Remote Nursing Jobs • US

If you are an Enrolled or Registered Nurse with over 2 years of recent blood collection experience then this could be for you. Responsibilities include meeting with life insurance applicants to conduct routine health screening assessments and pathology collection services. You will also be liaising with stakeholders in regard to the screening process and updating head office via our bespoke platform, medEbridge.

The Clinical Triage Specialist (CTS) (RN) delivers an exceptional patient experience and provides clinical support to CTS-MA team members, serving as a clinical resource. This role involves using nursing judgment to answer patient calls related to direct care, assessing symptoms, and triaging using approved nursing protocols to ensure appropriate care or self-care advice. Responsibilities include answering calls, prioritizing triage, updating patient information, providing clinical advice, managing electronic messages, and ensuring productivity and quality standards are met.

Deliver coordinated, patient-centered virtual Care Management by telephone and video that improves members' health outcomes. Create impactful care plans together with members and our diverse care team, and help members achieve the desired goals. Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.

The Denials Management Appeals Nurse manages medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted, utilizing his/her clinical background to address the clinical denials and will write sound, compelling factual arguments for appealing denials, maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria.

As a PRN QA Nurse Reviewer, review AI's output of OASIS-E, ICD-10 coding, and plan-of-care documents, then turn those insights into product improvements and front-line education. This role is ideal for detail-oriented individuals who thrive on mentoring peers and are excited about scaling quality through technology.

The Nurse Advice Line performs clinical triage and review of inbound member and patient calls to the PHP Nurse Advice Line to ensure that services rendered to customers meet clinically appropriate direction and triage. Utilizes clinical skills to coordinate, document, and communicate all aspects of the appropriate clinical advice and triage based on criteria and in adherence to adopted protocols.

Assists with the appropriate identification of diagnoses, conditions, and/or procedures that are representative of the patient’s hospital stay and care provided including Severity of Illness (SOI), Risk of Morality (ROM), during an inpatient hospitalization. Initiates concurrent queries to providers as supported by medical record documentation to improve the accuracy, integrity, and quality of patient data. Drives improvement toward quality physician documentation within the body of the medical record.

The Care Advisor is a licensed Registered Nurse reporting to the Clinical Services team who provides quality driven telephonic clinical assessments, health education, and utilization management services to a diverse population of callers/patients/members. The Care Advisor uses critical thinking, essential multitasking skills and effective communication. They use their clinical knowledge to assess, disposition, make recommendations for care, provide education and health information.

This position is responsible for conducting assessments of members who may need skilled nurse assessment services. The incumbent completes all assessments using a skilled care acuity tool and provides a recommendation for services based on members health care needs. Members who are assessed reside in the community or are ready to be discharged from a facility.

Responsible for conducting face-to-face assessments of members who may need skilled nurse assessment services. Completes all assessments using a skilled care acuity tool and provides a recommendation for services based on members health care needs. May serve as mentor or preceptor for new staff, complete quality assurance audits, inter-rater-reliability reviews, and may be involved in process improvement initiatives.