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Billing & Administrative Specialist

Ellie Mental Health Remote.co4 months ago

Apply Now4 months ago

location: remoteus

Apply Now

Billing & Administrative Specialist

FULL TIME • FULLY REMOTE – US

Benefits:

401(k)
Competitive salary
Health insurance
Home office stipend
Paid time off

Billing & Administrative Specialist

We are seeking an experienced Billing and Administrative Specialist to oversee the financial and administrative operations of our mental health clinic. The ideal candidate will have a strong background in medical billing and coding, along with excellent organizational and communication skills to effectively manage client interactions and administration.

Responsibilities:

Manage all aspects of billing and collections for services provided, including insurance claims processing, payment posting, and follow-up on outstanding accounts.
Ensure accurate coding of services rendered and adherence to billing regulations and guidelines.
Handle inquiries and resolve issues related to billing, insurance coverage, and payments from clients and insurance companies.
Maintain up-to-date knowledge of insurance policies, billing procedures, and coding updates to optimize reimbursement and minimize billing errors.
Oversee the day-to-day administrative operations of the clinic, including scheduling appointments and managing client records
Coordinate with clinicians and clinical director to streamline workflow processes and ensure efficient delivery of services.
Collaborate with external vendors, such as billing software providers and insurance companies, to resolve technical issues and improve billing efficiency.
Assist with preparing financial reports and analyses to monitor clinic revenue, expenses, and performance metrics.
Assist with other administrative tasks and projects as needed to support the overall functioning of the clinic.

Qualifications:

Minimum of 2-3 years of experience in medical billing and coding, preferably in a mental health setting.
Proficiency in medical billing software and electronic health record (EHR) systems. Experience with Valant EHR a plus.
Strong understanding of insurance claims processing, billing regulations, and coding standards (e.g., CPT, ICD-10).
Excellent attention to detail and accuracy in data entry and record-keeping.
Effective communication skills, both written and verbal, with the ability to interact professionally with clients, staff, and external stakeholders.
Some understanding of client scheduling in a clinical setting.
Proficient in the use of typical office technology (computers, e-mail, etc.). Experience with Microsoft 365 a plus.
Proven ability to multitask, prioritize tasks, and meet deadlines.
Strong leadership and interpersonal skills.
Ability to maintain confidentiality and handle sensitive information with discretion.
Commitment to providing exceptional customer service and promoting a positive clinic environment.
Desire to work in a collaborative atmosphere that embodies Ellie’s values (creativity, authenticity, humor, compassion, acceptance, determination);

What we have to offer:

Competitive salary, excellent benefits and paid time-off
Flexible scheduling

What else you should know:

Ellie Mental Health is a highly successful multi-clinic mental health organization originally based in Minnesota; however, Ellie in Boise is locally owned and operated. The owner and Director are lifelong Idahoans committed to expanding mental health services in our community. Our vision is to operate a small but mighty clinic with a dedicated team of kickass therapists and staff who support one another in providing excellent services to our clients and the larger community.

This is a remote position.

Compensation: $45,000.00 – $48,000.00 per year

Related Remote Health Care Jobs

Responsibilities

Deliver coordinated, patient-centered virtual Care Management by telephone and/or messaging that improves members’ health outcomes
Generate impactful care plans together with members and our multidisciplinary care team, and help members achieve their desired goals
Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
Partner with the members’ local providers to ensure coordinated care.
Provide compassionate, longitudinal follow-up care, building supportive relationships.

Qualifications:

Bachelor of Science in Nursing (BSN).
Must reside in a compact NLC state.
Active Compact RN license in good standing with the nursing board of their state.
Active California Nursing License preferred
Willingness to become licensed in multiple states.
Must have current CCM Certification
5+ years of experience in nursing preferred.
2+ years experience working in labor and delivery
2+ years experience working in infertility
Be willing and able to work until 6pm PST
Be comfortable discussing a wide variety of medical conditions
Spanish speaking desirable
Experience working remotely preferred; Comfortable with technology.
Be highly empathetic. We work with patients and their families who are going through challenging times. Ideal candidates. practice empathy and reassure patients that we are available to help them.
Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet volume goals without sacrificing quality. Good judgment for balancing priorities is a must.
Be flexible and comfortable with working in a rapidly-changing environment.
Strictly follow security and HIPAA regulations to protect our patients’ medical information.
Be pleasant, responsive, and willing to work with and learn from our team.
Strong verbal and written communication skills. A lot of time is spent on the phone with patients and families, as well as a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
Strong competence and ability to use multiple computer/medical record systems.
Collaborate well across multidisciplinary teams with clinical and non-clinical members to deliver a seamless, top-quality care experience to patients.
Ability to understand cultural and socioeconomic issues affecting members and to coordinate all available resources to serve members.
Excellent grammar, attention to detail, and efficient at writing medical information in easy-to-understand, patient-centric language.

Schedule

M-F 9a-6p PST

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community – no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included.

Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.

Clinical Coding Appeals Nurse

R1 RCM Remote.coabout 6 hours ago

Apply Nowabout 6 hours ago

location: remoteus

Apply Now

Clinical Coding Appeals Nurse

Remote, USA

Full time

R240000002599

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Clinical Coding Appeals Nurse, you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. Then you will draft appeal letters based on clinical judgment and knowledge and make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. To thrive in this role, you must have experience identifying different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters. Proficiency in basic computer skills is essential for excelling in this remote production-drive position.

Here’s what you will experience working as a Clinical Coding Appeals Nurse:

Review and interpret medical records to appeal denied and underpaid claims.
Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
Draft appeal letters that are well-written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance.
Ensure that all appeals are completed timely to ensure internal and external compliance deadlines are met.

Required Skills:

Active Registered Nurse license
Active AHIMA or AAPC Coding Certification including CCS, RHIA, RHIT, CCA, CPC-A, CPC-H (COC), CPMA, CIC, CDI, or CDIP

For this US-based position, the base pay range is $71,930.00 – $109,236.00 per year . Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent

Sr Director, Clinical Operations

Evolent Health Remote.co6 days ago

Apply Now6 days ago

location: remoteus

Apply Now

Sr Director, Clinical Operations

Work at Home

Full time

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they’re supported to live their best lives, and when they feel welcome to bring their whole selves to work. That’s one reason why ersity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

The Senior Director, Strategic Partner Programs is responsible for overseeing operational performance and improvement initiatives for dedicated customers.

Key responsibilities include:

Leading operational planning, implementation, and evaluation of clinical programs

Coordinating with key stakeholders internally and externally

Serving as a trusted advisor to clients and providing thought leadership

Creating and monitoring metrics for clinical, operational, and economic performance

Planning, prioritizing, and scheduling projects to meet timelines

Acting as a liaison between Clinical Operations and Partner Operations

Monitoring performance metrics and driving initiatives to optimize performance

Ensuring compliance with service level agreements

Collaborating with Finance, Analytics, and Operations to manage key performance indicators

Coordinating service delivery across a matrixed operational model

Additional duties:

Providing technical guidance on problem definition and resolution

Establishing client quality objectives and benchmarks

Identifying and resolving operational deficiencies for dedicated clients

Adhering to company policies, procedures, and standards

Addressing and resolving user issues and understanding user terminology

Providing customer support to both internal and external customers

Offering guidance on conflict resolution

Developing and ensuring compliance with policies and procedures

Promoting professional growth and development through education and skills competency

The Experience You’ll Need (Required):

Bachelor’s degree or 10 years of related experience

Five (5) to Seven (7) years of healthcare experience

Experience in working directly with Health Plan customers is required

Demonstrates strong analytical, organizational and critical thinking skills.

Ability to travel 25% for internal and external meetings

Technical requirements:

This role is a remote position. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

The expected base salary/wage range for this position is $140,000-150,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected iniduals, which may vary above and below the stated amounts.

Physician Practice Coder

Boston Medical Center Remote.co8 days ago

Apply Now8 days ago

location: remoteus

Apply Now

Physician Practice Coder

locations

Remote

time type

Full time

job requisition id

37114

Position: Physician Practice Coder

Department: Coding & Education

Schedule: Full Time, Remote

POSITION SUMMARY:

Conducts CPT and ICD-10 coding reviews by detailed examination of each line item in the physician medical record and charge session. Performs chart audits to ensure correct coding and charge capture have been applied appropriately. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers.

JOB REQUIREMENTS

EDUCATION:

Associates Degree (or direct work experience equivalent to at least 2 years)

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

CPC – Certified Professional Coder

CPC-A – Certified Professional Coder Apprentice

EXPERIENCE:

2-5 years experience required in a multi-specialty physician coding environment to include coding, compliance, and billing processes.

KNOWLEDGE AND SKILLS:

Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Work also requires basic concepts of human anatomy, physiology and pathology.
Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
Ability to work with accuracy and attention to detail
Ability to solve problems appropriately using job knowledge and current policies/procedures.
Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.

ESSENTIAL RESPONSIBILITIES / DUTIES:

Coding support

Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures. Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems. Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing.
Sequences diagnoses, procedures and complications by following ICD-10-CM, CPT-4, and the Uniform Hospital Discharge Data Set (UHDDS); adheres to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines as appropriate. Consults with the CDCI team to request appropriate physician or appropriate medical staff to clarify medical record information.
Maintains productivity standards set forth in Departmental Policies and procedures.
Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature and other educational programs.
Utilizes hospital’s cultural values as the basis for decision making and to facilitate the hospital’s goals and mission.
Follows established Hospital infection control and safety procedures.

Review and respond to coding questions.
Ensure billed service is being accurately coded.
Perform random chart audits.
Provide continual coding updates.
Research coding issues that arise.
Codes diagnoses and procedures from the medical record using ICD-10-CM and CPT-4/HCPCS classification systems.
Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
Reviews charts for documentation and signature.
Performs other duties as needed.

Must adhere to all of BMC’s RESPECT behavioral standards.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required). IND123

Equal Opportunity Employer/Disabled/Veterans

Manager Coding

Cotiviti Remote.co8 days ago

Apply Now8 days ago

location: remoteus

Apply Now

Manager Coding

US-Remote

Full-Time

Overview

The Coding Manager leads a team of coders, directly or indirectly, to deliver key components to the Cotiviti coding program. This role works with the Director of Coding, the Client team and other areas related to production, QA, and analytics for oversight of ongoing production and quality accuracy.

Responsibilities

Work with the Director, Coding Services to oversee CMS-HCC and HHS- HCC coding production and quality including the management of staff, hiring, promoting, evaluating, and training, disciplining, and mentoring at the client team level.
Facilitates all production meetings with Reporting, Data Capacity operations planning, and leadership to develop coding and abstraction production plans. Communicates production plans, quality goals and project priorities to internal Coding teams as well as external vendor partners in preparation for on-boarding and/or scheduling of all client projects, including on and offshore coding.
Resolve issues that impact coding production and the full utilization of coding abstraction services for MRA, CRA and Medicaid. This will involve working closely with chart retrieval staff, IT, Production Analytics, HR, Trainers, and the QA team.
Utilize Coding forecast and coding output data to monitor coding productivity and quality; address coders work performance concerns through meeting with the Coder and/or coding vendor leadership to develop an action plan as needed regarding production and quality accuracy standards. This includes the development of monitoring tools as needed to continually assess staff progress toward goal achievement.
Constructs and communicates internal system reports for all coders (Coder I, Coder II, QA I and QA II and Team Leads) in the Clinical Coding Department. These reports cross production and quality accuracy. Reports are reviewed daily, weekly, monthly, quarterly, and yearly as needed.
Ensures completion of various chart types (physician, hospital outpatient, hospital inpatient) from both a production and quality accuracy perspective.
Frequently meets with clients to provide meaningful updates on project progress; works closely with client success and coding quality to ensure successful deliverables.
Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction. Required
Complete all responsibilities as outlined in the annual performance review and/or goal setting. Required
Complete all special projects and other duties as assigned. Required
Must be able to perform duties with or without reasonable accommodation. Required

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Required

Qualifications

Bachelor’s degree, Coding certification; RHIA, RHIT, CRC, CCS, CCS-P, CPC, CPC-H (Nationally certified medical coder as certified by either AAPC or AHIMA) or 4 years equivalent work experience.
5+ years of HCC medical coding, record abstraction experience, including supervisory experience.
Ability to establish, monitor and enforce staffing schedules and production schedules.
Ability to analyze data to identify trends, outliers or areas that need attention from both a production and quality perspective, and implement changes as needed.
Ability to act as a coding resource or QA resource for Medicare Risk Adjustment, Commercial Risk Adjustment and Medicaid when production volume is required.
Excellent written and verbal skills including coaching and interpersonal skills, and client interaction.
Strong knowledge of medical terminology and anatomy and physiology.
Analytical and critical thinking skills to understand data to influence decision making.
Computer and technology literate.
Manage multiple client deliverables and competing deadlines simultaneously.
Awareness and adherence to HIPAA privacy and security regulations.
Must remain flexible to provide assistance in any emergent situations and/or projects.
Must be able to perform duties with or without reasonable accommodation.
Work is performed in an office setting with some possible travel.

Mental Requirements:

Communicating with others to exchange information.
Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

Remaining in a stationary position, often standing or sitting for prolonged periods.
Repeating motions that may include the wrists, hands, and/or fingers.
Must be able to provide a dedicated, secure work area.
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Base compensation ranges from $78,000 to $90,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.

Medical Coder - Hospital Outpatient

Guidehouse Remote.co8 days ago

Apply Now8 days ago

location: remoteus

Apply Now

Medical Coder – Hospital Outpatient

Location:Remote, United States

Full time

job requisition id: 23567

Job Description:

Job Family:

Health

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

Join Guidehouse’s Best in KLAS medical coding team!

Guidehouse is partnering with the DHA as part of a large-scale project in support of our military healthcare facilities and hospitals. This is an exciting opportunity to join a mission drive project and contribute to a best in KLAS medical coding team. We are proud to be recognized as a Military Friendly Employer for the fifth consecutive year, listed among the 2024 Military Spouse-Friendly Employers and we’re Great Places to Work certified. These roles are 100% remote and offer a flexible schedule.

We offer:

Competitive compensation and comprehensive benefits
A flexible, remote work arrangement
The opportunity to work the #1 ranked Best in KLAS medical coding team, and a rapidly growing global professional services firm
A collaborative, erse, and supportive workplace
Corporate membership to AAPC and the AAPC webinar subscription for our full-time team coders who are AAPC members
Encoder Pro as a resource tool for our full-time team members
Monthly education newsletter and education opportunities provided through our education department
AAPC approver instructor who helps coordinate your CEU’s or expanded CPC specialty certifications

If you are a skilled Medical Coder looking to make a difference for a mission driven project, apply today!

What You Will Do:

Oversees the maintenance of medical records and the coding of data from medical records.
Participates in the preparation of reports, provides information and prepares correspondence regarding patient admissions, treatment, discharges and deaths in accordance with departmental policies and legal requirements governing the release of medical information.
Works collaboratively with providers, other health care professionals and coding team to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to each patient, as well as ensuring compliant reimbursement of patient care services.
Infusion and Injection Charging
E/M Leveling

What You Will Need:

High School Diploma or equivalent
3 years of prior relevant medical coding experience
CCS, CPC-H, RHIT or RHIA Certification
Must be a US Citizen and willing to undergo a federal background check as part of the onboarding process

What Would Be Nice To Have:

Federal or Military medical coding experience
Experience working in any of the following systems: EPIC, Cerner, Next Gen, Allscripts or any other EHR.
Knowledge of Anatomy, Physiology and Medical Terminology.
Experience with Government and other Payer guidelines as they relate to compliant coding.
Willingness to maintain professional credentials at all times.
Associates Degree

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a erse and supportive workplace.

Benefits include:

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Hospital Coding Specialist II (Remote)

Marshfield Clinic Remote.co8 days ago

Apply Now8 days ago

location: remoteus

Apply Now

Title: Hospital Coding Specialist II (Remote)

locations

Marshfield, WI

time type

Full time

job requisition id

R-0040187

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title:

Hospital Coding Specialist II (Remote)

Cost Center:

101651098 HIM-Facility Coding

Scheduled Weekly Hours:

Employee Type:

Regular

Work Shift:

Mon-Fri; day shifts (United States of America)

Job Description:

JOB SUMMARY

Hospital Outpatient Coding:

The Hospital Coding Specialist ll reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes for billing, internal and external reporting, research and regulatory compliance activities. This inidual accurately codes outpatient conditions and procedures as documented in the medical record and applying the ICD Official Guidelines for Coding and Reporting. The Hospital Coding Specialist II provides charge validation and capture processes for various patient types. This inidual assigns codes for diagnoses, treatment, and procedures according to the appropriate classification system for outpatient encounters. The Hospital Coding Specialist II utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD diagnoses, ICD CPT/HCPCS codes including modifier assignment. This inidual validates and/or identifies chargeable items for various patient types (i.e., OBS, SDS) and enters them into the billing system to include the following outpatient visit types:

Ambulatory surgery (same day surgery), may include charge capture
Observation service encounters
Other hospital outpatient types in accordance with Coder II job descriptions, as assigned

Hospital Inpatient Coding:

The Hospital Coding Specialist II accurately codes inpatient conditions and procedures as documented in the International Classification of Diseases (ICD) Official Guidelines for Coding and Reporting and in the Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS-DRG (Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined Diagnosis Related Groups) for complex, multi-specialty inpatient services. This inidual understands and applies applicable medical terminology, anatomy and physiology, surgical technology, pharmacology and disease processes. The Hospital Coding Specialist II reviews professional and hospital inpatient medical record documentation and properly identifies and assigns:

ICD CM and PCS codes for all reportable diagnoses and procedures. This includes determining the correct principal diagnosis, co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures.
MS-DRG /APR-DRG
Present on admission indicators
HAC (Hospital Acquired conditions) and when required, report through established procedures
PSI conditions and report through established procedures
Discharge Disposition code
Works collaboratively with the Clinical Documentation Improvement Specialists to address documentation concerns and DRG assignments
Assists in the preparation of responses to DRG validation requests and other third party payer inquiries related to coding and DRG assignments as requested

JOB QUALIFICATIONS

EDUCATION

The inidual applying must meet the minimum qualifications in all three required sections below to be considered a candidate for interview. Please consider when listing minimum qualifications.

Minimum Required: Medical Coding Diploma or American Health Information Management Association (AHIMA) approved Health Information Management Degree or related program.

Preferred/Optional: None

EXPERIENCE

Minimum Required: Two years coding and reimbursement experience in a multi-specialty setting clinic/hospital or completion of coding degree or diploma will be considered in addition to the following:

Knowledge of medical terminology, anatomy and physiology, pharmacology, disease process, and surgical procedures
Knowledge of accepted medical abbreviations and their meanings
Knowledge in the use of specialized references such as the ICD and CPT-4 books, medical dictionaries and texts, and medical journals
Must have extensive knowledge of Coding Clinic, CPT Assistant and all official coding guidelines
Advanced knowledge of hospital information systems, encoders and other technology to facilitate a successful work environment while maintaining maximum communication and adhering to HIPAA security standards
Advanced knowledge Microsoft Outlook, Excel and Word functions
Technical skills required to learn and navigate a variety of software systems and trouble shoot computer problems
Strong written and verbal communication skills
Ability to think and work independently, yet interact positively with team
Advanced problem solving skills
Attention to detail is crucial to this position

Preferred/Optional: Experience with electronic health record systems.

CERTIFICATIONS/LICENSES

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position

Minimum Required: AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management) credential (i.e. CCS, CCS-P, RHIT, RHIA, CCA, CPC, CPC-H, COC) within one year of hire.

Preferred/Optional: AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management) credential (i.e. CCS, CCS-P, RHIT, RHIA, CCA, CPC, CPC-H, COC) at time of hire.

Given employment and/or payroll requirements of inidual states, Marshfield Clinic Health System supports remote work in the following states:

Alabama

Alaska

Arkansas

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Michigan

Minnesota

Mississippi

Missouri

Nebraska

North Carolina

North Dakota

Ohio

Oklahoma

South Carolina

South Dakota

Tennessee

Texas

Utah

West Virginia

Wisconsin

Wyoming

Marshfield Clinic Health System will not employ iniduals living in states not listed above.

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, ersity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every inidual should have the opportunity to attain their highest level of health. We embrace ersity and welcome differences in who we are and how we think. We believe that any inidual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Inpatient Medical Coder

Datavant Remote.co8 days ago

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location: remoteus

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Inpatient Medical Coder

Location: Remote United States

Requisition ID

2024-37576

Category (Portal Searching)

HIM / Coding

Position Type (Portal Searching)

Employee Full-Time

Equal Pay Act Minimum Range

$30.00 – $40.00 per hour

Job Description:

Overview

Datavant is a data platform company for healthcare whose products and solutions enable organizations to move and connect data securely. Datavant has a network of networks consisting of thousands of organizations, more than 70,000 hospitals and clinics, 70% of the 100 largest health systems, and an ecosystem of 500+ real-world data partners.

By joining Datavant today, you’re stepping onto a highly collaborative, remote-first team that is passionate about creating transformative change in healthcare. We hire for three traits: we want people who are smart, nice, and get things done. We invest in our people and believe in hiring for high-potential and humble iniduals who can rapidly grow their responsibilities as the company scales. Datavant is a distributed, remote-first team, and we empower Datavanters to shape their working environment in a way that suits their needs.

We’re looking for experienced and credentialed inpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace!

Responsibilities

You will:

Reviews medical records and assigns accurate codes for diagnoses and procedures.
Assigns and sequences codes accurately based on medical record documentation.
Assigns the appropriate discharge disposition to medical records.
Abstracts and enters the coded data for hospital statistical and reporting requirements.
Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution.
Maintains 95% coding accuracy rate and 95% accuracy rate for MS-DRG assignment and maintains site designated productivity standards.
Maintains minimum production of 1 charts per hour or site specific productivity standards.
Demonstrates excellent written and verbal communications skills.
Communicates professionally with co-workers, management, and hospital staff regarding clinical and reimbursement issues.

Qualifications

What you will bring to the table:

A minimum of 2 years of inpatient coding facility experience
CCS, RHIT, or RHIA preferred
Strong verbal and written communication skills

Bonus points if:

Associate or Bachelor’s degree from an AHIMA-certified HIM or Nursing Program, or completion of a certificate program from AAPC with a preference for CCS
Level 1 trauma facility experience
Experience in computerized encoding and abstracting software

Perks:

Full Benefits including a 401k Savings Plan
Access to 20-24 free CEUs per year, provided by Datavant, to support your continuous professional development
Compensation for AAPC/AHIMA dues
Company-provided equipment including computer, monitor, mouse, etc
Comprehensive training led by a credentialed professional coding manager
Exceptional service-style management and mentorship (we’re in this together!)

This position requires that you provide a high-speed internet connection, subject to applicable expense reimbursement requirements (if any), and a work environment free from distractions. Please note: that 1 or more assessments may be required as a condition to being hired for this role. There is no COVID vaccine requirement for this role.

We are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks (competitive San Francisco rates for US-based roles) and industry best practices.

We’re building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best ideas win, and personal growth is driven by expanding impact. This means we default to simple job titles (e.g., Software Engineer) rather than complex ones (e.g., Senior Software Engineer). The range posted is for a given job title, which can include multiple levels. Inidual rates for the same job title may differ based on level, responsibilities, skills, and experience for a specific job. The estimated salary range for this role is $30.00 – $40.00.

At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your responses will be anonymous and used to help us identify areas of improvement in our recruitment process. (We can only see aggregate responses, not inidual responses. In fact, we aren’t even able to see if you’ve responded or not.) Responding is your choice and it will not be used in any way in our hiring process.

This job is not eligible for employment sponsorship.

Equal Pay Act Minimum Range

$30.00 – $40.00 per hour

Bilingual (Spanish) Virtual Acute Care/Emergency Medicine Nurse Practitioner

Devoted Health Remote.co8 days ago

Apply Now8 days ago

location: remoteus

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Title: Bilingual (Spanish) Virtual Acute Care/Emergency Medicine Nurse Practitioner

Remote USA

Full time

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, erse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology – to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we’ve grown fast and now serve members across the United States. And we’ve just started. So join us on this mission!

Job Description

A bit about this role:

This position is an amazing opportunity for a caring Nurse Practitioner (APRN) to help build and staff our growing telehealth medical group called Devoted Medical.
Your primary focus will be delivering world class acute care to our members with emergent/critical illness. The Care OnDemand Nurse Practitioner will diagnose complex medical conditions, order and interpret diagnostic tests, and work with patients, families, and Care OnDemand team to establish care plans.
One of Devoted Medical’s missions is to bring care to where our members live meaning your visits will be virtual telehealth care. On a day-to-day basis you will work closely with co-clinicians at Devoted Medical including physicians and APRNs as well as medical assistants, documentation experts, practice administrators, and our close social work and clinical nurse partners at Devoted Health Plan.

Required skills and experience:

Role licensure and certification in good standing is required and the ability to get licensed in requested states within 90 days of hire date. You will be required to get licensed in additional states as needed.
RN and APRN licenses are active and in good standing.
Active BLS certification.
Must be bilingual in Spanish/English.

Desired skills and experience:

Experience in primary care, internal medicine, urgent care, emergency room, and/or geriatrics.
Experience performing visits over telehealth video platforms.
Experience in managing acute/chronic disease exacerbations including CHF exacerbations, diabetic emergencies, COPD exacerbations and hypertensive emergencies.
A strong desire to continue practicing acute care – you believe in the mission of bringing care to where the patient lives.

Your Responsibilities and Impact will include:

Performing Care OnDemand (acute care) visits including evaluating and diagnosing acute illnesses, ordering/interpreting diagnostic testing, establishing care plans including prescribing appropriate medications, and assessment for quality of care (STARS/HEDIS) interventions as well as social and home health/DME needs.
Work closely with the member’s care team including their PCP, specialists, and other Devoted team members including pharmacy, clinical nursing, and social work as well as interfacing with family members and caregivers in order to coordinate care for the member and deliver a collaborative care plan.
Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface.
In certain geographies, there will be a weekend on-call component to support our clinical nurses who triage calls from our members during the weekend.

Salary range: $125,000 – $135,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the inidual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a erse and vibrant workforce.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value ersity and collaboration. Iniduals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Bilingual Nurse (RN) Case Management Lead Analyst

Express Scripts Remote.co8 days ago

Apply Now8 days ago

location: remoteus

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Bilingual Nurse (RN) Case Management Lead Analyst

Remote, US

CategoryMedical & Pharmacy

Job Id24012216

Hours: Monday-Friday. Day shift with one evening shift per week required.

Bilingual in English/Spanish

Position Scope

Hours for the Position: Must be able to work 9a.m.-5:30p.m. with one evening shift required per week. Monday-Friday.

Nurse Case managers are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers, families, and caregivers to assist with navigating through the healthcare journey.

Additionally, the candidate will be responsible for the adoption and demonstration of the Care Solutions cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.
- Customer Strong: I deliver world-class experiences for all my customers.
- Me to We: I take accountability to trust, partner, and deliver.
- Own It: I see a need and deliver value because I care.
- Evolve and Adapt: I learn and adapt to meet evolving business needs.
- Be Bold: I pioneer and think broadly to solve challenges.
- Take Care: I prioritize self-care and act with compassion toward colleague.
Day in the Life Responsibilities
- Collaborates with customer in creation of care plan and documents plan in medical management system.
- Partners with each customer to establish goals and interventions to meet the customer’s needs.
- Establishes plan of care in conjunction with the customer and provider then document into a medical management system.
- Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.
- Empowers customers with skills to enhance interaction with their providers.
- Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.
- Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer’s provider and other Cigna Medical Management programs to provide whole-person health support.
- Tracks daily activities to trend volume and outcomes.
- Follows standard operating procedures.
- Toggles between multiple systems and applications.
- Research relevant topics in health promotion and disease prevention, as required for specific customers.
- Prioritizes work to meet commitments aligned with organizational goals.
- Understands and adheres to Case Management performance measures to deliver on key results.
- Completes training within the communicated time limit as required per role.
- Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
Minimum requirements
- Active unrestricted Registered Nurse (RN) license in state or territory of the United States.
- Minimum of two years full-time direct patient care setting as an RN required.
- Bilingual in English and Spanish (Fluency Speaking/Writing)
- Must be flexible to work days or evenings based on business needs
Preferred requirements
- For non-standard shift positions/State License Requirements: Available to work (Evenings after 11:30 a.m.) with a 12% shift differential.
- Must have an active and unencumbered RN License in the State of Residence
- Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management.
- Excellent communication skills including telephonic (verbal) and digital (messaging, emails).
- Skilled in clinical acumen to form a judgement and act.
- Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research.
- Ability to recognize, address and resolve conflicts in a professional, collaborative manner.
- Demonstrates sensitivity to culturally erse situations, participants, and customers.
- Demonstrates effective organizational skills and flexibility to meet the business needs.
- Adapts approach and demeanor in real time to match the shifting demands of different situations.
- Ability to manage multiple, complex situations in a fast-paced environment collaborating with clinical and other business partners.
- Some roles may require on-site meetings or audits twice a year require

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 75,300 – 125,500 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.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Evernorth Health Services

Evernorth Health Services, a ision of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] an update on your application or to provide your resume as you will not receive a response.

Qualified applicants with criminal histories will be considered for employment in a manner

consistent with all federal, state and local ordinances.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Care Advice Line Registered Nurse 1

Privia Health Remote.co8 days ago

Apply Now8 days ago

location: remoteus

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Care Advice Line Registered Nurse 1

CAL RN 1

Remote, USA, United States
Part-time
Department: 340 – Care Advice line

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

We are always seeking top talent for the After Hours Care Manager position and are currently reviewing resumes. If you meet the qualifications and are interested in future opportunities, we encourage you to appl

We are actively recruiting for an After Hours Care Manager to join our rapidly growing Population Health team. The primary role of the Care Manager will be to provide our patients with on-demand telephone-based care management services through a 24/7 Nurse Advice Line (i.e. telephone triage). Care Managers will assess symptoms/concerns of callers to determine the urgency and type of care needed, refer to or schedule appointments with providers as appropriate, and give health information and advice to callers. The goal of the Nurse Advice Line is to reduce unnecessary visits to the clinic and emergency department, provide information for self-care and symptom management, and to coordinate care across the healthcare delivery system. Care Managers operate in a team-based model, acting as an extension of the primary care provider.

Primary Job Duties:

Handles inbound communications from patients who are seeking information about symptoms or care concerns
Conduct outbound communications for follow-up and care coordination
Consult and coordinate with internal and external team members to assess, plan, implement and evaluate patient care plans, make appropriate referrals, and provide follow-up
Assist with finding appropriate providers, community resources, care solutions and coordinate priority appointments
Record member data in Privia’s web-based medical record system and associated EMRs, or health portals.
Research information online and in Privia’s internal knowledge databases
Provide health information, coaching, and critical thinking skills to assist our members with medical and wellness related issues
Other care management activities as needed (e.g. close “gaps in care,” complex care plans, etc.)
Must comply with HIPAA rules and regulations

Qualifications

This part-time role is primarily available for Nights, Weeknights and Holidays (9pm-9am EDT) , with flexible and alternating shifts (2, 4, 8, 6, 10 & 12 hours).
- Must maintain “on average” at least 16 hours of nights and/or weekend coverage)/week or 64 hours/month. Weekend times span from Friday, 9p EDT – Monday, 9a EDT. Flexible time off as needed.
Privia will help set up the home office setting with computers, high speed internet access and other equipment needed for the role.
Registered Nurse (RN) with current resident compact licensure in assigned state(s).
Bachelor’s degree, required
Experience in a call center, triage position, consulting environment or like environment.
Minimum 3+ years of recent clinical experience, with problem-solving and critical-thinking skills
Disease Management, Case Management, Utilization Review or Wellness experience
Without question, ‘Exceptional Customer Service’
Strong computer skills. Internet savvy
Clear, confident communication and listening skills
Self -motivated and self-disciplined a must
Willingness to do what it takes to get the job done and make patients the number one priority
Able to thrive in a quiet, secure home office environment
Detailed-oriented, organized with the ability to work well in fast-paced work environment
Bilingual – Spanish, Korean, Vietnamese, or Farsi preferred

The hourly range for this role is $24 to $31hr in base pay. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

Technical Requirements (for remote workers):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment.This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.

Nurse Care Manager - Telehealth

Signallamp Health Remote.co8 days ago

Apply Now8 days ago

location: remoteus

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Nurse Care Manager – Telehealth

USA
per hour Hourly pay with bonus opportunities
Hourly
Full Time

Join Signallamp Health: Empower Patients from the Comfort of Your Home

We’re on a mission to redefine the healthcare experience for chronically ill patients, and we need passionate Nurses to join our journey.

Imagine this: Most people only see their doctors when they’re unwell, face the stress of booking appointments, and endure lengthy waits in crowded waiting rooms. But what happens in those critical moments between visits? Who’s there when they grapple with medication side effects, need assistance with transportation, or are torn between a trip to the ER or waiting it out?

At Signallamp, we’ve transformed remote care management to ensure that these vulnerable iniduals are never alone. As a part of our team, you’ll work comfortably from your home, maintaining consistent connections with patients, offering them the guidance they need to navigate their health challenges, and ultimately bridging the gaps that traditional healthcare often overlooks.

Join us, and be at the forefront of compassionate, innovative care as one of our Registered Nurse Chronic Care Managers or Licensed Practical Nurse Chronic Care Managers.

Nursing on Your Terms: Home-Based, Tailored Schedules, Meaningful Relationships

As a Chronic Care Manager with Signallamp, you’ll deliver the compassionate care and patient education you’re renowned for, but with the added benefit of working from home. Skip the daily commute, save on gas, be there for your family when they need you, and enjoy the simple pleasures, like your pet’s company or flexibility for personal appointments.

Work schedule M-F 8-430pm EST or 11-730pm EST

After your first 6 months, choose a schedule that fits YOU:

4 days x 8 hours

4 days x 9 hours

4 days x 10 hours

Pick the rhythm that suits your life. And guess what? Your benefits stay the same!

Our nursing team is the backbone of long-lasting patient relationships. Engaging with the same iniduals monthly, our nurses offer the consistent, personalized support that is often missing in busy doctor’s offices. This level of attention not only makes patients feel valued but also empowers them to take better care of themselves, ensuring a longer, active, and safer life.

Benefits

Medical, dental, vision, short term disability, long term disability, life insurance
PTO, sick and holiday pay (including Black Friday, Christmas Eve and your birthday!)
Continuing Education Credits (CEU) paid for
Additional State licensure paid for
Employee Assistance Program (EAP) – free and confidential
401k with company match
Potential to flex time
Retention, referral and productivity bonus payments

A Day in the Life of a Chronic Care Manager

– Engage in regular check-ins with patients: Discuss changes since the last conversation, follow up on appointments, and understand any new instructions from their doctor.

– Delve into rich conversations and bond with patients, understanding their unique personalities and challenges.

– Establish and nurture trust with new patients and their families.

– Act as a vital link within the patient’s care team: Communicate seamlessly with providers and in-office staff.

– Harness your expertise to:

– Guide patients in prioritizing their health and understanding their conditions.

– Advocate for patients, providing answers and addressing medical concerns promptly.

– Use technology to manage and coordinate care, from gathering resources to setting care goals.

Utilize Electronic Medical Record (EMR) systems to:

– Review recent office visits.

– Liaise with the care team.

– Accurately document all actions taken for patients.

Hear more about working at Signallamp https://signallamphealth.com/learnaboutus/

You’re a Great Fit If Your Qualifications include:

Compassion: At the heart of everything, you provide heartfelt care to patients.

Licensing: You’re an RN/LPN licensed in any U.S. state. If your role involves caring for out-of-state patients, we’ll cover your licensing fees.

Experience:

– Minimum of 4 years in nursing care for chronically ill patients.

– Background in home health or primary care settings is a plus.

– Proficiency in using Electronic Medical Records (EMR).

Tech-savvy: Confidence in learning and adapting to new technology tools.

Time Management: Proven skills in managing your time effectively, especially when remote working.

Communication: Exceptional active listening skills, along with clear written and verbal communication.

Adjunct Faculty - Nursing

Excelsior College Remote.co8 days ago

Apply Now8 days ago

location: remoteus

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Adjunct Faculty – Nursing

Location: Virtual United States

Job Description:

Instructional faculty report to the Department Chair overseeing the course/content area they are teaching. This is a remote online part-time faculty position based within the continental United States.

Excelsior University provides fully developed courses with materials and activities to allow the faculty to focus on the students. Part-time faculty should expect to provide prompt and substantive responses to student needs, hold virtual office hours, assist in proctoring if applicable, offer timely formative feedback on student work, and demonstrate their subject matter expertise through constructive involvement with student discussions and learning activities. In addition, Excelsior looks for our instructional faculty to demonstrate a commitment to student success by supporting college engagement and retention initiatives, reaching out to struggling students and collaborating with faculty and support staff to ensure students have access to all available resources that impact success.

Duties and Responsibilities:

Implementing courses as designed by the University.
Bring inidual knowledge and expertise on the subject matter in the engagement of students.
Engage regularly and substantively with students via email, announcements, and online discussion boards.
Provide timely, high-quality feedback on student work.
Hold regular virtual office hours, weekly.
Participate in ATI proctoring if applicable.
Keep the department chair apprised of any student or course issues.
Follow University policies.
Complete University-required training and attending required pre-term meetings.
Respond to all messages from students and the University within 48 hours.
Utilize provided rubrics to grade all assignments timely and provide narrative feedback that summarizes the strengths and areas in need of improvement.
Cultivate a caring environment that supports open dialogue, collaboration, and opportunities for scholarly growth.
Enforce all University policies listed in the Faculty Handbook.
Submit final grades timely, within 3 days after the end of the term.

Qualifications: To perform this job successfully, an inidual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

Earned doctoral or terminal degree in Nursing or related field from a regionally accredited institution.
New York Registered Nurse licensure or the willingness to apply for New York state licensure.
Strong verbal and written communication skills, with ability to present information clearly, concisely, and accurately; friendly, persuasive speaking and writing style.
Experience in Nursing Education in areas such as teaching-learning strategies, educational technologies, writing course and module outcomes, curriculum design, assessment and evaluation strategies, and research, etc.

Rate of Pay:

A flat rate of $1000 per credit for a section of at least 10 undergraduate students or 8 graduate students. Courses that fall under these student headcounts are considered low enrolled courses.
Low enrolled courses will be paid on a directed study rate ($250/student for undergraduate courses and $300/student for graduate courses) based on the number of students enrolled in the course section at the close of late registration.

Remote applicants please be aware that the University is required to withhold New York state income taxes from your wages, as well as the state income tax, if applicable, in the state where you perform services. This is because of New York’s “convenience of the employer” rule, which requires the University, as a New York employer, to withhold New York income tax from the wages of its employees working outside of New York if the employee’s work is performed outside of New York for the convenience of the employee, rather than out of a business necessity of the University.

Senior Clinical Data Science Lead

ICON plc Remote.co9 days ago

Apply Now9 days ago

location: remoteus

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Senior Clinical Data Science Lead

Multiple US Locations

JR118622

Clinical Data Management, Data Science
ICON Full Service & Corporate Support
Hybrid: Office/Remote

About the role

Sr. Clinical Data Science Lead-US, Remote

ICON plc is a world-leading healthcare intelligence and clinical research organization. We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join us on our mission to shape the future of clinical development.

We are seeking a Senior Clinical Data Science Lead to join our erse and growing team within our Biotech Government and Public Health ision. You will be joining the world’s largest & most comprehensive clinical research organization, powered by healthcare intelligence. The Senior Clinical Data Science Lead (Senior CDSL) serves as the primary contact for internal and external team members regarding clinical data science data review activities and leads these review activities to ensure delivery of data fit for analysis. They are accountable for achieving clinical data science deliverables on-time, with high-quality, and to agreed financial metrics.

What you Will be Doing:

Develop and oversee timeliness of clinical data science activities during the life cycle of studies as it relates to data review and data delivery milestones
Provide input into clinical system development activities and clinical risk management activities
Track and keep functional management and those responsible for project management informed of any issues that might affect project target dates, scope or budget and escalates potential problems effectively and in a timely manner
Forecast budget, hours, and resourcing for clinical data review activities
Perform analytic review as defined in the scope of work and functional plans focusing on errors that matter or have a meaningful impact on the safety of the subject or interpretation of the final analysis
Accountable for the development of planning documents related to data review, data analytics, and data deliverables.
Participate in Sponsor and/or third-party audits.
Negotiate timelines and key deliverables with clients and/or external customers, vendors, and departments as needed
Travel (approximately 15%) domestic and/or international

Your Profile

5+ years of clinical data management experience in clinical research
2+ years of experience working in a clinical research organization (CRO)
Experience as a functional lead of multiple low and moderately complex studies, whilst acting as a resource for less experienced colleagues
Experience with all steps within the data science lifecycle and most major data science study tasks with proficiency in at least one Clinical Data Management system required (e.g., Medidata Rave, Crucial Data Solutions TrialKit, Inform, Oracle Clinical, Veeva)
Excellent communication skills
Budget and timeline management experience
Data Analytic and Data Validation experience
Bachelor’s degree or local equivalent

#LI-Remote

#LI-TG2

What ICON can offer you:

Our success depends on the quality of our people. That’s why we’ve made it a priority to build a erse culture that rewards high performance and nurtures talent.

In addition to your competitive salary, ICON offers a range of additional benefits. Our benefits are designed to be competitive within each country and are focused on well-being and work life balance opportunities for you and your family.

Our benefits examples include:

Various annual leave entitlements
A range of health insurance offerings to suit you and your family’s needs.
Competitive retirement planning offerings to maximize savings and plan with confidence for the years ahead.
Global Employee Assistance Programme, LifeWorks, offering 24-hour access to a global network of over 80,000 independent specialized professionals who are there to support you and your family’s well-being.
Life assurance
Flexible country-specific optional benefits, including childcare vouchers, bike purchase schemes, discounted gym memberships, subsidized travel passes, health assessments, among others.

ICON, including subsidiaries, is an equal opportunity and inclusive employer and is committed to providing a workplace free of discrimination and harassment. All qualified applicants will receive equal consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Paralegal

QuadMed Remote.co13 days ago

Apply Now13 days ago

location: remoteus

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Paralegal

United States

GENERAL PURPOSE OF JOB

Support and assist the legal team with a variety of responsibilities including contracts, case management, and other legal matters related to clients, vendors, and the healthcare industry.

KEY RESPONSIBILITIES

Act as liaison among various internal departments, funnel legal requests, and manage work allocation for the Legal team.
Develop resources and tools for the business to self-serve legal issues, and training resources for the Legal team to use with business partners.
Assist attorneys with drafting, reviewing, and revising legal documents, including provider, vendor, corporate, and client contracts as well as legal correspondence and memoranda.
Assist attorneys with management of healthcare-related litigation, including discovery, subpoenas, and preparing documents for hearings or trials.
Assist attorneys with legal research, case preparation, and document management related to healthcare law and regulatory matters.
Maintain and organize agreements and files, ensuring proper documentation and compliance with legal standards.
Support enterprise contract lifecycle management system.
Support the legal team in ensuring compliance with federal, state, and local healthcare regulations, including HIPAA.
Monitor regulatory changes that impact the healthcare industry and provide timely updates to the legal team.
Assist in responding to subpoenas and requests for medical records and patient information.
Other duties as assigned.

JOB REQUIREMENTS

Education:

Associates or bachelor’s in paralegal studies or a related field, or Paralegal certification.

Experience:

At least 8 years’ experience working as a paralegal either in corporate or law firm environment.
Experience in a healthcare environment preferred.

Certificates, Licenses, Registrations:

Paralegal certification preferred; required in the absence of Associate and/or bachelor’s degree in paralegal studies.

Knowledge, Skills & Abilities:

Ability to follow projects through to completion.
Strong attention to detail and accuracy.
Flexibility and ability to manage time independently and efficiently.
General familiarity with legal matters.
Excellent written and verbal communication skills.
Intermediate Proficiency in Microsoft Applications: Word, Excel, PowerPoint.
Strong interpersonal skills.
Must maintain a professional demeanor.
Must work well in a fast-paced, team-oriented environment and be able to take on independent responsibility.
Strong prioritization, organization, and project management skills.
Proven ability to work successfully with erse populations and demonstrated commitment to promote and enhance ersity and inclusion.

Coding Specialist 4 - Integrated procedures

University of Washington Remote.co14 days ago

Apply Now14 days ago

location: remoteus

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Title: Coding Specialist 4 – Integrated procedures

Location: Seattle United States

Req #:239439

Department:UW MEDICINE ENTERPRISE RECORDS & HEALTH INFO

Job Location: Remote/Hybrid

Salary:$5,749 – $8,228 per month

Other Compensation:

Union Position:Yes

Shift:First Shift

Benefits:As a UW employee, you will enjoy generous benefits and work/life programs. For a complete description of our benefits for this position,

Job Description:

UW Medicine Enterprise Records and Health Information has an outstanding opportunity for a CODING SPECIALIST 4, INTEGRATED PROCEDURES.

WORK SCHEDULE

100% FTE, Days

100% Remote

POSITION HIGHLIGHTS</p>

Implements the mission and goals of Enterprise Records and Health Information and incorporating a “patients are first” service culture

Performs daily activities related to coding and charge submission of abstract Current Procedural Terminology (CPT) professional fee and facility integrated procedure coding and billing

Analyzes the medical record to assign International Classification of Diseases (ICD), CPT and/or Healthcare Common Procedure Coding System (HCPCS) codes to ensure correct code assignment and optimal reimbursement in compliance with state and federal guidelines.

DEPARTMENT DESCRIPTION

Enterprise Records and Health Information (ERHI) is a Shared Service Department that supports all aspects of the patient medical record from governance, integrity, documentation timeliness, completion, clinical coding, billing, release, and tracking to management of access, retention, and destruction.

ERHI provides advice and resources related to the lifecycle management of all UW Medicine records

ERHI is an integral part of the Enterprise Revenue Cycle and has a unique role in the organization that supports both clinical and operational activities.

PRIMARY JOB RESPONSIBILITIES

Reviews available electronic and other appropriate documentation within Epic, or other source system to identify all billable procedures and services requiring facility and/or professional fee coding, ensuring all necessary codes use the appropriate ICD, CPT and/or HCPCS code

Ensure coded services, charges and clinical documentation meet appropriate guidelines or standards.

Queries physicians and/or consults with clinical department representatives, as appropriate, to verify services rendered and documented

Provides feedback to assist in the understanding of coding and documentation issues and opportunities.

Maintains seven- day turnaround times for Integrated Coding areas Cardiology, Gastroenterology and Pulmonology for those services and procedures that ERHI is responsible for coding; and understands charge lag impacts for facility and professional fee services

REQUIRED POSITION QUALIFICATIONS

High school diploma or equivalent

Three years of coding experience or equivalent education/experience.

Certified as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Interventional Radiology Cardiovascular Coder (CIRCC), Radiology Certified Coder (RCC) or Radiation Oncology Certified Coder (ROCC).

UW Medicine – Where your Impact Goes Further

UW Medicine is Washington’s only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine’s mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow’s physicians, scientists and other health professionals.

All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored. Nearly 29,000 healthcare professionals, researchers, and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center, UW Medical Center – Montlake, UW Medical Center – Northwest, Valley Medical Center, UW Medicine Primary Care, UW Physicians, UW School of Medicine, and Airlift Northwest.

Certified Coder

Community Health Network Remote.co14 days ago

Apply Now14 days ago

location: remoteus

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Certified Coder

Primary Location: United States-California-Fountain Valley

Job: Coder

Organization: MemorialCare Medical Foundation

Schedule: Full-time

Employee Status: Regular

Job Level: Staff

Work Schedule: 8/40 work shift hours

Shift: Day Job

Department Name: Document Improvement

HIM Clinical Inpatient Coder II

Children's Hospital Boston Remote.co14 days ago

Apply Now14 days ago

location: remoteus

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Title: HIM Clinical Inpatient Coder II – (Remote)

Location: United States

Status: Full-Time

Standard Hours per Week: 40

Job Category: Finance

Regular, Temporary, Per Diem: Regular

Remote Eligibility: Full-Time Remote

Job Description:

Under direction of HIM Coding leadership, abstracts, sequences and assigns diagnosis and procedure codes according to CMS Coding guidelines, CMS Correct Coding initiatives, ICD 10 CM and ICD-10-PCS coding conventions and Uniform Hospital Discharge Data Set UHDDS definitions to medical records of complex discharged inpatients including cases such as congenital conditions, trauma, post procedure complications, more complex fractures, spinal fusions and VP shunts. Assure timely completion for billing and reporting, as required for reimbursement and maintenance of patient database.

The HIM Clinical Inpatient Coder II – Remote will be responsible for:

Reviewing and interpreting medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures.
Abstracting data elements to satisfy statistical requests by the hospital, health system, medical staff, etc., and entering all coded/abstracted information into the designated system.
Utilizing standard coding guidelines, principles, and coding clinics to assign the appropriate ICD-10-CM codes for inpatient records to ensure accurate reimbursement.
Assuring the diagnosis and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG for accurate reimbursement. Reviewing coding for accuracy and completeness prior to submission to billing systems utilizing coding edits.
Ensuring efficient management of medical information and DNB as it pertains to the unbilled coding report.
Keeping informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics, and other resources, and implementing these updates in daily work.
Being proficient in technology usage such as Epic, Solventum (3M 360) systems.
Knowing Computer Assisted Coding (CAC).
Knowing when to escalate issues for resolution.
Acting as a mentor and subject matter expert to others.
Engaging in process improvement with coding team and management.
Working remotely.
Performing other duties as assigned or required.

To qualify, you must have:

High School / GED and an inpatient coding certification program or an Associate’s Degree in Health Information Management is required
Current AHIMA or AAPC Coding Certifications : CCS, CCSP, or CPC is preferred.
A minimum of one year of progressively complex Acute care inpatient setting inpatient is required
Fully remote position

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

#LI-Remote

Nurse Care Manager

Included Health Remote.co14 days ago

Apply Now14 days ago

location: remoteus

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Title: Nurse Care Manager (Adult), Temp to Hire

Location: Remote

Type: Contractor

Workplace: remote

Category: Clinical Strategy and Services

Job Description:

We’re looking for Nurse Care Managers for our Care and Case Management team, who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. The telephonic Nurse Care Manager will guide members through complex medical and behavioral Health situations, partnering with a multidisciplinary clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in an innovative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members’ needs, answering questions, and serving as an advocate. They should also excel at creating cohesive care plans, and should possess the clinical acumen to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.

Responsibilities:

Deliver coordinated, patient-centered virtual Care Management by telephone and/or video that improves members’ health outcomes.
Generate impactful care plans together with members and our multidisciplinary care team, and help members achieve the desired goals.
Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
Partner with the members’ local providers to ensure coordinated care.
Provide compassionate, longitudinal follow-up care, building supportive relationships.
Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
Coordinate necessary resources that holistically address members’ problems, whether clinical or social

Qualifications:

Bachelor of Science in Nursing (BSN).
Must have current CCM Certification
5+ years of experience in nursing preferred.
2+ years experience working in care management
Must reside in a compact NLC state.
Active Compact RN license in good standing with the nursing board of their state.
Active California Nursing License preferred
Willingness to become (and maintain) licensure in multiple states.
Work until 6pm PST (Preference for those based in MST/PST time zones)
Be comfortable discussing a wide variety of medical conditions and experience with populations across the age ranges
Spanish speaking desirable
Experience working remotely preferred; Comfortable with technology, as well as strong competence and ability to use multiple computer/medical record systems.
Be highly empathetic. We work with patients and their families who are going through challenging times. Ideal candidates practice empathy and reassure patients that we are available to help them.
Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet volume goals without sacrificing quality. Good judgment for balancing priorities is a must.
Be flexible and comfortable with working in a rapidly-changing environment.
Strictly follow security and HIPAA regulations to protect our patients’ medical information.
Be pleasant, responsive, and willing to work with and learn from our team.
Strong verbal and written communication skills. A lot of time is spent on the phone with patients and families, as well as a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
Excellent grammar, attention to detail, and efficient at writing medical information in easy-to-understand, patient-centric language.

Schedule: M-F 9a-6p PST

About Included Health

—–

Registered Nurse

Allina Health Remote.co14 days ago

Apply Now14 days ago

location: remoteus

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Registered Nurse

Title: RN Daytime Triage – Remote

Location: Minneapolis United States

Job Description:

Number of Job Openings Available:

Date Posted:

October 04, 2024

Department:

62000635 Allina Health Group Daytime RN Triage

Shift:

Day (United States of America)

Shift Length:

8 hour shift

Hours Per Week:

Union Contract:

Non-Union

Weekend Rotation:

Every 3rd

Job Summary:

Allina Health is a not-for-profit health system that cares for iniduals, families and communities throughout Minnesota and western Wisconsin. If you value putting patients first, consider a career at Allina Health. Our mission is to provide exceptional care as we prevent illness, restore health and provide comfort to all who entrust us with their care. This includes you and your loved ones. We are committed to providing whole person care, investing in your well-being, and enriching your career.

Key Position Details:

Remote Role: Must live within one hour of Apple Valley, MN

.8 FTE (64-hours per 2-week schedule)
8-hour day shifts
Every third weekend rotation
High Volume Phone Triage
Will also be cross trained to complete medication refills
Rotating Holiday schedule
Benefit Eligible

Job Description:

Nursing is the diagnosis and treatment of human response to actual or potential health problems. This includes establishing an intentional therapeutic relationship between a registered nurse and a patient and family. As a leader and the integrator of care, the professional nurse has the responsibility, authority, and accountability for planning, coordinating and evaluating the patient’s care needs.

Provides patient care support for centralized nursing program, outpatient and home care services. This includes Triage services, Anti-coagulation, and refill. Iniduals in this role will work in an outpatient clinic setting.

Principle Responsibilities

Assessment.
Collects, prioritizes and synthesizes comprehensive data pertinent to the patient’s health or situation.
Collects and prioritizes data in a systematic and ongoing process that involves the patient, family, other health care providers and environment as appropriate.
Integrates data relevant to the situation to identify needs, patterns and variances.
Uses appropriate evidence based assessment techniques and instruments in data collection.
Diagnosis.
Analyzes assessment data to determine nursing diagnoses.
Interprets assessment information to identify each patient’s needs relative to age, developmental stage and culture.
Formulates, revises and resolves nursing diagnoses that reflect the current patient status.
Validates and communicates nursing diagnoses with the patient, family and other health care team members.
Documents nursing diagnoses in compliance with the patient care guidelines.
Outcomes Identification.
Identifies expected outcomes inidualized to the patient.
Establishes, in the collaboration with the family, patient, realistic and measurable patient expected outcomes based on nursing diagnoses, patients present and potential capabilities, goals, available resources and plan for continuity of care.
Planning.
Develops a plan that prescribes interventions to attain expected outcomes.
Develops an inidualized plan considering patient characteristics or the situation as appropriate in conjunction with the patient, family and others.
Establishes a plan that provides for continuity of care.
Incorporates evidence based nursing practice takes into consideration current statutes, rules and regulations when developing the plan of care.
Implementation.
Implements the identified plan.
Implements interventions in a safe, timely, appropriate manner.
Utilizes evidence-based interventions and treatments specific to the diagnoses as appropriate.
Coordinates implementation of the plan of care if appropriate
Documents interventions according to documentation guidelines.
Evaluation.
Evaluates the patient’s progress towards attainment of the outcome.
Evaluates the patient’s/family’s understanding of and response to the plan of care.
Utilizes systematic and ongoing assessment data to revise diagnoses, outcomes and the plan of care.
Involves the patient, family, and health care team members in the evaluation process when appropriate.
Documents revisions in diagnoses, outcomes and the plan of care according to documentation guidelines.
Quality of Practice.
Systematically enhances the quality and effectiveness of nursing practice.
Participates in quality improvement activities related to nursing practice.
Incorporates available QI data to improve nursing practice and outcome.
Education.
Attains knowledge and competency that reflects current nursing practice.
Participates in educational activities related to nursing practice.
Acquires and applies the knowledge gained from educational experiences to current nursing practice.
Professional Practice Evaluation.
Evaluates one’s own nursing practice in relation to professional practice standards and regulatory guidelines.
Engages in self-evaluation of practice on a regular basis, identifying strengths and goals for professional development.
Obtains informal feedback regarding one’s own practice from patients, peers, professional colleagues, and others.
Collegiality.
Contributes to the professional development of peers, colleagues, and others.
Shares knowledge and skills in practice settings.
Provides immediate and ongoing positive and constructive feedback to colleagues regarding their performance.
Contributes to a supportive and healthy work environment.
Collaboration.
Collaborates with patient, family, and others in the conduct of nursing practice.
Partners with others to effect change and generate positive outcomes through knowledge of the patient or situation.
Ethics.
Acts in an ethical manner.
Maintains a therapeutic and professional patient-nurse relationship with appropriate professional role boundaries.
Serves as a patient advocate assisting patients in developing skills for self-advocacy
Uses available resources to help formulate ethical decisions.
Research.
Integrates research findings in practice.
Utilizes the best evidence, including research findings, to guide practice decisions.
Resource Utilization.
Incorporates factors related to safety, effectiveness, cost, and impact on practice in planning and delivering patient care.
Utilizes resources related to standards of care in a safe, effective and ethical manner.
Manages resources to assure they will be accessible to other in the future.
Leadership.
Provides leadership in the professional practice setting and the profession.
Functions as a professional role model.
Promotes a positive work environment.
Participates in shared decision-making.
Environmental Health.
Practices in an environmentally safe and healthy manner.
Attains knowledge of environmental health concepts, such as implementation of environmental health strategies.
Promotes a practice environment that reduces environmental health risks for workers and healthcare consumers.
Communicates environmental health risks and exposure reduction strategies to healthcare consumers, families, colleagues and communities.
Charge Nurse (only when acting in this role).
Demonstrates ability to coordinate and direct unit operation so the patient and family needs are met and resources are efficiently utilized in a safe manner.
Promotes an environment that encourages inidual growth, nurtures professional practice and fosters teamwork.
Collaborates effectively with unit staff, leadership and other disciplines.
Preceptor (only when acting in this role).
Demonstrates ability to identify the orientee’s learning needs and plans appropriate learning experiences.
Demonstrates ability to implement an inidualized orientation plan for the orientee.
Demonstrates ability to validate clinical competence of orientee.
Facilitates development of organizational and prioritization skills of orientee.
Demonstrates ability to evaluate interpersonal sills of orientee.
Serves as a professional role model.
Facilitated socialization of orientee into the organization and work group.
Other duties as assigned.

Required Qualifications

Associate’s or Vocational degree in nursing
Minimum 3 years RN experience

Preferred Qualifications

Experience in triage, anticoagulation, or remote nursing support

Licenses/Certifications

Licensed Registered Nurse-MN Board of Nursing required
Licensed Registered Nurse-WI Dept of Safety & Professional Services required by completion of orientation

Physical Demands

Sedentary:
Lifting weightUp to 10 lbs. occasionally, negligible weight frequently

Registered Nurse

Calibrate Health Remote.co14 days ago

Apply Now14 days ago

location: remoteus

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Registered Nurse

Location: United States

A modern approach to weight requires modern practices, and that means radically remodeling how intensive lifestyle intervention programs operate and scale. As part of our clinical program team, you’ll deliver several critical components of the Calibrate program: outreach and support for members to enhance their program progress, clinical program coordination, and confirmation of clinical appropriateness for clinical care pathways, introduction to our method, and setting program plans with members.

In addition to providing exceptional patient care, your feedback on how we can continue to improve our program to help patients achieve-and maintain-their metabolic health and weight loss goals will help shape and improve the program.

This is a part-time, hourly role with a rate of $50.00 per hour. Benefits are not included. There are two shifts being offered: 10am-6pm EST or 11am-7pm EST

Additional Details:

- Malpractice coverage provided by employer

- Weekdays plus possible weekend hours required

- Ability to flex hours up based on business needs during peak time

- Training will require a full-time weekday schedule for 3 weeks with some training during EST working hours

KEY RESPONSIBILITIES

- Consistently provide a world-class level of patient experience and clinical care

- Utilize and support a detailed clinical treatment paradigm, developed and updated by the Calibrate team and specialized to support obese patients achieve weight-loss goals

- Provide care management for patients who need additional clinical support throughout the program

- Serve as a program ambassador to address clinical and programmatic questions for patients at all stages of their Calibrate journey

- Engage cross-functionally with physicians, nurse practitioners, and support teams to coordinate care for patients

- Review and manage daily tasks; patient messaging and callbacks

BACKGROUND AND EXPERIENCE

- Bachelor of Science Degree in Nursing (BSN) graduate of an accredited school of nursing

- Current state license(s) in the state(s) practicing

- At least three years of direct clinical experience required, leadership experience preferred

- At least one year of health tech experience required

- At least two licenses required, one of which must be from the following list: Compact or, OR, IL, CT, HI, AK, CA

- Primary/preventative care, acute care, or emergency medicine experience required

- Demonstrated excellent written/verbal communication skills and virtual “bedside” manner

- Excellent communicator & critical thinker, with a customer service mentality

- Experience with project management, and strong organizational and time management skills

- Creative problem-solving skills that can be leveraged to empower others and drive member outcomes

- Self starter, solutions-oriented mentality

- Excited to build and deliver a new model for achieving lasting weight health

- Adaptable and flexible, but always puts the patient first

- Excellent at forging successful and respectful relationships with the entire team

- Quick learner, comfortable using a variety of applications and software

BENEFITS

- Competitive salary with opportunity for equity in an early stage, high growth business

- Generous paid time off, including an all-company holiday over Thanksgiving week

- Calibrate-funded health benefits (medical, dental, vision) – starting at zero cost to you

- Calibrate-paid disability and basic life insurance to give you peace of mind during unforeseen events

- Therapy on your time with free access to Headspace and HeadspaceCare

- An employee assistance program through Guardian to provide counseling across a range of personal topics

- Remote-first team

Competitive Paid Parental Leave for parents

Health Services Coordinator -Sales Account Coordination

Life Line Screening Remote.co16 days ago

Apply Now16 days ago

location: remoteus

Apply Now

Health Services Coordinator -Sales Account Coordination

Remote

Full Time

Entry Level

The Power of Prevention encompasses all that we do at Life Line Screening.

Do you have a passion for building and maintaining relationships and accounts? We’re looking for someone who believes in what we do and wants to help grow by identifying new locations and following up on previous partnerships that utilize our services hosting events for members of their communities and surrounding areas. This role is ideal for someone with a background in community outreach and marketing, fundraising, and following up on warm leads. This is a remote work from home position and requires experience in that type of setting with discipline and the ability to work independently meeting and exceeding goals and expectations.

What you’ll do:

The Community Sales Coordinator (known internally as Health Services Coordinator) will be responsible for effectively calling potential leads and developing long-term relationships with various community organizations. Plan, schedule, and coordinate a minimum of 32 to 35 community health events on a monthly basis, while prospecting for future events. Strong attention to detail and follow-through are required to book quality sites, effectively increasing overall revenue opportunities and providing a top-notch environment for our customers.

What you’ll need to be successful:

High School diploma or equivalent required
The ability to educate and gain buy-in from key stakeholders to book spaces
1-2 years’ experience with inside sales or call center (similar role/responsibilities)
1-2 years’ experience working in a remote/work from home capacity with little direction or supervision needed
Goal-oriented and motivated by a fast-paced environment
Ability to negotiate rates and be mindful of budget
Salesforce experience is a plus but not required
Excellent verbal and written communication skills
Strong attention to detail and organizational skills
Proven success in the sales and account management field
Ability to work within deadlines
Ability to make “cold-calls”
Skills in meeting and logistic coordinators
“Grass-roots” marketing experience

Life Line Screening is proud to be an equal opportunity employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age disability, protected veteran status, or other characteristics protected by law. Life Line Screening will only employ those who are legally authorized to work in the United States for this opening. Any offer of employment is conditional upon the successful completion of a background check and drug screen.

Nurse Case Manager - Workers' Compensation

Progressive Insurance Remote.co20 days ago

Apply Now20 days ago

location: remoteus

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Nurse Case Manager – Workers’ Compensation

Job Number: 234727

Join Forbes’ 2024 Best Employer for Diversity!

As a nurse case manager on our Workers’ Compensation Claims team, you’ll focus on telephonic medical case management, prioritizing early intervention and return-to-work strategies. In this role, you’ll coordinate high-quality medical care for claims involving disability and medical treatment. Additionally, you’ll provide in-house medical reviews to ensure compliance with claims handling laws and regulations.

Must-have qualifications

· Bachelor’s degree or higher from an accredited institution in a health or human services field, a minimum of five years clinical experience, and an active nursing license (i.e. RN, LCSW)

Preferred skills

Workers’ compensation or occupational accident experience
Insurance case management experience
Understanding of diagnosis codes (i.e., ICD-10)
Exposure to a broad severity of injuries, including catastrophic

Compensation

$70,100- $93,500/year
Gainshare bonus up to 24% of your eligible earnings based on company performance

Benefits

401(k) with dollar-for-dollar company match up to 6%
Medical, dental & vision, including free preventative care
Wellness& mental health programs
Health care flexible spending accounts, health savings accounts, & life insurance
Paid time off, including volunteer time off
Paid & unpaid sick leave where applicable, as well as short & long-term disability
Parental & family leave; military leave & pay
Diverse, inclusive & welcoming culture with Employee Resource Groups
Career development & tuition assistance

Energage recognizes Progressive as a 2024 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership.

Equal Opportunity Employer

For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://www.progressive.com/careers/how-we-hire/faq/job-scams/

#LI-Remote

Job: Claims

Primary Location: United States

Schedule: Full-time

Employee Status: Regular

Work From Home: Yes

TPR Pro Fee Coding Compliance Auditor

Tenet Healthcare Remote.co23 days ago

Apply Now23 days ago

location: remoteus

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Title: TPR Pro Fee Coding Compliance Auditor (Remote based in US)

Location: United States

Job Description:

The Coding Compliance Auditor conducts risk-based coding audits of professional fee diagnosis and procedural assignments in accordance with the official coding guidelines, as supported by clinical documentation in health record.

Essential Duties and Responsibilities:

Understands, interprets, and applies professional fee coding guidelines for coding audits. Audits include a complex review of the medical record to determine coding accuracy as well as compliance with other professional fee services such as teaching physician, incident-to and split/shared services.
Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
Identifies documentation that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, and HCPCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, HCPCS and CPT updates), as directed. Reviews AMA, CMS, and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
Others may be assigned.

Knowledge, Skills, Abilities:

Ability to consistently and accurately audit complex coding of professional fee services
Ability to create clear and concise audit reports
Expert level knowledge of medical terminology, ICD-10-CM/PCS and CPT coding guidelines and methodologies
Must be detail oriented and with the ability to work independently and in team setting
Computer knowledge of MS Office
Must display excellent written and verbal communication skills
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to research difficult coding and documentation issues and follow through to resolution
Ability to work in a virtual setting under minimal supervision

Education / Experience

High school diploma/GED is required.
Associates degree in relevant field preferred or combination of equivalent of education and experience.
Three (3) years coding experience of professional fee services with experience in multiple specialties.
One (1) year of experience in coding audit or quality review work.
AAPC Coding Credential is required.

Compensation:

Pay: $35.00 to $48.80 per hour. Compensation depends on location, qualifications, and experience.
Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
Observed holidays receive time and a half.

Benefits:

The following benefits are available, subject to employment status:

Medical, dental, vision, disability, life, AD&D and business travel insurance
Paid time off (vacation & sick leave)
Discretionary 401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

#LI-DM4

2403029636

Profee - Facility Surgery Coder

Atos Remote.co23 days ago

Apply Now23 days ago

location: remoteus

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Title: Profee – Facility Surgery Coder

Location: Irving United States

Job Description:

Who we are.

We are a team of passionate experts with a clear ambition: applying digital technology to advance what matters for our clients and society.

Together we create reliable and responsive digital foundations for the world’s businesses, institutions, and communities.

Profee – Facility Surgery Coder

Location: Remote (US Wide)

Requirements:

3+ years coding experience

2+ years of Oncology coding experience.

Minimum of 1 Coding Certification from AHIMA or AAPC; RHIA, RHIT, CPC, CCS

HCPCS – EPIC/ 3M 360 CAC experience required.

Experience in multi-specialty Oncology coding.

Experience in coding physician and facility, DX & CPT, Must be able to code for both.

Coder will assign medical diagnoses and procedures using appropriate classifications for assigned areas/record types. Responsibilities: Reviews medical records to determine all appropriate diagnostic and procedural code assignments using the appropriate classifications systems. Communicates with department manager/supervisor on coding, compliance and documentation issues. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Enhances coding knowledge and skills with continuing education activities and by reviewing pertinent literature. Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision.

Rewards and benefits:

Law and Superior Benefits
Wellbeing programs & work-life balance – integration and passion sharing events.
Opportunities for professional growth and career advancement.
Benefits platform -culture, shopping, sport, etc.
Continuous learning programs and online courses.
Possibility to participate to charity and eco initiatives.

Future career path:

After your 1st year in Atos you can apply to any position to keep growing as a professional.

If you’re ready to embark on this exciting adventure with us, sign in on jobs.atos.net.

For any questions, please contact our recruiter Luis Chapa – [email protected]

Join our phenomenal team to grow together!

#LI-US #LI-REMOTE

Learn more about us

At Atos, we embrace ersity as the ultimate engine of ingenuity for our clients, and we constantly strive to create a culture where people feel supported and encouraged. Read more about our commitment here.

Whether it is fighting climate change, promoting digital inclusion, or ensuring trust in data management – tech for good sits at the core of our identity. With numerous global recognitions for our ESG practices, we are committed to building a better future for all by harnessing the power of technology. Learn more here

Outpatient Coder - Same Day Surgery

Datavant Remote.co23 days ago

Apply Now23 days ago

location: remoteus

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Title: Outpatient Coder – Same Day Surgery – Remote – FT/PRN

Location: Remote United States

Requisition ID

2024-37522

# of Openings

Category (Portal Searching)

HIM / Coding

Position Type (Portal Searching)

PRN

Equal Pay Act Minimum Range

$20.00 – $30.00 per hour

Job Description:

Overview

Full Time & PRN Opportunities

Datavant protects, connects, and delivers the world’s health data to power better decisions and advance human health. We are a data logistics company for healthcare whose products and solutions enable organizations to move and connect data securely. Datavant has a network of networks consisting of thousands of organizations, more than 70,000 hospitals and clinics, 70% of the 100 largest health systems, and an ecosystem of 500+ real-world data partners.

We’re looking for experienced and credentialed outpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace!

We’re actively seeking Same Day Surgery/Observation Coders with the following experience:

Infusions/Injections
Facility E/M Leveling
Emergency Department
Ancillary
Academic facility coding

Responsibilities

What you will do:

Review medical records and assign accurate codes for diagnoses and procedures.
Assign and sequence codes accurately based on medical record documentation.
Assign the appropriate discharge disposition.
Abstract and enter the coded data for hospital statistical and reporting requirements.
Communicate documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution.
Maintain a 95% coding accuracy rate and a 95% accuracy rate for APC assignment and meet site-designated productivity standards.
Be responsible for tracking continuing education credits to maintain professional credentials.
Attend Datavant Health sponsored education meetings/in-services.
Demonstrate initiative and judgment in the performance of job responsibilities.
Communicate with co-workers, management, and hospital staff regarding clinical and reimbursement issues.
Function in a professional, efficient, and positive manner.
Adhere to the American Health Information Management Association’s code of ethics.
Be customer-service focused and exhibit professionalism, flexibility, dependability, and a desire to learn.
Handle a high complexity of work function and decision-making.
Possess strong organizational and teamwork skills.
Be willing and able to travel when necessary if applicable.
Comply with all HIM Division Policies.

Qualifications

What you will bring to the table:

Excellent written and verbal communication skills
AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC or CRC).
Strong written and verbal communication skills, adeptness in remote work, and exceptional time management skills.
Experience in computerized encoding and abstracting software.
Required to take and pass annual Introductory HIPAA examination and other assigned testing to be given annually
Proficiency with most or all of these coding specialties (Emergency Department, Same Day Surgery, Ancillary, Observation, Injections/Infusions, E/M leveling)

Bonus points if:

Must be able to communicate effectively in the English language.
2+ years of coding experience in a hospital and/or coding consulting role.
Experience in computerized encoding and abstracting software
Passing annual Introductory HIPAA examination and other assigned testing to be given annually in accordance with employee review

Perks:

20-24 free CEUs per year, provided by Datavant
AAPC/AHIMA dues compensation
Company equipment will be provided to you (including computer, monitor, etc.)
Comprehensive training led by a credentialed professional coding manager

To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion.

This position requires that you provide a high-speed internet connection, subject to applicable expense reimbursement requirements (if any), and a work environment free from distractions. Please note that 1 or more assessments may be required as a condition to being hired for this role. There is no COVID vaccine requirement for this role.

Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated pay range for this role is $20 – $30 per hour.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

This job is not eligble for employment sponsorship.

Equal Pay Act Minimum Range

$20.00 – $30.00 per hour

Specialty Clinic Coding Spec

Mercy Remote.co23 days ago

Apply Now23 days ago

location: remoteus

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Title: Specialty Clinic Coding Spec (Non-Exempt)

Location: United States

Business Professional

Other Professional Non-Clinical

Days

Regular

Full Time

Remote

Job Description:

We’re a Little Different

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.

At Mercy, we believe in careers that match the unique gifts of unique iniduals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”

This is a Remote Position

Please make sure you have your relevant certification(s) listed in your resume or application so we can verify eligibility for this position.

*Please note that as of the posting date of this job announcement, Mercy is unable to offer immigration sponsorship or visa assistance for this position. We encourage all eligible candidates, including U.S. citizens, permanent residents, and those with existing work authorization, to apply.

Overview:

The coder is responsible for reviewing and analyzing documentation present in the medical record for inpatient, outpatient and/or professional services to assign diagnoses/procedure codes as described by the physician(s) of record. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.

Qualifications:

Experience: 3 years coding experience in ICD-10-CM diagnoses/procedure coding and HCPCS/CPT procedure coding in the acute care inpatient/outpatient hospital or professional services setting.
Education: High school diploma
Certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Interventional Radiology Cardiovascular Coder (CIRCC)
Other: Working knowledge and high level of experience with the ICD-10-CM and/or CPT/HCPCS coding classification systems, MS-DRG’s, APC’s, MPFS/RVU’s, POA’s, and HAC’s; dependent upon whether an IP, OP, or Professional Services Coder. The physical demands described here are the representative of the minimums that must be met by an employee to perform all essential functions of the job. Most physical demands are below, plus: Frequent: Repetitive motion involves approximately 25% keyboard and 75% mouse for data entry.

We Offer Great Benefits:

Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period!

We’re bringing to life a healing ministry through compassionate care.

At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We’re expanding to help our communities grow. Join us and be a part of it all.

Nurse Case Manager

Medical Mutual Remote.co23 days ago

Apply Now23 days ago

location: remoteus

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Title: Nurse Case Manager

Location: United States, OH

Job Description:

Note: This position allows you the flexibility to work at home within the state of Ohio. We are looking for applicants that have a strong clinical case management background. Medicare experience is a plus.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and inidual plans.

Under limited supervision, the RN Case Manager evaluates and provides support to members, their families, and physicians in addressing member needs. Educates members and families to make informed personal health care decisions and determines the most effective treatment options. Facilitates communication between member, physician, and community.

Responsibilities

Independently manages complex health care cases by multiple means such as phone, email, and video conferencing. Verifies eligibility, benefits, enrollment history, clinical history, and demographics. Assesses patient needs by gathering information from the member, family, provider, and other stakeholders to monitor and evaluate for medical appropriateness and quality of care. Educates members and assists them in removing barriers and with various treatment options.
Facilitates and implements interventions based on agreed upon care treatment plan developed in collaboration with all participants in the members healthcare team. Coordinates services with community resources and support groups with members.
Keeps up to date on and maintains appropriate documentation within Company and regulatory guidelines, policies, and practices.
Performs other duties as assigned.

Qualifications

Education and Experience:

Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor’s Degree preferred.
3 years as a Registered Nurse with a combination of clinical and case management experience, preferably in the health insurance industry.
Case Management and Home health care experience is a plus.

Professional Certification(s):

Registered Nurse with current State of Ohio unrestricted license. Multiple state licensure preferred and may be required.
Certified Case Manager (CCM) or other industry recognized certification preferred (required within 3 years of hire).
Certification in Motivational Interviewing preferred.

Technical Skills and Knowledge:

In depth knowledge of health insurance benefits, health plans, and industry trends, and the ability to apply knowledge to achieve positive outcomes.
Strong knowledge of behavioral change techniques and health coaching (ex. readiness to change and motivational interviewing)
Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
Knowledge of disease continuums, expected patient outcomes and community services available.
Intermediate proficiency navigating windows and web-based systems and basic Microsoft Office skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
Discounts at many places in and around town, just for being a Medical Mutual team member.
The opportunity to earn cash rewards for shopping with our customers.
Business casual attire, including jeans.

Excellent Benefits and Compensation:

Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance – insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay idends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and inidual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Clinical Navigation, Nurse Practitioner - Physician Assistant

Included Health Remote.co26 days ago

Apply Now26 days ago

location: remoteus

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Clinical Navigation, Nurse Practitioner – Physician Assistant

Location: Remote

Type: Full-time

Workplace: remote

Category: Clinical Strategy and Services – Clinical Team

Job Description:

The Clinical Navigation NP/PA will connect with members using various modalities to assess their needs and goals, provide clinical guidance, and navigate members to resources to improve their health outcomes. This clinician will work with a multidisciplinary team to help optimize patients’ health outcomes.

Responsibilities:

Talk with patients, assess their needs, gather important clinical history, provide appropriate clinical guidance, and navigate them to Included Health services and external benefits as appropriate
Demonstrate strong clinical acumen across a variety of Included Health Service Lines, including Expert Medical Opinion, Treatment Decision Support, Healthy Days, and other service lines based on business needs
Meet Volume Targets: Ensure that the volume of patient encounters meets the established targets. This includes scheduling and conducting a specified number of encounters as outlined by departmental goals.
Maintain Quality of Services: Deliver high-quality clinical services that adhere to established standards and protocols.
Continuous Improvement: Participate in continuous improvement initiatives aimed at optimizing the efficiency and effectiveness of clinical services. This includes staying current with best practices and emerging trends in healthcare delivery.
Collaboration and Coordination: Work closely with other healthcare professionals and administrative staff to coordinate care and ensure that service delivery aligns with overall organizational objectives.
Collaborate across a multidisciplinary team with clinical and non-clinical members to deliver a seamless, top-quality care experience to our patients.
Evaluate, triage and manage pediatric and adult patients for both acute, chronic and mental health conditions
Collaborate on pilots, projects, and workflow changes to increase efficiency and improve member experience
Demonstrate empathy and excellent patient advocacy. You’ll work with patients and their families who are going through challenging times. You need to maintain perspective, demonstrate empathy, and be efficient and reassuring.
Function autonomously and document findings appropriately and timely
Strictly follow security and HIPAA regulations to protect our patients’ medical information
Scheduling flexibility to include evenings and weekends
Other responsibilities based on business need

Required Qualifications

Be a licensed NP/PA provider in good standing with your state board.
Maintain board certification
At least 3 years of NP/PA experience in a clinical setting is required
Willingness to obtain and maintain additional licenses as necessary.
Strong communication skills, with an emphasis on clear and detailed medical documentation.
High empathy and the ability to reassure patients and their families during challenging times.
Strong judgment and efficiency in balancing priorities.
Flexibility to work cross-functionally in a fast-paced environment.
Proficiency and enthusiasm for adopting new technologies, including AI, Electronic Health Records (EHR), and Google apps.
Comfortable providing care to all age groups, from newborns to adults.
Ability to thrive in a dynamic work environment while working independently.

Preferred Qualifications

5+ years of NP/PA experience in a clinical setting is preferred
Virtual care/telemedicine experience is preferred

Schedule

2,080 annual hours
40 hours per week / 80 hours per pay period
Shifts from 8 AM – 5 PM or 9 AM – 6 PM Pacific Time

Physical/Cognitive Requirements:

Regular attendance at assigned work location.
Ability to thrive in a fast-paced, high-intensity work environment.
Ability to remain seated for extended periods.
Manual dexterity sufficient to operate office equipment.
Occasional exertion of up to 20lbs. (e.g., lifting a laptop) may be required.
Professional interaction with leadership, employees, and members.

The United States new hire base salary target ranges for this full-time position are:

Zone A: $108,890 – $141,560 + equity + benefits

Zone B: $125,224 – $162,794 + equity + benefits

Zone C: $136,113 – $176,950 + equity + benefits

Zone D: $141,557 – $184,028 + equity + benefits

This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health’s commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Compensation structures and ranges are tailored to each zone’s unique market conditions to ensure that all employees receive fair and competitive compensation based on their roles and locations. Your Recruiter can share details of your geographic alignment upon inquiry.

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:

Remote-first culture

401(k) savings plan through Fidelity

Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents

Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)

12 weeks of 100% Paid Parental leave

Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)

11 Holidays Paid with one Floating Paid Holiday

Work-From-Home reimbursement to support team collaboration and effective home office work

24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

About Included Health

—–

Case Manager Nurse - RN

Personify Health Remote.co26 days ago

Apply Now26 days ago

location: remoteus

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Case Manager Nurse – RN

Job Location US-Remote

Job ID

2024-3545

Responsibilities

Who are you?

Telephonically manage cases on a long- or short-term basis per established Company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.

In this role you will wear many hats, but your knowledge will be essential in the following:

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information.
Evaluate and make referrals for wellness programs.
Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low risk cases ensuring confidentiality according to Company policy and HIPAA
Perform Utilization Review for assigned members.
Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.

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.

Qualifications

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

Knowledge of medical claims and ICD-10, CPT, HCPCS coding.
Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.
Ability to work independently making decisions and problem solving
Knowledge of community resources and alternate funding programs.
Computer proficiency or working knowledge of Microsoft Office Suite.
Excellent interpersonal, communication and negotiation skills.
Strong customer orientation.
Good time management skills and highly organized.
Graduation from an accredited RN program and possession of a current California RN license.
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.
Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to ersity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $66,000 to $76,000. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Licensed Nurse Practitioner

Included Health Remote.co26 days ago

Apply Now26 days ago

location: remoteus

Apply Now

Licensed Nurse Practitioner

Title: Licensed Nurse Practitioner – Urgent Care

Location: Remote

Type: Modified Full Time

Workplace: remote

Category: Clinical Team

Job Description:

We are seeking a highly motivated nurse practitioner with an active and unrestricted AZ State license and additional state licenses who enjoys management of all health conditions and who is passionate about raising the standard of healthcare for everyone. The Nurse Practitioner will be responsible for caring for patients, maintaining accurate and current patient records, and working collaboratively with our provider and support teams. Start a conversation with us and learn how you can positively impact the lives of patients and play a role in improving healthcare.

Currently unable to consider:

* Candidates residing in the following states: AL, GA, MS, MO, OK, SC, TN

Responsibilities:

Function autonomously to perform age-appropriate history and virtual examinations, evaluate, diagnose, recommend treatment plan and document findings appropriately and timely
Deliver high quality patient care while maintaining safety
Document medical information of patients and review patient history at each visit
Request consultation or referral with other health care providers when appropriate
Counsel and educate patients
Order and interpret diagnostic tests as needed
Evaluate, triage and manage pediatric and adult patients for both acute, chronic and mental health conditions
Actively maintain knowledge of current medical research and trends
Provide administrative support or cross-coverage for reviewing laboratory test results
Scheduling flexibility to include evenings and weekends

Required Qualifications:

Current and active Advanced Practice Registered Nurse (APRN) licensure in AZ State
Board certified – Current national certification as a Family Nurse Practitioner through AANp or ANCC
Multi-state licensure is required
Licensed Nurse Practitioner who also maintains an active RN license
Ability to obtain both RN and NP licensure in additional states
Graduate of an accredited school of nursing
Graduate of Master’s Degree level accredited Family Nurse Practitioner Program
3+ years of clinical experience as a Nurse Practitioner in primary care (preferred) or urgent care required
Experience/Comfortable with providing care for all ages, newborn to adult populations
Ability to function within an integrated medical practice
Outstanding clinical expertise
Excellent communication and interpersonal skills
Comfortable with technology
Demonstrate flexibility

Preferred Qualifications:

Telemedicine or virtual care experience preferred
Experience with Athena EMR preferred

Shift and Scheduling Obligations:

32 hours per week/64 hours per pay period
Weekly shifts must include a minimum of 8 evening hours scheduled between 5p-11p in clinician’s time zone
Every other weekend, both Saturday AND Sunday shifts; 8 hours per day, scheduled between 7am-11pm in the clinician’s time zone. Rotating day/evening shifts
3 holiday shifts required per calendar year

Physical/Cognitive Requirements:

Prompt and regular attendance at assigned work location (virtually).
Ability to remain seated in a stationary position for prolonged periods.
Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
Ability to interact with leadership, employees, and members in an appropriate manner.

The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. Finally, this job description is not intended in any way to create a contract of employment. Unless you have a written employment agreement signed by an authorized Included Health or Doctor On Demand representative, you are employed at-will.

The United States guaranteed base salary for this position is $75,810+ equity + benefits, with a target per-visit compensation of $18,699 (for a target compensation of approximately $94,509.20).

Included Health also offers additional productivity incentives for employees that exceed the visit target. Details of the incentive structure will be discussed during the interview process.

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:

– Remote-first culture401(k) savings plan through Fidelity

– Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

– Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents

– Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)

– 12 weeks of 100% Paid Parental leaveFamily Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

– Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)

– 11 Holidays Paid with one Floating Paid Holiday

– Work-From-Home reimbursement to support team collaboration and effective home office work

– 24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

#LI-Remote #LI-SK1

About Included Health

Regulatory Coordinator

City of Hope Remote.co28 days ago

Apply Now28 days ago

location: remoteus

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Behavioral Health Care Coordinator

Devoted Health Remote.co28 days ago

Apply Now28 days ago

location: remoteus

Apply Now

Behavioral Health Care Coordinator

Remote USA

Full time

Job Description

A bit about this role:

Devoted Medical was founded on the belief that if we treat each member like we would our loved ones, we can improve healthcare experiences and outcomes for our patients. The Behavioral Health Program is at the heart of this goal.

Devoted Medical has designed a Behavioral Health program to manage and coordinate care in a manner consistent with Devoted’s values of treating every member like family. Members with Behavioral Health conditions often lack access to high-quality care because of lack of access to community resources or personal barriers associated with their behavioral health needs that prevent them from following through to seek care.

We are on a mission to provide well coordinated behavioral health care to Devoted members. Our team combines short term intervention alongside seamless care coordination to support our members securing, and staying committed to community behavioral health intervention.

As a Behavioral Health Care Coordinator you will have the opportunity to provide care coordination services to members referred for Behavioral Health support.

Required skills and experience:

Bachelor’s Degree and 3 years’ work experience in a healthcare setting
Two (2) years of experience in a behavioral health setting
The ability to comfortably multi-task: you’ll be listening, talking and typing all at the same time
Comfortable working with internal and external stakeholders to advocate for our patients

Desired skills and experience:

Prior experience with customer service
Bilingual preferred (English/Spanish) but not required
Geriatric experience or experience coworking with a Medicare population
Health insurance experience, particularly MA or Medicaid
Prior experience working with complex patients and/or underserved populations

Your Responsibilities and Impact will include:

Serve as Behavioral Health’s “Care Traffic Controller,” working closely with patients and other Devoted teams to facilitate and track resolution of clinical needs, such as locating in network behavioral health services, scheduling appointments, collaborating with members to secure ongoing care in their community
Respond with unconditional positive regard and love in your heart to all members who call into Behavioral Health looking for an in-network BH provider
Complete telephonic customer support with patients and provider offices
Prepare for, and actively participate in, weekly Interdisciplinary Team Meetings, helping the team to identify high risk patients, resource needs, and next steps
Provide continuous administrative and outreach support for patients transitioning from Devoted’s Behavioral Health team to longer term care in their community, ensuring safe, smooth transitions
Coordinate relationships with community behavioral health partners including locating and confirming in network and community based providers and services as well as performing outreach and engagement with these services
Operate independently, be self-sufficient, be unwilling to suffer in silence, be vocal when support is needed, be comfortable with ambiguity, and be willing to go the extra mile to ensure Devoted patients are treated like family.

Salary Range: $22.00 – $29.00 / hour

Our Total Rewards package includes:

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Director Nursing Services

Ascend Learning Remote.co29 days ago

Apply Now29 days ago

location: remoteus

Apply Now

Title: Director Nursing Services

Location: United States

Job Description:

Full-Time

We Impact Lives Through Purpose-Driven Work in A People First Culture

Ascend Learning is the connection between a powerful portfolio of brands serving students, educators, and employers with outcomes-based, data driven solutions across the lifecycle of learning.

Our values-driven culture unifies our teams and inspires a mindset of action, innovation, and collaboration, with a relentless focus on customers.

We’re always looking for talented, passionate professionals to join us in our mission to help change lives. If this sounds like an environment where you’d thrive, read on to learn more.

The Client Success Team is responsible for supporting clients purchasing nursing solutions with product training, implementation, integration, consultation, and test preparation delivery to achieve client centric outcomes. The team leads the success planning, onboarding, training, SaaS implementation, ongoing proactive and reactive client support, consulting services, and the delivery of nursing products for Ascend’s nursing brands: ATI, APEA and NursingCE. The CS team is accountable for delivering high quality services and subsequently capturing and tracking key business performance indicators to client success including, client satisfaction, product adoption and usage, NCLEX pass rate, and institutional and student retention.

WHAT YOU’LL DO

The Director of Nursing Services is responsible for overseeing the delivery of domain expert services to customers including nursing consultation services, professional development, and advanced practice test prep delivery. The role requires expert knowledge in undergraduate and graduate nursing curriculum, accreditation procedures, faculty professional development, and advanced practice certification. The role partners with internal and external key stakeholders to ensure quality, outcome-driven, and up to date nursing services are delivered to customers. The role will manage a team of nursing domain experts delivering services to promote Nursing solutions as the leader in the industry for clients to achieve outcomes that support sales renewals and financial targets.

WHERE YOU’LL WORK

This position will work remote in the United States and will require up to 10% travel.

HOW YOU’LL SPEND YOUR TIME

Manage a team of domain expert nurse consultants and educators delivering expert services to customers.
Ensure the delivery of quality advanced practice products and certification prep reviews for client outcome achievement and satisfaction.
Collaborate with internal and external key stakeholders in Sales, Marketing, Product, Client Success and other key stakeholders for consistency in resource development and delivery. Ensure services lead to financial targets of the company for renewals.
Analyze industry trends and norms to lead strategy and development of professional development offerings at the regional and national level.
Analyze industry trends and norms to lead strategy and development of professional development offerings at the regional and national level.
Envision, lead creation, and present evidence-based presentations for thought leadership on nursing topics at regional and national conferences based on emerging industry trends.
Ensure compliance with ANCC guidelines for provider accreditation, record-keeping and virtual visits for ANCC self-study report, and company industry events and ensure ANCC guidelines are met for professional development offerings.
Support self-study virtual visit for ANCC provider accreditation.

WHAT YOU’LL NEED

Master’s Degree in Nursing, Doctorate in Nursing strongly preferred
5+ years of experience working in:
- Nursing Program Accreditation and Self-Study experience
- Graduate Advanced Practice and Undergraduate curriculum expertise
- Leadership and Administration in Nursing Academia
- Direct management experience of people

Embody expert knowledge of nursing accreditation and self-study process and procedures.
Strong experience and expert knowledge working in undergraduate and graduate nursing curriculum and test prep.
Innovative thinker with creative problem-solving and continuous improvement skills.
Ability to communicate, actively listen, and lead focus groups by creating a trusting environment throughout the process.
Demonstrates strong analytical skills with the ability to interpret data and present findings to inform leaders of valuable insights that drive effective decision making.
Detail oriented with thoroughness and accuracy when accomplishing a task.
Strong organizational skills with ability to successfully manage and prioritize daily tasks and responsibilities.
Proficient with current technology and experience with MS Office and webinar platforms.
Assess and understand unique program curriculums and solve for accreditation changes. Ability to listen to client needs and solve for integration set ups and builds that lead to client retention. Collaborate with cross functional teams including product, marketing, innovative technology solution teams.

BENEFITS

Flexible and generous paid time off
Competitive medical, dental, vision and life insurance
401(k) employer matching program
Parental leave
Wellness resources
Charitable matching program
Hybrid work
On-site workout facilities (Leawood, Gilbert, Burlington)
Community outreach groups
Tuition reimbursement

Fostering A Sense of Belonging

We seek out and celebrate all people and perspectives and cultivate an inclusive culture where everyone can thrive, feel valued and be their authentic selves. Our culture is firmly rooted in the belief that by embracing our differences and drawing on erse perspectives, we are a stronger, more innovative, and more successful organization where employees experience a sense of belonging.

About Ascend Learning

As a tech-enabled services company, Ascend Learning is a national leader in developing and delivering data-driven online educational content, software, assessments, analytics, and simulations serving institutions, students and employers across healthcare, fitness and wellness, public and workplace safety, skilled trades, insurance, financial services, cybersecurity, and higher education. We’re committed to accelerating the learning pathways that can move people into careers where they have the knowledge and skills to have an impact and help change lives in the communities they serve. Headquartered in Burlington, MA with additional office locations and hybrid and remote workers in cities across the U.S., Ascend Learning was recognized by Newsweek and Plant-A Insights Group as one of America’s 2023 Greatest Workplaces for Diversity.

Ascend Learning, LLC is proud to be an equal opportunity employer (M/F/Vets/Disabled). No agency or search firm submissions will be accepted. Applications for U.S. based positions with Ascend Learning, LLC must be legally authorized to work in the United States and verification of employment eligibility will be required at the time of hire.

Registered Nurse Home Hospital

Massachusetts General Hospital Remote.co29 days ago

Apply Now29 days ago

location: remoteus

Apply Now

Title: Registered Nurse Home Hospital- Virtual- 24-Noc

Location: United States

Job Description:

This RN Virtual position will be located at our New Logistic Command Center- Assembly Row, Somerville, MA.

24 hour/Night

The position to which you are applying is represented by a collective bargaining unit, Massachusetts Nurses Association.

The MGB Home Hospital Virtual Registered Nurse (VRN) is responsible for providing essential elements of the inpatient care delivery model into the patient’s defined living space. The MGB Home Hospital VRN provides quality care to patients through the implementation of nursing process, applied through a team-based nursing model, employing technology and remote care coordination to facilitate care delivery.

The MGB Home Hospital VRN will provide high quality, patient-centered, nursing care to our acute care patients during hospitalization. The VRN will work with a robust interdisciplinary team to promote highest patient outcomes. This role will utilize remote patient monitoring, assessment, planning, intervention, and critical thinking skills to care for acute care patient populations in the home. Leveraging the resources and expertise of the MGB Home Hospital team to implement collaborative workflows, standards, policies, protocols, guidelines, and documentation systems to support safe, reliable, high-quality evidence-based care within clinical protocols as the foundation.

Role Responsibilities

Performs and documents nursing process, assessment, diagnosis, planning, implementation, and evaluation of patients receiving care remotely, in their defined home.
Performs virtual care, patient assessment, remote patient monitoring and works with the clinical care team to provide care, trend data and respond accordingly.
Provide protocol driven assessments, care coordination and intervenes as appropriate and defined by MGB Healthcare at home protocols.
Exhibits sound clinical decision making and critical thinking skills for a erse patient population.
Maintain and practice in accordance with nursing guidelines, as well as institutional, local, and state regulations.
Performs admissions, discharges, and episodic visits within MGB Home Hospital, through high quality virtual patient-centered care.
Serve as a role model for professional nursing practice.
Utilize nursing knowledge to identify, prevent and or solve complex acute and/or recurring patient care problems.
Sharing expertise with multidisciplinary teams to serve as a staff resource.
Supporting research efforts to advance knowledge and promote evidence-based practice.
Perform other duties and responsibilities as assigned by Nursing Leadership.
Provide medication teaching, assist with medication administration and education to patients and families. Collaborate closely with pharmacy and care team regarding medication reconciliation process.
This RN will provide nursing care to patients in a team model, as well as, inidual.
Timely documentation of all nursing care to reflect in epic.
Answers, directs, and provides follow up on incoming clinical patient concerns.

Quality and Safety

Ensure compliance with reporting requirements in RL Solutions.
Participate in quality and safety education, rounds, and evaluations.
Promoting professional practice and a culture of safety; required to engage in process improvement efforts.
Must be able to work in a HIPPA compliant environment.

Qualifications

Education

Graduation from an accredited school of nursing. BSN preferred.
Emergency Nursing and Critical Care nursing experience is preferred.
BLS
Current license to practice as a Registered Nurse in Massachusetts
Excellent clinical and interpersonal skills.

Experience

Recent 3 years bedside nursing required. Emergency & Medical/Surgical Experience is preferred.
Excellent communication, interpersonal and organizational skills required.
Experience working in a start-up environment and or willingness to adapt to continuous change encouraged.
Telehealth, remote-patient monitoring experience preferred.
Proficiency with Epic, Microsoft outlook, Microsoft teams and web-based skills preferred.

Coder Phys Pract

Banner Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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Title: Coder Phys Pract

Location: Phoenix United States

Job Description:

Remote

locations

Remote Idaho

time type

Full time

Primary City/State:

Department Name: Coding Ambulatory

Work Shift:

Day

Job Category:

Revenue Cycle

Are you a superstar strong OBGYN Physician Complex Coder | Medical Coderlooking for the opportunity to code a wide variety of accounts? The ideal candidate would have 3 years+ of coding experience ideally in OBGYN.There are also opportunities for overtime with special projects from time to time. This requires being fully CPC (AAPC) or CCS or CCA (AHIMA)certified. Come join a strong team of 10 Coder with an Associate Director and Associate Manager.

If you are interested in a career with OBGYN, then Banner is the place you want to be. With our complex OBGYN Coder position, you will have the opportunity to code in our academic or non-academic team. Here at Banner you will be exposed to not only OBGYN services within our OBGYN teams we have subspecialties that belong to our clinics, such as Maternal Fetal Medicine where you would be coding for high risk pregnancies and deliveries, ultrasounds and some procedures,you will see specialized surgical cases related to pelvic organ prolapse and urinary retention, In Gynecology Oncology with this specialty you would be coding more complex Hysterectomies, pelvic exenterating, and robotic cases related to female cancers. With this group of subspecialties in OBGYN you have more opportunities to learn other services with our specialties that not all OBGYN offices perform is on this team. Production expectations depend on placement anywhere from 6 to 12 charts an hour. This is a great opportunity to build your OBGYN coding resume.

Banner Health provides your equipment when hired. You will be fully supported in training with continued support throughout your career here!

This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MD, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY.

The hours are flexible as we have remote Coders across the Nation. Generally, any 8-hour period between 7am – 7pm can work, with production being the greatest emphasis.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits

POSITION SUMMARY

Evaluates medical records, provides clinical and surgical abstraction and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines.

CORE FUNCTIONS

1. Analyzes medical information from medical records. Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes. Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards. Codes ICD CM and CPT4 for accurate APC assignment. Addresses National Correct Coding Initiative (NCCI) edits as appropriate. Reconciliation of charges as required.

2. Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the medical record into the electronic medical records. Seeks out missing information and creates complete records, including items such as disease and procedure codes, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons and anesthesiologists, and appropriate signatures/authorizations. Refers inconsistent patient treatment information/documentation to coding quality analysts, supervisor or inidual department for clarification/additional information for accurate code assignment.

3. Provides quality assurance for medical records. For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.

4. As assigned, compiles daily and monthly reports; tabulates data from medical records for research or analysis purposes.

5. Works independently under regular supervision. Uses specialized knowledge for accurate assignment of ICD/CPT codes according to national guidelines. May seek guidance for correct interpretation of coding guidelines and LCDs (Local Coverage Determinations).

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge and specialized formal training equivalent to the two year certification course in medical record keeping principles and practices, anatomy, physiology, pathology, medical terminology, standard nomenclature, and classification of diagnoses and operations, or an Associate’s degree in a related health care field.

Requires at least one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), Certified Coding Associate (CCA), Certified Professional Coder – Apprentice (CPC-A), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). Certification may also include a general area of specialty.

Six months providing professional coding services or other related healthcare experience within a broad range of health care facilities.

Must demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders.

Must be able to work effectively and efficiently in a remote setting, utilizing common office programs, coding software and abstracting systems.

PREFERRED QUALIFICATIONS

Specialty Certification.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment

Medical Coder II - Outpatient

Insight Global Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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Title: Medical Coder II – Outpatient

Location: FL-Jupiter

Job Type: Perm

Category: Medical Coder

Pay Rate: $46k – $58k (estimate)

Job Description: Job Description

Insight Global is seeking a Medical Coder II to join a hospital system in Jupiter, Florida. The Outpatient Coder will review and assign the correct ICD-10-CM codes based on documentation in the patients chart or script, demonstrate knowledge of current coding practices and have the ability to receive ongoing education pertaining to coding changes/updates mandated by CMS and various insurance entities. The Coder must be able to accurately facilitate the completion of incomplete medical records, monitor deficiencies, and meet established proficiency and productivities standards. Theyre responsible for reviewing ER document (HED) and assigning the appropriate points/procedure/CPT for E&M/Procedure levels using the HIC application for ER and IP patient types. The Coders are required to code I Lab, VLB, OBS, SDS and ERD, and Ancillary charts daily. The team sits fully remote and reports to the Director of HIM. They will be joining a team of 15 other Medical Coders

We are a company committed to creating erse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances.

Required Skills & Experience

-High school diploma, GED or equivalent

-CPC (Certified Professional Coder)

-1 year of experience with outpatient coding

-ICD-10-CM, CPT Assistant and Coding Clinics, Medial Terminology and Anatomy, AMA Coding Clinics and Faye Brown

-Strong communication, consistent and attention to detail

Nice to Have Skills & Experience

-CCS (Certified Coding Specialist)

-Experience with EPIC

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.

TPR Coding Compliance Auditor

Tenet Healthcare Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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Title: TPR Coding Compliance Auditor (Remote based in US)

Location: United States

Job Description:

Essential Duties and Responsibilities:

Understands, interprets, and applies professional fee coding guidelines for coding audits. Audits include a complex review of the medical record to determine coding accuracy as well as compliance with other professional fee services such as teaching physician, incident-to and split/shared services.
Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
Identifies documentation that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, and HCPCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, HCPCS and CPT updates), as directed. Reviews AMA, CMS, and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
Others may be assigned.

Knowledge, Skills, Abilities:

Ability to consistently and accurately audit complex coding of professional fee services
Ability to create clear and concise audit reports
Expert level knowledge of medical terminology, ICD-10-CM/PCS and CPT coding guidelines and methodologies
Must be detail oriented and with the ability to work independently and in team setting
Computer knowledge of MS Office
Must display excellent written and verbal communication skills
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to research difficult coding and documentation issues and follow through to resolution
Ability to work in a virtual setting under minimal supervision

Education / Experience

High school diploma/GED is required.
Associates degree in relevant field preferred or combination of equivalent of education and experience.
Three (3) years coding experience of professional fee services with experience in multiple specialties.
One (1) year of experience in coding audit or quality review work.
AAPC Coding Credential is required.

Compensation:

Pay: $35.00 to $48.80 per hour. Compensation depends on location, qualifications, and experience.
Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
Observed holidays receive time and a half.

Benefits:

The following benefits are available, subject to employment status:

Medical, dental, vision, disability, life, AD&D and business travel insurance
Paid time off (vacation & sick leave)
Discretionary 401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

#LI-DM4

2403029636

Pay Range: $30.60 – $48.80 hourly **Inidual wages are determined based upon a number of factors including, but not limited to, an inidual’s qualifications and experience

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified iniduals with disabilities unless doing so would result in an undue hardship.

Tenet participates in the E-Verify program. Follow the link below for additional information.

Coding Auditor & Educator

Trinity Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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Title: Coding Auditor & Educator (Remote)

Location: United States

Job Description:

Employment Type: Full-Time

Shift: Days

(SUMMARY) Position Highlights:

Competitive pay
Additional Benefits: tuition reimbursement, free parking, employee discounts
Quality of Life: Flexible work schedules
Advancement: professional growth within the organization
Location: Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD.

Description:

Monday-Friday

The Professional Coding Auditor Educator performs medical record audits including but not limited to analysis of medical record documentation, validation of primary and secondary diagnoses and procedures; and ensuring proper assignment of diagnosis and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS).

Responsibilities:

Monitors accuracy of centralized coders’ charge capture and coding with proper ICD-10, CPTs, as well as proper modifiers, adhering to local ministry and Trinity practices and policies.
Partners with leadership to improve HCC, high risk scoring, with provider and coder education.
Conducts ongoing reviews of patient medical record documentation and procedural and diagnosis coding by each practitioner.
Responsible for practitioner education in areas related to coding, documentation, and compliance.
Works closely with leadership and the department to establish and modify the charge description master (CDM) methodology and pricing models to ensure accuracy and regulatory compliance.
Reports to the Manager, Provider Revenue Operations

What you will need:

High school diploma or equivalent combination of education and experience
Certified Professional Coder or Registered Health Information Technician accreditation required.
Minimum of 2-5 years of professional coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCs modifiers. Knowledge of Medicare, Medicaid, and other third-party billing rules and regulations.
3-6 years of professional coding experience; ability to code from operative reports; prior auditing experience.( Preferred)
Effective verbal, written, and interpersonal communication skills with the ability to comfortably interact with erse populations.
Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation.
Ability to handle patient and organizational information in a confidential manner.
Ability to demonstrate competency with a standard desktop and Windows-based computer system, including a basic understanding of email, e-learning, intranet and computer navigation. Ability to use other software as required to perform the essential functions of the job.
Demonstrated dependability and regular attendance.
Solid understanding of ICD-10 and CPT coding and medical terminology, with knowledge of Medicare, Medicaid, Health Maintenance Organization and commercial insurance plans.
Ability to exercise independent judgment as appropriate within standard practices and procedures..

About us:

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 iniduals each year from Maryland’s two largest counties — Montgomery and Prince George’s counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services. We were named one of America’s 100 Best Hospitals for 2021.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate ersity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A erse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Coding Supervisor

Ensemble Health Partners Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Coding Supervisor

Remote – Nationwide

Full time

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

The Opportunity:

The Coding Supervisor is responsible for the day to day coding activities for the respective physician facilities within the company. This includes assisting the Manager and/or Director, and/or Coding Sr. Leader, with duties assigned to assure Accounts Receivable goals are met.

Job Responsibilities:

The supervisor is responsible for the staffing, organizing and directing of coding activities within a given facility under the direction of the market Coding Manager. They will coach (SMART Responsibilities where applicable), develop, complete timely performance evaluations and discipline those staff members under their responsibility as needed.
Assists with the creation and delivery of educational presentations/material related to coding.
Monitors progress and achievement of coding goals and objectives and reports such information in a timely manner as requested by leadership.
Monitors workflow, productivity and quality of coding and abstracting functions per system guidelines. Performs routine audits of work performed by all staff members.
Maintains knowledge of all federal and state rules and associated coding guidelines.
Assists in the development of policies and procedures and monitors staff compliance with policy and procedures.
Acts as site resource person for coding related questions, to include assisting members of the medical staff and members of the management team.
Completes staff schedules and timecards according to Company policy. Holds staff accountable for compliance with paid time off, (PTO) policies.
Acts as a technical resource and assists with resolution of technical issues and/or works with appropriate staff/department to rectify technical issues impeding the functions of the coding team.
If workload demands, accurately assigns codes to any medical record in conformance with American Hospital Association, (AHA) coding guidelines and/or financial payer requirements. Assigns appropriate modifiers and present on admission, (POA) indicators as necessary.

Experience We Love:

3+ years of general surgery, plastics and bariatrics coding experience
3+ years of leadership experience
Ability to function independently with minimal supervision, as well as part of a team.
Knowledge of medical record content to include electronic medical records, (EMRs.)
Ability to function under continual deadlines.
Ability to maintain accuracy during frequent interruptions.
Proficiency in keyboarding skills and working knowledge of computers.
Excellent communication skills.

Minimum Education:

Bachelors Degree or Equivalent Experience

Licensure/Certification Required:

Candidates must have and keep current at least one of the following professional certifications:

CPC (Certified Professional Coder)
CCS-P (Certified Coding Specialist-Phys Based)
CCS (Certified Coding Specialist)
RHIA (Registered Health Information Administrator)
RHIT (Registered Health Information Technician)

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

REGISTERED NURSE - Personal Health Advocate

Health Advocate Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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REGISTERED NURSE – Personal Health Advocate

locations

US Remote

time type

Full time

job requisition id

R9672

Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate’s supervisors are promoted from within the company. Join our award winning team!

2024:

Excellence in Customer Service Awards: Organization of the Year (Small)
Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner

As part of Teleperformance in the US, we were also named #95 in the 2024 ‘Fortune 100 Best Companies to Work For®’ in the USA by Great Places to Work (GPTW®)

Position Overview

At Health Advocate, we are committed to providing our customers with services that improve the health, well-being and productivity of their employees. The Personal Health Advocates are a dedicated team of Registered Nurses who assist our members in navigating the healthcare system by facilitating access to healthcare providers, health and benefit information, health services and resources and entitled benefits coverage.

Essential Job Functions

Receive calls from members in regards to various healthcare issues (e.g., infertility, disease, medication, etc.) and determine best course of action/s to assist the members while adhering to established policies, procedures, and key performance indicators (KPIs) (e.g. case close targets, abandon rates, member follow up, all quality indicators, etc.)
Build relationships with members in order to collaborate and develop plans of action by going above and beyond members’ initial requests, taking responsibility for members’ case records, and encouraging members to call back with future issues/ questions.
Assist and educate members in understanding their medical conditions, associated health testing, test result interpretation, and health options available to them.
Provide members choices in medical care providers and services based on the members’ clinical needs, geographic locations and available benefit offerings.
Research providers through credentialing, education checks and affiliations with notable medical centers within the member’s plan
Facilitate communication among members, treating physicians, and insurance carriers, which may include assisting members with asking necessary health questions to physicians or clarifying insurance plan provision
Take appropriate steps on behalf of members by assisting with scheduling health appointments, re-scheduling health appointments, facilitating record and information transfers, and researching and resolving various problems as applicable
Document cases in the department’s case management system using approved processes and procedures
Escalate cases appropriately and on a timely basis to supervisor or internal resources for review as applicable
Keep up-to-date on patient care procedures which include diagnosis, pre-certification, prior authorization, pre-service and post-service denials
Continuously stay up to date on various health issues and medical procedures necessary to offer top of the line feedback to members
Intercede for the member to obtain an earlier appointment.
Help members obtain prescriptions
Help members with pre-service fee negotiations
Place outbound follow up calls for issues that cannot be resolved during the initial call
Respond to member cases in delegate box, answers and after hours calls
Mentor new team members

Team Interfaces/Customer Service

Establish and maintain a professional relationship with internal/external customers, team members and department contacts
Cooperate with team members to meet goals or complete tasks
Provide customer service that exceeds customer expectation
Treat all internal/external customers, team members and department contacts with dignity/respect
Escalate work flow and communication issues to supervisor

Minimum Qualifications

Education- BSN or RN degree from an accredited college or university required
Minimum three to five years clinical and/or medical management experience
Active and unrestricted State or Multi-State RN License
Understanding of medical terminology to assist in locating appropriate care options

Strong Communication skills and phone etiquette
Strong ability to explain complex issues to employees/retirees
Highly effective listening skills
Strong problem solving/issues resolution skills
Excellent customer service and customer resolution skills
Organizational and administrative skills
Experience with Microsoft Word and Excel
Ability to work in a team environment

Mental and Physical Requirements-

This position is a remote position. The employee will need to have a dedicated HIPPAA compliant work space. Have access to internet and router.
The nature of the work in this position is sedentary and the incumbent will be sitting most of the time
Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day
Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day

Related Duties as Assigned

The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents
Consequently, job incumbents may be asked to perform other duties as required
Also note, that reasonable accommodations may be made to enable iniduals with disabilities to perform the functions outlined above
Please contact your local Employee Relations representative to request a review of any such accommodations

Company Overview

Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.

Awards:

2023:

National Customer Service Association All–Stars Award: Service Organization of the Year.
Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner

2022:

Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
Excellence in Customer Service Awards: Organization of the Year (Small)
Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)

2021:

Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Silver Winner
Stevie® Awards for Sales & Customer Service: Most Valuable Response by a Customer Service Team (COVID-19). Bronze Winner
Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)

2020:

National Customer Service Association All–Stars Award: Organizations of 100 or Greater, Runner-Up
Communicator Award of Distinction: October 2019 Broker News
MarCom Awards: Gold, COVID Staycation Ideas brochure
MarCom Awards: Platinum, 2021 Well-being Calendar
Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium category (Silver)

Health Advocate is an Equal Opportunity Employer that does not discriminate on the basis of race, color, sex, age, religion, national origin, citizenship status, military service and veteran status, physical or mental disability, or any other factor not related to job requirements. We respect and value ersity, and are committed to the principles of Equal Employment Opportunity.

VEVRAA Federal Contractor requesting appropriate employment service delivery systems, such as state workforce agencies and local employment delivery systems, to provide priority referrals of protected veterans.

PAY TRANSPARENCY NONDISCRIMINATION PROVISION

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to iniduals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)

Clinical Admin Coordinator

Judge Group Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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Centralized Order Entry Pharmacist

HCA - Hospital Corporation of America Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Title: Centralized Order Entry Pharmacist

Location: US

Job Description:

Do you have the career opportunities as a(an) Centralized Order Entry Pharmacist you want with your current employer? We have an exciting opportunity for you to join Work from Home which is part of the nation’s leading provider of healthcare services, HCA Healthcare.

SCHEDULE: NIGHT SHIFT

MUST BE LICENSED IN TEXAS

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
Free counseling services and resources for emotional, physical and financial wellbeing
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
Employee Stock Purchase Plan with 10% off HCA Healthcare stock
Family support through fertility and family building benefits with Progyny and adoption assistance.
Referral services for child, elder and pet care, home and auto repair, event planning and more
Consumer discounts through Abenity and Consumer Discounts
Retirement readiness, rollover assistance services and preferred banking partnerships
Education assistance (tuition, student loan, certification support, dependent scholarships)
Colleague recognition program
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Centralized Order Entry Pharmacist where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary and Qualifications

As the Centralized Order Entry (COE) Pharmacist, you will monitor, evaluate and make recommendations to assure the appropriate and effective use of pharmaceuticals for patient care. You will use the medication process to assess, plan, intervene, when necessary, implement and evaluate patient care in compliance with client hospital policies, protocols and procedures.

What you will do in this role:

Provide patient care activities to ensure safe and effective drug therapy.
Accurately enter orders in the computer in a timely manner.
Follow facility procedures when non-formulary drugs, target drugs, restricted drugs and investigational drugs are ordered.
Screen for drug interactions, allergies, order duplications, appropriate diagnosis, renal and liver function prior to order entry.
Address facility queues in a timely manner.
Investigate and report adverse drug events and medication incidents.
Review and interpret all physician orders received, using the patient profile.
Monitor for incompatibilities, concentration and rate on intravenous drugs.
Document clinical interventions and follow-up when indicated.
Assess orders for age-specific appropriateness from neonatal through geriatric.

What qualifications you will need:

Bachelor’s degree from an accredited college of pharmacy is required.
Pharm D is preferred.
One (1) year of hospital experience is preferred
Meditech experience is preferred.
License – State Board of Pharmacy Required
MUST BE LICENSED IN TEXAS

HealthTrust Supply Chain is a critical part of HCA Healthcare’s strategy. Our focus is to improve performance and reduce costs. We do this by joining non-clinical and administrative functions. HealthTrust Supply Chain best practice methodologies. We develop, apply and monitor cost-efficient initiatives and programs for HCA Healthcare. By improving facility efficiency, medical professionals can focus on our mission – patient care.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

“Bricks and mortar do not make a hospital. People do.”- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Centralized Order Entry Pharmacist opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value ersity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

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Details

United States

Pharmacy and Pharmacy Technician

Work from Home

schedule Full-time • Work From Home

About HCA Healthcare

What matters most to our erse and talented colleagues is giving people the absolute best healthcare in the most compassionate way possible.

Manager of Client Coding Integration

Ensemble Health Partners Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Manager of Client Coding Integration

Remote – Nationwide

Full time

Thank you for considering a career at Ensemble Health Partners!

The Opportunity:

The Manager of Client Coding Integration is responsible for assisting in the development and evolution of the overall strategy for Ensemble Coding Operations. The Manager is responsible for assisting with all client coding customer service operational processes and workflow, including but not limited to, new client onboarding, provider clinical documentation improvement, support of operational coding processes, and customer coding relationship management. The Manager interprets client policies and procedures, recommends changes as appropriate, and provides relevant feedback. The Manager assists the Director of Coding Integration with the oversight and implementation of Coding Operations operational planning, service commitment, workflow processes and internal controls. As the Manager, this person serves as a key promoter of Ensemble PRC Coding Operations and is responsible for setting the tone of Coding Operations as a service organization, continuously seeking to understand, meet, and exceed customer expectations and needs.

Job Responsibilities:

Sets clear goals and objectives for team members to drive operational excellence and problem-solving initiatives
Ensures understanding and adherence to policies, practices, and procedures by direct reports, customers, and stakeholders
Collaborates with practice Leadership teams to provide coding direction and guidance, fostering transparency and efficiency in coding processes
Works closely with PRC Coding Operations to identify and resolve client issues promptly, maintaining alignment with organizational objectives
Facilitates active engagement of client leadership in coding reporting with physicians, promoting transparency and collaboration.
Collaborates with client leadership and physicians to ensure customer satisfaction and address coding accuracy concerns effectively
Maintains effective working relationships with client leadership and providers, serving as a liaison between Ensemble PRC Coding Operations and practice management
Supports strategic initiatives to enhance working relationships with clients, participating in committee meetings and strategic updates
Proactively manages operational challenges within practice operations and coding teams, ensuring timely resolution and effective communication
Contributes to innovation and knowledge sharing efforts within Coding Operations, identifying and implementing process improvements
Participates in delivering coding training and education programs for physicians and client leadership, promoting continuous improvement
Supports the performance review process for direct and indirect reports, fostering professional development and organizational success

Experience We Love:

5-7 years relevant experience
3-5 years of supervisory/management experience in Coding
Experience working in large organizations, preferred.
Consulting or proven work experience in areas of process reengineering and project management strongly preferred.
Travel to client sites (estimate 20-40% travel)
PC skills demonstrates proficiency in Excel, Power Point, and ability to work in multiple EMR systems (Meditech, AllScripts, Cerner, Power Chart, Epic)
Tactical execution oversees the development, deployment and direction of complex programs and processes.
Customer relationship establishes and maintains longterm customer relationships, building trust and respect by consistently meeting and exceeding expectations. Cultivating strategic customer relationships and ensuring that the customer perspective is the driving force behind all valueadded business activities.

Minimum Education:

Bachelors Degree or Equivalent experience

Licensure/Certification Required:

Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):

CPC (Certified Professional Coder)
CCS-P (Certified Coding Specialist-Phys Based)
CCS (Certified Coding Specialist)
RHIA (Registered Health Information Administrator)
RHIT (Registered Health Information Technician)

Join an award-winning company

Three-time winner of “Best in KLAS” 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

Innovation
Work-Life Flexibility
Leadership
Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Centralized Coding Specialist - Remote PRN

LifePoint Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Title: Centralized Coding Specialist – Remote PRN

Location: Denver, CO United States

Job Description:

The Physician Services Revenue Integrity team at Lifepoint Health is a nationwide revenue cycle management services provider that has been offering high quality medical billing services since 2004. We offer a rewarding work environment with career advancement opportunities while maintaining a small company, employee-focused atmosphere.

This is a fully remote position! You must live in the United States.

We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

We are always looking for people inspired to help us in our mission. If you are someone who wants to change the lives of patients, drive success for our partners and be part of a team driven to improve care, we may have your next opportunity.

We are currently seeking a Centralized Coding Specialist. This remote-based position will spend the bulk of their time making sure that their clients are fully supported from a charge entry, coding, and billing perspective.

The Centralized Coding Specialist will spend the bulk of their time making sure that their clients are fully supported from a charge entry, coding, and billing perspective. You will be responsible for reviewing a patient’s medical record after a visit and translating the information into codes that insurers use to process claims. You will make sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations, complying with medical coding guidelines and policies. Following up and clarifying any information that is not clear. Clearinghouse knowledge and working experience is also a plus You would be working in a team environment with guidance from the Manager – Coding and Integrity. This position also works closely with the AR department for coding related issues.

Perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding compliance. Demonstrates a thorough understanding of complex coding, and reimbursement, as they relate to physician practices and clinic settings. Keeps informed regarding current coding regulations, professional standards and company/department policies and procedures and effectively applies this knowledge.

This Position is 100% Remote; can work from anywhere within the US.

ESSENTIAL FUNCTIONS

Seeking Certified Pro-Fee with a minimum of 3-5 years’ coding experience.
Experience with Provider Based and Rural Health preferred.
Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding.
Resolve medical record documentation deficiencies through healthcare provider query and provide routine feedback to correct deficiencies.
Perform quality assessment of records, including verification of medical record documentation (both electronic and handwritten).
Responsible for researching errors or missing documentation from medical record in order to provide accurate coding processes.
Abstract and assign the appropriate ICD-10, HCPCS/CPT codes; including Level I & Level II modifiers as appropriate for all diagnosis and procedures performed in outpatient and inpatient settings.
Assist in the development and ongoing maintenance of processes and procedures for each assigned client revolving around system use, billing/coding rules, and client specific guidelines.
Manage time effectively to meet all required deadlines and timeframes for client and department needs.
Collaborate in a team environment with the Department Manager and other staff on a regular basis.
Ensure compliance with all relevant regulations, standards, and laws.

Other Functions

1. Maintains regular and predictable attendance.

2. Performs other essential duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES: The requirements listed below are representative of the knowledge, skills and/or abilities required.

Education: High school diploma or equivalent required. Bachelor’s Degree preferred or equivalent experience

Experience: 3-5 years of medical coding experience

License or Certification:

This position requires credentialing through AHIMA, and/or AAPC

The following certifications are accepted:

CPC
CEMC
CPMA
CRC
CPB
Specialty certification
CCS-P
RHIT

Skills and Abilities:

Ability to create and follow written procedure.
Ability to provide professional written communication and excellent customer service.
Technical proficiency with computers, basic Microsoft software, and medical software systems (PM/EHR)
Strong organizational skills
Excellent communication skills and ability to work in a team environment.
Strong technical and computer skills (PM/EHR Software, Excel, Outlook, MS Office, Web)
Ability to learn new systems, software, and client specialties quickly.
Self-starter with little to no supervision

PHYSICAL AND MENTAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential job responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 20 pounds. Repetitive motion of upper body required for extended use of computer. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

WORK ENVIRONMENT AND TRAVEL REQUIREMENTS:

Work environment characteristics described here are representative of those that an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential job responsibilities.

Benefits

At Lifepoint, our Mission of Making Communities Healthier extends to our employees. We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

Pay range: $25-31/hour DOE The final agreed upon compensation is based on inidual education, qualifications, experience, and work location. This position is bonus eligible.

Lifepoint Health is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status or any other basis protected by applicable federal, state or local law.

Nurse Practitioner (Telehealth) - Colorado

Devoted Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Nurse Practitioner (Telehealth) – Colorado

locations

Remote USA

Full time

Job Description

This role is a fully remote position to care for our current members in Colorado.

A bit about this role:

This position represents an amazing opportunity for a caring nurse practitioner (APRN). Your primary focus will be delivering world class comprehensive care to our members. One of Devoted Medical’s missions is to bring care to where our members live – meaning your visits will be predominantly virtual telehealth.

Required skills and experience:

APRN with 3 or more years working in outpatient clinical practice.
An active and clear RN and APRN license in one of the following states: Colorado
Active BLS is required at time of hire and must be maintained while employed at Devoted Medical.

Desired skills and experience:

Experience in primary care, family medicine, geriatrics and/or palliative care.
Experience performing Medicare annual wellness visits or in-home comprehensive visits with elderly patients or Medicare patients.
Experience performing visits over telehealth video platforms.
An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps.

Your Responsibilities will include:

Conduct primarily telehealth video visits to members with the opportunity for a small volume of home based visits (drive to member’s home). In some instances when appropriate and compliant with licensure, you may also provide telehealth visits to members located in other geographies.
Primarily perform comprehensive assessment visits (CAVs) including comprehensive diagnosis/disease review, medication review, and assessment for quality of care (STARS/HEDIS) interventions as well as social and home health/DME needs.
Work closely with other members of the member’s care team including their PCP, specialists, and other Devoted team members including pharmacy, clinical nursing, and social work as well as interfacing with family members and caregivers in order to coordinate care for the member and deliver a collaborative care plan.

Salary Range: $115,000 – $122,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the inidual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Nurse/APC Fellow- Medical Standards Implementation

Planned Parenthood Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Title: Nurse/APC Fellow- Medical Standards Implementation

Location: Telecommuter

Type: Fellow

Workplace: remote

Category: Medical Services

Job Description:

Planned Parenthood is the nation’s leading provider and advocate of high-quality, affordable sexual and reproductive health care for all people, as well as the nation’s largest provider of sex education. With more than 600 health centers across the country, Planned Parenthood organizations serve all patients with care and compassion, with respect, and without judgment, striving to create equitable access to health care. Through health centers, programs in schools and communities, and online resources, Planned Parenthood is a trusted source of reliable education and information that allows people to make informed health decisions. We do all this because we care passionately about helping people lead healthier lives.

Planned Parenthood Federation of America (PPFA) is a 501(c)(3) charitable organization that supports the independently incorporated Planned Parenthood affiliates operating health centers across the U.S. Planned Parenthood Action Fund is an independent, nonpartisan, not-for-profit membership organization formed as the advocacy and political arm of Planned Parenthood Federation of America. The Action Fund engages in educational, advocacy, and electoral activity, including grassroots organizing, legislative advocacy, and voter education.

Planned Parenthood Federation of America (PPFA) and Planned Parenthood Action Fund (PPAF) seek a Nurse Fellow – Medical Standards Implementation for January 2025 through December 2025. This job reports to the Director of Medical Standards Implementation in the Medical Services Team in the Care and Access Division of PPFA. The Medical Services Team is dedicated to supporting Planned Parenthood affiliates in the delivery of high-quality health care.

We invite you to explore the PPFA Medical Services Student Nurse/APC Fellowship, an employment and learning experience for students in an undergraduate nursing program or graduate nursing/APC students. During this telecommuter opportunity, you’ll be a member of an interdisciplinary healthcare team and work alongside clinicians, RNs, and administrative professionals at PPFA. You will also have access to clinical resources, and to PPFA-sponsored continuing education activities, professional development activities, and networking opportunities.

The PPFA Medical Services Student Nurse/APC Fellowship is a paid 12-month part-time program from January through December 2025, providing opportunities to gain valuable clinical support skills and experience. The fellow will typically work 15 hours per week, with scheduling flexibility based on student needs, including the ability to work evening and weekend hours. Weekday daytime hours will occasionally be required, which will be discussed and arranged with the supervisor. We understand that you are a student first and that your schedule will change throughout the program.

Purpose:

Provide support to the Medical Services Team to increase quality, safety, equity and consistency of affiliate clinical care by enhancing implementation and training programs related to PPFA Medical Standards & Guidelines (MS&Gs).
Learn about and contribute to clinical support and administrative activities necessary to help support frontline Planned Parenthood affiliate staff in their delivery of patient care.

Delivery:

Under the direction of the Director of Medical Standards Implementation:

Participates in the planning, designing, delivery, and evaluation of trainings to enhance implementation of the PPFA MS&Gs, which may include federation-wide virtual and live activities.
Participates in continuing education (CME/CE) application processes.
Reviews, edits, and creates implementation and training resources to enhance affiliate implementation of the PPFA MS&Gs.
Reviews, edits, and creates patient education resources.
Assists in supporting the PPFA Clinical Advisory Committee (CAC), including planning for and participating in the quarterly CAC meetings and supporting the CAC membership process.
Reviews, uploads, removes and edits Medical Services intranet resources.
Participates in the planning and evaluation of the annual meeting of the National Medical Committee.
Completes other duties as assigned.

Engagement:

Regularly collaborates with all staff within the Medical Services Team at PPFA.
May interact with staff of all levels in other departments and isions, as well as at affiliates and a wide variety of professionals and professional organizations external to Planned Parenthood.

Knowledge, Skills and Abilities (KSAs):

Education/Credentials: Currently enrolled in an accredited undergraduate nursing program through at least November or December 2025 or currently enrolled in an accredited graduate clinician program through at least November or December 2025. Preferred: enrollment in a nursing education program.
Experience: at least two years of employment experience.
Comfort with technology and with learning new technologies.
Excellent computer skills, as this position will require the use of Google Suite, Microsoft Office Suite, Adobe Pro, Asana, Smartsheet, and webinar platforms, among others.
Knowledge of communicating with erse groups, working with a multicultural workforce, and exhibiting sensitivity and appreciation of cultural differences is required.
Must be a self-starter with the ability to work with remote supervision.
Must have good oral and written communication skills.
Must be able to perform literature searches.
Must be detail-oriented.
Must be flexible.
Must have excellent interpersonal and customer service skills.
Must be comfortable working with telecommuters.
Must recognize the value of ersity and maintain relationships with staff and external audiences that respect inidual dignity.

Travel: None required, though optional travel to 1 meeting may be possible

Total offer package to include generous vacation + sick leave + paid holidays, inidual/family provided medical, dental and vision benefits effective day 1, life insurance, short/long term disability, paid family leave and 401k. We also offer voluntary opt-in for Flexible Spending Account (FSA) and Transportation/Commuter accounts.

We value a truly erse workforce and a culture of inclusivity and belonging. Our goal is to attract qualified candidates and encourage applications from all iniduals without regard to race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law. We’re committed to creating a dynamic work environment that values ersity and inclusion, respect and integrity, customer focus, and innovation.

PPFA participates in the E-Verify program and is an Equal Opportunity Employer.

#LI-SY1

*PDN-HR

Roles that are denoted as NYC, DC, or both will work a hybrid schedule, requiring 2-3 days per week in the office unless the role is denoted as onsite, which requires working onsite full time or 5 days per week.

One stop solution to your remote job hunt!

Responsibilities

Qualifications:

Overview

Responsibilities

Qualifications

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title:

Cost Center:

Work Shift:

Job Description:

Position Scope

Hours for the Position: Must be able to work 9a.m.-5:30p.m. with one evening shift required per week. Monday-Friday.

Nurse Case managers are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers, families, and caregivers to assist with navigating through the healthcare journey.

Additionally, the candidate will be responsible for the adoption and demonstration of the Care Solutions cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

Customer Strong: I deliver world-class experiences for all my customers.

Me to We: I take accountability to trust, partner, and deliver.

Own It: I see a need and deliver value because I care.

Evolve and Adapt: I learn and adapt to meet evolving business needs.

Be Bold: I pioneer and think broadly to solve challenges.

Take Care: I prioritize self-care and act with compassion toward colleague.

Day in the Life Responsibilities

Collaborates with customer in creation of care plan and documents plan in medical management system.

Partners with each customer to establish goals and interventions to meet the customer’s needs.

Establishes plan of care in conjunction with the customer and provider then document into a medical management system.

Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.

Empowers customers with skills to enhance interaction with their providers.

Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.

Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer’s provider and other Cigna Medical Management programs to provide whole-person health support.

Tracks daily activities to trend volume and outcomes.

Follows standard operating procedures.

Toggles between multiple systems and applications.

Research relevant topics in health promotion and disease prevention, as required for specific customers.

Prioritizes work to meet commitments aligned with organizational goals.

Understands and adheres to Case Management performance measures to deliver on key results.

Completes training within the communicated time limit as required per role.

Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.

Minimum requirements

Active unrestricted Registered Nurse (RN) license in state or territory of the United States.

Minimum of two years full-time direct patient care setting as an RN required.

Bilingual in English and Spanish (Fluency Speaking/Writing)

Must be flexible to work days or evenings based on business needs

Preferred requirements

For non-standard shift positions/State License Requirements: Available to work (Evenings after 11:30 a.m.) with a 12% shift differential.

Must have an active and unencumbered RN License in the State of Residence

Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management.

Excellent communication skills including telephonic (verbal) and digital (messaging, emails).

Skilled in clinical acumen to form a judgement and act.

Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research.

Ability to recognize, address and resolve conflicts in a professional, collaborative manner.

Demonstrates sensitivity to culturally erse situations, participants, and customers.

Demonstrates effective organizational skills and flexibility to meet the business needs.

Adapts approach and demeanor in real time to match the shifting demands of different situations.

Ability to manage multiple, complex situations in a fast-paced environment collaborating with clinical and other business partners.

Some roles may require on-site meetings or audits twice a year require

CAL RN 1

Company Description

Job Description

Qualifications

Additional Information

About the role

Primary Location: United States-California-Fountain Valley

Job: Coder

Organization: MemorialCare Medical Foundation

Schedule: Full-time

Employee Status: Regular

Job Level: Staff

Shift: Day Job

Responsibilities:

Qualifications:

Nurse Case Manager – Workers’ Compensation

Responsibilities:

Required Qualifications

Preferred Qualifications

Schedule

Physical/Cognitive Requirements:

Responsibilities

Qualifications

Responsibilities:

Required Qualifications: