Clinical Review Manager, Blue Advantage Inpatient UM The Blue Advantage Inpatient Utilization Management team is seeking an experienced RN to support clinical reviews for hospital admissions, injections, and specialty services for our adult and senior populations. This role is ideal for a nurse with hands on inpatient hospital experience who is passionate about ensuring members receive appropriate, timely medical care. You will play a key role in identifying barriers to care, applying standardized clinical guidelines, and connecting members with resources that improve outcomes. What You’ll Do - Review clinical documentation for inpatient admissions, injections, and specialty services for adult members - Apply standardized clinical guidelines to support utilization management decisions - Take and manage inbound clinical requests by phone, requiring consistent phone coverage throughout the shift - Identify barriers to care and connect members, especially seniors, with appropriate resources - Support high quality, medically necessary care while ensuring compliance with UM standards Skills We’re Looking For - Active RN with a minimum of three years of clinical nursing experience - Inpatient hospital experience with a strong understanding of acute care workflows - Background working with adult populations across a variety of care settings - Strong computer skills and comfort navigating multiple clinical systems - Ability to interpret clinical information and apply it to standardized guidelines - Clear, professional communication skills for frequent phone based interactions - Dependable professional with a demonstrated history of stability and long term commitment in prior roles - Excitement around and experience leveraging approved AI tools such as Copilot to drive efficiencies, streamline workflows, and support high quality outcomes Job Responsibilities - Initiate referrals to ensure appropriate coordination of care. - Seek the advice of the Medical Director when appropriate, according to policy. - Assists non-clinical staff in performance of administrative reviews - Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility. - Occasional weekend work may be required. - Must be able to pass Windows navigation test. - Testing/Assessments will be required for Digital positions. - Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Job Qualifications License - Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience - 3 years - Clinical experience required Skills\Certifications - Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) - Working knowledge of URAC, NCQA and CMS accreditations - Must be able to work in an independent and creative manner. - Excellent oral and written communication skills - Strong interpersonal and organizational skills - Ability to manage multiple projects and priorities - Adaptive to high pace and changing environment - Customer service oriented - Superior interpersonal, client relations and problem-solving skills - Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

When our values align, there's no limit to what we can achieve. At Parexel, we all share the same goal - to improve the world's health. From clinical trials to regulatory, consulting, and market access, every clinical development solution we provide is underpinned by something special - a deep conviction in what we do. Each of us, no matter what we do at Parexel, contributes to the development of a therapy that ultimately will benefit a patient. We take our work personally, we do it with empathy and we're committed to making a difference. The Senior Clinical Research Associate (Sr. CRA) is responsible for the site management, site monitoring and close-out of assigned clinical trials investigator sites to ensure patient safety and quality study execution in accordance with applicable prevailing laws, Good Clinical Practices (GCP), and the Sponsor's standards. The Sr. CRA is accountable for site management and monitoring, managing investigator site relationships to ensure effective delivery of clinical trials (e.g. enrollment, database release), to safeguard the quality of investigator sites (e.g. patient safety, site quality and compliance with GCP), to maintain investigator and site staff engagement and satisfaction, and to enhance the company’s image with its external stakeholders. The Sr. CRA is responsible for the resolution of all protocol-related issues for assigned investigator sites and will work closely with the Site Care Partner (SCP), and other members of the study team, as required, in activities associated with the set-up, running and close-out of sites in a clinical trial. Monitoring Responsibilities and Study Conduct: - Ensure proper conduct of clinical trials in accordance with the Study Monitoring Plan (SMP) and applicable prevailing laws, GCP, and the Sponsor's standards to achieve project goals, timelines and quality - Manage assigned operational aspects for implementation of clinical trial activities at assigned investigator sites from site activation through to database lock, ensuring relevant timelines and quality deliverables are met - During study conduct, serve as the primary point of contact for assigned investigator sites. Work in partnership with and/or escalate to the SCP to ensure quality of site delivery - Interface with the study team as needed, facilitate information flow between members of the study team, vendors and assigned investigator sites - Partner with Site Care Partner to perform investigator site development, coaching and training of site personnel to ensure ongoing compliance with protocol and the safeguarding of patients; provide protocol training to, and address protocol related questions from the investigator site staff when required, including discussions on known/anticipated operational and clinical trial risks - Attend investigator meeting when required (virtual or F2F). Provide enrollment support and ensure progress by responding to site activation and recruitment issues from investigators. Partner with Site Care Partner and the study team to define and support recruitment initiatives at site level - Conduct onsite, remote/electronic monitoring as needed for study site initiation, routine monitoring and study site closure activities and ensure these are conducted accordance to the SMP, Standard Operating Procedures (SOPs) and commensurate with emerging issues and technologies - Monitor site level adverse events (AEs) and serious adverse events (SAEs) and collaborate with the Drug Safety Unit and follow-up with investigators sites, as needed, to bring SAE reports required information to resolution - Submit all required reports, documentation, updates and tracking within required timeframes, including but not limited to Trial Master File (TMF) documentation, site reports, site follow up letters, protocol deviations, patient recruitment, clinical supply management, study progress and metrics - Identify and resolve investigator site issues within required timeframes; agree and develop corrective and preventative actions with investigator and site personnel to close open issues and to prevent recurrence/persistence of issues - Resolve data queries within required timelines, prepare investigator site close-out plan and conduct close-out activities within required timelines - Ensures adequate oversight of the investigational product at the investigator site, including receipt, handling, accounting, storage conditions, and destruction activities - Support database release as needed - May undertake the responsibilities of an unblinded monitor where appropriate Clinical/Scientific and Site Monitoring Risk: - Maintain thorough understanding of the product, protocol and therapy area in sufficient details to have appropriate discussions with the investigator and site team - Interact with investigator site heath care professionals in a manner which enhances the Sponsor's credibility, scientific leadership and in order to facilitate their clinical development goals - Support the study clinician in ensuring patient safety, eligibility and providing clinical guidance to investigators - Drive Quality Event (QE) remediation, when applicable - Serve as a point of contact for audit conduct, and drive Audit Observation corrective action/preventive action (CAPA) development and checks, when applicable Skills: - Extensive knowledge of clinical trial methodologies, ICH/GCP, Food and Drug Administration (FDA) and local country regulations - Monitoring Experience: Minimum 3 years relevant experience in clinical research site monitoring (preferably 2 years in Oncology) - Preferred therapeutic experience in Oncology, Vaccines, Internal Medicine or Infectious Diseases - Must be fluent in English and in the native language(s) of the country they will work in - Ability to travel 60-80% - Valid driver’s license and passport required Education: - Bachelor’s degree in life sciences or professional degree in life sciences such as nursing, pharmacy, medical background or equivalent #LI-LO1 EEO Disclaimer Parexel is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to legally protected status, which in the US includes race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Clinical Triage Nurse - Work at Home Medellin Colombia Application Deadline: 13 April 2026 Department: Operations Employment Type: Full Time Location: Medellin, CO Compensation: $1,300 / two weeks Description The Telephone Triage Nurse (RN) will be responsible for monitoring, answering, and responding to calls received through our emergency line outside of office hours. This individual will provide timely and appropriate guidance to patients in the critical postoperative period and, when necessary, escalate cases to the appropriate surgeon. Key Responsibilities - Answer and respond to all incoming calls to our after-hours emergency line. - Listen to the patient's concerns, gather relevant information to provide guidance on proper care, and determine when to escalate the case to the surgeon. - Respond to incoming emails related to postoperative cases and create cases in Salesforce. - Create, manage, and close patient cases in Salesforce. Skills, Knowledge & Expertise - Advanced knowledge of medical terminology. - Excellent verbal and written communication skills with diverse audiences (patients, family members, and physicians). - Superior listening skills with the ability to quickly comprehend instructions in emergency situations. - Ability to frequently synthesize patient data and implement an appropriate action plan based on the situation (strong critical thinking skills and good judgment).

We are seeking a Clinical Nurse in the department of Gastroenterology who will serve as a patient advocate and is part of a team of nurses, doctors, medical office coordinators, and other clinical support staff. The Clinical Nurse demonstrates responsibility and accountability with patients, family members, other providers and support personnel regarding patient care and unit operations. Specific Duties and Responsibilities - Provide clinical support to Gastroenterology and Hepatology physicians. - Provide direct patient care based on the nursing process; work collaboratively with a multidisciplinary health care team to optimize team performance. - Ensure patient and physician calls are returned in a timely manner, and all patient interactions are documented appropriately in EPIC. - Utilize assessment skills and critical thinking to triage patient calls and complaints, respond as needed, or forward a detailed message to the appropriate physician. - Answer questions from patients regarding physician instructions, medications, prescription refills, non-critical biopsy and testing results, and other aspects of clinical care. - Retrieve diagnostic results, coordinate physician review of results, and call patients with physician recommendations. - Assist physicians in conducting comprehensive, age appropriate and episodic health assessment of patients/families with real, potential, acute and/or chronic health problems, which may include the psychosocial, cognitive and personal assets and limitations of the patient/family with an emphasis on wellness. - Communicate to the patient the plan of care, pre-procedural education, post-procedural education, additional follow-up within the department of GI/Hepatology and any necessary referrals outside of the department. - Assess and/or manage follow-up plans, specific to the age of patient. - Regularly give effective, complete, and accurate instructions regarding good health maintenance including disease prevention and home health care according to department guidelines and under the supervision of a physician. - Record and document health assessment data necessary to maintain, coordinate and/or expedite required services. - Act as a resource to health care staff and implement educational programs to improve health status of patients/families taking the developmental needs of the patients and families into consideration. - Maintain electronic equipment provided by the division and communicate with the IT department to discuss any necessary updates and maintenance. - Maintain needed supplies and equipment. - Address operational issues as needed to ensure clinic is functioning efficiently. - Triage patient calls and assess patients with urgent problems and/or health concerns that cannot be handled by scheduling/administrative staff and determine appropriate and timely disposition. - Communicate with providers and patients as needed. - Contact patients to obtain clarification on medication dosing and/or to discuss clinical problems; discuss recommendations with physicians and ensure appropriate follow-up with patients. - Assist with prior authorization requests for testing/treatments and medications as needed. - Participate and be flexible within the division of GI/Hepatology to meet clinical needs, e.g. willingness to cross-train to cover infusion and/or motility testing - Request consultations with appropriate departments when necessary, i.e. email patient referrals, call other departments outside of GI/Hepatology to facilitate patient care (radiology, pathology). - Adapt to changes in technology and software to ensure efficient office practice. - Attend nursing meetings and any additional mandatory meetings as required. - Assume responsibility for own professional development and remain current in clinical practice by attending relevant continuing education. - Assume responsibility and accountability for time management, professional relationships and interpersonal interactions. - Other duties as assigned by the clinic nurse manager. Minimum Qualifications - Individual must be a registered nurse, licensed in the State of Maryland - Completion of the JHH credentialing process to include verification of CPR (BLS) certification prior to start date. - Maintain current licensure and certification during duration of employment. - Additional education may substitute for required experience, and additional related experience may substitute for required education beyond a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula. Preferred Qualifications - BSN Degree - Two years of direct patient care experience. - Two years of specialized experience in Clinical Gastroenterology Classified Title: Clinical Nurse Role/Level/Range: ACRP/03/ME Starting Salary Range: $64,600 - $113,300 Annually ($83,000 target; Commensurate w/exp.) Employee group: Full Time Schedule: M-F 8:30a - 5p FLSA Status: Exempt Location: Remote Department name: SOM DOM Gastroenterology Personnel area: School of Medicine