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JOB DESCRIPTION Job Summary The Care Review Clinician, IP Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. This position will support our Molina One Care Services business in Massachusetts. We are looking for a candidate with a MA RN licensure. Candidates with UM Medical Review background and experience using MCG or InterQual are highly preferred. Hours: Monday - Friday 8:00 AM to 5:00 PM EST Remote position in MA Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines., • Analyzes clinical service requests from members or providers against evidence based clinical guidelines., • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures., • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members., • Processes requests within required timelines., • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner., • Requests additional information from members or providers as needed., • Makes appropriate referrals to other clinical programs., • Collaborates with multidisciplinary teams to promote the Molina care model., • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience., • Registered Nurse (RN). License must be active and unrestricted in state of practice., • Ability to prioritize and manage multiple deadlines., • Excellent organizational, problem-solving and critical-thinking skills., • Strong written and verbal communication skills., • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM)., • Recent hospital experience in an intensive care unit (ICU) or emergency room. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJNurse Pay Range: $30.37 - $59.21 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. This position will support our Molina One Care Services business in Massachusetts. We are looking for a candidate with a MA RN licensure. Candidates with case management and home health are highly preferred. Bilingual candidates are encouraged to apply to support our diverse communities! Hours: Monday - Friday 8:00 AM to 5:00 PM EST Remote position with 25-50% field travel in Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, OR Worcester based on case load and where you reside. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments., • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals., • Conducts telephonic, face-to-face or home visits as required., • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly., • Maintains ongoing member caseload for regular outreach and management., • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care., • Facilitates interdisciplinary care team (ICT) 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., • May provide consultation, resources and recommendations to peers as needed., • Care manager RNs may be assigned complex member cases and medication regimens., • Care manager RNs may conduct medication reconciliation as needed., • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience., • Registered Nurse (RN). License must be active and unrestricted in state of practice., • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law., • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA)., • Demonstrated knowledge of community resources., • Ability to operate proactively and demonstrate detail-oriented work., • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations., • Ability to work independently, with minimal supervision and self-motivation., • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations., • Ability to develop and maintain professional relationships., • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change., • Excellent problem-solving, and critical-thinking skills., • Strong verbal and written communication skills., • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V PJNurse Pay Range: $30.37 - $59.21 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Description Full-time, 35 hours/week NOT remote Responsible for assigned nursing duties for Clinical Assessment and Eligibility (CAE)/State Home Care Program. Will Perform Coordination of Care screenings to determine medical eligibility and all duties required under the Coordination of Care Program and Waiver Program. • Complete initial assessments and annual reassessment visits on all personal care and home health aide clients, interim visits as needed., • Develop appropriate care plans for personal care clients., • Prepare and maintain nursing paper and electronic files., • Provide consultation on Protective Services, Elder at Risk and Respite Care cases., • Act as a liaison with agency providers., • Act as resource person for medical matters to all Greater Springfield Senior Services staff., • Act as a backup to the nurse of any other medical programs., • Active member of the interdisciplinary team providing nursing consultation to case management staff., • Advocate and act as a resource in areas of interest and/or concern for elders., • Assist with information and referrals., • Requires valid driver's license and reliable transportation., • Graduate from a school of nursing school accredited by the National League for Nursing, • Ability to utilize technology in the field to complete On Site Assessments including Laptops, Tablets, Personal Hot Spots Devices, WIFI, etc., • Working knowledge of spreadsheets, word processing and data entry, including Windows, Word, and Excel helpful, • Ability to conduct professional assessments in a variety of home settings in a manner that is respectful and supportive to the occupants of the home, • Ability to work with persons with diverse backgrounds, skills and abilities Must be able to climb multiple flights of stairs Travel reimbursement is $0.70/mile Public Service Loan Forgiveness (PSLF) If you are employed by a not-for-profit organization such as GSSSI, you may be eligible for the PSLF Program for student loans. Job Posted by ApplicantPro

Job Description At Pathfinder Recovery, we’re redefining addiction treatment by blending evidence-based therapy with cutting-edge technology. If you’re a licensed therapist ready to make a meaningful impact - and you’re excited about using tools like AI-powered medical records and bioinformatics to enhance care - we want to hear from you. About the Role We’re seeking a dedicated Nurse to provide virtual, patient-centered care for individuals in our addiction and mental health programs. You’ll have the flexibility of remote work, the support of an experienced clinical team, and access to technology that streamlines documentation and improves continuity of care - so you can focus on delivering compassionate treatment. What You’ll Do • Conduct virtual assessments by observing, monitoring, and documenting patient health, behaviors, symptoms, and self-reported vitals., • Coordinate with physicians, behavioral health specialists, and interdisciplinary teams to implement individualized treatment and recovery plans., • Provide education and guidance on safe use of prescribed treatments and medications, including medication-assisted treatments (MAT) such as Vivitrol and Naltrexone., • Maintain accurate and timely electronic health records (EHR) in compliance with HIPAA and organizational standards., • Educate patients on health maintenance, medication compliance, relapse prevention, and mental health self-care strategies via telehealth platforms., • Support patient access by assisting with telehealth platforms and promoting digital literacy., • Remote, part-time role with flexible scheduling., • Hourly compensation of $30–$55 per hour, with opportunities for growth., • Work closely with a collaborative team of physicians, therapists, and medical staff., • Access to innovative telehealth tools and real-time monitoring technology., • Direct involvement in advancing accessibility and excellence in addiction and mental health care. Requirements • Active LPN, RN, or higher licensure in Massachusetts., • Associate’s or Bachelor’s Degree in Nursing, or equivalent education qualifying for licensure., • At least 1 year of nursing experience., • Knowledge of substance use and mental health treatment preferred., • Strong critical thinking, active listening, and communication skills., • Familiarity with HIPAA, confidentiality standards, and electronic medical record systems. This is a part-time remote position.

Job Description About Cataldo Since 1977, Cataldo Ambulance Service, Inc. has continually distinguished ourselves as a leader in providing routine and emergency medical services. Cataldo is the largest private EMS provider and private ambulance service in Massachusetts. As the needs of the community and the patient change, we continue to introduce innovative programs to ensure the highest level of care is available to everyone in the areas we serve. While Cataldo began as an ambulance service company, we continue to grow through innovation and expand the services we offer to the local communities. Through our partnerships with health systems, hospitals, managed care organizations, and others, we continue to provide in-home care through the state’s first and largest Mobile Integrated Health program, SmartCare. MIH Contract Nurse Job Description Mobile Integrated Healthcare is delivering the future of healthcare by providing the right care, at the right time, in the right place. Providing an option for on-demand, in-home physician supported care, our innovative SmartCare division is improving patient outcomes, increasing patient satisfaction, and reducing the number of hospital admissions and re-admissions through community paramedicine. We are seeking licensed Registered Nurses to perform Minimum Data Set (MDS) assessments for home care patients across Massachusetts. This is a Per Diem ideal for nurses seeking flexible scheduling and supplemental income. You will conduct in-home assessments, document findings, and ensure timely and accurate submission of MDS forms. Mobile Integrated Health (MIH) Contract Nurse Job Benefits • Starts at $40, with bonus incentives for completing additional assignments during the shift, • Per Diem - Minimum commitment of 40 hours/month, • Hybrid position. Blend of Work from Home and on site visits, • Shifts available 7 days/week within the hours of 0800-20:00, • Shift of 5, 8, or 12 hours in duration decided by employee, • Customizable shift configurations, including day and evening options. Create a schedule that fits your lifestyle and availability, • Assessments estimated to take 45-60 minutes, • Position is a hybrid care model that will incorporate in-person, virtual, and telephone visits with patients, • Temporary Assignment, • Travel to patients residence to complete in-person comprehensive MDS assessments, • Conduct virtual visits with patients to complete comprehensive MDS assessments, • Conduct phone visits with patients to complete comprehensive MDS assessments, • Conduct patient interviews, review health records, and collect necessary data, • Accurately complete and submit MDS documentation within required timelines, • Maintain patient confidentiality and adhere to HIPAA regulations, • Coordinate with the scheduling team to confirm visits and report any changes or issues, • Active and unrestricted Massachusetts Registered Nurse (RN) license, • Experience with MDS assessments in home health, long-term care, or related settings preferred, • Strong clinical assessment skills and attention to detail, • Ability to work independently and manage time effectively, • Comfort with electronic documentation systems, • Associate Degree in Nursing required; Bachelor’s in Nursing preferred.., • Experience working in HIPAA-compliant or healthcare settings., • Experience with electronic medical records (EMR)., • Prior experience in care management or managed care (preferred), • Ability to conduct independent assessments and escalate clinical concerns appropriately., • Strong organizational, communication, and interpersonal skills., • Intermediate to advanced proficiency in Microsoft Office and EHR platforms., • Able to work independently in the field and navigate shifting priorities., • Willing to travel throughout Massachusetts with a valid, unrestricted driver’s license and current auto insurance, • Comfortable with technology and remote collaboration platforms., • Ability to sit for extended periods of time, • Ability to operate a motor vehicle

Adheres to structure and processes for tracking and trending reportable incidents, quality of care events, member service concerns, and mortalities. Supports the creation and ongoing revision of policies and procedures reflective of state requirements for all quality management functions, including

Responsibilities: Change the lives of our patients/residents and at the same time enjoy the rewards of fully knowing your patients/residents and their families as a Registered Nurse - RN.

We make your travel healthcare journey easy by taking care of all the details, so you don’t have to. Host Healthcare is seeking a travel nurse RN Home Health for a travel nursing job in Sprinfield, Massachusetts. Job Description & Requirements ~ Specialty: Home Health ~ Discipline: RN ~ Start

The RN will collaborate with a multidisciplinary treatment team to develop and implement treatment plans while maintaining a safe therapeutic environment. Ideal candidates will possess a valid RN license, advanced knowledge in behavioral health, and crisis management skills. As a Registered Nurse (R

Change the lives of our patients/residents and at the same time enjoy the rewards of fully knowing your patients/residents and their families as a Registered Nurse - RN.

Valid state license as a Registered Nurse (RN).

As a Registered Nurse (RN) at MiraVista Behavioral Health Center, you will provide compassionate care for patients in both adolescent and adult psychiatric programs. Join Us as a Registered Nurse (RN)!. As a Registered Nurse (RN), do you aspire to be a part of a cohesive and compassionate team that

New Grad RN (0-1 year of RN Licensure). Experienced RN (1+ years of RN Licensure). Sign on bonus (Sign on Bonuses are paid to external hires only; not applicable for internal or company transfers, unless otherwise specified.

LHC Group is seeking a Registered Nurse (RN) Home Health for a nursing job in Springfield, Massachusetts. Current RN licensure in state of practice.

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

The Registered Nurse (RN) role at MiraVista involves providing direct and indirect care to adolescent patients in a psychiatric setting, focusing on both their physical and psychological needs. The Registered Nurse (RN) will have the following:. When you join the growing MiraVista team as a Register

Behavioral Health Registered Nurse / RN. Behavioral Health Registered Nurse / RN. Current state licensure as Registered Nurse / RN.

Registered Nurse (RN) $15,000 Sign On bonus at Georgia Hospice Care summary: As a Registered Nurse at Georgia Hospice Care, you will evaluate patients and develop care plans, ensuring quality communication between patients, families, and the care team. And just like all of our team members, our RNs

New Grad RN (0-1 year of RN Licensure). Experienced RN (1+ years of RN Licensure). Sign on bonus (Sign on Bonuses are paid to external hires only; not applicable for internal or company transfers, unless otherwise specified.

Registered Nurse RN Home Health at Enhabit Home Health & Hospice summary:. The Registered Nurse RN Home Health provides essential home-based patient care while serving as the primary contact for care coordination among various disciplines. Registered Nurse RN Home Health.

Valid state license as a Registered Nurse (RN).

Registered Nurse (RN), Float pool, Evening shift at MiraVista summary:. If this sounds like the right place for you then keep reading and learn more about why MiraVista is the perfect place to work. Valid RN license in Massachusetts, BSN preferred.

Valid state license as a Registered Nurse (RN).

Experienced RN (1+ years of RN Licensure). Sign on bonus (Sign on Bonuses are paid to external hires only; not applicable for internal or company transfers, unless otherwise specified. Experience: Minimum of 2 years RN experience required.

Registered Nurse (RN) Inpatient Psych All Shifts at MiraVista summary:. As a Registered Nurse (RN) at MiraVista Behavioral Health Center, you will provide compassionate care for patients in both adolescent and adult psychiatric programs. Join Us as a Registered Nurse (RN)!.

Valid state license as a Registered Nurse (RN).

When you join the growing MiraVista team as a Registered Nurse (RN) you'll receive:. Registered Nurse (RN), Adolescent Inpatient Psych Days at MiraVista summary:. The Registered Nurse (RN) position at MiraVista involves providing compassionate care to adolescent patients in an inpatient psychiatric

Change the lives of our patients/residents and at the same time enjoy the rewards of fully knowing your patients/residents and their families as a Registered Nurse - RN.

LHC Group is seeking a Registered Nurse (RN) Home Health for a nursing job in Springfield, Massachusetts. Current RN licensure in state of practice.

Registered Nurse (RN), Adult Inpatient Psych Evenings at MiraVista summary:. As a Registered Nurse (RN) in Adult Inpatient Psych, you will provide both direct and indirect care to patients in a supportive and compassionate environment. The Registered Nurse (RN) will have the following:.

By teaching, guiding, and caring for individuals, you'll be part of their journey toward greater independence and self-confidence. With opportunities to learn and grow, you'll gain valuable skills and experience while being part of a team that values your contributions. And with over 1,500 employees

Experienced RN (1+ years of RN Licensure). Sign on bonus (Sign on Bonuses are paid to external hires only; not applicable for internal or company transfers, unless otherwise specified. It also stands for Baystate's many opportunities for growth and learning in the region's only academic medical cent

Change the lives of our patients/residents and at the same time enjoy the rewards of fully knowing your patients/residents and their families as a Registered Nurse - RN.

When you join the growing MiraVista team as a Registered Nurse (RN) you'll receive:. Registered Nurse (RN), Per Diem at MiraVista summary:. As a Registered Nurse (RN) at MiraVista, you will provide direct and indirect care to patients while assessing their physical and psychological conditions.

Valid state license as a Registered Nurse (RN).

Be currently licensed as a Registered Nurse (RN) in the state of employment. Registered Nurse RN Home Health at Enhabit Home Health & Hospice summary:. The Registered Nurse RN Home Health provides essential home-based patient care while serving as the primary contact for care coordination among vari

As a Registered Nurse (RN), do you aspire to be a part of a cohesive and compassionate team that makes a meaningful impact on the lives of patients? Are you looking for an opportunity to grow your career and work for a young and vibrant organization that is expanding? If you are, then look no more!

Posted job title: RN - Home Health About Host Healthcare At Host Healthcare, we provide a truly comfortable experience as you explore your travel nursing, therapy, or allied career. We make your travel healthcare journey easy by taking care of all the details, so you don’t have to. Host Health

Sign on bonus (Sign on Bonuses are paid to external hires only; not applicable for internal or company transfers, unless otherwise specified. Experienced RN (1+ years of RN Licensure). Experience: Minimum of 2 years RN experience required.

Job Description & Requirements ~ Specialty: Home Health ~ Discipline: RN ~ Start Date: ASAP ~ Duration: 13 weeks ~40 hours per week ~ Shift: 8 hours, days ~ Employment Type: Travel Why choose Host Healthcare? Because a great Host provides a worry-free travel experience and always puts

RN/LPN (Registered Nurse / Licensed Practical Nurse Required. LPN (Licensed practical nurse)/RN (registered nurse). RN or LPN Reinforce supports and provides health care instructions to patients and their families.

Behavioral Health Registered Nurse / RN. Behavioral Health Registered Nurse / RN. Current state licensure as Registered Nurse / RN.

Experienced RN (1+ years of RN Licensure). Sign on bonus (Sign on Bonuses are paid to external hires only; not applicable for internal or company transfers, unless otherwise specified. At Baystate Health, RN means more.

Registered Nurse (RN), Float pool, Evening shift at MiraVista summary:. If this sounds like the right place for you then keep reading and learn more about why MiraVista is the perfect place to work. Valid RN license in Massachusetts, BSN preferred.

Valid state license as a Registered Nurse (RN).

As a Registered Nurse (RN) in Adult Inpatient Psych, you will provide both direct and indirect care to patients in a supportive and compassionate environment. The Registered Nurse (RN) will have the following:. Valid RN license in Massachusetts, BSN preferred.

Valid state license as a Registered Nurse (RN).

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