Nursing & AI

AI Analyzes Nurses’ Observations to Reduce Patient Danger

An AI-powered tool called CONCERN Early Warning System (CONCERN EWS) analyzes nurses' observations and electronic health records to detect early signs of patient deterioration, leading to reduced mortality rates and shorter hospital stays.

WEEKLY JOB LISTINGS

Medical Claim Review Nurse (RN) Remote IL & WI

Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. 

This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must have strong skills with organization, multitasking, problem solving, and using clinical judgment. Candidates with proficient knowledge of MS Office, PEGA, QNXT, MCG is highly preferred. Further details to be discussed during our interview process.

This is a remote position.

Illinois & Wisconsin RN compact licensure required

Clinical Documentation Integrity Specialist RN

We're seeking a Clinical Documentation Integrity Specialist (CDIS) RN to join our team! In this role, you'll be responsible for performing concurrent review of medical records to ensure complete and accurate clinical documentation to support severity of illness, risk of mortality for outcomes reporting, and for hospital reimbursement. The position requires a strong attention to detail and process orientation and an ability to think globally about documentation requirements in the medical records. The CDS must communicate effectively in oral and written form to physicians and other clinicians to promote accurate and complete documentation during the patient’s course of care. CDS supports the hospital’s overall compliance efforts designed to ensure the accuracy of diagnosis and procedural coding, Diagnosis Related Group (DRG) assignment, severity of illness (SOI), and expected risk of mortality (ROM).

This position is remote/work from home and must be within 60 miles of a UnityPoint health affiliate in IL, IA, or WI.

PLEASE NOTE: This position is subject to pre-hire testing.

Utilization Management Nurse – Behavioral Health Focus (Remote)

A Managed Care Organization is seeking a Utilization Management Nurse to review provider-submitted service authorization requests and evaluate medical necessity, with a primary focus on behavioral health services. This position plays a key role in ensuring members receive appropriate and timely care by performing prior authorizations and concurrent reviews.

Care Manager, Telephonic Nurse

The Clinical Care Coordinator helps to ensure optimal continuity of care for patients transitioning into and out of our services. They are responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. The Clinical Care Coordinator is expected to communicate with the CenterWell Home Health clinical team and help facilitate timely patient follow-up for patients in need of (additional) services when appropriate. The Clinical Care Coordinator is under the general supervision of the Manager of Care Coordination and under established performance criteria. This is a work-from-home telephonic nurse position

Triage Nurse I - Carebridge

Seeking candidates who have an active, unrestricted RN Compact license or Multi-state RN licenses in either of the following states: AZ, FL, IA, IN, KS, MA, NM, OH, PA, TN, TX or VA.

Carebridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. Carebridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services

Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Work Shift: Eight (8)10-hour work shifts, 7am - 5pm (Central Standard Time) in a two-week period, including Saturday and Sunday every other weekend.

The Triage Nurse I - Carebridge is responsible for determining the appropriate Care Management program for members referred through internal and external sources and various data sources and reports. Utilizing department guidelines, completes triage process and applies established criteria to assign members to appropriate care management component. Deals with least complex cases having limited or no previous Triage care experience. 

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