Medical Director

Job Title: Medical Director - Utilization Management Location: Remote - Preference EST or nearby Pittsburgh PA,NY,WV Duration: 6 Months Contract with possible extension Position Overview As part of a physician team, the Medical Director ensures utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of requested treatments or services. Depending on the nature of the case, telephonic peer-to-peer discussions may be required. The Medical Director ensures compliance with NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of a multidisciplinary team for case and disease management and advises the team on high-risk and complex cases. Special projects may also be assigned to support and improve member care. Responsibilities Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer-to-peer discussions, to determine medical necessity and appropriateness. Complete initial determinations, appeals, grievances, and other reviews as assigned. Compose clear and concise rationales for provider and member determination notifications while adhering to required compliance standards including NCQA, URAC, CMS, DOH, and DOL regulations. Ensure all aspects of the medical management process are consistent with community standards of care. Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary teams on cases requiring physician expertise. Participate in protocol and guideline development to ensure consistency in the review process. Manage projects and/or participate on project teams requiring physician subject matter expertise. Preference will be given to candidates with payer-side Utilization Management experience within a health insurance environment. Candidates with only hospital-side UM experience may not meet requirements. Required Qualifications Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). Minimum 5 years of direct patient care experience in hospital, outpatient, or private practice settings. Board Certification in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards. Active medical state licensure required for PA, NY, or WV. Expected productivity: 55 cases completed in an 8-hour day. Critical thinking skills. Case management experience. Customer service skills. Strong oral and written communication skills. Collaboration and listening skills. Telephone skills. General computer skills. Experience with clinical software. Managed care experience. Preferred Qualifications Master's Degree in Business Administration/Management or Public Health. Minimum 1 year of Medical Management experience within a Health Insurance Plan. Strong knowledge of the managed care industry. Experience with MCG or InterQual.

Emergency Medicine Physician Assistant in Framingham, MA

Are you looking for a rewarding career in emergency medicine? TeamHealth has the perfect opportunity for you! We are seeking a full-time emergency medicine physician assistant to provide high-quality, patient-centered care in a fast-paced emergency department. The PA works collaboratively with attending physicians, nursing staff, and other healthcare professionals to evaluate, diagnose, and treat patients presenting with a wide range of acute illnesses and injuries. This role emphasizes efficient clinical decision-making, strong communication, and adherence to evidence-based emergency care practices. We are currently seeking experienced candidates only. About the Role Perform comprehensive and problem-focused histories and physical examinations Order, interpret, and act on diagnostic tests including labs, imaging, and EKGs Diagnose and manage a broad spectrum of acute conditions (e.g., abdominal pain, chest pain, respiratory distress, orthopedic injuries, lacerations, infections) Perform emergency procedures as credentialed: splinting, incision and drainage, foreign body removal, wound care, and more Initiate and manage treatment plans including medications, fluids, and therapeutic interventions Recognize and stabilize patients with life-threatening conditions; initiate appropriate consults and transfers Document all patient encounters accurately and timely within the EMR Competitive compensation with an estimated base salary range of $75 to $90 hourly with the opportunity to earn incentives including shift differential. Full time clinicians are eligible for an excellent comprehensive benefits package to include: 401(k) plan, health, dental and vision insurance, PTO, long and short term disability, FSA, group term life insurance, and employee assistance program. Want to learn more? Apply today! California Applicant Privacy Act:

Adult Care Management RN

Position Title: Adult Care Management RN Department: Transitional Care Management/P4P Job Description: New to OU Health? Ask your recruiter about our competitive wages and total rewards package including a sign-on bonus and possible relocation assistance if you are located outside of 100 miles! This position may be filled as a Level 1, 2, or 3 depending on specific education, experience, and license requirements. Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary responsibility of the role will be to assess, plan, implement, coordinate, monitor, and evaluate the options and services required to meet the healthcare needs of patients, while promoting quality outcomes and patient satisfaction. Essential Responsibilities Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position. Conduct comprehensive assessments of patients' health status, medical history, and ongoing care needs. Develop individualized care plans in collaboration with the interdisciplinary healthcare team, patients, and their families to ensure continuity of care. Provide education to patients and their families regarding their health conditions, treatment plans, medications, financial expectations, and self-care strategies. Coordinate and facilitate communication between patients, families, healthcare providers, and community resources to optimize patient care outcomes. Evaluate effectiveness of care plans and adjust as necessary. Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and cost-effectiveness. Advocate for appropriate allocation of resources and services to meet patients' needs while adhering to regulatory guidelines and reimbursement criteria. Collaborate with insurance providers, social workers, and other stakeholders to ensure timely authorization of services and coverage for patients. Monitor and evaluate patient outcomes, healthcare processes, and care delivery systems to identify areas for improvement. Participate in quality improvement initiatives and interdisciplinary care conferences to promote evidence-based practices and enhance patient safety and satisfaction. Ensure compliance with federal, state, and local regulations, as well as accreditation requirements related to care management and patient care. Implement strategies to minimize readmissions, prevent complications, and optimize care planning processes. General Responsibilities Performs other duties as assigned. Minimum Qualifications (Level 1): Education Requirements: Associate's degree, or higher, in nursing required. Experience Requirements : Minimum of 0 - 3 years Nursing experience required, with Care Management experience preferred. License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC . Basic Life Support from the American Heart Association required. Minimum Qualifications (Level 2): Education Requirements: Bachelor's degree in nursing required. Experience Requirements: At least 3 years of Care Management experience. License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC . Basic Life Support from the American Heart Association required. Minimum Qualifications (Level 3): Education Requirements: Bachelor's degree in nursing required. Experience Requirements: At least 5 years of Care Management experience. License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC . Basic Life Support from the American Heart Association required for inpatient setting. Knowledge/Skills/Abilities Required Demonstrates expertise in regulatory requirements regarding the care management discipline. Strong communication, interpersonal, and leadership skills. Detailed oriented with excellent organizational skills. Commitment to fostering a culture of continuous learning, quality improvement, and patient-centered care. Strong assessment, critical thinking, and problem-solving skills Strong knowledge of healthcare regulations, including CMS guideline Show clear understanding of utilization management principles and integrate these with care management responsibilities. Serve as liaison between patients, families, and healthcare providers. Proficiency in utilizing electronic health records (EHR) and care management software. Strong assessment, critical thinking, and problem-solving skills. Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.

Pocono Summit FT Phlebotomist

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Phlebotomist is responsible for collecting blood, and non-blood, specimens using appropriate blood collection equipment according to the Laboratory Specimen Collection Manual and Phlebotomy Procedures. JOB DUTIES AND RESPONSIBILITIES: Interprets verbal and written physician orders, obtains blood specimens from patients (all ages) using appropriate blood collection equipment (needles, lancets, etc.), handles and processes lab specimens, and follows safe practices according to the SLUHN policies/manuals Perform outpatient EKG's (as needed), operates centrifuge, and ensure proper specimen transfer and storage Timely communications to the outpatient lab central scheduler, regional coordinators, and managers Travel between sites, when needed, for unscheduled absences and/or emergencies On an ongoing basis, review for understanding and comply with all Network and departmental policies and procedures PHYSICAL AND SENSORY DEMANDS: Continuously maintaining body equilibrium to prevent falling when walking, standing, crouching, or running. Rarely ascending or descending ladders, stairs, scaffolding, ramps, poles and the like using feet/legs and/or hands/arms. Rarely moving about on hands and knees or hands and feet. Continuously bending body downward and forward by bending legs and spine. Continuously picking, pinching, or otherwise working primarily with fingers rather than the whole hand or arm as in gross manipulation. Rarely use of one or both feet or legs to move controls on machinery or equipment. Continuously seizing, holding, grasping, turning or otherwise working with hand(s). Frequently entering text or data into a computer or other machine by means of a keyboard. Occasionally bending legs at knees to come to rest on knee(s). Frequently extending hand and arms in any direction. Frequently remaining in a seated position. Consistently standing to remain on one's feet in an upright position. Continuously bending or turning, generally to a side. Continuously walking to move about on foot. EDUCATION: High School graduate or equivalent required. Successful completion of a phlebotomy school with a minimum of 100 successful hours. 1-2 years of secondary education preferred. Valid driver's license required. TRAINING AND EXPERIENCE: At least 1 year of Phlebotomy experience preferred. Basic computer skills. Effective independent judgement in the performance of the assigned duties and strong customer service skills. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's St. Luke's University Health Network is an Equal Opportunity Employer.

Experienced Registered Nurse, Acute Rehab Center (ARC), Opportunities at Multiple Campuses

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. Nurses are pivotal to providing the care that is needed and demanded in our communities. At St. Luke's, we are proud to be the forerunners of that higher quality standard. Our philosophy and professional practice model are our commitment to safe, compassionate and quality patient centered care. Nursing uniquely leaves a lasting impression on patients and families who rely on these skills. Here at St. Luke's, PCRAFT values are the guiding core principles of our health care team and the qualities we strive for with every encounter. Pride, caring, respect, accountability, flexibility and teamwork are the qualities our team will deliver every time. As a patient or prospective employee, you can count on every member of the St. Luke's team to display PCRAFT values in every situation. St. Luke's Acute Rehabilitation Center (ARC) is the region's leading choice for inpatient rehabilitation, offering a full spectrum of rehabilitation services for individuals who have experienced a serious illness or injury. Through an intensive, individualized treatment program involving speech, physical and occupational therapies, patients can re-learn or develop the skills to live as independently as possible and regain their sense of well-being and function. The ideal Nursing candidate must be able to provide specialized rehab care for patients with various diagnoses and treatment needs. Patient care is driven by a multidisciplinary team, utilizing a patient centered approach, clinical excellence, and patient safety as our guide to patient outcomes. Come join the team that has a passionate focus on supporting their patients on their journey to recovery. Hospital Locations - openings may vary by campus availability: - Bethlehem Campus - Grand View Campus, Sellersville - Lehighton Campus - Sacred Heart Campus, Allentown SHIFT DETAILS: Positions may be available on various shifts includingweekend program options and per diem. Apply now to talk to a recruiter about our current openings! Full time, 36 or 40 hours per week Part time, less than 36 hours per week Holiday and weekend requirements per unit and company policies Per Diem, minimum of 2 shifts/month. JOB DUTIES/RESPONSIBILITIES Registered Nurse Provides nursing care through the nursing process, assesses, plans, implements, coordinates, evaluates and documents the effects of care. Works cooperatively with ancillary, nursing and other patient-team personnel to maintain standards for professional nursing practice. Maintains confidentiality of all materials handled within the Network/ Entity as well as the proper release of information. Demonstrates/models the Network's Service Excellence Standards of Performance in interactions with all customers (internal and external). Complies with Network and departmental policies regarding attendance and dress code. Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated. TRAINING AND EXPERIENCE: RN: Minimum of one year nursing experience required.Individualized orientation program for all areas. Maintain current BLS certification. RNs with less than 1 year of experience please see our internship page EDUCATION: Registered Nurse with current license to practice in the State of Pennsylvania. Current Pennsylvania License. PHYSICAL AND SENSORY REQUIREMENTS: Sit up to 2 hours per day; 1 hour at a time. Stand for up to 10 hours per day; 8 hours at a time. Walk 6 hours per day; 10 minutes at a time. Consistently lift, carry and push objects up to 10 lbs. Occasionally lift, carry and push objects up to 75 lbs. Transports patients weighing up to 500 lbs. via wheelchair, bed and/or stretcher. Frequently stoop and bend. Frequently reach above shoulder level. Must be able to perceive attributes of an object through touch. Must be able to hear as it relates to normal conversation and high and low frequencies. Must be able to see as it relates to general, near, far, color and peripheral vision. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's St. Luke's University Health Network is an Equal Opportunity Employer.

Occupational Therapist

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Occupational Therapist Home Health works collaboratively with other members of the interdisciplinary team to ensure delivery of high quality occupational therapy services in accordance with the physician's orders and with the agency's programs and policies. Services are provided in the patient's place of residence. JOB DUTIES AND RESPONSIBILITIES: Performs initial evaluation to identify functional deficits. Establishes Plan of Treatment in consultation with the physician including short and long-term goals. Guides the patient in their use of therapeutic, creative, and/or self-care activities for the purpose of improving or restoring function and putting function to practical use. Plans program for patient utilizing physical or mental activities, crafts, avocations, exercises, and daily self-care activities, to reach maximal level of function. Instructs in the use of equipment that will help improve function in the home. Observes, records and reports patient's response to treatment and any changes in patient's condition to physician. Communicates with the Rehab Program Manager, Patient Care Manager, Clinical Coordinator and appropriate staff in order to plan total patient and family care. Confers with other disciplines as appropriate in planning rehabilitation for the patient. Records reflect the family oriented approach. Documentation is timely, accurate, legible and in compliance with the agency policy and directives. Records make clear the goals and plans made with the patient and/or family. Evaluates and documents the effectiveness and outcomes of care on an ongoing basis and makes revisions as needed. Plans for discharge as appropriate. Instructs other health team personnel, when appropriate, in certain areas of occupational therapy including activities of daily living, in which they may work with the patients. This includes the patient and family members. Uses own transportation to provide care at patient's residence: Must have and maintain valid PA or NJ Driver's License; Must have and maintain a good driving record accepted by the Network insurance carrier; Must have and maintain motor vehicle insurance with the minimum requirements established by PA or NJ; Must obey and adhere to all motor vehicle regulations and laws while operating vehicle; Must perform routine maintenance on vehicle. PHYSICAL AND SENSORY REQUIREMENTS: Must be able to sit for up to ninety minutes at a time. Be able to tolerate standing for thirty to forty-five minutes consecutively. Must be able to use hands/fingers to manipulate dials on machines. Must have the ability to lift/move patients up to 300 lbs., push/pull patients weighing up to 300 lbs. Must have the ability to frequently stoop/bend, squat, crouch, kneel and reach above shoulder level. Must be capable of tactile sensation as it relates to feeling for muscle spasms, texture and skin temperature. Must have the ability to hear as it relates to normal conversation. Must be capable of seeing as it relates to general vision, depth perception, and peripheral vision. EDUCATION: Bachelor's Degree in Occupational Therapy required. Master's Degree preferred. Occupational Therapist License in the state as determined by the job location. TRAINING AND EXPERIENCE: Preferably one or two years experience under a qualified registered Occupational Therapy supervisor. CPR certification required. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's St. Luke's University Health Network is an Equal Opportunity Employer.

Nurse Practitioner - Part Time Float in St. Louis, MO 170060

A-Line Staffing is now hiring a Nurse Practitioner - Part Time Float in St. Louis, MO. The Nurse Practitioner will be working for a Fortune 500 company and has career growth potential. This would be part time hours with a flexible float schedule. If you are interested in this position, please apply directly to this job posting or email resume to Jenise Nottage . Compensation: • The pay for this position is $74.87 per hour • Benefits are available to full-time employees after 90 days of employment • A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates Highlights: • This position is a contract assignment with potential for extension based on performance and business needs • The required availability for this position is 2 days per week and every other weekend • Weekday hours are 8:30am-7:30pm • Saturday hours are 8:30am-5:30pm • Sunday hours are 8:30am-4:30pm • This is a safety sensitive, patient-facing role • DEA registration application will be required during onboarding unless otherwise noted Responsibilities: • Provide primary and family evidenced-based care including assessment, diagnosis, treatment, health counseling, and disposition planning • Collaborate daily with the MinuteClinic clinical care team to improve patient outcomes and continuity of care • Perform routine examinations, diagnostic testing, chronic condition management, and wellness screenings • Educate patients on healthy lifestyle choices and preventive healthcare services • Handle clinic administrative duties including opening/closing procedures, inventory management, patient follow-up, insurance verification, and payment collection • Coordinate with healthcare professionals to maintain comprehensive patient care plans • Maintain accurate electronic medical records and documentation • Practice autonomously while managing multiple patient care responsibilities Requirements: • Minimum of 1 year of recent Primary Care experience as a Nurse Practitioner in family medicine, primary care, or urgent care required • Active and unrestricted NP/PA license in the state of Missouri in good standing • Master's Degree from an accredited Family Nurse Practitioner program • Current National Board Certification required • Current BLS certification through AHA or ARC required • Strong verbal, written, organizational, and multitasking skills • Ability to work independently and collaboratively within a clinical care team • Proficiency with Electronic Medical Systems (EMS) and healthcare technology • Willingness to obtain multi-state licensure • Verifiable High School Diploma or GED required Education: • Required: Master's Degree level Family Nurse Practitioner program • Required: Current National Board Certification • Required: High School Diploma or GED If you are interested in this position, please apply directly to this job posting or email resume to Jenise Nottage