15 health nurse jobs found in Jefferson City, MO

Become a part of our caring community and help us put health first The Compact licensed telephonic Care Manager works from home in a call center environment. They assess and evaluate members' needs and requirements to achieve or maintain optimal wellness by providing care coordination and facilitating member or family interaction with resources appropriate for the care and wellbeing of the member. Job Description Humana Care Support is a division of Humana dedicated to helping adults remain independent in their homes. Our nurses are called Care Managers, because our case management services are centered on the person rather than the condition. The Care Manager uses a range of strategies and techniques to manage a member's physical, environmental, and psycho-social health issues. They identify and resolve barriers to effective care and continuously monitor progress through assessments and evaluations to ensure members achieve their desired health outcomes. Role...

Become a part of our caring community and help us put health first The Care Manager, Telephonic Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. Work schedule can be between 8am-6:30pm EST. The Care Manager Telephonic Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their...

Job Description As a Senior Clinical Consultant, you will collaborate with customer stakeholders and leaders to build relationships and positively impact clinical performance, satisfaction, and outcomes during projects involving the Oracle Health Workforce and Workload Solution Suite, formerly known as Clairvia, in Acute and Outpatient care. Drawing on your clinical expertise, you will guide customers and internal teams, help design effective clinical workflows, and analyze current and future states to identify gaps and recommend strategies for change adoption to achieve workforce and workload goals. You will own the customer's value measurement plan, support the engagement management team in meeting deliverables and timelines, lead customer meetings to align clinical goals with technology, and foster relationships to drive business outcomes. This role focuses on Oracle Health Workforce and Workload solutions like scheduling, caregiver assignments, acuity-based outcomes, and...

Company : Highmark Inc. Job Description : JOB SUMMARY This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate...

Become a part of our caring community and help us put health first Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team. This position reviews the clinical appropriateness of prior authorization (PA) requests and ensures that all benefits authorized meet medical necessity and other Medicare and/or Medicaid criteria if applicable, to promote cost-effective delivery of health care services. Share your talents and develop your skills all while doing your part to improve the lives of others. Essential Duties and Responsibilities: Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing facility therapies, and all outpatient procedures pursuant to applicable Medicare and Medicaid criteria, iCare guidelines, and PA Department policies and procedures. Review PA requests for inpatient medical stays, skilled nursing facility stays, long term acute hospital stays, inpatient...

Summary The Licensed Practical Nurse (LPN) is a part of the Patient Aligned Care Team (PACT) with a focus on patient centered care. LPN duties are performed in a manner that promotes quality health care, positive customer service and the maintenance of an environment committed to serving the Veteran. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency Area of Consideration - This job is open to current permanent Department of Veteran Affairs employees, current permanent Federal employees of other agencies and all US Citizens. NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below. Duties VA Careers - Licensed Practical Nurse: https://youtube.com/embed/Ae85IP1Oiz4 Total Rewards of a Allied Health Professional LPNs use practical nursing knowledge and skills to provide care according to...

Company : Highmark Inc. Job Description : JOB SUMMARY This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives. ESSENTIAL RESPONSIBILITIES Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager's professional discipline. Function in accordance with applicable state,...

Job Description The Nurse Informatics Executive supports VA's Federal EHR deployment and advances clinical informatics initiatives to enhance care delivery and patient outcomes. This role requires deep expertise in clinical care, health informatics, executive leadership, and change management to drive organizational transformation. Collaborating with stakeholders at all levels - including clinical end users and leadership at VAMC, VISN, and national levels - the Nurse Informatics Executive aligns organizational goals, fosters cross-functional collaboration, and ensures successful EHR implementation. Key responsibilities include driving end-user adoption, resolving implementation challenges, and optimizing workflows using data-driven solutions. The Nurse Informatics Executive leverages clinical data analytics to support evidence-based decision-making, regulatory adherence, and long-term strategic objectives. By evaluating and recommending informatics solutions, the...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients'...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs clinical review and data abstraction of patient records to support compliance with nationally recognized quality initiatives and the network's clinical process improvement and patient safety initiatives. The incumbent requires in-depth understanding of anatomy, physiology and clinical scenarios, critical thinking skills, attention to detail and the ability to meet set deadlines. The incumbent will be responsible for communicating with physicians and staff to seek clarification and provide education as needed. ESSENTIAL RESPONSIBILITIES Abstracts key clinical findings accurately and in a timely manner and performs direct data entry for inclusion into an aggregate database to meet the requirements of the state, internal use, third party payer requirements and external quality improvement participation based on guidelines. Identifies outliers, records them appropriately...

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Special Investigations Unit (SIU) Investigator - Remote Job Description The Special Investigations Unit (SIU) Investigator is responsible for conducting standard investigations of potential pharmacy, member, and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively identifies improvement opportunities in investigation procedures and FWA prevention efforts ensure proper identification of potential FWA. The SIU Investigator prepares investigative reports for leadership, remediation actions, recovery efforts, internal committees and/or referral to state and federal law enforcement agencies. Responsibilities Develop...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: Your Future Evolves Here Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: To ensure the appropriate utilization of services act as an advocate for our members and to ensure the highest quality and cost-effective care. Collaboration Opportunities :...

Become a part of our caring community and help us put health first This team would support mass moves, provider departures, center consolidations / relocations, mergers and acquisitions and health plan terminations. Their goal would be to reduce membership loss / enable us to retain the highest amount of membership across these experiences. We want a team to be able to help navigate the members we gain from these efforts through changes, questions or concerns and generally provide churn reducing, customer service. We envision this role would not involve any sales, would be the most entry level role in my org and would help to potentially develop a career path into our other existing roles. W * * ork schedule: M-F, 8:30am-5:00pm EST Role Responsibilities: Conduct outbound and answer inbound calls related to any attrition mitigation marketing communications PCP Terminations - Help ensure engaged members get their questions answered, understand the...

Become a part of our caring community and help us put health first Who We Are Humana's CenterWell Senior Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country. CenterWell Medical Group is the newest line of business under the CenterWell umbrella, providing virtual wraparound services to a broad population of members who need it the most. We're a fast-growing organization changing how clinical care is delivered - using innovation, data, and technology to keep patients healthier. Our team is mission-driven, collaborative, and unafraid to challenge the status quo in healthcare. About the Role We're seeking a Clinical Operations Lead for CenterWell Medical Group who brings energy, creativity, and a bias toward action in transforming healthcare. This is a hands-on role for someone who loves to take big ideas and turn them into tangible results. Reporting directly to the Chief Medical...