4 Remote Rn jobs in the United States
Medical Director - Post-Acute Care - Evicore - Remote
Posted today
Job Viewed
Job Description
- The Medical Director provides timely expert medical review of medical necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about the medical service under review while located in a state or territory of the United States.
Responsibilities include:
- Provide timely expert medical review of medical necessity requests for clinical services related to post-acute care and render a clinical opinion about the medical service under review, including post-decision reviews.
- Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions.
- Participate in proactive peer to peers to assist with appropriate and timely discharge planning.
- Document all actions related to clinical review sessions and attest to review qualifications as required.
- Conduct weekly Case Conferences with nursing and social worker teams; discussing every assigned member receiving care in a post-acute care facility, focusing on discharge planning, complex medical care management, quality of care, appropriate level of care, and appropriate length of stay.
- Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications.
- Support the review of eviCore clinical guidelines.
- Support and communicate eviCore policies and procedures to the provider community.
- Testify at ALJ Hearings when your cases are being appealed
- Assist with staff educational training and in-service programs and serve as a clinical resource for eviCore staff.
- Serve as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable.
- Available for scheduled weekend call from home based on business needs.
- Participate in Joint Operating Committee (JOC) meetings, including the collection and review of data relevant to the client, and other virtual events with the provider engagement team in your specified territory.
- Participate in all required educational and quality improvement activities and maintain passing scores in all assessments.
- Assist in reviewing case determinations from clients responding to a provider or member complaint
- Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications
- Other duties as assigned
Minimum Education, Licensure and Professional Certification requirement:
- M.D or D.O with active board certification in primary care specialties (Family Medicine, Internal Medicine or Emergency Medicine) OR board certification in Physical Medicine and Rehabilitation required (recognized by the American Board of Medical Specialties or American Osteopathic Association)
- Three (3) or more years of relevant clinical practice post residency/fellowship required
- Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review Doctor of Medicine or Doctor of Osteopathic Medicine.
- Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management
- Ability to commit to a set, weekly work schedule (Monday through Friday)
- Strong computer skills: ability to work autonomouslywith automated processes, computer applications, and systems
- Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of the time
- In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
NON-COMPACT STATE - PT Remote CCM/RTM Care Management Nurse (CA)
Posted 26 days ago
Job Viewed
Job Description
Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents live-changing problems before they happen for patients with two or more chronic conditions. We believe every patient with chronic disease deserves consistent check-ins, follow-up, and support.
The position of the Nurse Chronic Care Coordinator, Remote will perform telephonic encounters with patients on behalf of our partners each month and develops detailed care plans within our care plan templates in the electronic health record. This begins as an Independent 1099 Contractor position but offers the potential to reach full-time W2 employment (with employee benefits).
Esrun Health is seeking Nurses to work part-time from their home office while complying with HIPAA privacy laws. You will set your own hours and will not be held to a daily work hour schedule. You will be contracted to work a minimum of 20hrs/wk. Esrun Health wants its team members to have the flexibility to balance their work-life with their home life. Part-time team members will typically need to dedicate an average of 20-30 hours per week to care for their assigned patients. This unique business model allows you to choose what days and what hours of the day you dedicate to care for your patients.
The Care Coordinator will be assigned a patient panel based on skill and efficiency level and is expected to carry a patient panel of a minimum of 100 patients per calendar month. Care Coordinators will be expected to complete encounters on 90 percent of the patients they are assigned.
Esrun Health utilizes a productivity-based pay structure and pays $10.00 per completed patient encounter up to 99 encounters/month, $0.25/encounter from 100-149 encounters/month, 12/encounter from 150-199 encounters/month, 14/encounter from 200-249 encounters/month, and 16/encounter for >250 encounters/month. Payment tier increases require 2 months consistency to achieve. A patient encounter will take a minimum of 20 minutes (time is cumulative including chart review, call times/attempts/texts, care plan development, care coordination, and documentation time).
What your impact will be:
- The role of the Care Coordinator is to abide by the plan of care and orders of the practice.
- Ability to provide prevention and intervention for multiple disease conditions through motivational coaching.
- Develops a positive interaction with patients on behalf of our practices.
- Improve revenue by creating billable CCM episodes, increasing visits for management of chronic conditions.
- Develops detailed care plans for both the doctors and patients. The care plans exist for prevention and intervention purposes.
- Understand health care goals associated with chronic disease management provided by the practice.
- Attend regularly scheduled meetings (i.e., Bi-Monthly Staff Meetings, monthly one on one's, etc.). These “mandatory” meetings will be important to define the current scope of work.
What we are looking for:
- Graduate from an accredited School of Nursing. (LPN, LVN, RN, BSN, etc.)
- Current license to practice as an RN/ LVN/LPN with no disciplinary actions noted
- A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home health care.
- Hands-on experience with Electronic Medical Records as well as an understanding of Windows desktop and applications (Microsoft Office 365, Teams, Excel, etc.), also while being in a HIPAA compliant area in home to conduct Chronic Care Management duties.
- Ability to exercise initiative, judgment, organization, time-management, problem-solving, and decision-making skills.
- Skilled in using various computer programs (If you don’t love computers, you won’t love this position!)
- High Speed Internet and Desktop or Laptop computer (Has to be operation system of Windows 10 or higher or Mac) NO Chromebooks and no iPad.
- Excellent verbal, written and listening skills are a must.
What will make you stand out:
- Quickly recognize condition-related warning signs.
- Organized, thorough documentation skills.
- Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills.
- Clear diction. Applies exemplary phone etiquette to every call.
- Committed to excellence in patient care and customer service.
What we offer:
- Contract position with opportunity to become a full-time position, to include benefit options (Medical, Dental, Vision, 401K, Life).
- Streamline designed technology for your Chronic Care operations.
- Established and secure company since 1976, providing critical software solutions for many verticals in countries ranging from North America, Europe, Asia, and Australia
- Core Values that unite and guide us.
- Autonomous and Flexible Work Environments
- Opportunities to learn and grow.
- Community Involvement and Social Responsibility
About us:
Esrun Health, a division of Harris Computer, is on a mission to redefine remote care. Our program offers a customized model of remote care services that blends Chronic Care Management (CCM), Remote Therapeutic Monitoring (RTM), Remote Physiologic Monitoring (RPM), Behavioral Health Integration (BHI), and/or Transitional Care Management (TCM) for each client based on their specific practice needs.
As a Harris healthcare business, we are able to maintain a people-focused, small company experience with the financial security of a large organization.
Nurse Care Manager (RN/LPN) - REMOTE MICHIGAN
Posted 24 days ago
Job Viewed
Job Description
Chronic Care Coordinator
Location: MICHIGAN - 100% REMOTE (NOT A COMPACT STATE)
Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents live-changing problems before they happen for patients with two or more chronic conditions. We believe every patient with chronic disease deserves consistent check-ins, follow-up, and support.
The position of the Remote Chronic Care Coordinator will perform telephonic encounters with patients on behalf of our partners each month and develops detailed care plans within our care plan templates in the electronic health record. This begins as an Independent 1099 Contractor position but offers the potential to reach full-time W2 employment (with employee benefits).
Esrun Health is seeking nurses to work part-time from their home office as independent contractors while complying with HIPAA privacy laws. You will set your own hours and will not be held to a daily work hour schedule. Esrun Health wants its team members to have the flexibility to balance their work-life with their home life. Part-time team members will typically need to dedicate an average of 20-30 hours per week to care for their assigned patients. This unique business model allows you to choose what days and what hours of the day you dedicate to care for your patients.
The Care Coordinator will be assigned a patient panel based on skill and efficiency level and is expected to carry a patient panel of a minimum of 100 patients per calendar month within the first three months of assignment. Care Coordinators will be expected to complete encounters on 90 percent of the patients they are assigned each month unless patients are unable to participate due to current health conditions.
Compensation Structure
Esrun Health utilizes a productivity-based pay structure :
$10.00 per completed patient encounter up to 99 encounters/month.
$0.25 100-149 encounters/month
$12 00 150-199 encounters/month,
$14. 0 200-249 encounters/month
$16. 0 >250 encounters/month.
Payment tier increases require 3 months consistency to achieve.
There is a $1/en ounter incentive compensation for bilingual nurses equal to 3/hr.
A patient encounter will take a minimum of 20 minutes (time is cumulative to include chart review time, time spent during call attempts and the non-face-to-face encounter, time for care coordination, and time spent for documentation/billing time).
What your impact will be:
- The role of the Care Coordinator is to abide by the plan of care and orders of the practice.
- Ability to provide prevention and intervention for multiple disease conditions through motivational coaching.
- Develops a positive interaction with patients on behalf of our practices.
- Improve revenue by creating billable Chronic Care Management episodes, increasing visits for management of chronic conditions.
- Develops detailed care plans for both the doctors and patients. The care plans exist for prevention and intervention purposes.
- Understand health care goals associated with chronic disease management provided by the practice.
- Attend regularly scheduled meetings (i.e., Bi-Monthly Staff Meetings, monthly one on one's, etc.). These “mandatory” meetings will be important to define the current scope of work.
What we are looking for:
- Graduate from an accredited School of Nursing (LPN, LVN, RN, BSN, etc.)
- Current active license to practice as an RN/ LVN/LPN held in the state of MICHIGAN (NOT A COMPACT STATE) with no disciplinary actions noted or licensed in the non-compact state where the applicable practice is located.
- A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home health care.
- Hands-on experience with Electronic Medical Records as well as an understanding of Windows desktop and applications (MIcrosoft Office 365, Teams, Excel, etc), also while being in a HIPAA compliant area in home to conduct Chronic Care Management duties.
- Ability to exercise initiative, judgment, organization, time-management, problem-solving, and decision-making skills.
- Skilled in using various computer programs (If you don’t love computers, you won’t love this position!)
- High Speed Internet and Desktop or Laptop computer (Has to be operation system of Windows or Mac) NO Chromebooks OR iPads
- Excellent verbal, written and listening skills are a must.
What will make you stand out:
- Quickly recognize condition-related warning signs.
- Organized, thorough documentation skills.
- Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills.
- Clear diction. Applies exemplary phone etiquette to every call.
- Committed to excellence in patient care and customer service.
- Ability to troubleshoot minor technological issues related to remote working environment.
What we offer:
- Contract position with opportunity to become a full-time position, to include benefit options (Medical, Dental, Vision, 401K, Life).
- Streamline designed technology for your Chronic Care operations
- Established and secure company since 1976, providing critical software solutions for many verticals in countries ranging from North America, Europe, Asia, and Australia.
- Core Values that unite and guide us
- Autonomous and Flexible Work Environments
- Opportunities to learn and grow
- Community Involvement and Social Responsibility
RN Quality Specialist- Telephonic Registered Nurse II - Accredo - Work from Home, Anywhere, USA (...
Posted 1 day ago
Job Viewed
Job Description
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position, you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
Full time work from home - you MUST reside in a compact state.
Start Date: 9/15/2025.
Shift for this role: 11am - 8pm EST Monday - Friday
Please note, the first 6-7 weeks of training will be varied and may start between 8am-11:30am EST depending on the week.
The primary responsibility of this role is to provide telephonic education to patients and caregivers following Clinical Protocols and working within the nursing scope of practice and guidelines. Additionally adverse event/product complaint reporting to pharma partners.
This opportunity allows you to improve the health and well-being of others, while giving them a sense of security. If you are an RN and looking for a Telephonic role, this opportunity is for you! Read on to learn more.
How you will make a difference:
Take ownership of patient experience via telephone: Provide telephonic education that includes (but not limited to) disease and drug specific education to both patients and caregivers. Follow clinical protocols and work within the nursing scope of practice and guidelines while assessing and documenting clinical data and intervention.
Be a coach to empower your patients to be at their best. Focus on the overall well-being of your patients. Collaborate with the patient's treating physician to inform them of any new symptoms and health-related matters with an entire network of nurses on which you can learn. At Accredo, you are a part of an eco-system that will support you and advocate you.
Grow alongside your peers in a patient-centered environment. Aid our clinical departments with new hire training and mentoring as well as conduct peer-to-peer quality documentation checks to provide feedback to management.
ESSENTIAL FUNCTIONS
• Adhere to principles stipulated by program-specific contractual agreements and company practices
• Build relationships with assigned patients throughout duration of program
• Provide patient-centric education regarding treatment and disease states for assigned products
• Manage caseload including scheduled maintenance and adherence, scheduled calls/interactions, updating program database per company protocols
• Deliver customized interactions based on patient's needs
• Participate in program-specific customer meetings and training sessions
• Participate in program-specific orientation meetings and demonstrate clinical and systems competency on tests
• Complete and submit adverse event and product complaint reports to the pharmaceutical companies or FDA, followingcontract guidelines and internal practice standards
- Within the defined time limit, using internal protocols determines if the event meets reporting requirements to the manufacturer or the FDA. Once determined, report the event as outlined within the clinical tools.
- Responsible for accurate documentation of the event that adhere to contractual /FDA requirements.
- Respond to manufacturer and/or internal requests when an adverse clarification is required.
- Responsible for reporting any errors to the leadership team in a timely manner.
- Complete all applicable trainings on time and remain compliant.
• Perform special projects and other duties as it pertains to specific contract performance
Minimum Qualifications:
- Registered Nurse (RN) compact license required.
- Must have at least 2 years of relevant clinical experience.
- MUST reside in a compact state.
- Require an active unencumbered license in the state that they reside and should have completed the NCLEX or a recognized state board exam.
- The RN must have the ability, with no restrictions, to apply for additional single state licenses.
- Must maintain all nursing licenses required for this role is a condition of employment, and the failure or inability to do so will result in termination of employment.
- Proficient in using micro soft applications.
- Must have hard wired internet connection. Minimum Internet speed: 5MBPS upload/2 MBPS download - Cable broadband or Fiber Optic Required.
- Excellent phone etiquette
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 32 - 54 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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