovascular Intensive Care Unit Nurses, or CVICU RNs, provide critical care to patients with potentially life-threatening heart conditions.

Registered Nurse (RN) - Med Surg. Registered Nurse (RN) - Telemetry. If you're a passionate RN ready for your next exciting challenge, don't wait!.

Travel Registered Nurse RN Cardiovascular Intensive Care Unit CVICU at OneStaffMedical summary:. Cardiovascular Intensive Care Unit Nurses, or CVICU RNs, provide critical care to patients with potentially life-threatening heart conditions.

A facility in Cedar Rapids, IA is seeking its next amazing RN (Registered Nurse) to work in ER (Emergency Room).

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

Responsibilities Join an amazing team at a nationally recognized Top Place to Work in Healthcare! As a Home Care RN with UnityPoint at Home, you'll provide one-on-one care to patients with total autonomy over your role. The RN Case Manager uses clinical nursing knowledge, physical assessment, teach

They will also, educate the patient, circulating nurse and/or scrub nurse, and potentially RN first assistant or operating room director.

Requirements: * An active RN License in the state of application * Valid CPR * Valid drivers license and proof of automobile insurance Preferred: * Medicare Skilled Nursing experience * Basic understanding of Oasis * 1-year RN experience in a health care setting As an employer accepting Medicare

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidates to tr

Be part of an extraordinary life! Cottage Grove Place is recruiting for a hospitality focused Registered Nurse (RN) to join our team! This position provides direct nursing care to residents and delegates and supervises the care provided by our Certified Nursing Assistants (CNAs) and Oral Medication

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidates to tr

This position is accountable for providing quality care to all patients and is committed to delivering superior customer service in all internal and external interactions. Train patient (and/or care partner) in the practice of self-care Peritoneal Dialysis or Hemodialysis upon meeting federal and st

The PACU RN treats inpatients and outpatients according to their needs, monitoring their vital signs to determine necessary care.

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidates to tr

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidates to tr

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidates to tr

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country.We want the same like-minded, awesome candidat

Neonatal Intensive Care Nurses care for premature and critically ill newborns in the neonatal intensive care unit (NICU) of a hospital. These babies are born needing immediate medical attention, so Neonatal Intensive Care Nurses connect them to technology that helps them breathe and allows them to b