Evry Health is seeking a tech-savvy Nurse to join our team. This is an exciting role allowing the ability to work with members across the continuum with ~75% utilization review and ~25% care coordination. Our teams are 100% virtual. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone. About Evry Health and Globe Life We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company. Roles and Responsibilities - Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions. Presents recommendations based on clinical review, criteria, and organizational policies to physician reviewers for final determination. - Conducts prior authorization, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of care by applying MCG guidelines, medical policy, and benefit structure for defined service requests. - Monitors clinical quality concerns, make referrals appropriately, identify and escalate care quality issues, and quickly identifies outlier cases, long length of stay cases or complicated prior authorization requests. - Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care. - Assists departmental staff with issues related to coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals. - Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement. - Effectively assess and facilitate appropriate utilization of clinical programs and/or discharge planning by thoroughly assessing and screening for proper care coordination following discharge. - Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. - Ability to assist and facilitate working relationship with Medical Director on CM and UM cases. - Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations with positivity, enthusiasm, and helpful personality. - Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls. Experience and Skills Desired - Previous healthcare/managed care appeals experience. - Must have a current, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume. - Diploma from an accredited school/college of nursing required. - You have 1-2 years of experience working at a health plan performing utilization management using standard practice guidelines. - You have working knowledge of medical and insurance industry terminology including basic level CPT/ICD10, authorizations, digital health programs, NCQA/URAC standards. - You have 3-5 years of clinical experience in a hospital or ambulatory setting assisting with direct patient care. - You have a passion for quality, teamwork, problem solving, and critical thinking. - You can work independently and comfortable in a fast-paced, deadline-oriented, tech savy, work environment. - You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology. - You have experience outreaching and educating members telephonically. - You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system. - Bonus: Familiarity with Salesforce/Healthcloud/CareIQ. - Bonus: CCM or ACM certification, MCG certification - Bonus: Appeals experience Telecommuting Requirements - This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. - Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. This position requires work during the stated business hours as well as rotating on-call weekends for utilization review cases. - Required to have a dedicated work area established that is separate from other living areas and provides information privacy. - Ability to keep all company sensitive documents secure. - Must live in a location that receives an existing high-speed internet connection/service. Benefits Package - Competitive salary - Comprehensive health, dental, and vision insurance as well as life and disability - Retirement savings plan with company match - Generous time off/vacation - Professional development opportunities - Flexible and remote work environment Evry Health is an EEO employer - Read More Here

Role Description We are currently seeking an experienced and compassionate Paediatric Community Speech and Language Therapist (SALT) to join a supportive SEND Therapy team based in West Essex. This role is based at St John’s Road, Stansted Mountfitchet, and offers flexible working arrangements, including consideration for virtual working. You will be working within a community setting, supporting children and young people with Special Educational Needs and Disabilities (SEND). The service is committed to delivering high-quality, child-centred care, helping children develop essential communication and language skills to support their daily lives and educational outcomes. This opportunity is ideal for a Band 6 or Band 7 therapist with experience in paediatrics and SEND, who is confident working independently while also contributing to a wider multidisciplinary team. Key Responsibilities - Assess, diagnose, and provide therapy for children and young people with speech, language, and communication needs (SLCN), including those with SEND. - Deliver tailored intervention plans in community and/or virtual settings. - Work collaboratively with families, carers, schools, and other professionals to support holistic care. - Maintain accurate and up-to-date clinical records in line with professional and organisational standards. - Participate in multidisciplinary team meetings, reviews, and service development initiatives. Qualifications - A recognised degree in Speech and Language Therapy (or equivalent). - HCPC registration and membership (or eligibility) with the Royal College of Speech and Language Therapists (RCSLT). - Proven experience working with paediatric caseloads, particularly children with SEND. - Strong communication, organisational, and clinical reasoning skills. - The ability to work independently and manage a varied caseload. How to Apply If you’re interested in registering with Pulse, learning more about this role, or exploring other opportunities, we’d love to hear from you. Please apply using the link below. Reasonable Adjustments If you have a disability or require any reasonable adjustments during the recruitment process or within the workplace, please let us know as early as possible. We are committed to providing the support you need throughout your journey with us. International Recruitment Notice Please note that we are unable to accept applications from individuals residing in countries listed on the Red or Amber list of the Code of Practice for the International Recruitment of Health and Social Care Personnel in England, as defined by the World Health Organisation (WHO) Workforce Support and Safeguard List.

Role Description We are currently looking for a reliable and detail-oriented Remote Medical Scribe to support a healthcare practice based in the United States. The ideal candidate will assist providers by documenting patient encounters, updating medical records, and ensuring accurate and timely charting while working remotely. - Document patient encounters in real time or from recorded sessions - Accurately enter clinical notes, diagnoses, and treatment plans into the EMR - Review and update patient charts for accuracy and completeness - Assist providers by organizing clinical documentation and records - Ensure compliance with documentation standards and clinic protocols - Provide general administrative support related to clinical documentation as needed Qualifications - Previous medical scribe or medical virtual assistant experience preferred - Strong English communication and listening skills - Experience with EMR systems - Strong attention to detail and documentation accuracy - Reliable internet connection and quiet work environment - Ability to work during U.S. Central Time hours Requirements - Your most updated Curriculum Vitae (CV) - A 1-minute introduction video discussing your previous work experience in the U.S. healthcare field - A valid ID - A list of EMR systems you have used Benefits - Rate: $5/hour for the first 3 months, increasing to $6/hour thereafter - Payment Method: Wise - Payment Cycle: Biweekly How to Apply Send your application through www.vitalvirtuals.com . We look forward to hearing from you.

Pay Range: $73,600.00 - $110,400.00 Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process. At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. What you will do: - Manage members through evidence-based care, promoting access to the healthcare system, and assessing needs to identify appropriate interventions and support services as well as reduce barriers to evidence-based care. Member management includes, but is not limited to, conducting health assessments (telephonic and face-to-face) to identify high-risk or emerging risk members for education and intervention; evaluating and modifying action plans by working with members and collaborating with providers. - Evaluate member services to ensure appropriate levels and coordination of care, including pre-authorization, concurrent review, quality-of-care screening, and discharge planning. Ensure member and provider satisfaction by demonstrating knowledge of member plan benefits and community resources. - Identify opportunities to moderate claims costs for employer group and individual members. Promote and monitor use of wraparound service programs for optimal member experience while managing chronic and acute care needs. - Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans for improving members’ total health. Provide continuity and consistency of care by building positive relationships between members, families, providers, care coordinators, social support partners, and the health plan. - Engage in team operations including supervision, team huddles, staff meetings, case rounds, metric management, training opportunities, department initiatives, and projects. Work collaboratively to develop and implement solutions, identify barriers, and exemplify corporate values through accountability, collaboration, integrity, and respect. - Perform other duties as assigned What you’ll need to succeed: - Unrestricted Rhode Island Nursing License - Unrestricted Massachusetts Nursing License - Three years’ experience in a medical/clinical environment or managed health plan - Must obtain Certified Case Manager (CCM) certification within three years of employment The extras: - Bachelor’s degree in nursing - Certified Case Manager (CCM) - Reside in Rhode Island or other Nurse Licensure Compact state (NLC) - Bilingual Spanish, Portuguese - Experience working in a managed care/health maintenance organization - Experience implementing and upholding Quality, CMS, NCQA requirements - Knowledge of utilization management and/or coordination of care - Knowledge of population health and chronic condition management principles, aligning with corporate initiatives such as specialty within high-risk maternity and rising risk conditions such as diabetes, hypertension, COPD, etc. - Understanding of health care delivery system access points and services - Demonstration of successful (member) engagement via application of Motivational Interviewing techniques and health coaching - Ability to navigate the healthcare delivery system - Understanding of evidence-based care programs and approaches - Strategic and critical thinking skills - Strong analytical skills - Strong business acumen - Strong presentation negotiation, problem-solving, and decision-making skills - Strong written and verbal communication skills - Ability to work effectively with a wide variety of people in individual and group settings - Strong organizing skills, with the ability to prioritize and respond to shifting deadlines - Strong time management skills Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: - In-office: onsite 5 days per week - Hybrid: onsite 2-4 days per week - Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit  www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.