Offres rn utilization review à Tampa, FloridaCréer des alertes d'emploi

WellMed, part of the Optum family of businesses, is seeking a Senior Practice Support Specialist to join our team in Florida. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The Sr. Practice Support Specialist (PSS) serves as a clinical liaison between contracted primary care practices and WellMed contracted clinical operations. This role is designed to drive value-based care performance and reduce avoidable utilization through proactive patient outreach, coordinated clinical interventions, and improved provider engagement. The PSS supports practices in managing high-risk patients and implementing population health strategies aligned with organizational priorities. This role reports to the Provider Relations Leader and works in a matrixed leadership environment. Clinical activities will occur under the direction of the WellMed Senior Medical Director and in accordance with Company protocols, established nursing practice standards, and the relevant state regulatory requirements. The role is field based with an expected travel requirement of 75-85% to contracted provider offices. Primary Responsibilities: • Care & Value Optimization, • Manage patient census across assigned practices, focusing on high-risk and high cost cohorts, • Monitor and influence key utilization metrics: ER visits, Admits/K, Readmits/K, SNF/ASC/hospital usage, and palliative care engagement, • Serve as a liaison between PCPs, hospitalists, specialists, and care management programs to ensure coordinated care delivery, • Support practices in implementing contingency plans for high-risk patients (HF, COPD), including documentation of advanced directives and care bundle elements, • Conduct weekly touchpoints with the medical director dyad partner to review admissions and determine escalations to contracted providers, • In partnership with PBM and Medical Director team, analyze utilization and performance data to identify trends and root causes, • Develop action plans aligned with market goals (quality, cost, coding), • Produce and share scheduled/ad-hoc reports on key metrics, • Patient Coordination & Engagement, • Ensure monthly visits for Band 5 and other high-risk cohorts per prioritization list., • Facilitate timely follow-up for hospital discharges and transitions of care, • Conduct weekly 'tuck-in calls' to high-risk members, • Provide education on call us first, • Assist practices in managing high-cost patients and ensuring follow-up on screenings and lab measures, • Referral & Specialist Strategy Support referral management aligned with preferred specialist strategy • Facilitate Tier 1 Cardiology/HF clinic referrals and support optimization of guideline directed medical therapy (GDMT), • Quality & Risk Adjustment Support, • Provide education and baseline support for risk adjustment documentation before coder SME engagement, • Drive timely closure of care gaps (medication adherence, preventive screenings, HEDIS/STAR measures), • Assist practices in understanding and applying QRA strategies In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. 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: • Associates Degree in Nursing, • Current, unrestricted RN license required, specific to the state of employment or able to obtain compact license within 30 days of hire • 4+ years in any combination of provider relations, network management, care management, and/or clinical operations. • Medicare Advantage, HEDIS, STAR, CMS reimbursement models, risk adjustment • Proven solid analytics, communication, relationship-building, and proficiency in Microsoft Office, • Travel: Ability to travel extensively (up to 75-85%) and possess a valid drivers license issued by the state of practice Preferred Qualifications: • Bachelor's degree in Business or Healthcare Administration, • CPC Certification, • Experience in value-based care or population health management Performance Metrics • Reduction in Admits/K and Readmits/K, • Increased engagement of high-risk cohorts and care initiatives, • Timely closure of care gaps and improved documentation accuracy, • Provider satisfaction and resolution of escalated issues Physical & Mental Requirements • Ability to sit/stand for extended periods; operate office equipment., • Ability to drive and travel extensively., • Ability to lift up to 25 lbs., • Ability to comprehend instructions and apply logical reasoning 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 salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job DescriptionJob Title: Director of Nursing (DON) Job Description: Learning Tree PPEC Tampa, LLC is a Prescribed Pediatric Extended Care (PPEC) facility dedicated to caring for medically complex children for up to 12 hours daily, Monday through Saturday. Our mission is to provide exceptional, compassionate care tailored to each child’s needs in a safe environment, helping them achieve their highest potential. We are seeking a passionate, fun, and caring Director of Nursing (DON) to lead our nursing team and oversee the daily operations of our PPEC center. Responsibilities: • Organize and direct the clinical services of the PPEC., • Supervise all nursing staff and unlicensed assistive personnel., • Initiate and oversee each child’s Plan of Care for Initial Admissions and re-certification process., • Ensure the Plan of Care is executed as prescribed by the physician., • Maintain timely and accurate documentation in each child’s medical record., • Provide direct patient care as needed., • Develop, coordinate, and implement goals, standards of practice, policies, and procedures for the nursing service, including:, • Assessing each child’s healthcare needs., • Ongoing observation and monitoring of each child’s condition., • Notifying the Administrator of significant changes in a child’s health status., • Maintaining records in compliance with state guidelines., • Enforce and demonstrate compliance with all state and federal regulations, Medicaid requirements, and Learning Tree PPEC Tampa policies and procedures., • Maintain communication with the Medical Director to ensure all regulations and protocols are up to date and accurate., • Assist the Administrator with:, • Staff development, in-service training, and continuing education., • Staff performance reviews., • Continuous quality improvement and utilization review processes., • Ensuring appropriate daily staffing levels with qualified personnel and/or independent contractors in compliance with state-specific guidelines., • Perform other duties as assigned by the PPEC Administrator.Qualifications and Skills:, • Current Florida Registered Nurse (RN) license., • Current Cardiopulmonary Resuscitation (CPR) certification., • Minimum of two (2) years of general pediatric nursing experience, with at least six (6) months caring for medically fragile infants or children in a PPEC, pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), or a similar care setting within the past five (5) years., • Strong leadership and personnel development skills., • Excellent communication and interpersonal skills., • Outstanding organizational and stress management abilities., • Strong problem-solving aptitude., • Bilingual candidates are strongly desirable.Job Hours:, • PPEC operating hours: Monday through Friday, 7:00 AM - 7:00 PM. Saturdays 8:00 - 4:00 (hours may vary depending on PPEC's needs), • Salary will be discussed during the interview process.Job Type: Full-time Schedule: • Day shiftExperience:, • Pediatric Nursing: 2 years (Required)Work Location:, • In-person If you are a compassionate and dedicated nurse who wants to make a difference in the lives of children and their families, we would love to meet you!

Job DescriptionPosition: Market Physician Executive (MPE) - Float Monogram Market Physician Executive Floats (MPE) are mission driven physician leaders who are dedicated to improving the well-being, quality of life, and health outcomes for our patients. The MPE will lead our in-home multi-specialty polychronic care model in an assigned market. Each market is comprised of 5-10 practices led by local advanced practice providers (APP), registered nurses (RN), licensed clinical social workers (LCSW), and pharmacists (PharmD). The MPE Float will collaborate with Monogram Health’s Multi Specialty Platform to leverage employed specialists to deliver in-home specialty care. Monogram Health deploys a proven risk based model to ensure health equity and health equality leveraging proprietary next generation AI algorithms to predict the appropriate level of care. Aligning with the quadruple AIM, the MPE will focus to improve patient experience, population health outcomes, provider satisfaction and lower costs. The primary goal of each MPE Float is to deliver exceptional outcomes through disease detection and evidence based clinical pathways and disease treatment. Reporting to the Region President, the Market Physician Executive (MPE) Float is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market. The MPE Float oversees the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market. In support of the advance practice providers the MPE Float is expected to review and approve care plans and direct the treatment plans for our patients. The MPE Float will collaborate with community physicians, facilities, and partners in peer to peer and direct patient care decision making. Roles and ResponsibilitiesClinical Guidelines Execution – 25% • Know, understand, and deliver on Monogram Health’s proprietary evidenced based clinical pathways., • Ensure adherence to established clinical guidelines and Monogram Model of Care., • Review and approve APP, RN, SW and PharmD plans of care., • Appropriate and timely patient document within Salesforce and Athena clinical activities, interventions, and tasks., • Review, approve and co-sign APP encounters., • Clinical and Operations Performance and Quality Improvement – 25%, • Overall accountability for reducing total cost of care and Medical Loss Ratio., • Responsible for clinical outcomes to include, but not limited to, clinical interventions closure, inpatient/outpatient, • utilization, pharmacological prescribing and therapy management, multi-specialty platform and HEDIS/Gap Closure, • Actively lead daily high risk and concurrent review rounds., • Direct supervision of front line clinical and operations team members., • Oversee and delegate operational responsibility to Market Manager, to deliver on daily operations, such as patient engagement, scheduling, administrative oversight, strategic implementations, and P&L management., • Regularly assess and present market performance and outcomes to Executive and Senior Leaders .Patient Care and Treatment – 25%, • Provide direct and indirect patient care (including diagnosis and treatment of disease)., • Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways., • Conduct Peer to Peers with community, facility, and health plan partners., • Order labs, referrals, and complete actions to drive patient outcomes, close care gaps, and Clinical Intervention closure.Population Health Management (PHM) – 20%, • Provide clinical guidance and direction to Market teams to drive Population Health Management activities, including, • identifying and intervening on High-Risk Patients, formulating strategies to reduce admissions/readmissions, complete, • quality post hospital discharge visits, and improving the quality of visits., • Collaborate with Medical Economics, Finance and other stakeholders to root cause and action against utilization trends impacting care and outcomes., • Present and guide population health strategies in clinical and operational meetings., • Conduct patient reviews to target high utilizers, high risk and high opportunity patients and patient cohorts.Miscellaneous – <5%, • Participate in Monogram On-Call activities Needs will vary; 7 days on call minimum once/quarter., • Provide coverage for other MPEs, during PTO or vacancy, as needed.Position Requirements, • Must be willing and able to obtain hospital privileges at required facilities., • This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel., • Demonstrated experience applying evidence based clinical criteria., • Experience in renal care and geriatrics., • Strong management and communication skills., • Active, unrestricted state medical license required in each state within the market., • Experience with high need Medicare Advantage and managed Medicaid populations., • Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment., • Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare. Willingness to become licensed in multiple states., • MD (Medical Doctor) or DO degree from an accredited medical school., • BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine,, • Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.Benefits, • Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts, • Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources, • Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave, • Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts About Monogram Health: Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

Atlas Medstaff is currently seeking candidates in the RN, Cath Lab profession for a 13 week contract in the Riverview, Florida area. Both of those recognitions are fueled by real reviews by real travel nurses and allied healthcare professionals that work with our team.

RN – Registered Nurse – Medical/Surgical - Telemetry. RN - Registered Nurse - Med/Surg/Tele. The RN responsibilities include:.

PRN Positions Available on Day & Night Shifts - Days: 7 am - 7 pm * Nights: 7 pm - 7 am. Must possess a current license as an RN in the state where the center is located.

Reviews and recommends changes to nursing policies and procedures. Registered Nurse (RN) [Required].

RN (Registered Nurse) license is required. RN - Registered Nurse - Cardiac Surgical - Nights. RN - Registered Nurse - Cardiac Surgical.

Registered Nurse (RN) [Required].

Our partnering hospital is seeking a compassionate and skilled RN for a 13-week nursing assignment. Free Private Furnished Housing or Tax-Free Subsidy. Not for You? Refer a Friend and Earn Up to Seven Hundred and Fifty Dollars by Visiting.

Previous experience with Cerner Electronic Medical Record [Preferred]. Registered Nurse (RN) [Required].

Fully furnished housing or housing stipend.

We're hiring experienced RNs for flexible, field-based assignments providing discreet, physician-supervised care in clients' homes. RN with active, unencumbered license (multi-state compact preferred).

RN must have completed an approved education, received and maintained certification. If you are interested in learning more about this job, or if you are a healthcare professional looking for a new position in any capacity, contact Marina - call/text 617-430-7080 or.

RN (Registered Nurse)- Homecare- Temple Terrace. Reviews plan of care and program protocols and identifies areas for healthcare teaching/education, care coordination, goal setting and discharge planning needs, as applicable. Current Registered Nurse (RN) License for the state in which the nurse prac

Our commitment to impact beyond the contract empowers healthcare professionals to discover purpose and flexibility in their journey. License Reimbursements and processing assistance with our internal licensing department. Travel Farther Together Referral Program - earn up to $1,200 per clinician you

Joseph's Hospital is Pathway to Excellence designated, which showcases the positive practice environment where RNs can excel in their practice. RN (Registered Nurse) license is required. RN - Registered Nurse - Neuro PCU - Nights.

Prepare, and present, patient's record to the Clinical Record Review Committee, as indicated. Consult with the attending physician, concerning alterations of Patient Care Plans, checks with the appropriate supervisor, and makes changes, as appropriate. Participate in case conferences, discuss with t

RN - Registered Nurse - Orthopedics. The RN responsibilities include:. Joseph's Hospital is Pathway to Excellence designated, which showcases the positive practice environment where RNs can excel in their practice.

Reviews patient history, physical diagnostics, and laboratory data, and reports abnormal results to the physician. Optimizes daily schedules to support productivity, efficiency, and best practice visit utilization. Registered Nurse (RN) [Required].

Registered Nurse (RN) PRN | Home Health Visits in North Tampa. We are seeking an Exceptional Registered Nurse (RN) to join our team. Competitive Pay – The more you work, the more you earn.

Minimum of 1 year of direct patient care experience; prior home health RN experience strongly preferred. At Empath Health, you'll find purpose, partnership, and possibility in a culture where compassion drives excellence and every team member helps make life's journey more meaningful. For further in

The Registered Nurse ( RN ) is responsible to plan and deliver nursing care to patients/residents requiring long-term and/or rehabilitative care. Now Hiring Registered Nurses (RNs)!. Registered Nurse (RN ) Job Summary:.

RN - Registered Nurse - Neuro PCU. RN - Registered Nurse - Neuro PCU. The RN responsibilities include:.

We are seeking an experienced and highly skilled Nurse Practitioner to join our growing aesthetics and wellness practice in Florida.The ideal candidate will have extensive expertise in advanced injectable treatments, peptide therapy, hormone replacement therapy (HRT), and aesthetic procedures.This i

BayCare is currently in search of our newest RN Hospital Clinic - Pediatric Oncology, who is passionate about providing outstanding customer service to our community. RN (Registered Nurse) License - Florida Dept of Health. RN - Registered Nurse - Pediatric Oncology.

Wellness & Beauty Nurse Practitioner (NP or PA).Are you a passionate Nurse Practitioner or Physician Assistant with a flair for aesthetics? Ready to elevate clients' confidence by enhancing their natural beauty? Join our dynamic medical aesthetics team and bring your expertise to life in a role wher

Title: RN – Registered Nurse – Neuro PCU. The RN responsibilities include:. Joseph's Hospital is Pathway to Excellence designated, which showcases the positive practice environment where RNs can excel in their practice.

We're looking for a part-time Assistant Store Manager to help lead our Tampa store! This role is a perfect blend of leadership, creativity, and operational supportyou'll play a key role in driving store performance, developing the team, and ensuring an exceptional guest experience.As Assistant Store

RNs must be comfortable and proficient with electronic medical record documentation. Two years of RN Clinical experience in acute care, SNF, Hospice, Home Health. IMMEDIATE RN CAREER OPPORUNITY IN HOME HEALTH: West Pasco Region.

Previous experience with Cerner Electronic Medical Record [Preferred]. Registered Nurse (RN) [Required].

The RN responsibilities include:. Joseph's Hospital is Pathway to Excellence designated, which showcases the positive practice environment where RNs can excel in their practice. RN (Registered Nurse) license is required.

Associate's of Nursing (Required), Bachelor's of NursingAcute/Critical Care Clinical Nurse Specialist (CCNS) - EV Accredited Issuing Body, Advanced Cardiac Life Support Cert (ACLS) - RQI Resuscitation Quality Improvement, Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) - EV Acc

Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications. Current RN License in in State of operations required. Assures quality of care by adhering to therapeutic standards; measuring health outcomes against client care goals and standar

As a national learning health system, we're transforming care delivery, advancing clinical outcomes, and empowering our nursing teams in a collaborative effort to give people a healthier tomorrow. Apply today for our RN PCU opportunity. You will maintain and review patients' records including postin

RN experience in the Hemodialysis in an Acute Care setting. RN - Registered Nurse - Hemodialysis - Days.

We are hiring- Registered Nurse (RN) - PRN/Part-time role, flexible work schedule, travel to patient sites in-home care. RNs must be comfortable and proficient with electronic medical record documentation. Two years of RN Clinical experience in acute care, SNF, Hospice, Home Health.

RN – Registered Nurse – Medical/Surgical. The RN responsibilities include:. Joseph’s Hospital is Pathway to Excellence designated, which showcases the positive practice environment where RNs can excel in their practice.

Registered Nurse (RN) [Required]. Basic RN Nursing Skills [Required]. AORN Standards (OR) [Preferred].

The RN responsibilities include:. Joseph's Hospital is Pathway to Excellence designated, which showcases the positive practice environment where RNs can excel in their practice. RN (Registered Nurse) license is required.

Are you a skilled and motivated RN seeking a career with a focus on growth and teamwork? We invite you to:. Connect with HR to learn more about our benefits package and other incentives we offer. RN licensure in the state of practice (or NLC) required.

We cover the cost of CRNI (Certified Registered Nurse Infusion) and ONCC (Oncology Nursing Certification Corporation) certifications to support your career advancement. Ensure Compliance and Quality – Maintain accurate records in the Electronic Health Record (EHR) system, review nursing documentat

Apply today for our RN Registered Nurse PCU opening and continue to learn!. If growth and continued learning is important to you, we encourage you to apply for our RN Registered Nurse PCU opening. Are you a continuous learner? With more than 94,000 nurses throughout HCA Healthcare, we are one of the

BrightStar Care of Lakeland and Winter Haven is hiring a Spanish Speaking RN in the Tampa area for infusion help. Active RN license in the state of practice.

Attends required safety training programs and understands responsibilities related to general and specific job-related safety, including following Hospital Exposure Control Plans for Bloodborne and Airborne Pathogens. Registered Nurse (RN) [Required].

RN - Registered Nurse - Medical/Surgical Telemetry. RN - Registered Nurse - Med/Surg/Tele. The RN responsibilities include:.

Registered Nurse (RN) [Required].

RN - Registered Nurse - Orthopedics - Days. Title: RN – Registered Nurse – Orthopedics. The RN responsibilities include:.