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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><h4>Full Time Employees are eligible for:</h4><ul><li>Medical / Pharmacy</li><li>Dental</li><li>Vision</li><li>Voluntary benefits (listed twice — likely a redundancy)</li><li>401k with employer match</li><li>Virtual Care</li><li>Life Insurance</li><li>PTO</li></ul><h4>Part Time Employees are eligible for:</h4><ul><li>401k with employer match</li><li>PTO</li></ul>

U.S. Renal Care

Dialysis Registered Nurse - Charge

Job Title Nurse Clinical/UKHC/Good Samaritan / 11A WEPP Requisition Number NR14219 Working Title Nurse Clinical/UKHC / Good Samaritan /11A WEPP Department Name H6130:Emergency Services Work Location Lexington, KY Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education ADN Required Related Experience No experience required. Required License/Registration/Certification Active Kentucky Registered Nurse (RN) license, Temporary Work Permit (TWP), Provisional License or active compact state Registered Nurse (RN) license that is in good standing and American Heart Association (AHA) Basic Life Support certification for the Healthcare Provider valid for at least 6 months after employment date Physical Requirements The essential functions for this position include the ability to lift, carry, push, and pull 50-100 pounds on a daily basis and 25-50 pounds frequently; as well as stand, walk and sit for long periods of time. The conditions of work may involve exposure to communicable diseases, hazards of radiation, and injury from intractable patients or sharp instruments. Shift MUST BE ABLE TO WORK EVERY SATURDAY AND SUNDAY, 11AM – 1130PM. THIS IS A WEEKEND PREMIUM POSITION. WORK 24 HOURS EACH WEEK, GET PAID FOR 32 HOURS / WEEK. Job Summary The primary responsibilities for this position consist of providing total, comprehensive, continuous and patient centered care which includes: assessing, documenting, planning, implementing, teaching, developing, and evaluating a comprehensive nursing plan of care; delivering direct patient care; ensuring patient satisfaction; training and delegating duties for Nursing Care Technicians (Nursing Assistant); and adhering to University policies and procedures as well as federal, state and local regulations. Furthermore, this environment supports collaborative efforts among the nursing staff and the team of physicians to increase communication and enhance expected patient outcomes. This includes utilization of the nursing process in conjunction with a comprehensive patient-centered plan of care, ensuring patient satisfaction. Skills / Knowledge / Abilities The ideal candidate will have the following: knowledge of Maslow’s eight Basic Human Needs and the priority within Gordon’s Functional Health Patterns Frame Work as well as Swanson’s Caring model; superb direct patient care and critical thinking skills; basic computer navigation skills and working knowledge of the internet; ability to communicate in a professional and respectful manner with patients and their families, co-workers and physicians; and strong organizational, prioritization, and delegation skill. The candidate will be highly motivated, pro-active and confident in advocating for patients and their family members. Will also enjoy working in a strong team environment and provides open, honest communication with fellow staff and physicians. In addition, the ideal candidate will possess exceptional technical skills and a proven ability to work in a team as well as independently. Does this position have supervisory responsibilities? No Preferred Education/Experience BSN + AT LEAST 1 YEAR OF RN EXPERIENCE PREFERRED Deadline to Apply 09/21/2025 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. The University follows both the federal and state Constitutions as well as all applicable federal and state laws on nondiscrimination. The University provides equal opportunities for qualified persons in all aspects of institutional operations and does not discriminate on the basis of race, color, national origin, ethnic origin, religion, creed, age, physical or mental disability, veteran status, uniformed service, political belief, sex, sexual orientation, gender identity, gender expression, pregnancy, marital status, genetic information or social or economic status. 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.

Nurse Clinical/UKHC/Good Samaritan / 11A  WEPP

JOB SUMMARY This position requires the employee to facilitate and maintain the development of strong and engaged bargaining units. &nbsp;The employee is part of the Oregon Nurses Association (ONA) labor department, which empowers healthcare workers to advocate for themselves, their patients, their families, and their communities.COMPENSATION AND BENEFITS: This is a full time, exempt position. The salary is based on applicable years of experience applied to the wage scale outlined in the union staff ’s collective bargaining agreement.Effective July 1, 2024 ONA offers an annual starting salary range for this position of $77,998.71 to $112,495.81 depending on experience.ONA also offers an exceptional benefits package including employer contributions (90%) to medical, dental and vision premiums, as well as employer paid long and short-term disability and life insurance. Opportunity to enroll in 401K plan after 6 months of employment which includes a 3% employer contribution, with additional longevity contributions after 5 years. Union members are also enrolled in a union pension plan. &nbsp;Annual PTO is 25 vacation days, 8 personal days and 12 sick leave days.OUR COMMITMENT TO EQUITY AND FAIRNESS ONA is deeply committed to diversity and inclusion in its hiring practices. We are an affirmative action, equal opportunity employer. Our employment decisions are made without regard to race, color, religion, gender, gender identity, national origin, age, disability, marital status, veteran or military status, or any other legally protected status. Women and people of color are encouraged to apply.TO APPLY: For more information and/or to apply for this position, please click here (applications which do not include a resume will not be considered):&nbsp; <a href="https://secure.entertimeonline.com/ta/ONAG18.careers?ShowJob=436594455" target="_blank">https://secure.entertimeonline.com/ta/ONAG18.careers?ShowJob=436594455</a>&nbsp;

Oregon Nurses Association

Internal Labor Representative (Eugene)

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!Role: The Librus APRN is a key clinical leader in the delivery of person-centered, value-based care to Institutional Special Needs Plans (ISNP), ACOs, and high-risk payors residing in Skilled Nursing Facilities, communities, or private homes. Working in alignment with the payor's model of care and under the Librus program, the APRN performs comprehensive clinical assessments, closes care gaps, participates in IDT meetings, ensures accurate HCC coding, reduces unneeded hospitalizations, and delivers high-quality primary and supportive care to medically complex patients. This role also includes providing end-of-life services, including comfort and symptom-focused care without formal hospice enrollment, ensuring quality of life and dignity are prioritized during serious illness and advanced aging.Qualifications: Required:<ul><li>Licensed APRN with active certification (Adult/Geriatric NP, FNP, or similar) in the state of Florida.</li><li>DEA license with prescriptive authority.</li><li>Minimum 3 years of experience as a nurse practitioner, preferably in geriatrics, SNF, hospice, palliative care, or complex care management.</li><li>Demonstrated experience with HCC coding and risk adjustment models.</li><li>Familiarity with Medicare Advantage care gap closure metrics.</li></ul>Preferred:<ul><li>Experience with ISNPs, D-SNPs, or other value-based Medicare models.</li><li>Knowledge of SNF workflows and interdisciplinary care teams.</li><li>Comfort and skill in end-of-life conversations and palliative approaches.</li></ul>Schedule &amp; Travel:<ul><li>Full-time, Monday–Friday with flexibility for urgent needs</li><li>On-site presence in designated SNFs with occasional local travel</li><li>Minimal on-call rotation, shared with other advanced practice providers</li></ul>Competencies:<ul><li>Advanced clinical assessment and diagnostic skills</li><li>Coding and documentation proficiency (HCC, SOAP, risk adjustment)</li><li>Compassionate care mindset with emotional intelligence</li><li>Collaborative leadership across multiple teams</li><li>Strategic time and case management abilities</li></ul>Responsibilities of all employees:<ul><li>Represent the Company professionally at all times through care delivered and/or services provided to all clients.</li><li>Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.</li><li>Comply with Company policies, procedures and standard practices.</li><li>Observe the Company's health, safety and security practices.</li><li>Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.</li><li>Use resources in a fiscally responsible manner.</li><li>Promote the Company through participation in community and professional organizations.</li><li>Participate proactively in improving performance at the organizational, departmental and individual levels.</li><li>Improve own professional knowledge and skill level.</li><li>Advance electronic media skills.</li><li>Support Company research and educational activities.</li><li>Share expertise with co-workers both formally and informally.</li><li>Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.</li></ul>Job Responsibilities: Clinical Care Delivery:<ul><li>Serve as the primary advanced practice provider for assigned ISNP members, High-Needs ACO patients, and similar settings, delivering direct, evidence-based care in collaboration with facility and plan/payor staff.</li><li>Perform routine and urgent clinical assessments, diagnose and manage chronic and acute conditions, and adjust care plans.</li><li>Provide palliative and hospice-like care interventions focused on comfort, dignity, and patient-centered goals.</li></ul>HCC Coding &amp; Gap Closure:<ul><li>Conduct comprehensive annual and episodic assessments to ensure accurate capture of chronic conditions per CMS HCC guidelines.</li><li>Close quality gaps related to screenings, labs, immunizations, and chronic disease management per ISNP, Payor and plan metrics.</li><li>Maintain thorough, compliant documentation to support both care delivery and risk adjustment requirements.</li></ul>Model of Care Alignment:<ul><li>Operate as a clinical champion of the Librus Model of Care, emphasizing proactive interventions, interdisciplinary collaboration, and reduced avoidable hospitalizations.</li><li>Partner with the RN Care Coordinator and facility teams to ensure service continuity, integration, and alignment.</li></ul>Advanced Illness Management:<ul><li>Lead or participate in goals-of-care discussions, advance directive review, and shared decision-making with patients and families.</li><li>Support members through end-of-life transitions with empathy and skill, even without formal hospice enrollment.</li><li>Utilize comfort-focused prescribing and symptom management protocols.</li></ul>Collaboration &amp; Reporting:<ul><li>Attend IDT meetings and collaborate regularly with payor physicians, SNF staff, and Librus leadership.</li><li>Communicate care plans effectively with patients, caregivers, and staff.</li><li>Submit timely and accurate clinical documentation, coding, and quality reporting.</li></ul>This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.

Chapters Health System

Nurse Practitioner CareNu

<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.

Dialysis Registered Nurse - Floater

Position:&nbsp; Therapist/ UM Therapy Reviewer&nbsp;Reports To: Manager, Utilization Management&nbsp;Salary Range:&nbsp; DOEPosition Description: Therapist Reviewers are responsible for conducting re-authorization/certification and authorization activities for therapy home health services, by utilizing appropriate company policies, Medicare Chapter 7, Milliman Care Guidelines, and clinical department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of physical, occupational therapy and speech language pathology visits to ensure quality member outcomes, and to optimize member benefits.Essential Functions:<ul><li>Responsible for the review of medical records, including more complex cases, to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) are medically necessary.</li><li>Provides and/or facilitates clinical management and/or other related activities and serves as a resource to other team members while demonstrating fiscal responsibility and maintaining the highest standards of care and ensuring compliance with all policies, procedures, and regulatory requirements. Promotes interdisciplinary health plan consumers/beneficiaries’ care planning and supports questions from nurses in addition to agency, physician, member/family calls, etc.</li><li>Applies professional therapy, NCQA standards, CMS and Medicaid government regulation and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.</li><li>Maintains knowledge of regulations and requirements through review of current regulations and/or policies. Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with regulations and requirements. Research and obtain additional data, consult with clinical reviewers and medical directors, when necessary.</li><li>Acts as a resource for internal and external customers. Participates in or leads intradepartmental teams, projects, and initiatives. Maintains quality and productivity standards, and ensures reviews are conducted within the required timeframes.</li><li>Periodic Weekend and Holiday Rotation based on business needs</li><li>Collaborate with colleagues to enhance their understanding of key considerations when reviewing therapy-related approvals and denials, including required documentation and criteria.</li><li>Develops and maintains positive customer relations and coordinates with various departments within the company to ensure customer requests and questions are handled appropriately and in a timely manner.</li><li>Other duties as requested.</li></ul>Office Location:<ul><li>Office located at 7600 North 16th Street Suite 140 Phoenix, AZ 85020</li><li>Remote</li></ul>Qualifications:<ul><li>Requires graduate of a college level program in physical therapy, occupational therapy or speech language pathology.</li><li>Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.</li><li>Current active unrestricted license or certification as a PT, OT or SLP required in applicable states.</li><li>Working knowledge of home care process and CMS regulatory and federal requirements.</li><li>Ability to exercise initiative and independent judgement.</li></ul>Knowledge and Experience:<ul><li>Requires extensive knowledge in the areas of home health community-based physical, occupational therapy and speech language pathology services and utilization/case management.</li><li>NCQA and URAC knowledge is helpful.</li><li>Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers.</li><li>3 years of home health experience is preferred.</li><li>Managed care, utilization review/management or case management experience preferred</li><li>Computer skills such as MS Office products - Outlook, Excel, Word, Adobe, and the ability to work within multiple medical management systems</li></ul>tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship

tango

Utilization Management Therapist Reviewer

Salary Range:&nbsp;&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. <h4>Job Summary</h4>The Manager, Appeals &amp; Grievances (A&amp;G) &amp; General Operations (Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals &amp; Grievances Department to ensure clinical grievances, complaints, appeals and complex issues are investigated and resolved using regulatory guidance across all lines of business. Provides direct supervision to the A&amp;G clinical team and the unit that supports them in order to assure operational effectiveness which includes the implementation and adherence to L.A. Care's Policies &amp; Procedures that meet Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), the California Department of Managed Health Care (DMHC), the Managed Risk Medical Insurance Board (MRMIB), National Committee for Quality Assurance (NCQA) and other rules/ regulations/ standards. The Manager is responsible for establishing and monitoring processes to oversee and coordinate the identification, documentation, reporting, investigation and resolution of all member appeals and grievances in a timely and culturally-appropriate manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for L.A. Care Plan Partners, including identifying opportunities for improvement.This position will be a role model for integrity and will establish and maintain effective professional work relationships, working collaboratively with all levels of management and business owners to help guide the discipline of planning, organizing, securing, managing, leading, and controlling resources to achieve specific goals.Manages all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;<h4>Duties</h4>Manage and oversee the handling of clinical grievances and appeals, for L.A. Care and Plan Partner members. Establishes and oversees processes and all relevant member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member grievances. Serve as the Key Contact for State Fair Hearings, internal and external audits, DMHC and DHCS inquiries. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member and provider grievances.Responsible for timely daily operations in the A&amp;G Clinical Services Unit and other general operations units. &nbsp;Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and Compliance Department, internal Quality Oversight Committee, etc. Collaborates with cross-functional departments &nbsp;to ensure the use of appropriate appeal and grievance issue codes, timely resolution, and refers to community partners as appropriate. &nbsp;Lead, participate and provide representation of the A&amp;G Team at Internal and External meetings/ workgroups and acts as the point person for A&amp;G Programs especially the Clinical Programs.Develop and execute on strategic opportunities to improve the overall appeals &amp; grievance process. Create a best in clinical appeals process that is efficient and effective in managing member appeals.Work cross functionally and collaboratively within Appeals and Grievances with key internal partners to build a high functioning, results oriented environment and organization.&nbsp;<h4>Duties Continued</h4>Partner with internal and external stakeholders to build and maintain collaborative relationships and partnerships. Identify areas of connection to leverage and create added value for L.A. Care.Provide input into the development of automation to guide the team to process efficiencies for all lines of business while maintaining compliance and manageable workloads for staff.Responsible for maintaining and updating on an annual basis, or as necessary, appeal and grievance policies and procedures, member correspondence, etc., consistent with regulatory changes. &nbsp;Develop and maintain inventory reports for the appeals process ensuring appropriate productivity, compliance, and inventory management. &nbsp;Identify and implement continuous business process improvement recommendations to leverage organizational added value to the Appeals and Grievances Department. &nbsp;Develop and implement short and long-term strategies to improve team results, reducing administrative expenses.Manage staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others. Supervision of the Clinical Services unit and general operations within Appeals and Grievances. Maintain a team of top talent, providing a culture of teamwork and collaboration.&nbsp;Perform other duties as assigned<h4>Education Required</h4>Bachelor's Degree in Nursing<h4>Education Preferred</h4><h4>Experience</h4>Required:6 years of clinical acute care experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment and/or public services or public benefits programs.At least 3 years of management level operations leadership experience.Experience working with firm deadlines, regulators, detail oriented with the ability to interpret and apply regulationsExperience building relationships with organizations and business partners.Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.Preferred:&nbsp; Managed care experience.<h4>Skills</h4>Required: Excellent analytical, problem solving, planning and implementation skills.Demonstrated strong writing and communication skills.Demonstrates excellent leadership, communication, and negotiation skills with the ability to interact and influence all levels of the organization including executive management and key decision -makers.Demonstrates professional judgement, and critical thinking, to promote the delivery of quality, cost-effective care.Time management and priority setting skills.Excellent understanding of NCQA, DMHC, DOI, DHCS, and CMS regulatory requirements.Knowledge of Coordination of Care, Medicare and Medi-Cal regulations, prior authorization, level of care and length of stay criteria sets.Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.Able to operate PC-based software programs including proficiency in Word, Excel and PowerPoint presentations.Excellent verbal, written communication and presentation skills.<h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assignedSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul> Nearest Major Market: Los Angeles Job Segment: Nursing, Registered Nurse, Nurse Management, Medicaid, Medicare, Healthcare

L.A. Care Health Plan

Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical)

Job Requirements This specific restaurant is independently owned and operated by a Whataburger franchise.&nbsp;Please click on the apply button below to be redirected to this franchisee’s website. Once there, you will be able to learn more about this position information and their application process.

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