Vancouver Coastal Health seeks a Clinical Resource Nurse to join the Intensive Case Management team at Heiltsuk Hospital in Bella Bella, BC, where hybrid work schedules may be available
The Remote Clinical Denials RN reviews, analyzes, and appeals clinical denials from insurance companies and third-party payers. A strong clinical background, knowledge of medical necessity criteria, and expertise in appealing denied claims are required. Responsibilities include conducting denial root-cause analysis, retrospective medical record reviews, and collaborating with hospital staff.
Sailor Health is seeking compassionate and action-oriented RN Healthcare Advocates to support older adults on Medicare throughout their health journeys. As a Healthcare Advocate, you’ll be a trusted partner for patients and families—offering empathetic guidance, tackling complex care challenges, and ensuring our patients feel supported and empowered.
The Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes. The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome.
Deliver virtual comprehensive care to patients of all ages across a wide range of conditions, while working closely with provider and support teams. Conduct age-appropriate history and virtual exams; evaluate, diagnose, and treat a broad range of conditions. Manage acute, chronic, and mental health conditions for pediatric and adult patients and provide cross-coverage for tasks such as reviewing lab results.
Support nursing communities within the assigned geographic location. Audit clinical services, review outcomes, and strategize to improve resident care. This position is a support and leadership role, working alongside management teams to develop and implement processes, identify and resolve issues, while also managing staff.
The Concurrent Utilization Review (UR) Nurse conducts real-time clinical reviews to ensure the medical necessity and appropriateness of healthcare services provided to members under a managed care health plan, assessing inpatient admission and continued stays, coordinating with healthcare providers, facilitating communication with payers, ensuring compliance with health plan policies and clinical guidelines, and collaborating with the Medical Director and clinical leadership for complex cases, denials, and escalated reviews.
We're seeking board certified Nurse Practitioners with broad clinical expertise and a passion for improving healthcare access and quality to deliver virtual comprehensive care to patients of all ages across a wide range of conditions, while working closely with our provider and support teams. This is a Modified Full-Time role (32 hours/week) reporting to the Urgent Care Manager. This role requires an active RN compact license and licensure in multiple states.
These will be completely remote positions, working entirely from the Nurse’s home reviewing cases, educating patients, and managing health care costs. The Nurse will be working remotely Monday through Friday, 8 hours per day for the dependents of our Nation’s Active Duty and eligible retirees.
The Psychiatric Nurse Practitioner will care for children and adults with eating disorders in a 100% virtual Telehealth platform. You will provide psychiatric assessments and medication management for patients with eating disorders and co-occurring psychiatric conditions. Apply your skills in a multidisciplinary team environment, collaborating with various professionals to support patients' recovery.