Remote Rn Utilization Review Nurse Jobs in Raleigh, NC

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Field Remote Advanced Practice Clinician in the Jump Start Assessment (JSA) program is a physician-led and advanced practice clinician-driven program that is intended to care for and support Alignment Healthcare patients with complex and chronic care needs. Works within an interdisciplinary team environment that includes physicians, nurse practitioners, physician assistants, case managers, and other health care team members to ensure proper delivery of clinical and home-based patient care. Assess', develops, and coordinates options and services promoting quality care in order to achieve optimal health care outcomes while also ensuring cost-effective care complying with Alignment policy and all state and federal regulations. Our members are typically aged 65 and over and home and virtual visits will be between 45 and 60 minutes depending on whether it is an annual or initial visit.
Responsibilities:
1. Conduct in-home assessments (with some outpatient clinical work) on health plan members.
2. In-Home Assessments will include obtaining comprehensive history, physical exam, medication review, and appropriate cognitive/depression/safety screenings.
3. Comfort with End-of-life care discussions imperative.
4. Laboratory specimen collection in the home setting when appropriate.
5. Identify diagnoses to be used in active medical management and care management of patients with focus on chronic disease management.
6. Communicate findings of the patient assessment to inform the PCP of potential gaps in care.
7. Provide patient/family/caretaker education, with an emphasis on close monitoring and follow up of patient needs.
8. Emphasis on knowledge of appropriate community resources for referral.
9. Comply with all HIPAA regulations and maintain security of protected health information (PHI).
Job Requirements:
Experience:
• Required: None
• Preferred: One (1) year of prior clinical or home care experience. Previous EMR experience preferred. Experience in care of older adult (geriatric) patients preferred
Education:
• Required: Master's degree from an accredited NP Program or PA program
Specialized Skills:
• Required:

• Ability to communicate positively, professionally and effectively with others.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Licensure:
• Required: Active North Carolina state Nurse Practitioner or Physician Assistant license
Active RN License and Furnishing number (Must, upon hire) NP only
Active Nurse Practitioner Board Certification/Physician Assistant Certification
NPI Number, DEA, Valid BLS
Valid North Carolina driver license and current automobile insurance
• Preferred:
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this field remote job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $109,932.00 - $164,899.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com.