clinical registered nurse

CenterWell

<div><h1 class="jobSectionHeader">Become a part of our caring community 
</h1>
The Clinical Care Nurse (RN) is a clinic-based nursing role focused on improving patient outcomes. You will support safe Transitions of Care (TOC), reduce avoidable ED utilization, and drive Medicare Advantage Stars and quality performance. The Clinical Care RN plays a critical role in advancing clinical quality and supporting patients across transitions of care to improve patient outcomes.
 
 
CenterWell/Conviva clinic locations may be available in the following areas: CW Oviedo Main, CW Longwood New 
 
As a Clinical Care RN, you will contribute to Medicare Advantage Stars ratings by proactively identifying care opportunities, engaging patients and providers, and driving evidence-based interventions. You will balance direct patient education and outreach with data-driven quality improvement efforts. The Clinical Care RN aligns daily responsibilities with organizational values, integrity, respect, empathy, and commitment to health equity &ndash; to enhance patient health outcomes and satisfaction.<div><div>
Job Description</div></div><div><div><div><div><div><div><div><div><div>
Role Scope
<ul><li>Transitions: Care transition support, follow-up coordination, and avoidable readmission prevention for discharged inpatient, observation and emergency department patients.</li><li>
Quality: Medicare Advantage Stars, HEDIS and quality performance across value-based population.
</li><li>Population Health: Deliver culturally appropriate chronic disease education to activate patients are chronic disease self-management, particularly in DM, HTN, CHF and COPD.
</li></ul>Duties and Responsibilities:
<ul><li>Analyze clinical data and trends from platforms such as Athena EMR and DataHub to identify gaps in care related to Stars and HEDIS measures and Transitions of Care and post-hospitalization needs, prioritizing high-impact opportunities.
</li><li>Proactively identify recently discharged inpatient, observation and emergency department patients and coordinate timely post-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements, with the aim of addressing root causes of utilization and supporting patients to prevent avoidable readmissions or return visits.
</li><li>Conduct targeted patient and provider outreach via phone, telehealth and in-clinic visits to close care opportunities, provide tailored education on preventive care, chronic disease management, and medication management.
</li><li>Conduct post-discharge outreach to assess understanding of discharge instructions, bottles-out medication reconciliation, symptom monitoring, and follow-up appointment adherence. Identify and escalate barriers, collaborating with providers and care team to prevent readmissions and avoidable ED utilization.
</li><li>Collaborate effectively with interdisciplinary teams, including providers, care assistants, center administrators, medical assistants, pharmacy, and quality improvement staff&mdash;to implement evidence-based interventions and optimize workflows.
</li><li>Document all outreach efforts, clinical interactions, and outcomes accurately and in compliance with organizational and CMS regulatory standards.
</li><li>Prepare, participate and discuss patients in center huddles and high-risk rounds with providers and the center-based and interdisciplinary team.
</li><li>Participate in quality improvement projects, provider education sessions, team huddles to stay current with evolving clinical guidelines and organizational priorities.
</li><li>Monitor progress toward Stars and Transitional Care Management goals, proactively identify barriers, and help develop innovative solutions to improve clinical performance and patient engagement.
</li><li>Support clinic operations through provider collaboration, care coordination, and community education initiatives.
</li><li>Coordination and facilitation of center and market-based Wellness Events-focused in-person engagement for Stars care opportunity closures.
</li><li>Maintain patient confidentiality in accordance with HIPAA.
</li><li>Document patient encounters accurately and timely in the indicated platform (e.g., medical record).
</li><li>Follow organizational policies related to safety, infection control, and attendance.
</li><li>Perform other duties as assigned.</li></ul></div></div></div></div></div></div></div></div></div><h1 class="jobSectionHeader"> 
Use your skills to make an impact
 
</h1><div>Required Qualifications:</div><div><div><div><div><div><div><div><div><div><ul><li>
Must meet one of the following requirements: Associate&rsquo;s degree in nursing (ADN) or Bachelor&rsquo;s degree in nursing (BSN).</li><li>
Active, unrestricted RN license in Florida.</li><li>
3+ years' clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management.</li><li>
Proficiency with electronic health records (e.g., Athena EMR), data analytics tools (e.g., DataHub, Compass Rose, SalesForce HealthCloud &ndash; per your prior employer&rsquo;s population health tools), and Microsoft Office Suite.</li><li>
Willing and able to complete and maintain Basic Life Support training.
</li></ul>Preferred Qualifications:<ul><li>
Knowledge of Medicare Advantage Stars, HEDIS, CAHPS, and CMS quality requirements.</li><li>
Experience with Transitions of Care, hospital discharge or ER follow up programs.</li><li>
Strong clinical judgment, data analysis skills, and ability to apply evidence-based practices.</li><li>
Excellent communication and motivational interviewing skills to educate and empower members.</li><li>
Commitment to health equity, inclusiveness, and patient-centered care.</li><li>
Bilingual in English and Spanish with full professional proficiency. (strongly preferred)</li><li>
Basic Life Support trained.</li></ul>
Additional Information
Core Competencies:<ul><li>
Clinical quality improvement and strategic gap closure.</li><li>
Transitions of Care coordination and post-discharge support.</li><li>
Member and provider engagement with motivational interviewing.</li><li>
Regulatory compliance and documentation accuracy.</li><li>
Data interpretation and actionable reporting.</li><li>
Cross-functional collaboration and teamwork.</li><li>
Time management balancing administrative and outreach duties.</li></ul>
Values &amp; Mission Alignment:<ul><li>
Demonstrate integrity, respect, and empathy in all interactions.</li><li>
Uphold the mission to improve health outcomes and member satisfaction through proactive, compassionate care.</li><li>
Champion continuous learning, innovation, and professional growth.</li></ul>
Work Information:
This role requires an in-center presence, involving daily commute to assigned clinic(s) and occasional (quarterly) travel within the market to alternative clinic(s) for strategic meetings.<ul><li>
Workstyle: Clinic-based, in-center 5 days per week.</li><li>
Location: Must reside in designated market area, in reasonable commutable distance to assigned clinic(s).</li><li>
Hours: Monday&ndash;Friday, 8:00 AM&ndash;5:00 PM; additional time may be required.</li></ul>
TB Statement:
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Driving Statement:
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.</div></div></div></div></div></div></div></div></div>
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. 

$71,100 - $97,800 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.<h1 class="jobSectionHeader"> 
About Us 
</h1>
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient&rsquo;s well-being.
About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com. 
 
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</div>

Clinical Care Registered Nurse (RN)

DaVita

<div>Posting Date
06/12/2026
5800 Harford Road, Baltimore, Maryland, 21214, United States of America
DaVita is hiring a Clinical Coordinator to lead outpatient dialysis care for patients with end-stage renal disease. In this role, you&rsquo;ll oversee treatment, guide clinical staff, and ensure the highest standards of care and safety. 
 
Key Responsibilities:<ul><li>
Coordinate patient care plans and monitor outcomes</li><li>
Supervise clinical staff, including PCTs</li><li>
Ensure safe, compassionate dialysis delivery</li><li>
Build long-term relationships with patients and families</li><li>
Work in a fast-paced, team-oriented environment</li></ul> 
Requirements:<ul><li>
Current RN license and CPR certification</li><li>
18+ months RN experience, including 6+ months dialysis</li><li>
Charge RN readiness approval required</li><li>
ADN required; BSN preferred</li><li>
ICU, ER, or Med/Surg experience preferred</li><li>
CNN/CDN certification a plus</li><li>
Basic computer skills (MS Word, Outlook)</li><li>
Flexible schedule, including weekends and holidays</li></ul> 
What We Offer:<ul><li>
Medical, dental, vision, 401(k) match</li><li>
PTO and PTO cash-out</li><li>
Paid training and development</li><li>
Family and mental health support (Headspace, EAP, child/elder care)</li></ul> 
Ready to lead and make a difference? Apply now.
#LI-SH1
At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as &quot;a place where I belong.&quot; Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.
This position will be open for a minimum of three days.
The Wage Range for the role is $45.00 - $59.00/hour.
Clinical Coordinator ICHD Experienced: $45.00 - $59.50/hour.
<div>For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates</div>
Compensation for the role will depend on a number of factors, including a candidate&rsquo;s qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits
Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.
Beware of Recruitment Fraud
DaVita will never ask for payment or personal financial information at any point in the hiring process, nor will we ever communicate with you using email addresses outside of the DaVita secure network. If you receive a request like this, it is not legitimate. Do not share your information.</div>

Clinical Coordinator - Registered Nurse

Penn State Health

<div><div>Penn State Health - Hershey Medical Center
Location: US:PA: Hershey
 
Work Type: Full Time
 
FTE: 1.00
 
Shift: Day
 
Hours: 8:00a - 4:30p
 
Recruiter Contact: Denisse M. Rosado at drosado1@pennstatehealth.psu.edu
SUMMARY OF POSITION:
Under the direction of the Cancer Center Clinical Trials Office Administrative Director, the Clinical Research Cancer nurse will lead day-to-day operations of clinical research studies conducted by principal investigator(s) at Penn State Cancer Institute Clinical Trials Office. The RN Clinical Research nurse will perform a variety of duties involved in the collection, compilation, documentation, and analysis of clinical research data; introduced to the navigating process in the clinical research environment.
MINIMUM QUALIFICATION(S):
<ul><li>Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN license through the interstate Nurse Licensure Compact or Associate Degree in Nursing. With Associates Degree, required to enroll to BSN within three (3) years of their start date Oncology clinical nursing experience at least two (2) years</li>
</ul>PREFERRED QUALIFICATION(S):
<ul><li>Bachelor's of Nursing Degree one (1) year Clinical Trials Research experience</li>
</ul>WHY PENN STATE HEALTH?
Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.
Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:
<ul><li>Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton).</li>
<li>Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave.</li>
<li>Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection.</li>
<li>Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program.</li>
<li>Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling.</li>
</ul>WHY PENN STATE HEALTH MILTON HERSHEY MEDICAL CENTER?
Penn State Hershey Medical Center is Central Pennsylvania&rsquo;s only Academic Medical Center, Level 1 Regional Adult and Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital, Hershey Medical Center values the hard work and dedication that our employees exhibit every day. Through our core values of Respect, Integrity, Teamwork, and Excellence, our employees are a team committed to compassionate care for our diverse patient population, our community and each other. As a valued team member, we promote continued professional development, specialty certification, continuing education, and career growth.
YOU TAKE CARE OF THEM. WE&rsquo;LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence &ndash; that&rsquo;s Penn State Health. But what makes our healthcare award-winning? That&rsquo;s all you.
This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
Penn State Health is an Equal Opportunity Employer and does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health&rsquo;s policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.
 Union: Non Bargained</div></div><div></div>

RN Registered Nurse Clinical Research Cancer - Hem Onc Clin Trials

CommonSpirit Health

<div>
 *Job Summary and Responsibilities*
 
 
 As our Clinician Research RN, you will leverage your clinical nursing expertise to critically support and execute clinical research studies, ensuring the highest standards of participant care, data integrity, and compliance within designated research areas.
 
 
 Every day you will actively participate in the lifecycle of clinical trials, which includes identifying and screening potential study participants, providing in-depth education about research protocols, and carefully monitoring participant well-being. Your responsibilities will involve performing essential clinical assessments, accurately collecting and documenting study data, and vigilantly observing for adverse events.
 
 
 To be successful in this role, you will exhibit excellent organizational capabilities, meticulous attention to detail, and a commitment to ethical conduct in research. Your ability to effectively communicate with participants and collaborate within a research team will be key to contributing to meaningful research outcomes.
 
 
 <ul>
 <li>
 Demonstrates current knowledge of federal and state regulations, guidelines, and policies governing the conduct of clinical trials.
 </li>
 <li>
 Ensures study documents are maintained in compliance with applicable regulations, guidelines and policies (ie- FDA, OHRP, IRB)
 </li>
 <li>
 Complies with licensure, contractual, protocol and policy requirements
 </li>
 <li>
 Directs intradepartmental and external resource activities relating to assigned studies
 </li>
 <li>
 Assists in the review and development of proposed study budgets
 </li>
 <li>
 Ensures compliance with all study billing process requirements
 
 
 </li>
 </ul>
 *Job Requirements**Required*
 
 
 <ul>
 <li>
 Bachelor's degree in related field
 </li>
 <li>
 One (1) year of clinical RN experience
 </li>
 <li>
 Licensed Registered Nurse: AZ
 
 
 </li>
 </ul>
 *Preferred*
 
 
 <ul>
 <li>
 Master's degree in related field
 </li>
 <li>
 One (1) year of RN experience within clinical research
 
 
 </li>
 </ul>
 Where You'll Work
 
 
 Hello Humankindness: Join a Legacy of Healing at Saint Joseph&rsquo;s Hospital and Medical Center (SJHMC) Ready to make a real difference? Join SJHMC in Phoenix AZ., a 571-bed nonprofit founded by the Sisters of Mercy over 125 years ago. We're more than a hospital; we're a global destination for life-changing care, embracing patients with humankindness. Here, your calling will flourish. We're not just a workplace; we're a community dedicated to a mission of service.
 
 
 
 Leaders In Specialized Care
 
 
 
 <ul>
 <li>
 Barrow Neurological Institute (BNI): A world-renowned center for groundbreaking neurological research and innovative treatments.
 </li>
 <li>
 Norton Thoracic Institute (NTI): A national leader in advanced thoracic care with pioneering surgical techniques.
 </li>
 <li>
 Level I Trauma Center: One of Arizona's busiest ERs, providing immediate, comprehensive care for critically injured patients 24/7.
 
 
 </li>
 </ul>
 Why SJHMC?
 
 
 <ul>
 <li>
 Culture of Excellence &amp; Well-being: We care for our people, fostering professional and personal growth.
 </li>
 <li>
 Community &amp; Collaboration: Be part of a network committed to global health and well-being.
 </li>
 <li>
 Join a Legacy, Shape a Future: Over 20% of our patients travel internationally for our specialized care.
 
 
 </li>
 </ul>
 This is an invitation to join a family of dedicated professionals at the forefront of medical innovation, united by the power of humankindness.
 
 
 *Pay Range*
 
 
 $32.38 - $48.17 /hour
</div>

Clinical Research Nurse

Rite of Passage

<div>✨Join Our Team at the Mansfield Juvenile Treatment Center &ndash; Where Opportunity Meets Purpose✨

Mansfield Juvenile Treatment Center (MJTC) is a 40-bed, all-boys program located on 236 acres at the foot of the stunning Poteau Mountains, offering breathtaking lakeview sunsets and fresh mountain air. Our center is dedicated to providing a safe, supportive environment where students can thrive and achieve their full potential. At MJTC, we offer more than just a job &ndash; we offer a chance to make a real difference. Our comprehensive training programs for staff empower individuals to promote a well-rounded, normalized high school experience for our students, while fostering an environment of growth, positive change, and achievement. We welcome individuals who are passionate about making a meaningful impact in the lives of youth. Whether you&rsquo;re a seasoned professional or new to the field, MJTC offers a dynamic work environment where you can grow, learn, and contribute to positive change. Come as you are and help us create lasting change in the lives of the students we serve &ndash; all while working in a beautiful, scenic setting.

Pay: $29 per hour; increases with experience

 Perks &amp; Benefits: Medical, Dental, Vision and Company paid Life Insurance within 90 days, 401k match of up to 6% after 1 year of employment, Paid Time Off that can be used as soon as it accrues and more! ROP-benefits-and-perks-2 (https://riteofpassage.com/wp-content/uploads/2024/10/ROP-benefits-perks-2024-v2.pdf)

What you will do: As the Lead Registered Nurse, you will oversee and support the delivery of high-quality health care services for youth and staff within our program. You will provide direct nursing care, coordinate medical services, and mentor nursing team members while ensuring compliance with all county, state, and Rite of Passage standards. In this leadership role, you will serve as the primary clinical lead for the site medical team, administering medications, conducting health assessments, managing treatment plans, and coordinating appointments, follow-ups, and laboratory testing with physicians, psychiatrists, and outside providers. You will also provide health education and training to staff and students on first aid, infection control, CPR, medication safety, and emergency procedures. Additionally, you will manage medical supplies, pharmaceuticals, and budgets, maintain accurate and confidential medical records, and promote a safe, compassionate environment by modeling professionalism, empathy, and ethical care. Collaboration with interdisciplinary teams, community partners, and external agencies will be essential in addressing the holistic health needs of those we serve. 


To be considered you should: Possess a Bachelor&rsquo;s degree in related health care field ~ current RN licensure in the state of Arkansas is required ~ Minimum of 2 years of previous medical services administration ~ Prior experience supervising staff is needed ~ Be at least 21 years of age ~ Be able to pass a criminal background check, drug, physical, and TB test ~ Be able to pass a search of the child and adult abuse central registry ~ meet the requirements to be an eligible driver, including having an active Driver&rsquo;s License

Schedule: Monday through Friday, 8 AM to 5 PM; weekends and evenings as needed.

Apply today and Make a Difference in the Lives of Youth!

After 40 years of improving the lives of youth, we are looking for passionate advocates to continue the legacy of helping young people become successful adults. As a Lead RN, you will have the unique opportunity to create a positive, safe and supportive environment for the youth we serve while building a career rich in growth opportunities and self-fulfillment.

Follow us on Social!

Instagram (https://www.instagram.com/p/C69HW2PRrof/?img_index=1) / Facebook (https://www.facebook.com/roprams/) / Linkedin (https://www.linkedin.com/company/rite-of-passage/?viewAsMember=true) / Tik Tok (https://www.tiktok.com/@riteofpassage.1984?lang=en) / YouTube (https://www.youtube.com/@riteofpassage.1984/videos)<h4 class="jobSectionHeader">
Experience</h4>
Required<ul><li>
2 year(s): Minimum of two years of previous medical services administration, including demonstrated experience in operating and securing comprehensive health services programs.
</li></ul><h4 class="jobSectionHeader">Education</h4>
Required<ul><li>
High School or better</li></ul><h4 class="jobSectionHeader">
Licenses &amp; Certifications</h4>
Required<ul><li>
Registered Nurse</li></ul><h4 class="jobSectionHeader">
Behaviors</h4>
Preferred<ul><li>
Team Player: Works well as a member of a group</li><li>
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well</li><li>
Dedicated: Devoted to a task or purpose with loyalty or integrity</li></ul><h4 class="jobSectionHeader">
Motivations</h4>
Preferred<ul><li>
Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work</li><li>
Self-Starter: Inspired to perform without outside help</li><li>
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization</li></ul>
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.</div>

REGISTERED NURSE

Briljent

<div>
 
 Description
 
 
 
 We are seeking a detail-oriented
 
 Clinical Auditor Registered Nurse
 
 to support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs. This role is responsible for evaluating quality of care, reviewing medical records and program policies and identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings clinical knowledge, regulatory awareness, and strong analytical and writing skills. This is a remote position with occasional travel required within Indiana.
 
 
 
 Key Responsibilities
 
 
 
 <ul>
 <li>
 Review medical records and related documentation to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.
 </li>
 <li>
 Conduct medical record and compliance reviews independently and provide preliminary findings to the Lead Reviewer.
 </li>
 <li>
 Identify potential documentation deficiencies, and billing compliance issues.
 </li>
 <li>
 Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
 </li>
 <li>
 Assist with audit responses and appeals as needed.
 </li>
 <li>
 Ensure all work aligns with state, federal, and national healthcare and Medicaid guidelines.
 </li>
 <li>
 Stay current on clinical guidelines, policies, regulations, and Indiana Medicaid program and policy updates.
 </li>
 <li>
 Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.
 </li>
 <li>
 Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 <ul>
 <li>
 RN license preferred; Indiana license or compact license accepted.
 </li>
 <li>
 Coding certification such as CCS or CPC strongly preferred.
 </li>
 <li>
 Candidate located in or near the Indianapolis area is preferred.
 </li>
 <li>
 At least 1 year of Medicaid claims review, billing compliance, or healthcare reimbursement experience.
 </li>
 <li>
 Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred.
 </li>
 <li>
 Knowledge of CPT coding guidelines and ICD-10 standards.
 </li>
 <li>
 Proficiency in Microsoft Excel, Word, and Outlook.
 </li>
 <li>
 Strong analytical, critical thinking, problem-solving, and technical writing skills.
 </li>
 <li>
 Ability to work independently and collaboratively in a fast-paced environment.
 </li>
 <li>
 Experience working with healthcare providers strongly preferred.
 </li>
 <li>
 Knowledge of healthcare claims data and fraud, waste, and abuse preferred.
 
 
 </li>
 </ul>
 
 Physical Requirements &amp; Environmental Conditions:
 
 An employee must meet these physical demands to successfully perform the essential functions of this job. Employee is regularly required to talk or hear, sit, and utilize technology tools such as a laptop computer for extended periods of time. Specific vision abilities include close vision and the ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
 
 
 Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes diversity and inclusion are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.
 
</div>

Clinical Auditor - RN

Beth Israel Lahey Health

Burlington, MA &bull; Lahey Hospital and Medical Center &bull; Full-time &bull; Day
 <div>When you join the growing BILH team, you're not just taking a job, you&rsquo;re making a difference in people&rsquo;s lives.

Join the Cath Lab Team at Lahey Hospital 
Lahey Hospital, part of Beth Israel Lahey Health (BILH), is a 335-bed Level I trauma center with a dynamic and high-volume STEMI program. Our cardiac catheterization lab performs approximately 4,000 procedures annually, including over 1,000 percutaneous coronary interventions (PCIs), making us one of the region&rsquo;s busiest and most advanced interventional cardiology centers. 
Our team is made up of experienced and passionate Registered Nurses, Radiologic Technologists, and Scrub Technicians who collaborate to deliver high-quality care. We work ten-hour shifts (7:00 AM &ndash; 5:30 PM) and rotate on-call responsibilities during weeknights, weekends, and holidays. 
As a Cath Lab team member, you take the lead&mdash;prioritizing, coordinating, and delegating patient care throughout procedures. You are autonomous in your practice and thrive in a fast-paced, high-acuity setting. 
You&rsquo;ll work side-by-side with a multidisciplinary team, including physicians, to ensure each patient receives safe, efficient, and compassionate care. You&rsquo;ll monitor patients, circulate during procedures, and provide moderate sedation. 
We care for individuals with complex cardiovascular and peripheral vascular disease, and our structural heart program is rapidly expanding, offering cutting-edge procedures such as TAVR, MitraClip, TriClip, and PFO/ASD closure. 
You bring curiosity and drive to the role&mdash;excited to learn and continuously expand your knowledge in the ever-evolving world of interventional cardiology. 
If you&rsquo;re ready to grow your career in a supportive, innovative, and high-performing environment, we want to hear from you. 
Join us. Make an impact. Be a part of something bigger at Lahey&rsquo;s Cath Lab.

Requirements:
 
Active Massachusetts Nursing License
 
BLS
 
ACLS
 
Preferred:
 
2+ years of nursing experience
 
Current or recent critical care/ICU and ER experience
 
Any cath lab experience
Under the general supervision of the Nurse Manager/Assistant Nurse Manager/Tertiary Team Leader, the Staff Registered Nurse: Tertiary Care practices within the Lahey Clinic Professional Practice Model, MA Nurse Practice Act, ANA Standards of Practice and Code of Ethics and demonstrates Lahey Clinic&rsquo;s core values that reflect its Mission. The nurse-patient/family relationship, continuity of care and accountability are central to the delivery of individualized high quality patient care.

A Staff Registered Nurse: Tertiary Care demonstrates the knowledge and skills necessary to provide expected standards of care based on physical, psychosocial, cultural, educational, spiritual, safety and age-appropriate considerations of patients.

The Staff Registered Nurse: Tertiary Care, in accordance with the Nurse Practice Act of Massachusetts Rules &amp; Regulations- 244 CMR 3.0, shall bear full and ultimate responsibility for the quality of nursing care he/she provides to individuals and groups. Included in such responsibility are health maintenance, teaching, counseling, collaborative planning and restoration of optimal functioning and comfort or for the dignified death of those they serve.
<div>The Staff Registered Nurse: Tertiary Care assumes the responsibility for the plan of care and has the authority to make decisions and is held accountable for decisions specific to assessment, planning, implementation and evaluation of the plan. The registered nurse facilitates the coordination of care across the continuum and demonstrates safe practice within the domains of: 
<ul><li>Clinical judgment and decision making</li><li>Professional Relationships</li><li>Clinical leadership</li><li>Clinical scholarship</li></ul></div>

A responsibility and function of the Staff Registered Nurse: Tertiary Care includes Delegation &amp; Supervision in accordance with the Nurse Practice Act of Massachusetts Rules &amp; Regulations- 244 CMR 3.0 Registered Nurse and Licensed Practical Nurse: Board of Registration in Nursing and the ANA Principles of Delegation. The delegating registered nurse at Lahey Clinic bears the full and ultimate responsibility that includes but is not limited to:
<ul><li>Making an appropriate assignment</li><li>Properly and adequately teaching, directing and supervising the delegate</li><li>The outcome of the delegation</li></ul>

The Staff Registered Nurse: Tertiary Care provides care directly to patients and in collaboration with other health care team members. The Staff Registered Nurse: Tertiary Care maintains a current level of knowledge and skill with technical procedures as defined by nursing specialty organization, complies with all regulations and standards of regulatory and accrediting bodies, and is currently licensed in the state of Massachusetts as a registered nurse.

Job Description:

Essential Duties &amp; Responsibilities: including but not limited to:
<div>
I. Clinical Judgment and Decision Making: Ways in which nurses come to understand the problems, issues or concerns of patients/families, to attend to relevant/critical information, and to respond in concerned and involved ways. 
A. The Staff Registered Nurse: Tertiary Care is expected to and is accountable for providing safe patient care by demonstrating organizational skills that maintain and coordinate safe delivery of quality care for assigned patients/families. 
<ul><li>Develops a culturally competent plan of care that identifies patient problems, expected outcomes, and addresses preventative measures.</li></ul>
B. Performs systematic patient and family assessment relevant to practice settings. 
C. Delivers care that is specific to the age of the patient. 
D. Evaluates effectiveness of care and adapts plan based on patient/family response.</div> 
 
II. Professional Relationship: The professional relationship is based upon Lahey Clinic&rsquo;s guiding principles and positive effective communication. This relationship extends beyond formal assessment to integrate the particular patient&rsquo;s response and his/her religious/spiritual, ethnic and cultural beliefs into the plan of care.
<div>
A. Establishes professional relationship with nurses, physicians and other colleagues and patients and families. 
<ul><li>The relationship includes the patient and family as a partner in care and is based upon Swanson&rsquo;s Theory of Caring.</li></ul>
B. Educates the patient and family about the patient&rsquo;s illness and treatment including preventative measures appropriate to the patient. 
C. Supports Lahey Clinics commitment to community based activities both within the Lahey community and beyond.</div>

III. Clinical Leadership: The Staff Registered Nurse: Tertiary Care supports the development of others and creates a practice climate of responsiveness and learning based on Benner&rsquo;s Novice to Expert skills acquisition model. This supports the retention and recruitment of clinically competent nurses. The ability to lead and influence the reasoning of colleagues in the patient&rsquo;s best interest depends on skillful comportment, authoritative clinical knowledge and wisdom, the conviction to act as an ethical agent despite adverse consequences, and the ability to listen and enhance others&rsquo; strengths.

A. Demonstrates professional behavior by adhering to unit policies and procedures, practice guidelines specific to the setting and the ANA Code of Ethics. 
B. Demonstrates skills as a responsive team member. 
C. Demonstrates role of nurse as teacher. 
D. Demonstrate ability to fulfill role in Regulatory compliance and readiness.

IV. Clinical Scholarship: The Staff Registered Nurse: Tertiary Care achieves clinical scholarship through experiences with patients, through collaboration with colleagues and leadership and through formal education. Learning is transformed into knowledge through self-reflection and analysis.

A. Upholds standards of quality nursing care. 
B. Demonstrates a commitment to life long learning. 
C. Demonstrates evidenced based practice (EBP) in nursing.
<div>
Organizational Requirements: 
<ul><li>Incorporates Lahey Clinic Guiding Principles, Mission Statement, and Goals into daily activities.</li><li>Complies with all Lahey Clinic Policies.</li><li>Complies with behavioral expectations of the department and Lahey Clinic.</li><li>Maintains courteous and effective interactions with colleagues and patients.</li><li>Demonstrates an understanding of the job description, performance expectations, and competency assessment.</li><li>Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.</li><li>Participates in departmental and/or interdepartmental quality improvement activities.</li><li>Participates in and successfully completes Mandatory Education.</li><li>Performs all other duties as needed or directed to meet the needs of the department.</li></ul></div>

Minimum Qualifications:

Education: Graduate of a state approved and/or accredited School of Nursing

<div>Licensure, Certification, Registration: 
<ul><li>Current license to practice professional nursing from the Massachusetts Board of Registration</li><li>BLS certification from American Heart Association or American Red Cross.</li></ul></div>

Skills, Knowledge &amp; Abilities:
 
Clinical Skills/Technical Knowledge 
a. Demonstrates the necessary clinical skills and technical knowledge to provide care for patients according to Nursing Policy and Procedures. See Skill Record. 
b. Demonstrates the necessary clinical skills and knowledge to provide care for patients according to the unit-specific competencies. See Skill Record. 
c. Excellent interpersonal and organizational skills.

Experience: &ndash; None &ndash; 


Pay Range:
$37.00 &ndash; $95.37

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

<h2 class="jobSectionHeader">As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.</h2>

<h2 class="jobSectionHeader">More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.</h2>

<h2 class="jobSectionHeader">Equal Opportunity Employer/Veterans/Disabled</h2></div>
 <div><h3 class="jobSectionHeader">Job details</h3>
<ul><li><div>Employment: Full-time</div></li>
<li><div>Hours/Week: 40</div></li>
<li><div>Shift: Day</div></li>
<li><div>Category: Nursing</div></li>
<li><div>Pay Range: $37.00 - $95.37</div></li>
<li><div>FLSA: Non-Exempt</div></li>
<li><div>Req ID: JR97588</div></li></ul></div>

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