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Role Description The Lead Remote Navigator provides day-to-day leadership and operational oversight to a team of Remote Navigators across multiple service lines in a call center or distributed remote environment. This role balances direct call handling and queue coverage with team coordination, performance monitoring, training, scheduling, and timecard approval. The Lead Navigator is responsible for resolving team escalations within established workflows in collaboration with the Manager, and reporting new or emerging issues to the Manager with proposed solutions. The Lead Remote Navigator ensures that navigators are meeting service level and quality metrics, adhering to workflows, and delivering a high-quality patient experience over the phone and through digital channels. This role leads training and onboarding, creates and manages team schedules, holds weekly supervision with direct reports, approves timecards, and participates in the Training & Development committee and implementation working groups in a leadership capacity. The Lead Remote Navigator is also a power user and internal champion of the AI tools that augment navigator workflows, providing structured feedback to Product and Operations on tool performance. What you'll do - Escalation Handling - Handles escalated patient and family calls from Remote Navigators. - For issues within existing workflows: resolves escalations with feedback and ensures proper documentation. - For new or emerging issues: reports to Manager/Supervisor and collaborates on developing solutions. - Direct Patient Navigation - Maintains a direct call handling function across 3+ service lines as needed to maintain queue coverage. - Provides advanced care coordination across complex patient pathways using digital and AI-enabled workflows. - Serves as backup to the call queue to maintain service levels during high-volume periods. - Ensures team adherence to HIPAA requirements and all program standards. - Monitors patient data and metrics to identify care gaps and guide team outreach strategies. - Collaborates with AI tools to streamline patient interactions and prioritize higher-acuity cases. - Contributes to an environment of psychological safety where ideas are welcomed and appreciated. - Client Communication - Acts as an indirect communication link between client site partners and Rely Health leadership — all client-facing program requests are channeled appropriately through established protocols. - People Management - Holds Bi-weekly supervision meetings with all direct reports to review performance, provide feedback, and support professional development. - Creates and manages call center shift schedules, adjusting as needed to ensure full queue coverage across all service lines. - Reviews and approves timecards for all direct reports. - Monitors day-to-day remote team operations and serves as the first internal point of contact for team members. - Coordinates and supports recruitment, onboarding, and training of new remote navigators. - Conducts quality audits of remote navigator performance using call recordings, documentation review, and metric analysis. - Provides real-time service recovery when patient concerns arise, implementing coaching and process improvement plans. - Collaborates with Manager on performance reviews and developmental feedback. - Communicates employee changes to Human Resources in coordination with Supervisor. - Training - Supports implementation of program expansion and new client site initiatives. - Trains new Navigator team members on remote workflows, call center tools, role expectations, and digital platforms. - Evaluates performance during onboarding and provides structured feedback. - Creates training content for remote workflows, digital communication tools, and AI platform use. - Coordinates group workshops and team workgroups. - Leads participation in the Training & Development committee and implementation working groups, driving initiatives from the remote navigation perspective. - Technology - Monitors team technology usage and call center metrics in Rely Health tools, reporting results to leadership and clients as needed. - Works with Operations and Product teams to test new digital tool enhancements and provide structured feedback. - Ensures all team members are trained and proficient on required technology platforms. - Provides actionable remote usability feedback on AI, call center, and care navigation tools. - Conducts testing on new call center tools and features prior to team rollout. - Uses no-code tools to build or adjust basic campaigns, reminders, or engagement workflows as directed. - Serves as power user and internal champion for AI tools that augment navigator workflows. - Identifies opportunities to optimize AI tool prompts, scripts, and configurations based on observed patient outcomes and call center performance data. Qualifications - High school diploma or GED. - 2+ years of full-time equivalent experience in patient care navigation, call center navigation, or related healthcare coordination role. - 1+ years leading or mentoring a team. - Experience training other employees. - Healthcare experience. - Familiarity with healthcare technology platforms and tools. - Ability to maintain high productivity in a remote or distributed work setting. - Understanding of and ability to comply with all HIPAA and confidentiality requirements. Preferred Qualifications - Experience working with individuals within hospitals or public health settings. - Experience with underserved populations. - Knowledge of Medicare, Medicaid, and commercially insured payer common practices and policies. - Individuals with lived experience. - 40+ wpm typing proficiency. - EHR/EMR or call center CRM documentation experience. - Experience using technology, apps, and software. - Experience with AI-assisted care tools or digital health platforms. - Bilingual proficiency is a plus. Competencies (Knowledge / Skills / Abilities) - Knowledge of medical terminology. - Knowledge of HIPAA and Protected Health Information (PHI) rules and practices. - Proficiency in Microsoft Office, Google Suite, and video conferencing. - Active listening, de-escalation, and motivational interviewing skills. - Ability to manage complex, multi-stakeholder care cases independently. - Ability to maintain a high level of productivity autonomously. - Data analysis skills — ability to identify care gaps and drive metric-based outreach. - Deeper knowledge of insurance, billing, and healthcare systems. - Flexible and creative problem-solving. - Dynamic communication skills in a virtual and phone-based environment. - Analytical skills — ability to translate call metrics and patient data into team performance action. - Ability to monitor, coach, and hold accountable a distributed remote team. - Proficiency in remote collaboration tools, queue management systems, and digital platforms. - Ability to build and implement new remote processes and tools. - Strong organizational, scheduling, and queue management skills. - Ability to drive high performance, culture, and employee engagement in a virtual setting. - Empathetic critical thinking and collaborative remote leadership style. - Strong interpersonal skills — ability to establish trust and credibility as a peer and leader across a remote team. - Ability to thrive and hold others accountable in a performance-based environment. Benefits - 401(k) - Dental insurance - Health insurance - Vision insurance - LT/ST Disability and Life Insurance - Technology reimbursement - Paid time off (Vacation, Sick, Holiday) - Paid Parental leave - Professional development
Role Description We are seeking a warm, compassionate, and highly organized Dental Front Office Receptionist to serve as the premier digital face of our premium Orange County practice. The ideal candidate leads with kindness and brings an infectious, positive energy that instantly puts dental patients at ease. This position demands an exceptionally polished, ultra-clear, and fluent English and Spanish verbal delivery. You will act as the vital bridge between our clinical providers and our diverse patient community, balancing high-volume front desk administrative coordination with meticulous dental insurance breakdowns. Core Responsibilities - Front Office Administration & Open Dental CRM Operations - Concierge Phone Management: Answer and navigate a multi-line VoIP phone system in both English and Spanish, greeting every caller with flawless professional clarity, warmth, and a welcoming presence. - Strategic Appointment Settings: Schedule, confirm, and optimize patient appointments directly within Open Dental CRM, strategically routing hygiene recalls and restorative treatments to ensure smooth patient flow. - Patient Intake & Chart Management: Collect, audit, and systematically update patient demographics, Spanish/English intake forms, and digital charts to maintain complete, HIPAA-compliant electronic records. - Financial Administration: Process virtual check-ins and check-outs, manage billing inquiries, collect patient co-pays, and execute accurate end-of-day financial reconciliation. - Administrative Liaison: Manage office correspondence, triage digital faxes, route mail, and collaborate flawlessly with the on-site clinical team to manage daily schedules. - Comprehensive Insurance Verification Duties - OON & PPO Eligibility Verification: Verify patient insurance eligibility and full benefits prior to scheduled appointments using online portals, direct phone inquiries, and clearinghouse tools. - Detailed Benefit Breakdown: Confirm and document highly specific coverage details inside Open Dental CRM, including deductibles, co-pays, co-insurance, annual maximums, and plan limitations. - Discrepancy Resolution: Identify and fix insurance discrepancies or inactive coverages before the patient arrives at the physical Orange County clinic to prevent backend claim denials. - Pre-Authorizations & Multi-Insurer Rules: Obtain formal pre-authorizations and referrals required by insurance networks, managing Coordination of Benefits (COB) and secondary insurance tracking. - Compassionate Cost Presentation: Break down and communicate complex insurance benefits and out-of-pocket cost estimates to patients clearly and empathetically in their preferred language. Qualifications - Healthcare Admin Experience: Minimum 2 years of direct administrative or receptionist experience working within a medical or dental practice setting. - Open Dental Mastery: Solid, hands-on working proficiency with Open Dental CRM (specifically the scheduling, charting, and billing modules). - Phonetic Clarity: Exceptionally crisp, clear, and professional verbal communication skills in English. - Bilingual Fluency: Complete, seamless spoken and written fluency in both English and Spanish. - Insurance Verification Competency: Documented experience executing deep-dive dental/medical insurance verification workflows, insurance portals, and billing procedures. - Compliance Standards: Strict working knowledge of HIPAA privacy regulations and patient confidentiality protocols. - Remote Ecosystem: A perfectly quiet, secure home office space free of background noise, operating via high-speed internet and an automated time-tracking system. Preferred Qualifications - Direct experience inside a private dental practice setting. - Deep knowledge of dental-specific coding (CDT) and medical coding (CPT). - Certification in Medical/Dental Office Administration or a related field.
Role Description We are seeking an experienced Nurse Practitioner (NP) passionate about remote care delivery. In this role, you will lead diabetes education and management by conducting phone visits for initial member consultations. You will be responsible for: - Evaluating diagnoses, medications, and lab results to assess member acuity and validate candidacy and continuation in our clinical program. - Identifying and prescribing CGMs (Continuous Glucose Monitor) for applicable members. Key responsibilities include: - Providing call-based care to members in Perry Health’s Remote Patient Monitoring (RPM) program. - Delivering swift, empathic care to members and assessing their clinical competencies. - Evaluating medical history and data to determine member eligibility for the clinical program. - Serving as the primary clinical point of contact for practice-wide escalations. - Collaborating with the broader care team — including RNs, RDs, and Accountability Coaches — to reinforce clinical goals and SMART goal progression. - Adhering to Perry Health policies, procedures, and standard operating procedures to ensure ongoing clinical quality and compliance. Qualifications - Education: Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) from an accredited institution; active certification as a Nurse Practitioner. - License: Valid, unencumbered state nurse practitioner license required. Multi-state licensure required. Current priority need states are Alabama, Utah, and Iowa. - Experience: Minimum 3+ years of experience managing patients with diabetes. - Knowledge: Familiarity with continuous glucose monitors (CGMs) and behavior change theory is a plus. - Skills: Motivated learner, willing to acquire proficiency with the necessary technology; experience or training in Motivational Interviewing to support sustainable behavior change is a plus. - Traits: Creative thinking, an eye for detail, ability to work independently, a positive attitude, and the ability to excel in a fast-paced atmosphere while collaborating with diverse groups at all levels of the organization. - Language: Spanish-speaking highly preferred. Requirements - Candidate must hold valid, unencumbered nurse practitioner licensure with prioritization in the following states: AL, UT, IA, IL, IN, MI, GA, FL. - Must reside in the United States with consistent access to a clean, quiet workspace; solid internet connection; and proficient technical experience. - Provide availability for the next two months by the 15th of each month. Benefits - Contractors are paid on a monthly basis following Net 30 payment terms. - Clinical Pay: $30.00 per completed consult. Consults are scheduled in 20-minute slots and require a minimum of 15 minutes of engagement time per member for the visit to be billable. - Non-Clinical Pay: $30.00/hour flat rate for required meetings and training.
Role Description Claxton Dietetic Solutions, LLC is seeking a Registered Dietitian to provide clinical nutrition services in the long-term care/rehabilitation setting. This is a PRN / Remote opportunity for approximately 0-40 hours/week. - Conduct nutrition assessments and documentation - Complete MDS assessments and care plans - Monitor weights and nutrition risk - Participate in nutrition at-risk meetings - Strong communication with the IDT Qualifications - Registered Dietitian credential (CDR) required - Active state licensure in the State of Tennessee - Preference given to candidates holding licensure in multiple states - Strong organizational and time-management skills - Long-term care or geriatric experience is required Requirements - Criminal background check - TB screening - Drug screening Benefits - Competitive compensation based on experience, licensure, role scope, and location - Continuing education opportunities - Employee discounts
UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Role Description As a SCA (Service Contract Act) Nurse Advice Line RN, you will play a critical role in delivering high-quality, evidence-based care to Beneficiaries across the globe. Using advanced clinical decision support tools, you will provide real-time health education and symptom triage through phone, chat, and video platforms—helping individuals make informed decisions about their health when they need it most. This is a dynamic, fast-paced role ideal for nurses who thrive on variety, critical thinking, and meaningful patient interaction—all in a virtual environment. This position will work as part of a 24/7 Call Center line, and we have full-time positions available. Training, regardless of schedule, will be 40 hours per week for 4 weeks during regular daytime business hours, Monday - Friday. You will have the flexibility to work remotely from a compact state* as you take on some exciting challenges. Available shifts listed below will either be a 5X8, 4X10 or 3X12 schedule. Shifts Available (noted in Central Time Zone). - Day shift schedules: - 5am – 1:30pm – Sun, Mon, Thurs, Fri, Sat - 5:30am – 2pm – Sun, Mon, Tues, Wed, Thurs - 6:30am-7pm – Sun, Mon, Sat - 6:30am - 5pm – Sun, Thurs, Fri and Sat - 9am – 7:30pm – Sun, Mon, Fri and Sat - Evening shift schedules: - 1:30pm – 12am – Sun, Wed, Fri, Sat - 1:30pm – 12am – Mon, Tues, Fri, Sat - 1:30pm – 12am – Mon, Thurs, Fri, Sat - 2:30pm – 1am – Mon, Thurs, Fri, Sat - 3:30pm – 12am – Sun, Mon, Thurs, Fri, Sat - 3:30pm – 12am – Sun, Mon, Tues, Fri, Sat - 3:30pm – 12am – Sun, Mon, Tues, Wed, Thurs - 11am – 7:30pm – Sun, Mon, Tues, Wed, Thurs Primary Responsibilities: - Clinical Competence - Provide symptom triage and health education for patients of all ages using evidence-based protocols - Assess a wide range of medical concerns and guide patients toward appropriate care - Documentation and Care Delivery - Provide high-quality clinical services within scope of practice and in alignment with established team processes and protocols. - Conduct comprehensive assessments, including thorough health history collection. - Accurately document all interactions in a timely manner in accordance with policy. - Quality and Communication - Communicate effectively with beneficiaries to ensure clear understanding of care recommendations and health guidance. - Collaborate and communicate promptly with internal staff to support continuity of care. - Determine appropriate dispositions and deliver tailored health education. - Teamwork and Collaboration - Partner with leadership and teammates to meet performance and service expectations. - Support onboarding and development of new team members as a preceptor or mentor. - Participate in team meetings, training, and continuous improvement efforts. Qualifications - Current active compact RN license in home state - Ability to get licensed in non-compact states (If their home state is FL – their school has to be nationally certified) - Ability to pass security clearance - 3+ years of recent clinical experience - Solid clinical experience with ability to triage all age groups - Advanced technical skills – use multiple programs simultaneously, multiple monitors, and multitasking while on call - Hard wired Internet Preferred Qualifications - Experience with military or veterans - Bilingual in English and Spanish Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations.
Role Description TruHealth is seeking an advanced practice provider, either a nurse practitioner (NP) or physician assistant (PA) with experience in primary care or internal medicine, preferably with geriatrics focus. This position gives you the opportunity to improve outcomes for long-term care residents by collaborating with a team of providers and case managers. You’ll enjoy a great benefit/pay package and possibilities for career growth. If you are an advanced practice registered nurse (APRN or NP) or physician assistant (PA) who enjoys working with the aging population, consider joining the TruHealth team. Our providers work primarily within nursing homes or assisted living communities with residents who are enrolled in special Medicare Advantage plans. You will be responsible for providing plan members with personalized, coordinated health care that improves quality of life and prevents unnecessary hospital visits. As one of our advance practice providers, you will exercise your independent judgement to treat patients with acute and chronic conditions, consulting with a supervising physician as appropriate. You will work closely with our facility partners and health plan leadership to implement our national model of care in compliance with all federal and state regulations. Our NPs and PAs are team players who contribute to TruHealth’s success and help our partners enhance their residents’ quality of life. Duties include: - Assessing patients’ medical and mental health needs and providing a plan of care that proactively manages their conditions and addresses barriers to care - Ensuring compliance with local, state, and federal agencies related to clinical services you provide - Prescribing medications and ordering lab work, diagnostic procedures and consultations - Monitoring patients’ compliance and response to their treatment and modifying those plans - Working with RN case managers as part of an integrated care team Qualifications - FNP, AGNP, AHACNP or PA license required - Degree from an accredited APRN or PA program - 3 years’ experience in clinical nursing or rehab in geriatric populations - Electronic Health Records experience - Working knowledge of Microsoft applications, including Word, Outlook and Excel Requirements - May be required to provide training and advice to facility staff Benefits - Competitive pay - Excellent benefits - Growth opportunities - Culture that values work–life balance
UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Role Description Sign-on Bonus up to $30,000 for External Candidates Telephonic After-Hours Call - Evenings, Nights & Rotating Weekends Required Full-Time (40 Hours) The Telehealth Urgent Care program is a comprehensive integrated care delivery program. The National On Call advanced practice clinician (APC) is responsible for providing telephonic/telehealth care and direction to patients, caregivers, and facility staff providing 24/7 coverage including holidays. In this remote role you will provide virtual care for patients in various settings. This excellent opportunity affords a collaborative role bringing enormous satisfaction in the care and comfort of our patients. In this role you will have the ability to achieve work-life balance. Scheduling: - This is a Full Time, work from home position requiring various shift coverage with a mix of weekday, weeknights, weekend, and holiday coverage. - Flexibility and the ability to adapt are a must as you will cross cover multiple markets and teams. - 24/7 coverage required. - Minimum commitment of 40 hours per week. - Every other weekend coverage between 8-12 hour shifts covering both day and night shifts is required based on business needs. - Expectations that you are working or have approved PTO for 26 weekends a year. - Unapproved time away/Unpaid Time Off will result in the need to add additional weekend shifts to your schedule based on need. - Holidays are required for all APCs on a rotation basis. - Holiday scheduling is completed at the beginning of the year for advanced planning. Primary Responsibilities: - Available on provided telephonic platform, both taking and placing calls to coordinate and manage care for members. - Available to use video platform based on clinical need. - Working hours should be performed in a secure location as patient privacy is required. - Utilize EMR proficiently to provide acute care to members during all shifts and holiday hours. - Deliver cost-effective, quality care to members. - Manage both medical and behavioral, chronic, and acute conditions effectively, in collaboration with a physician or specialty provider. - Perform comprehensive assessments and document findings in a concise/comprehensive manner. - Responsible for ensuring encounter is documented appropriately to support the diagnosis at that visit. - Ensure that all quality elements are addressed and documented. - Utilize evidence-based practice guidelines. - Must attend and complete all mandatory educational and MyLearning training requirements. - Coordinate care as members transition through different levels of care and care settings. - Monitor the needs of members and families while facilitating any adjustments to the plan of care. - Review orders and interventions for appropriateness and response to treatment. - Address and be able to have advanced care plan conversations with members and families. - Evaluate the plan of care for cost effectiveness while meeting the needs of members, families, and providers. - Exhibit original thinking and creativity in the development of new and improved methods and approaches. - Function independently and responsibly with minimal need for supervision. - Demonstrate initiative in achieving individual, team, and organizational goals and objectives. - Participate in quality initiatives. - Availability to check Optum email intermittently for required trainings, communications, and monthly scheduling. Qualifications - NP: Graduate of an accredited Master of Science Nursing or Doctor of Nursing Practice program. - Active and unrestricted license in the state which you reside, as well as State of New York and the State of Massachusetts. - Ability to gain a collaborative practice agreement, if applicable in your state. - Active Nurse Practitioner certification through a national board. - Current, active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations. - Proficient computer skills including the ability to document medical information with written and electronic medical records. Requirements - 3+ years of clinical experience as an APC. - Active and unrestricted license in additional states: New York, New Jersey, Connecticut, Maine, New Hampshire, Rhode Island. - Experience in meeting the medical needs of patients with complex behavioral, social and/or functional needs. - Experience working in a nursing home, or with seniors in an acute care facility. - Understanding of Geriatrics, Chronic Illness, and acute disease management. - Understanding of Advanced Illness and end of life discussions. - Ability to develop and maintain positive customer relationships. - Adaptability to change. Benefits - Compensation generally ranges from $125,000 - $175,000. - Total cash compensation includes base pay and bonus based on several factors. - Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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Role Description Atrium Health Women’s Health is expanding services to offer a new virtual Women’s Health Model to improve access, convenience, and quality to patients within our existing service line. The clinic will initially be 2 APPs with plans to expand the team to support our existing Women’s Care practices through video visits. - Virtual Women’s Care management for new and established AH Women’s Care patients. - Support with multi-state licensing. - Opportunity for work/life balance with no daily commute, completely virtual. - Excellent benefits package, relocation assistance, CME allowance. Qualifications - Passion for Innovation. - Strong virtual presence. - Solution oriented and ability to think outside the box. - Minimum 1 year of a strong gynecological background is required. Requirements - Master's Degree or Doctorate of Nursing Practice required. - License to practice as a Registered Nurse required. - Certification in the area of practice from a nationally recognized certifying body required. - ACNP, AGACNP, AGNP, PNP, or PNP-AC board certification preferred based on population served. Benefits - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training. - Premium pay such as shift, on call, and more based on a teammate's job. - Incentive pay for selected positions. - Opportunity for annual increases based on performance. - Paid Time Off programs. - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability. - Flexible Spending Accounts for eligible health care and dependent care expenses. - Family benefits such as adoption assistance and paid parental leave. - Defined contribution retirement plans with employer match and other financial wellness programs. - Educational Assistance Program.
Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.
Role Description The Registered Nurse Telehealth provides remote nursing support to assist in the delivery of patient care through telehealth services. This role works under the supervision of the Regional Telehealth Nurse Manager and in collaboration with onsite clinical staff to assess patient needs, support care planning, and guide patient education. The position supports the nursing process by assisting with assessment, planning, implementation, and evaluation of care. The RN Telehealth helps ensure safe, effective, and coordinated patient care using virtual technology. Key Responsibilities - Provide support and guidance to onsite staff in the delivery of telehealth nursing services. - Assist with assessment of patients’ physical, psychological, and social needs in collaboration with onsite clinical staff. - Support planning and implementation of individualized treatment programs as directed by healthcare practitioners. - Assist onsite staff through use of remote access and virtual technology while following established policies and protocols. - Document nursing encounters accurately and communicate clinical information to appropriate staff members. Qualifications - Graduate from an accredited school of nursing. Requirements - Prefer a minimum of one (1) year correctional healthcare experience or a minimum of one (1) year clinical experience. - Have and maintain current licensure as a Registered Nurse within the state of employment. - Must be able to obtain and maintain CPR certification. Benefits - Comprehensive benefits including medical, dental, vision, paid time off, and 401k. - DailyPay, receive your money as you earn it! - Tuition Assistance and dependent Scholarships. - Employee Assistance Program (EAP) including free counseling and health coaching. - Company paid life insurance. - Tax free Health Spending Accounts (HSA). - Wellness program featuring fitness memberships and product discounts. - Preferred banking partnership and discounted rates for home and auto loans. - *Eligibility for perks and benefits varies based on employee type and length of service.
Role Description Ready to (Please Note: All Candidates MUST possess an active Compact Licensure and be available to work within the Pacific Timezone) What You'll Actually Do - Telephonically coordinate wellness and disease management for members with chronic conditions, including but not limited to diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia. - Proactively contact targeted members to promote health and restore optimal functioning by applying nationally recognized care guidelines and comparing current care with industry standards. - Review gaps in care and medical and pharmacy paid claims data to develop a comprehensive clinical profile; create individualized care plans and provide close follow-up for actively managed patients. - Collaborate with members to ensure assignment to a primary care provider; facilitate referrals to specialists as needed; assist with obtaining durable medical equipment and reviewing pricing for high-cost medications. - Support the Utilization Review process for assigned members in accordance with organizational and regulatory standards. - Assess member needs and initiate referrals to case management, prenatal, wellness programs, and external vendor services as appropriate. - Maintain complete, accurate, and timely documentation of case-managed members in designated systems; document all interventions and patient contacts while ensuring confidentiality and privacy of member records. - Track and monitor moderate and high-risk member populations and associated interventions to demonstrate improvements in overall health outcomes. - Meet established productivity, quality, and turnaround time standards on a daily, weekly, monthly basis. - Successfully participate in and pass external audits, including NCQA and URAC. - Maintain HIPAA compliance and confidentiality requirements in accordance with company policies and procedures. - Complete all required annual training within designated timeframes. KEY COMPETENCIES: - To be successful in a remote healthcare environment, individuals must demonstrate strong technical aptitude, communication skills, and the ability to work independently. Upon Hire, must have: - Basic computer literacy with the ability to navigate multiple systems simultaneously. - Ability to work on multiple screens with proficient typing skills. - Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Microsoft Outlook. - Strong verbal and written communication skills, including the ability to clearly explain complex or technical information and accurately interpret information received from others. - Ability to work independently, manage time effectively, utilize written resources to problem-solve and make informed decisions. - Foundational knowledge of medical claims processing and medical terminology, including ICD10, CPT, and HCPCS coding. Post-Training Expectations: - After completion of initial training and a structured ramp period (approximately three [3] months total), demonstrate proficiency in required systems and tools. - Ability to quickly adapt to additional systems or tools as job responsibilities evolve. Qualifications - Graduate of an accredited Registered Nurse (RN) program with a current, unrestricted Registered Nurse license issued in the United States. - The organization may require additional state licensure(s) to meet operational and business needs. - California, Washington and Oregon Licenses required after hire. - Prior experience in case management, wellness or disease management coordination, or an equivalent combination of education, clinical training, and relevant professional experience. - Demonstrated ability to apply clinical knowledge in a managed care, population health, or remote healthcare environment. - Bilingual English/Spanish preferred. - Willingness to travel. Requirements - Ability to perform the essential functions of the position safely and effectively, with or without reasonable accommodation, including meeting established qualitative and/or quantitative productivity standards. - Ability to maintain regular, punctual attendance in accordance with organizational policies. - Ability to remain seated for extended periods of time (approximately six [6] to eight [8] hours per workday). - Continuous use of a computer workstation, including frequent keyboarding and mouse usage, requiring repetitive hand and finger movements. - Ability to perform frequent neck twisting and occasional bending of the neck and waist as required to perform job duties. Benefits - Competitive base salary and benefits effective day one. - Comprehensive medical and dental through our own health solutions (yes, we use what we build). - Paid Time Off—rest and recharge time is non-negotiable. - Mental health support, retirement planning, and financial protection. - Professional development with clear career progression and learning budgets. - Mission-driven culture where diverse perspectives drive real impact on people's health. Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. This position offers a base salary range of $31-$38 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing. Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.
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