Remote Nursing Jobs · Customer Service

• Provide after-hours triage, clinical assessment, and interventions via phone for patients and families.
• Coordinate care by collaborating with physicians, facilities, and vendors to ensure positive outcomes.
• Document all interactions in EMR and review team documentation for accuracy and compliance.

Moments Hospice provides compassionate end-of-life care and support to patients and families. It is a hospice organization with a supportive culture that offers ongoing training and advancement opportunities.

• Acts as a patient advocate coordinating transitions to the next level of care per regulations and agency policies.
• Collaborates with MJHC and inpatient facilities to evaluate inpatients for transitional planning and home health services.
• Uses telephonic outreach with discharge planners and case managers for Elderplan's SNP.

Elderplan and HomeFirst are Medicare and Medicaid managed care health plans under MJHS, offering personalized care to help people remain independent. MJHS fosters a collaborative culture focused on excellence, respect, work-life balance, and career development.

• Perform medical reviews and utilization management to determine medical necessity for services and appeals.
• Evaluate medical records and document decisions using clinical guidelines and protocol sets.
• Educate members, providers, and staff on coverage determinations, medical terminology, and coding procedures.

Palmetto GBA is a healthcare administrator and one of the nation's largest medical claims processors. As part of BlueCross BlueShield of South Carolina, we've served clients for 70+ years and offer training and tuition assistance.