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<h4>How you'll change lives</h4>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.<h4>What you'll be doing</h4>Patient care. You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. Teamwork. You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.Safety &amp; Quality. Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.

U.S. Renal Care

Dialysis Registered Nurse

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.<ul><li>A Home Therapy nurse trains home hemo or peritoneal dialysis patients in-center and sometimes in the patient’s home.</li><li>We Will Train - In-center hemodialysis, critical care, and home health are great backgrounds.&nbsp; </li><li>Work Schedule – 4 days a week, 8am to 4pm; 5 days when training a patient; Modified schedules are possible based on patient caseload at the facility.</li><li>Competitive on-call pay when placed in on-call rotation. </li><li>Holidays – Home Training Nurses rarely work on a holiday. </li><li>We lead the industry in clinical quality improvement, delivering amongst the best patient outcomes in the U.S. as measured by the CMS ESRD Quality Incentive Program.</li><li>We remain an industry leader in home dialysis with 17% of dialysis treatments delivered in our patients' homes.&nbsp; </li></ul>The Home Therapy Registered Nurse, as qualified by federal and state regulations, provides patient training and ongoing support for all patients choosing a home dialysis modality.&nbsp; This position is accountable for providing quality care to all patients and is committed to delivering superior customer service in all internal and external interactions.&nbsp;&nbsp; ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.&nbsp; Other duties and tasks may be assigned.<ul><li>Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements as they pertain to home dialysis program and patient care requirements.</li><li>Train patient (and/or care partner) in the practice of self-care Peritoneal Dialysis or Hemodialysis upon meeting federal and state regulations governing Registered Nurse qualifications.</li><li>Conduct home visits to assess the patient's home environment per policy; initially and minimally annually thereafter.&nbsp; Routinely evaluate patient performance and assess the home environment more frequently as needed to improve care.</li><li>Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li>Document all nursing services in the Electronic Medical Record including but not limited to training sessions, routine and non-routine in-person interactions, and phone conversations.&nbsp; Documentation should accurately reflect the patient status and nursing interventions and be written to ensure continuity of care.</li><li>Participate in infection control monitoring, implementation, and recording as requested.</li><li>Be familiar with emergency equipment and all emergency operational procedures.&nbsp; Communicate and regularly review Emergency Preparedness procedures with all home patients, including but not limited to emergency disconnection from dialysis equipment, what to do and who to contact if displaced from home.</li><li>Ensure clinic and patient supply inventory and usage is appropriate for patient prescriptions and place orders in timely manner to avoid fees and penalties.</li><li>Continually seek to improve patient and quality outcomes through tracking and trending of program and patient performance, use of critical thinking skills and root cause analysis to improve patient and quality outcomes.&nbsp; Assist in obtaining data for the continuous quality improvement activities.</li><li>Obtain routine and non-routine laboratory tests as ordered and communicate critical lab values and urgent patient needs to the responsible physician or physician extender in a timely manner.</li><li>Complete and document monthly review of patient medication profiles.&nbsp; Administer medications as ordered by the physician.</li><li>Responsible for performing on call nursing services, nights and weekends, on a rotational basis as needed or assigned.</li><li>Flexible with staffing locations and hours to accommodate patient and USRC home program needs.</li><li>Regular and reliable attendance is required for the position.</li></ul>Home Hemodialysis Only:<ul><li>Coordinate home evaluation with technical services department to ensure that the necessary electrical, plumbing and drainage requirements for proper equipment operation are met prior to patient acceptance into home program.</li><li>Ensure required and appropriate water sampling is complete per policy and product requirements.&nbsp; Monitor and report water sample and culture results.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</li></ul>

Dialysis Registered Nurse, Home Hemo & Peritoneal RN - Greenwood, IN

The RN Charge Nurse is responsible for overseeing nursing services each shift and functions as a nursing supervisor. This position provides daily supervision of staff on duty during operational hours.Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.<ul><li> Assist with clinical and operational processes to improve patient health and minimize hospitalizations and missed treatments.</li><li> Demonstrate effective use of supplies and staff labor hours.</li><li> Complete and document monthly review of patient medication profiles. Administer medications as ordered by the physician.</li><li> Assist physician during patient rounds and transcribe and implement physician orders timely.</li><li> Assist with the implementation of anemia management and medication protocols as requested.</li><li> Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.</li><li> Perform duties at all times within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations.</li><li> May give direct patient care to the extent of performing efficient, safe dialysis, if allowed by state regulations.</li><li> Responds to all emergencies in clinic.</li><li> Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li> Maintain collaborative working relationship with Medical Director and physicians.</li><li> Participate as a member of the Interdisciplinary team in all required patient assessment and care planning activities.</li><li> Assist in orientation of new staff as a preceptor or in assigning a preceptor.</li><li> Acts as resource person and participates in implementing and evaluating dialysis services and assures that policies and procedures are updated.</li><li>Assists Administrator in interviewing, hiring, evaluating, and disciplinary actions of center staff</li></ul>

Dialysis Registered Charge Nurse

<h4>How you will change lives</h4>As a Patient Care Technician (PCT) at US Renal Care, you will be an integral part of a cross-functional team providing care and delegated activities of treatment to patients. The PCT will work under the supervision of a Registered Nurse (RN) or Charge Nurse (CN) for patients with renal failure.<h4>What you'll be doing</h4>Patient care. You will work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include gathering patient stats before and after treatment, initiating treatment, monitoring patients during treatment, terminating treatment, and collecting patient blood samples per physician orders.Technician Duties. You will ensure quality comes first by preparing machines for hemodialysis treatments, cleaning and disinfecting machines after treatment, and conducting machine safety checks and logging results for quality control, ensuring all protocols and regulations are followed.Safety and Quality. You will use appropriate safety measures, including personal protective equipment. Working under the supervision of a Charge Nurse, you will adhere to all company policies, procedures, and state/federal laws and regulations. You will participate in all required staff meetings and continuing education offerings.PATIENT CARE TECHNICIAN STATE SPECIFIC BOARD OF NURSING REQUIREMENTS California<ul><li>Must possess current Certified Hemodialysis Technician (CHT) certificate from California Department of Public Health (CDPH) at time of hire OR</li><li>Hired at USRC location recognized by state of California as an approved dialysis technician training program and obtain California state certification (CHT) within six (6) weeks of successful completion of training program. </li></ul>Maryland<ul><li>Must possess current Certified Nursing Assistants -- Dialysis Technicians (CNA-DT) certificate from Maryland Board of Nursing OR</li><li>Hired at USRC location recognized by state of Maryland as an approved dialysis technician training program and obtain Maryland CNA-DT certificate within three (3) months from date of hire OR</li><li>Out-of-state applicant must have active BONENT certification and provide proof of initial application for CNA-DT certification.</li></ul>New Mexico<ul><li>Must have New Mexico dialysis technician certificate at time of hire OR</li><li>Hired at USRC location recognized by state of New Mexico as an approved dialysis technician training program and obtain New Mexico state certification within six (6) months of successful completion of training program OR</li><li>New Mexico certification of hemodialysis technician is required for out of state applicant with active state or national hemodialysis certification; must obtain New Mexico state certification prior to working as a Certified Hemodialysis Technician. </li><li>After January 1st, 2024, all initial applications for the certified hemodialysis technician will require a national hemodialysis technician certificate.</li><li>The applicant must submit proof of a valid national hemodialysis technician certificate from a recognized organization.</li><li>Hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients</li></ul>OHIO<ul><li>Must have Ohio dialysis technician intern certificate at time of hire OR</li><li>Hired at USRC location recognized by state of Ohio as an approved dialysis technician training program and submit application for Ohio dialysis technician intern certificate to board no later than four (4) weeks prior to completion of the approved training program.</li><li>Must obtain Ohio Board of Nursing Certificate (OCDT) not less than twelve (12) months and not later than eighteen (18) months of enrolling in the USRC OCDT program.</li></ul>OREGON<ul><li>Must possess current Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division at time of hire OR</li><li>Must obtain Oregon dialysis technician provisional certificate within three (3) weeks of successful completion of training program and obtain Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division within eighteen (18) months. An Oregon Provisional Certification is valid for six months and can be renewed for one additional six month period.</li></ul>&nbsp;

Dialysis Registered Nurse - PRN

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.The Home Therapy Registered Nurse, as qualified by federal and state regulations, provides patient training and ongoing support for all patients choosing a home dialysis modality.&nbsp; This position is accountable for providing quality care to all patients and is committed to delivering superior customer service in all internal and external interactions.&nbsp;&nbsp; &nbsp; ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.&nbsp; Other duties and tasks may be assigned.<ul><li>Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements as they pertain to home dialysis program and patient care requirements.</li><li>Train patient (and/or care partner) in the practice of self-care Peritoneal Dialysis or Hemodialysis upon meeting federal and state regulations governing Registered Nurse qualifications.</li><li>Conduct home visits to assess the patient's home environment per policy; initially and minimally annually thereafter.&nbsp; Routinely evaluate patient performance and assess the home environment more frequently as needed to improve care.</li><li>Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li>Document all nursing services in the Electronic Medical Record including but not limited to training sessions, routine and non-routine in-person interactions, and phone conversations.&nbsp; Documentation should accurately reflect the patient status and nursing interventions and be written to ensure continuity of care.</li><li>Participate in infection control monitoring, implementation, and recording as requested.</li><li>Be familiar with emergency equipment and all emergency operational procedures.&nbsp; Communicate and regularly review Emergency Preparedness procedures with all home patients, including but not limited to emergency disconnection from dialysis equipment, what to do and who to contact if displaced from home.</li><li>Ensure clinic and patient supply inventory and usage is appropriate for patient prescriptions and place orders in timely manner to avoid fees and penalties.</li><li>Continually seek to improve patient and quality outcomes through tracking and trending of program and patient performance, use of critical thinking skills and root cause analysis to improve patient and quality outcomes.&nbsp; Assist in obtaining data for the continuous quality improvement activities.</li><li>Obtain routine and non-routine laboratory tests as ordered and communicate critical lab values and urgent patient needs to the responsible physician or physician extender in a timely manner.</li><li>Complete and document monthly review of patient medication profiles.&nbsp; Administer medications as ordered by the physician.</li><li>Responsible for performing on call nursing services, nights and weekends, on a rotational basis as needed or assigned.</li><li>Flexible with staffing locations and hours to accommodate patient and USRC home program needs.</li><li>Regular and reliable attendance is required for the position.</li></ul>Home Hemodialysis Only:<ul><li>Coordinate home evaluation with technical services department to ensure that the necessary electrical, plumbing and drainage requirements for proper equipment operation are met prior to patient acceptance into home program.</li><li>Ensure required and appropriate water sampling is complete per policy and product requirements.&nbsp; Monitor and report water sample and culture results.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</li></ul>Salary / Compensation StatementCompensation for the role will depend on several factors, including a candidate's experience, qualifications and skills. U.S. Renal Care offers a comprehensive total rewards package, which includes a 401k match, healthcare coverage, and a broad range of other benefits.

Dialysis Registered Nurse, Peritoneal RN

Job Title Respiratory Therapist Senior/UKHC Requisition Number RE51335 Working Title Respiratory Therapist Senior Department Name H3410:Respiratory Services Work Location Lexington, KY Grade Level 11 Salary Range $26.00-45.70/hour Type of Position Staff Position Time Status Full-Time Required Education AS Click here for more information about equivalencies: <a href="https://hr.uky.edu/employment/working-uk/equivalencies" target="_blank">https://hr.uky.edu/employment/working-uk/equivalencies</a> Required Related Experience No experience required. Required License/Registration/Certification Licensure through the Kentucky Board of Respiratory Care and Registered Respiratory Therapist (RRT) through the National Board of Respiratory Care at time of hire. Physical Requirements This position requires regularly sitting at a computer workstation for extended periods of time; standing or walking with objects weighing up to 10 pounds; and lifting, pushing, and/or pulling objects weighing up to or over 50 pounds; intermittently standing or walking with objects weighing up to 25 pounds; performing tasks with repetitive motions (such as typing); and occasionally working at heights above four feet and/or in confined spaces. Also involves some exposure to risk of injury from moving, lifting, or positioning patients, equipment, or materials; and exposure to hazardous chemicals and fumes including waste, radiation, burns, cuts/punctures, blood-borne or airborne pathogens, and combative/violent people. Shift Must be able to work three 12.5-hour shifts per week (7:00 p.m. – 7:30 a.m.) Will also be required to work weekends and holidays. Job Summary UK HealthCare is seeking registered respiratory therapists dedicated to wellness, safety, and patient-centered care. The Respiratory Therapist Senior ensures competent care of patients through airway management, mechanical ventilator management, blood gases, oxygen therapy, aerosol therapy, and other duties as it relates to assure the quality of patient care. The ideal candidate will perform proper documentation of patient care activities and interventions; record therapy and results as required by hospital policy and regulatory agencies; and communicate with other healthcare teams to ensure the quality care of patients. Positions available at the following locations: Albert B. Chandler Hospital and Good Samaritan Hospital. Albert B. Chandler Hospital remains the No. 1 hospital in Kentucky and the Bluegrass Region, according to U.S. News &amp; World Report’s Best Hospitals Rankings and offers a large, state-of-the-art (569-bed) teaching hospital with over 100gunn ICU beds across multiple service lines. Chandler hosts the region’s only Level 1 trauma center and is also home to the Markey Cancer Center which has earned designation by the National Cancer Institute. Respiratory therapists at Chandler will have the excellent opportunity to deliver a considerable range of services covered under their RT license. Good Samaritan Hospital is a smaller (180-bed) hospital that provides community-based patient care while still offering ICU, progressive and acute levels of care. Good Samaritan offers a community hospital feel where it is easy to quickly develop strong working relationships with nursing and physician teams. The starting pay for this position was recently adjusted. The minimum hourly rate for this position will now be $30.00/hour. All pay rates will be based on candidate’s experience. Multiple positions available. Review of applications will begin immediately, and applications will be accepted until the deadline date or until all positions are filled which could be prior to deadline date listed. Skills / Knowledge / Abilities The ideal candidate will have patient care experience; strong computer skills; and excellent communication skills. Does this position have supervisory responsibilities? No Preferred Education/Experience Chandler/Good Samaritan: Hospital experience preferred.Kentucky Children’s Hospital: Pediatric respiratory experience in a hospital setting preferred. Deadline to Apply 10/07/2025 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Respiratory Therapist Senior/UKHC

SUMMARYThe Acute Registered Nurse provides acute dialysis care and treatment to patients within a hospital environment. This position performs duties as assigned by the Charge Nurse or Acute Manager, including assisting and supervising Patient Care Technicians and Licensed Vocational Nurses. Acute nurses may report directly to an Acute Manager, Administrator or the first line of regional operational management which may be an Area Director, Regional Director, or Vice President of Operations, depending on the region/demographics.Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.GROWTH· Assist with clinical and operational processes to improve patient health and minimize hospitalizations and rehospitalization.· Ensure patient and treatment charge information and other related data are accurate and submitted appropriately. · Demonstrate effective use of supplies and staff labor hours.· May participate in inventory management, including end-of-month inventory reporting and adherence to company purchasing protocols.· Perform duties as assigned to meet the patient care or operational needs.OUTCOMES· Administer medications as ordered by the physician..· Provide patient education and follow up as needed.· Assist with program's target goals in meeting quality metrics for patient outcomes in accordance with quality patient care and Company goals.OPERATIONALREADINESS· Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.· Perform duties at all times within limitations established by and in accordance with company policy and procedures, hospital policy, applicable state and federal laws and regulations.· Complete water quality verification and equipment safety checks prior to each treatment, to include second verification as required.· Complete pre and post treatment physical assessments.· Complete pre and post Handoff Communication with hospital nurses.· Initiate and terminate patient treatments to include connecting and disconnecting catheters and cleaning catheter sites.· Set up dialysis machines; report machine problems to biomedical technician and/or Acute Manager as appropriate.· Clean, disinfect and provide quality control of dialysis machines as required by policy and procedures.· Participate in infection control monitoring, implementation, and recording as requested.· Use personal protective equipment as necessary.· Be familiar with emergency equipment and all emergency operational procedures, as required by hospital.OPERATIONALREADINESS (cont.)· Demonstrate effective staffing based on acuity, skill mix and company guidelines.· Ensure provision of dialysis related services such as Hemodialysis, Peritoneal dialysis, Continuous Renal Replacement Therapy (CRRT) and Plasmapheresis (TPE) if contracted to do so.· Participate in all surveys as required.· Ensure nursing care is carried out as directed and treatment is administered in accordance with physician orders.· Ensure appropriate and required information is documented in patient records.· Inform Supervisor, Medical Director or Physician and Hospital Liaison of all incidents, conditions, and concerns related to patient care, staff and patient safety, and in accordance with company policy.· Prepare and maintain dialysis machines and systems per policy: maintain dialysis records, prepare dialysis water treatment system for use according to established procedure and understand technical operations to troubleshoot problems independently.· Notify Bio-Medical Technician regarding machine or water treatment malfunctions, values out of parameters and document as required. PARTNERSHIPS· Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician.· Maintain collaborative working relationship with physicians, nurse practitioners, and other hospital healthcare professionals.· Actively promote GUEST customer service standards; develop effective relationships at all levels of the organization.· Address patient concerns timely and professionally; following hospital policy.STAFF DEVELOPMENT/ RETENTION· Participate in staff meetings as required. Attend and complete all company and hospital required in-service and continuing education.· May delegate tasks to competent licensed and unlicensed staff per applicable state practice act.· Assist with staff training as requested.· Lead staff in team concepts and promote a team effort.

Dialysis Registered Nurse - Roswell Park Acutes

Our Per Diem&nbsp;requirements are one weekend shift per month as well as one holiday per year.&nbsp;Duties and Responsibilities:<ul><li>Assume the charge nurse role if applicable and/or unit nurse role by:</li><li>Receiving and giving accurate and thorough shift reports</li><li>Keeping the physicians informed of patient’s conditions, change of conditions, LOC and triage information and needs</li><li>Correctly entering and taking off physician orders</li><li>Oversight of the care of patients by auxiliary personnel</li><li>Organizing and delegating patient care activities</li><li>Monitoring and/or performing diagnostic screening tests as ordered by physician</li><li>Providing thorough and accurate patient information during shift exchange for end of shift report</li><li>Assess individual patient care needs, initiate medical treatment plan and competently implement/instruct all care in the appropriate nursing practice to all staff.</li><li>Serve as a resource to treatment team members.</li><li>Perform nursing assessments, LOC, and review patient histories to document all necessary information in the Electronic Medical Record on all patients admitted to Caron.</li><li>Prepare patients for examinations: height/weight, vitals, collect and process lab specimens including UDS, UA, Chem Sticks, etc. following proper infection control procedures.</li><li>Utilize safe and effective practices of medication management as defined by policy including the oversight of self-administration observation of medication.</li><li>Administer and monitor the effects of medications, ensure accurate medication is ordered and administered for controlled substances and conduct accurate med counts.</li><li>Provide appropriate patient education as determined by patient assessments/needs and treatment plans.</li><li>Conduct 14-day, 25-day and PRN meetings with patients for assigned units when in unit nurse role.</li><li>Monitor and/or perform withdrawal assessments and appropriately implement/instruct the necessary nursing interventions.</li><li>Accurately and thoroughly document in the medical record utilizing approved medical record language and abbreviations adhering to the medical record policies and procedures.</li><li>Schedule all patient appointments related to their medical treatment.</li><li>Work a flexible schedule based upon service demands and work mandatory overtime as needed.</li><li>Attend all mandatory trainings as identified by Caron policies.</li><li>Attend multi-disciplinary treatment team meetings when in unit nurse role.</li><li>Maintain the quality control logs.</li><li>Provide support services for patient care issues to staff at other Caron facilities.</li><li>Maintain adequate staffing for each shift.</li><li>Ensure the highest level of professionalism for self and staff and maintain a clean and organized work environment.</li><li>Complete yearly training requirements and mentor new employees.</li><li>This job description reflects management’s assignment of essential functions and does not prescribe or restrict the tasks that may be assigned.</li></ul>Physical Requirements:The physical and mental demands described here are representative of those that must be met to successfully perform the essential functions of this job.&nbsp; Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.<ul><li>Lifting: up to 50 pounds on occasion.</li><li>Standing: up to several hours at a time, this may include walking, climbing steps, and descending steps.</li><li>Walking: must be able to ambulate throughout the assigned facilities on campus or Caron properties.</li><li>Sitting: up to several hours at a time for data entry into the computer or medical record documentation.</li></ul>EDUCATION/EXPERIENCE QUALIFICATIONS:<ul><li>Currently licensed as RN or LPN in Pennsylvania.</li><li>Current Certified Addiction Registered Nurse (CARN) certification preferred.</li><li>1-3 years’ experience working as an RN or LPN preferably in ER, acute care or mental health setting</li><li>Current CPR/First Aid training/certification.</li><li>21 years of age or older is required</li><li>Requires a current, valid, unrestricted driver’s license</li><li>Two years continuous sobriety preferred if in recovery.</li><li>Previous hospital/chemical dependency rehabilitation treatment program experience desired.</li><li>Possess a working knowledge of addictions with age specific patient populations preferred.</li><li>Working knowledge of electronic medical record and charting.</li></ul>

Caron Treatment Centers

Registered Nurse (RN) - Per Diem

The hiring range for this role is: &nbsp;$103,676.95 - $159,759.88This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation.<li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed 25%</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval 25%</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations 25%</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives 15%</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations 10%</li> Job Overview: Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation. Essential Functions<ul><li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations</li></ul>QualificationsEducation <ul><li>Required Bachelor's Degree in nursing or related field from an accredited university; or equivalent work experience</li><li>Preferred Master's Degree</li><li>Experience </li><li>5+ Years of experience with Utilization Management and Medical Policy development in a managed care setting Required</li><li>Knowledge Skills and Abilities </li><li>Excellent written and verbal communication skills Ability to translate complex, technical and/or quantitative information in clear, concise, and understandable documents of presentation Advanced project management skills for planning and executing multiple projects and a detail orientation to ensure compliance with accreditation standards and accuracy of statistics Demonstrated ability to identify and create strategies that support initiatives and translate these into strategic action plans Ability to work well in an interdisciplinary clinical team environment Demonstrated ability to foster strong working relationships with customers and business stakeholders and contact Demonstrated ability to handle multiple projects, prioritizing critical aspects/tasks, working under pressure and meeting deadlines Ability to lead independent research Technical proficiency with information technologies (e.g. Microsoft Office) and literature-search databases Demonstrated abilities in data analysis, synthesis, and reporting, including systematic analysis of clinical literature Ability to conduct comparative analysis of external medical policies, with detailed analysis of specific clinical indications Demonstrated ability to understand complex medical technology assessments and detailed analysis of specific clinical indications in medical policies</li><li>Certifications &amp; Licenses </li><li>Required: RN-CS - RN Certified Clinical Specialist -</li><li>Preferred: CPHM - Certified Professional in Healthcare Management - AIHM</li><li>Preferred: Certified Professional Coder (CPC) - AAPC</li><li>Preferred: Accredited Case Manager (ACM) - ACMA</li></ul> Extra Posting information: A minimum of four years of experience with Utilization Management and Medical Policy development in a managed care setting. Experience with URAC/NCQA accreditation requirements. Experience presenting information to large audiences (town hall calls, professional conferences, etc.), both virtually and in-person. Experience in leading cross-functional work Experience related business experience which demonstrates knowledge and understanding of PPO operations, business practices and processes, as well as knowledge of corporate goals.#LI-Hybrid

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