Work-life balance. * Remote setting ROLE DESCRIPTION: This individual will utilize clinical ... Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the ...
Work-life balance. * Remote setting ROLE DESCRIPTION: This individual will utilize clinical ... Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the ...
Chronic Care Manager (Remote - Compact States)
Oregon, IL · Remote
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ...
Chronic Care Manager (Remote - Compact States)
Oregon, IL · Remote
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ...
Registered Nurse - AI Trainer
Rockford, IL · Remote
$50 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...
Quick apply
Registered Nurse - AI Trainer
Rockford, IL · Remote
$50 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...
RN - AI Trainer
Rockford, IL · Remote
$50 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...
Quick apply
RN - AI Trainer
Rockford, IL · Remote
$50 - $60/hr
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Manager, Care Management
Dekalb, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Dekalb, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Dekalb, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Dekalb, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Freeport, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Freeport, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Rockford, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Rockford, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Rockford, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Rockford, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Dekalb, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Dekalb, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Freeport, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Freeport, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Rockford, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Rockford, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Freeport, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Manager, Care Management
Freeport, IL · Remote
Active Registered Nurse (RN) license or Social Work (SW) license * 5+ years of professional ... This is a remote position that requires travel. * Travel: 50 - 75% field-based interactions ...
Clinical Quality Assurance Coordinator (32314)
Rockford, IL · Remote
$26.50 - $28.50/hr
Are you a Nurse (LPN, LVN or RN) seeking a role that challenges you, helps you grow, and lets you ... Why This Role Rocks: * 100% Remote - Enjoy the flexibility of working from home! * Impactful Work ...
Clinical Quality Assurance Coordinator (32314)
Rockford, IL · Remote
$26.50 - $28.50/hr
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Clinical Quality Assurance Coordinator (32314)
Rockford, IL · Remote
$26.50 - $28.50/hr
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Clinical Quality Assurance Coordinator (32314)
Rockford, IL · Remote
$26.50 - $28.50/hr
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Clinical Quality Assurance Supervisor (RN, LPN, LVN) - 100% Remote Schedule: Monday-Friday, 8:30 AM-5:00 PM CT (with occasional weekend coverage) Make an Impact - Lead Quality in Clinical Excellence ...
Clinical Quality Assurance Supervisor (RN, LPN, LVN) - 100% Remote Schedule: Monday-Friday, 8:30 AM-5:00 PM CT (with occasional weekend coverage) Make an Impact - Lead Quality in Clinical Excellence ...
Clinical Quality Assurance Coordinator - Supervisor (32090)
Rockford, IL · Remote
$35 - $40/hr
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Clinical Quality Assurance Coordinator - Supervisor (32090)
Rockford, IL · Remote
$35 - $40/hr
Clinical Quality Assurance Supervisor (RN, LPN, LVN) - 100% Remote Schedule: Monday-Friday, 8:30 AM-5:00 PM CT (with occasional weekend coverage) Make an Impact - Lead Quality in Clinical Excellence ...
Clinical Quality Assurance Coordinator - Supervisor (32090)
Rockford, IL · Remote
$35 - $40/hr
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Clinical Quality Assurance Coordinator - Supervisor (32090)
Rockford, IL · Remote
$35 - $40/hr
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Clinical Quality Assurance Coordinator (32125)
Rockford, IL · Remote
$26.50 - $28.50/hr
Are you an RN ready to take the next step in your career? ExamWorks is excited to welcome a ... Why You'll Love This Role: -100% Remote - Work from where you're most comfortable - home! -Flexible ...
Clinical Quality Assurance Coordinator (32125)
Rockford, IL · Remote
$26.50 - $28.50/hr
Are you an RN ready to take the next step in your career? ExamWorks is excited to welcome a ... Why You'll Love This Role: -100% Remote - Work from where you're most comfortable - home! -Flexible ...
Clinical Quality Assurance Coordinator (32125)
Rockford, IL · Remote
$26.50 - $28.50/hr
Are you an RN ready to take the next step in your career? ExamWorks is excited to welcome a ... Why You'll Love This Role: -100% Remote - Work from where you're most comfortable - home! -Flexible ...
Clinical Quality Assurance Coordinator (32125)
Rockford, IL · Remote
$26.50 - $28.50/hr
Are you an RN ready to take the next step in your career? ExamWorks is excited to welcome a ... Why You'll Love This Role: -100% Remote - Work from where you're most comfortable - home! -Flexible ...
Remote Oracle Rn information
What is the difference between Remote Oracle Rn vs Remote Oracle Database Administrator?
| Aspect | Remote Oracle Rn | Remote Oracle Database Administrator |
|---|---|---|
| Certifications | Oracle Nursing Certification, RN License | Oracle Certified Professional (OCP), Database Certification |
| Work Environment | Healthcare settings, clinics, hospitals | IT departments, data centers, corporate environments |
| Job Focus | Patient care, clinical procedures | Database management, system maintenance |
Remote Oracle Rn roles focus on patient care and clinical responsibilities in healthcare settings, requiring nursing licenses and healthcare certifications. In contrast, Remote Oracle Database Administrators handle database systems, requiring IT certifications and technical expertise. Both roles are remote but serve different industries and skill sets, making their job functions distinct despite similar titles.
Full-time
Medical, Dental, Vision, Life, Retirement
Posted 14 days ago
Job description
*Must have Mental Health and/or Substance Abuse experience*
ABOUT US:
Hines is a nationwide, independent leader in personalized managed health care, focused on what's important to you-comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.'s reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.
WHAT WE OFFER:
- Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, company paid and voluntary life insurance. Critical Illness, accident insurance and flexible spending also available!
- 401k plan with company match, fully vested after 1 year.
- No weekends and nights!
- Paid Holidays
- Work-life balance.
- Remote setting
ROLE DESCRIPTION:
This individual will utilize clinical knowledge and communication skills to obtain patient specific information regarding patient condition and proposed treatments and procedures to determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement. This individual will certify treatment for confinement when criteria and/or practice guidelines are met, in accordance with the health benefit plan, disability, workers compensation regulations and state and federal regulations. If these conditions do not appear to be met, this individual will defer decision to a second level reviewer. This individual interfaces with case managers and disease management nurses on active cases involved in other Hines' programs.
*****This is a Monday through Friday position, 9:30 AM to 6:00 PM.******
RESPONSIBILITIES AND PERFORMANCE:
- Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to the clinical areas addressed in most initial clinical reviews. .
- Demonstrates ability to assess a patient's current medical status, including complications and untoward events, which may require additional intervention. Provides certification of medical, disability and workers compensation cases.
- Demonstrates a thorough understanding of criteria sets and their limitations including when a second level review is required.
- Evaluates appropriateness of current plan of care.
- Assesses aftercare needs, implements discharge planning and/or case management referral in a timely manner.
- Maintains knowledge of current advances and trends in medical care.
- Demonstrates knowledge of URAC guidelines, Hines policies and procedures, and standards of practice and their revisions. Able to attain and maintain the minimal quality assurance performance standards.
- Demonstrates assertiveness in completion of precertification and concurrent review within the guidelines of URAC, disability, workers compensation regulations, and state and federal requirements and according to the Hines policies and procedures.
- Performs onsite evaluations as needed or requested.
- Additional responsibilities as assigned.
PM21
COMMUNICATION:
- Communicates with hospital staff, physicians, other providers and Hines customer contacts in a competent, calm, effective and professional manner.
- Effectively communicates the need to refer to a higher-level review for questionable plans of treatment.
- Provides written documentation concerning the clinical information obtained regarding the patient's status, benefit and claim concerns, and validation of criteria.
- Communicates knowledge of policies and procedures, URAC guidelines, disability and workers compensation regulations, state and federal requirements, and standards of practice.
PERSONAL AND PROFESSIONAL:
- Participates in self-evaluation by identifying areas of strength and limitations and offers and accepts constructive criticism.
- Creative and assertive.
- All First Level Reviewers are required to sign and honor a confidentiality statement at the time of hire and annually at the time of performance reviews.
Requirements
QUALIFICATIONS:
- Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed. For mental health/substance abuse, licensed medical professional with an unrestricted license in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in may perform first level reviews. Accepted licensure includes but is not limited to RN, LMSW, LMHC.
- Must have Mental Health or Substance Abuse experience.
- Successful completion of UR nurse orientation program.
- Minimum of 3 years recent acute clinical practice required, 5 years preferred.
- Managed care, disability or workers compensation experience helpful but not mandatory.
- Customer service oriented.
*Hines welcomes diversity and as an equal opportunity employer all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.*
Salary Description
$57,244 - $62,180 per year