Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve. Provider Management Specialist 1 (Nurse Reviewer) Location: Illinois (Remote with On‑Site Visits) Position Overview The Provider Management Specialist conducts provider compliance reviews, evaluates documentation, and performs on‑site visits to ensure adherence to state regulations. This role requires strong clinical experience, attention to detail, and excellent customer service while working both remotely and in the field. Duties & Responsibilities - Build and maintain positive relationships with users and providers to deliver high‑quality customer service. - Evaluate providers for compliance with applicable regulations and program requirements. - Coordinate and schedule on‑site provider visits and clearly communicate all visit requirements. - Conduct informational provider compliance interviews. - Assess provider documentation, business practices, and operational processes against established standards. - Collect, organize, and submit data and documentation obtained from provider sites. - Utilize technology to manage all review activities, including converting paper documentation to electronic format and uploading via web‑based applications. - Conduct in‑person assessments of physical provider sites for compliance. - Summarize on‑site visit findings in clear, accurate reports. - Identify trends in non‑compliance or ineffective business practices. - Make timely and appropriate recommendations to the Supervisor. - Maintain HIPAA standards and confidentiality at all times. - Perform other duties as assigned. Required Skills - Strong interpersonal skills with the ability to relate to diverse staff and providers. - Active listening skills and effective communication techniques. - Computer literacy, including MS Word, Excel, Outlook, and web‑based applications. - Process‑oriented, results‑driven approach to work. - Ability to foster teamwork with colleagues at all levels. - Ability to work independently and within a team environment. - Excellent customer service and professional communication (verbal and written). - High accuracy, strong attention to detail, and commitment to quality. - Ability to meet deadlines and adhere to strict standards. - Ability to travel to provider sites throughout the state of Illinois. Qualifications Education - Bachelor’s degree in any field (Nursing preferred) Experience - 2+ years of clinical experience working with: - Critical care providers - Public health providers - Providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities - 1+ year of experience performing quality assurance reviews. Certification - Active Illinois Registered Professional Nurse (RN) license required. Working Conditions - Remote work and on‑site visits (2 to 3 per week) at provider facilities across Illinois. Benefits Through SSO SSO offers a comprehensive benefits package supporting your well‑being, financial stability, and long‑term growth, including: - Health, dental, and vision insurance - 401(k) with discretionary employer match - Paid time off and holidays - Flexible spending accounts - Additional employee perks Keyword Search Terms Nurse Reviewer, Provider Management Specialist, RN Reviewer, Compliance Nurse, Provider Compliance, Healthcare Quality Review, Medicaid Compliance, Clinical Reviewer, Illinois RN, Site Visit Nurse, Healthcare Auditor, Public Health Nursing, QA Nurse, Provider Monitoring. Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role. Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship (including H-1B sponsorship) by SSO and under the federal laws relating to the F-1 STEM EAD program, this position is not eligible to support a STEM EAD extension application. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant.

Anticipated End Date: 2026-03-16 Position Title: Nurse Case Manager II (US) Job Description: Telephonic Nurse Case Manager II Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Shift: Monday - Friday 8:00am to 4:30pm EST and 2-3 late evening 11:30am to 8:00pm EST per month. *****This position will service members in different states; therefore, Multi-State Licensure will be required. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. How you will make an Impact: - Ensures member access to services appropriate to their health needs. - Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. - Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. - Coordinates internal and external resources to meet identified needs. - Monitors and evaluates effectiveness of the care management plan and modifies as necessary. - Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. - Negotiates rates of reimbursement, as applicable. - Assists in problem solving with providers, claims or service issues. - Assists with development of utilization/care management policies and procedures. Minimum Requirements: - Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. - Current, unrestricted RN license in applicable state(s) required. - Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: - Certification as a Case Manager and a BS in a health or human services related field preferred. - Oncology experience preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,464 to $124,872. Locations: Colorado; Nevada; New York. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 2nd Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Concurrent Denial Nurse BU - Utilization Management Location Cleveland Facility Remote Location Department Nursing Administrative Supervisors-Indian River Hospital Job Code 0019IR Shift Days Schedule 9:00am-5:00pm Job Summary Job Details CCIR Bidding Period: 12/9/2025 - 12/16/2025 Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. You will work alongside dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world. As a Concurrent Denial Nurse, you will support the Utilization Management Department by reviewing concurrent and retrospective clinical inpatient denials to ensure medical necessity criteria is met. We are looking for a Registered Nurse who is a subject matter expert in utilization management, has experience with MCG criteria, and is comfortable educating Caregivers and Physicians. In this role, you will get to work with a dynamic team of like-minded professionals and gain experience at an elite healthcare organization. A caregiver in this position works days from 7:30AM – 4:30PM. A caregiver who excels in this role will: - Serve as the expert in Utilization Management functions and be a resource to the department in general and the hospital. - Review and analyze concurrent and retrospective clinical denials and follow the specific payer processes. - Serve as an expert in payer specific process and communicate between payer and CCIRH to identify/resolve denial process issues. - Work in collaboration with the local physician advisor team and support the peer-to-peer process. - Perform the routine activities of a UM Specialist when needed while taking a leadership role. - Utilize knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures and basic disease processes. - Utilize knowledge and experience with Care Guidelines and /or other UM criteria sets. - Utilize advanced interpersonal and communication written and verbal skills necessary to gather and exchange data (both internally and externally) with members of the health care team. - Recommend resource utilization when needed - Utilize analytical skills to gather data, identify problems and facilitate resolution. - Prioritize and organize work to meet changing priorities. - Utilize knowledge of multiple hospital information systems and department’s software. - Assist with education and monitoring of UM specialist's reviews. - Participate in payer specific p2p calls or local meetings as needed. Minimum qualifications for the ideal future caregiver include: - Bachelor’s Degree in Nursing or related field - Current Florida Resident with active Florida License - Completion of an accredited Registered Nursing Program (RN) - Current valid license in the State of Florida as a Registered Nurse (RN) - Basic Life Support (BLS) certification through the American Heart Association (AHA) or American Red Cross - Three years of full-time Utilization Management experience - Demonstrated above average competence in Utilization Management Processes Preferred qualifications for the ideal future caregiver include: - Case Management certification (CCM or ACM) Physical Requirements: - Requires extensive reading, telephone , computer use - Must be able to work well under pressure and maintain professional demeanor under adverse conditions Personal Protective Equipment: - Follows Standard Precautions using personal protective equipment as required The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster. Cleveland Clinic is pleased to be an equal employment opportunity employer.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are seeking an experienced Care Navigation RN to provide direct, patient-centered support to our members. In this role, you will be the primary point of contact for members navigating complex health journeys. You will utilize your clinical expertise to improve health outcomes, reduce barriers to care, reduce costs, and provide compassionate advocacy within a high-performance, virtual environment. - Deliver coordinated, patient-centered virtual Care Navigation by telephone and digital channels to improve member health outcomes and satisfaction. - Lead proactive outreach efforts to identify high-risk individuals; complete comprehensive clinical assessments and develop tailored care plans for enrolled members. - Utilize the Nursing Process and a holistic "whole person" approach—including pharmacy interventions, crisis support, and disease-specific education—to support members. - Assist members in navigating the complexities of the healthcare system, providing education and empowerment to help them meet their healthcare goals. - Provide longitudinal Care Navigation during acute episodes, such as hospitalizations and rehabilitation stays, supporting both the member and their family through the transition of care. - Identify clinical or social barriers to health and provide targeted interventions, connecting members to relevant health benefit resources and social determinants of health (SDOH) support. - Work alongside other stakeholders and partners on co-managed cases and collaborate with internal teams to resolve complex benefit and claims questions. - Build supportive, trusting relationships through passionate follow-up care and consistent advocacy. - Maintain strict compliance with all regulatory, accreditation, and internal policy standards. - Demonstrate an understanding of the functions of other departments, communicate with other departments appropriately and maintain positive working relationships. Qualifications - Active RN license in a compact state with the ability to obtain licensure in other states as needed. - 2+ years of experience in case management for a health plan or TPA and 2+ years of experience in a hospital or clinical setting. - Experience across multiple specialties, including med/surg, oncology, behavioral health, maternity, critical care/emergency, pediatrics, or community care. - Strong competence in using multiple computer/medical record systems (EMRs), preferably Salesforce, and Google Workspace. - Ability to talk, type, and navigate an electronic chart simultaneously in a remote setting. - Proven ability to prioritize assignments, manage a busy caseload, and meet daily goals independently. - Experience in telephonic care management with no direct/face-to-face patient contact. - A drive for identifying and implementing clinical best practices. Requirements - Knowledge of Managed Care Programs. - Knowledge or certification in Motivational Interviewing. - Case Manager Certification. Benefits - Great overall employee experience with opportunities for career growth. - Meaningful mission-driven work. - Above average total rewards package. - Salary range for this position is $71,400 - $118,000 annually. - Numerous factors including education, skills, work experience, certifications, etc. will be considered when determining compensation. - Alternative medicine coverage. - Generous PTO. - Up to 16 weeks paid parental leave. - Paid holidays. - 401k program. - Transportation perks. - Education reimbursement. - Paid paw-ternity leave.