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At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Days - 4 ten hour shifts per week
Call rotation is required (for nights, weekends and holidays)
**Previous OR experience is preferred

Responsible for serving as a clinical expert in the delivery and management of comprehensive patient care, utilizing research and evidence-based practice as necessary; for expertly caring for patients from multiple services/specialties, and for more complex diagnosis.Job Description

Minimum Qualifications

Education: Graduate of an accredited School of Professional Nursing; Bachelors of Nursing preferred

Licenses/Certifications: 

• Current State of Texas license or temporary/compact license to practice professional nursing 
• Certified in Basic Life Support required
• Additional certifications may be required based on discipline and/or nursing unit requirements

Experience / Knowledge / Skills:

• Three (3) years nursing experience in area of specialty
• Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities

• Plans, coordinates, and directs all activities between the interdisciplinary team to direct and facilitate departmental throughput in order to attain positive outcomes.
• Coordinates with ancillary departments such as lab, radiology, registration, and bed board to ensure proper turn-around times.
• Makes daily assignments for all personnel according to the applicable skills inventory and the age and needs of the patient/population served.
• Identifies and utilizes available resources to resolve problems; coordinates and collaborates with other clinical coordinators ensuring departmental staffing coverage.
• Acts as a liaison, to departmental staff, medical personnel, patients and family members; assist in any patient care concerns, issues and complaints; conducts daily leadership rounding on assigned unit.
• Utilizes critical thinking and sound clinical judgment and works autonomously to solve problems.
• Escalates issues or notifies nursing leader/supervisor of significant occurrences, intervention, or delays, as appropriate.
• Facilitates resolution to patient problems and concerns, ensuring appropriate service recovery.
• Acts as a mentor/coach to assigned staff and provides input into the annual performance review of those staff members.
• Participates in a systemic, interdisciplinary, and ongoing evaluation of programs, process improvement and desired client-centered outcomes.
• Considers the diverse needs of each patient through the entire continuum of care, providing and ensuring the highest level of service according to established service standards, optimizing the patient experience.
• Adheres to all regulatory and Texas Board of Nursing standards.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; may serve as preceptor, mentor and resource to less experienced staff.
• Other duties as assigned.

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Collaborates with the physician and healthcare team in the delivery of patient care, utilizing the nursing process. Provides professional nursing care to patients, including conducting nursing assessments, assisting with exams and treatment, patient education, and maintenance of medical records. MHHS hires RNs based on years of experience groupings (i.e. newly licensed RN [working under the supervision of RN clinical preceptor], less than 1 year, 1-3 years, 3 to 10 and 10+).Job Description

Children's Memorial Hermann TMC is actively seeking a skilled and enthusiastic Infusion Oncology RN to join their team!

This position has 2 shifts available:

- 4 x 10 hr shifts

- Mon-Wed; Friday; Off-Thursday OR Mon-Wed; Friday; Off-Thursday

-No weekends, No holidays, No on call required

-Must have 3+ years of IMU or ICU pediatric experience; open to 5+ years of general pediatrics

-Must have BLS, PALS, APHON

-Highly prefer port certification

Interview: Zoom/Job Shadow

We offer DAY ONE benefits including medical, dental, and vision. We also offer a generous PTO accrual package, no cost education options, and a 6% match on a 403(b) retirement plan.Sound like you? Apply TODAY!

Minimum Qualifications

Education: Graduate of an accredited School of Professional Nursing; Bachelors of Nursing preferred

Licenses/Certifications:

• Current State of Texas license or temporary/compact license to practice professional nursing
• Certified in Basic Life Support
• Additional certifications may be required based on discipline and/or nursing unit requirements

Experience/ Knowledge/ Skills:

• RN I < 1 year
• RN II = 1-3 years
• RN III = 3-10 years
• RN IV = 10+ years
• Effective oral and written communication

Principal Accountabilities

• Delivers safe and appropriate care to patients, according to the nursing skills inventory and the age and needs of the patient/population served.
• Coordinates the planning for the delivery of nursing care with an interdisciplinary team and administers appropriate clinical decisions in the delivery of patient care.
• Collaborates with, directs, and may delegate to the healthcare team in the attainment of positive outcomes based on data, research, evidence, and professional standards of care.
• Coordinates treatment plans; develops/implements discharge and/or transfer plans.
• Participates in a systemic, interdisciplinary, and ongoing evaluation of programs, process improvement and desired client-centered outcomes.
• Considers the diverse needs of each patient through the entire continuum of care, providing and ensuring the highest level of service according to established service standards, optimizing the patient experience.
• Adheres to all regulatory and Texas Board of Nursing standards.
• Performs other duties as assigned, within scope of practice and clinical competency.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
• Other duties as assigned.

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Responsible for serving as a clinical expert in the delivery and management of comprehensive patient care, utilizing research and evidence-based practice as necessary; for expertly caring for patients from multiple services/specialties, and for more complex diagnosis.Job Description

Memorial Hermann TMC is actively seeking a skilled and enthusiastic RN, Clinical Coordinator for the Cancer Center.

• Full Time/DAYS

• Must have 5 or more years of RN experience

• Must have 2 or more years of Oncology experience

• No on call, holidays or weekends

• In Person Interviews

We offer DAY ONE benefits including medical, dental, and vision. We also offer a generous PTO accrual package, no cost education options, and a 6% match on a 403(b) retirement plan.

Sound like you? Apply TODAY!

Minimum Qualifications

Education:  Graduate of an accredited School of Professional Nursing; Bachelors of Nursing preferred

Licenses/Certifications: 

• Current State of Texas license or temporary/compact license to practice professional nursing

• Certified in Basic Life Support

• Additional certifications may be required based on discipline and/or nursing unit requirements

Experience / Knowledge / Skills

• Three (3) years nursing experience in area of specialty

Principal Accountabilities

• Plans, coordinates, and directs all activities between the interdisciplinary team to direct and facilitate departmental throughput in order to attain positive outcomes.

• Coordinates with ancillary departments such as lab, radiology, registration, and bed board to ensure proper turn-around times.

• Makes daily assignments for all personnel according to the applicable skills inventory and the age and needs of the patient/population served.

• Identifies and utilizes available resources to resolve problems; coordinates and collaborates with other clinical coordinators ensuring departmental staffing coverage

• Acts as a liaison, to departmental staff, medical personnel, patients and family members; assist in any patient care concerns, issues and complaints; conducts daily leadership rounding on assigned unit

• Utilizes critical thinking and sound clinical judgment and works autonomously to solve problems; escalates issues or notifies nursing leader/supervisor of significant occurrences, intervention, or delays, as appropriate

• Facilitates resolution to patient problems and concerns, ensuring appropriate service recovery.

• Acts as a mentor/coach to assigned staff and provides input into the annual performance review of those staff members

• Participates in a systemic, interdisciplinary, and ongoing evaluation of programs, process improvement and desired client-centered outcomes

• Considers the diverse needs of each patient through the entire continuum of care, providing and ensuring the highest level of service according to established service standards, optimizing the patient experience

• Adheres to all regulatory and Texas Board of Nursing standards

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Employee Signature:________________________________________ Date:_________________

Manager Signature:_________________________________________ Date:_________________

Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served.  Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles.  Specific age groups that are served by this position are circled:

|      Neonate      |         Infant         |      Pediatric      |    Adolescent    |         Adult         | Adult/Geriatric |

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The Patient Flow Center is intended to improve the quality and safety of care, reduce the need for out of area placements, and optimize the use of resources. The Patient Flow Center RN Coordinator assists with placement of patients in the acute care setting in accordance with established guidelines to the appropriate facility and service line. This role typically reports to the Manager, Patient Flow Center.Job Description

MUST HAVE 3 OR MORE YEARS OF RN EXPERIENCE

WORK HOURS: VARIED/10A-6P

SHIFTS: 3/8HR SHIFTS PER WEEK, ROTATING WEEKENDS

MINIMUM QUALIFICATIONS

Education: Graduate of an accredited School of Professional Nursing; Minimum Associates Degree of Nursing required; Bachelors of Nursing preferred

Licenses/Certifications: 

• Current State of Texas license or temporary/compact license to practice professional nursing required

• Additional certifications may be required based on discipline and/or nursing unit requirements

Experience / Knowledge / Skills:

• Three (3) years of acute care hospital RN experience within the last 5 years (i.e. emergency department, critical care, intermediate, or medical/surgical units)

• Preferred experience in an admission/bed placement center.

• Previous OA/house supervisor experience desirable

• Ability to type on computer

• Familiarity with computer software, electronic health records

• Demonstrated excellent critical thinking with strong clinical nursing assessment skills.

• Effective communication (oral/written) skills.

• Ability to manage multiple priorities of equal importance in a fast pace environment.

• Excellent customer service skills.

• Demonstrated ability to quickly adjust to change.

PRINCIPAL ACCOUNTABILITIES

• Uses critical thinking and clinical judgement skills in directing patients to the most appropriate level of care and unit assignment while ensuring accurate and complete communication with all areas across the system.

• Organizes placement process to meet patient load influx and minimizes bed assignment delays.

• Acts as a clinical resource to non clinical team members within the Patient Flow Center.

  • Utilizes clinical knowledge of current census information and potential inpatient bed needs to project accurate and appropriate placement of incoming patients.

  • Conducts admission reviews related to level of care changes, to assure patient is placed in the appropriate bed based on physician order and level of care required.

  • Applies professional nursing skills in applying the four aspects of the nursing process (assessment, planning, implementation and evaluation) when indicated to evaluate needs of incoming patient based on level of care, availability of beds, physician order, and unit capability.

  • Uses critical thinking skills and knowledge of disease processes to intervene and/or guide non clinical personnel when there is a known or unknown confounding factor which would negatively impact the patient and/or patient flow.

• Manages all patient placement and progression functions in a responsive manner responding to all callers with the aid of the electronic health record, approved clinical protocols, and established patient care protocols and healthcare information.

• Works with all Memorial Hermann hospital teams and key stakeholders on facilitating efficient, timely placement of patients across the system.

  • Facilitate the coordination of patient placement with physicians, staff RNs, and other departments while meeting state and federal regulations (COBRA/EMTALA); plan of care to optimize patient outcomes and decrease length of stay in an unbiased, standardized manner

• Uses available tracking systems to maintain ongoing surveillance of available staffed beds. Monitors progress with bed assignments and arrivals of patients to assigned units; monitors for timeliness of transfers and discharges.

• Incorporates knowledge of hospital and unit admission criteria, unit specialties, limitations, and patient need when determining proper patient placement.

• Conducts or participates in daily bed meetings where appropriate.

• Alerts department leadership of delays with patient flow for individual patients and departments experiencing delays.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.

• Other duties as assigned.

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Collaborates with the physician and healthcare team in the delivery of patient care, utilizing the nursing process. Provides professional nursing care to patients, including conducting nursing assessments, assisting with exams and treatment, patient education, and maintenance of medical records. MHHS hires RNs based on years of experience groupings (i.e. newly licensed RN [working under the supervision of RN clinical preceptor], less than 1 year, 1-3 years, 3 to 10 and 10+).

Our new Cath Lab program will include: IR, Neuro IR, Hybrid, and StructuralJob Description

Minimum Qualifications

Education:  Graduate of an accredited School of Professional Nursing; Bachelors of Nursing preferred

Licenses/Certifications:

• Current State of Texas license or temporary/compact license to practice professional nursing
• Certified in Basic Life Support
• Additional certifications may be required based on discipline and/or nursing unit requirements

Experience / Knowledge / Skills:

• RN I

Want to make extra money on YOUR schedule? Join our exclusive list of research study participants and start earning extra income today!

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Don't miss out on this chance to turn your free time into valuable earnings!

Participants are needed on a wide range of topics such as:

• Health Issues (Research for cures and new medications to treat ailments)
• Consumer Products (Your experience with consumer products)
• Shopping (Shopping experiences)
• Internet Usage (How you use the internet)
• Vehicles (recreational vehicles and automobiles)
• Employment (Various types of jobs or career fields)
• Food & Beverages (the consumption of various foods and beverages)
• Entertainment (About TV, movies or video games)
• Social Media (the use of different social media platforms)
• Financial (Banking and investing)
• Retirement (Planning what, when and how)
• Gender (studies based on your gender)
• Housing (Renters or Homeowners)

Compensation:

• Earn up to $250+ in Just ONE Hour! (Focus Group Session)
• Earn up to $3,000+ (Multi-Session Studies)

Benefits:

• Flexibility to take part in discussions online or in-person.
• No commute needed if you choose to work from home.
• No minimum hours. You can do this part-time or full-time
• Enjoy free samples from our sponsors and partners in exchange for your honest feedback of their products.
• You get to review and use new products or services before they are launched to the public.

Qualifications:

• Speak and/or read English
• Must be 18yrs old or older
• Must have either a phone, computer or tablet with internet connection

Experience:

• Start Immediately - No Experience Needed! Anyone Can Participate!

Education:

• Open to all education levels - Your opinion matters!

Remote working/work at home options are available for this role.

Want to make extra money on YOUR schedule? Join our exclusive list of research study participants and start earning extra income today! Perfect for anyone seeking remote, part-time, or temporary work, these opportunities require no previous experience and offer unmatched flexibility. Choose the studies that suit you best—whether online, in-person, or over the phone—and get paid for sharing your opinions. Don't miss out on this chance to turn your free time into valuable earnings! Sign up now and take control of your work-life balance.

• Health Issues (Research for cures and new medications to treat ailments)
• Consumer Products (Your experience with consumer products)
• Shopping (Shopping experiences)
• Internet Usage (How you use the internet)
• Vehicles (recreational vehicles and automobiles)
• Employment (Various types of jobs or career fields)
• Food & Beverages (the consumption of various foods and bevera ges)
• Entertainment (About TV, movies or video games)
• Social Media (the use of different social media platforms)
• Financial (Banking and investing)
• Retirement (Planning what, when and how)
• Gender (studies based on your gender)
• Housing (Renters or Homeowners)

• Earn up to $250+ in Just ONE Hour! (Focus Group Session)
• Earn up to $3,000+ (Multi-Session Studies)

• Flexibility to take part in discussions online or in-person.
• No commute needed if you choose to work from home.
• No minimum hours. You can do this part-time or full-time
• Enjoy free samples from our sponsors and partners in exchange for your honest feedback of their products.
• You get to review and use new products or services before they are launched to the public.

• Speak and/or read English
• Must be 18yrs old or older
• Must have either a phone, computer or tablet with internet connection

• Start Immediately - No Experience Needed! Anyone Can Participate!

• Open to all education levels - Your opinion matters!

Remote working/work at home options are available for this role.

Want to make extra money on YOUR schedule? Join our exclusive list of research study participants and start earning extra income today!

Perfect for anyone seeking remote, part-time, or temporary work, these opportunities require no previous experience and offer unmatched flexibility. Choose the studies that suit you best—whether online, in-person, or over the phone—and get paid for sharing your opinions.

Don't miss out on this chance to turn your free time into valuable earnings!

Participants are needed on a wide range of topics such as:

• Health Issues (Research for cures and new medications to treat ailments)
• Consumer Products (Your experience with consumer products)
• Shopping (Shopping experiences)
• Internet Usage (How you use the internet)
• Vehicles (recreational vehicles and automobiles)
• Employment (Various types of jobs or career fields)
• Food & Beverages (the consumption of various foods and beverages)
• Entertainment (About TV, movies or video games)
• Social Media (the use of different social media platforms)
• Financial (Banking and investing)
• Retirement (Planning what, when and how)
• Gender (studies based on your gender)
• Housing (Renters or Homeowners)

Compensation:

• Earn up to $250+ in Just ONE Hour! (Focus Group Session)
• Earn up to $3,000+ (Multi-Session Studies)

Benefits:

• Flexibility to take part in discussions online or in-person.
• No commute needed if you choose to work from home.
• No minimum hours. You can do this part-time or full-time
• Enjoy free samples from our sponsors and partners in exchange for your honest feedback of their products.
• You get to review and use new products or services before they are launched to the public.

Qualifications:

• Speak and/or read English
• Must be 18yrs old or older
• Must have either a phone, computer or tablet with internet connection

Experience:

• Start Immediately - No Experience Needed! Anyone Can Participate!

Education:

• Open to all education levels - Your opinion matters!

Remote working/work at home options are available for this role.

Speech Language Pathologist (SLP) Pediatric Home Health Pay: $62,000-$100,000/year
Sign-On Bonus Opportunity!
Eligible candidates may qualify for a $10,000sign-on bonus* as part of their total compensation package. Bonus eligibility and payout structure will be shared early in the interview process.
A Role Designed Around You
At Care Options for Kids, we've built a home health SLP role around what our therapists value most: flexibility, manageable caseloads, and real support. This position allows you to focus on delivering high-quality pediatric care without excessive documentation, long drive times, or unrealistic expectations.
In this role, you'll provide pediatric speech therapy in home-based settings, collaborate closely with families and care teams, and deliver individualized care using efficient, point-of-care documentation tools.
If you're an SLP looking for a sustainable role that fits real life, this position was designed with you in mind.
Care Options for Kids Benefits
~ Weekly Pay and Direct Deposit
~ Medical, Dental, and Vision Insurance
~ Life, LTD, and STD Coverage
~ Supplemental Insurance Options
~401(k) Retirement Plan
~ Paid Time Off (PTO)
~ Continuing education through an online learning portal
~ Industry-leading training and professional development
~ Employee Referral Bonus Opportunities
~ Company Vehicle Program*

Support that Expands Your Impact
Opportunities to participate in COFK's Global Outreach Program, providing therapy services to underserved children abroad, with travel and participation costs covered by Care Options for Kids
A top-tier EHR designed to streamline documentation and reduce administrative burden
Access to clinical leadership when you need guidance, collaboration, and support in the field
Requirements
Master's degree in Speech Language Pathology
Eligible for or holds CCC-SLP
Valid state licensure or certification in a Speech Language Pathology
Current BLS/CPR certification
Reliable transportation and a valid driver's license
Care Options for Kids is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
*Restrictions Apply. Connect with your Talent Acquisition Specialist for more details.
#RDTHNV
Salary:
$62000.00 - $100000.00 / year
Remote working/work at home options are available for this role.

Job title UM RN Appeals Coordinator - Work from Home About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

UM RN Appeals Coordinator - Work from Home

Job Description:

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job Description:

BroadPath, a Sagility Company, is hiring UM RN Appeals Coordinator to join our remote team! Claims Processors are responsible for the accurate and timely entry, review, and resolution of medical claims ranging from simple to moderately complex. This includes reviewing front-end claims and validating information submitted by patients or providers seeking reimbursement from the insurance company. All claim processing must align with CMS guidelines and client-specific policies and procedures.

Schedules, pay rates, and program details may vary based on business needs and client assignment.

Compensation Highlights

• Base Pay: up to $50 per hour
• Pay frequency: Weekly pay

Schedule Highlights

• Training Schedule: 2 weeks, Monday – Friday; 8:00 AM - 5:00 PM CST

• Production Schedule: Monday – Friday; 8:00 AM - 5:00 PM CST (Flexible)

Responsibilities

A. Performs necessary review to ensure compliance with HHSC and other regulatory entities

• Collaborate: Partners with the physician team to identify strategies for action and determine appropriate guideline citations or responses based on the category of denial
• Develop: Creates training materials and examples for nursing staff to enhance understanding of criteria application, benefit use, and the appeal, External Medical Review (EMR), and Fair Hearing processes
• Coordinate: Ensures continuity of care needs are met and advocates on behalf of Members and families for out-of-network authorization approvals
  Implement: Identifies problems, barriers, and opportunities within processes and develops resolutions or revisions as needed
• Evaluate: Conducts quarterly assessments of appeal status and program activities, preparing reports for both the State of Texas and internal review
• Analyze: Reviews requests against regulatory and decision-making guidelines and benefit allowances, implements actions in collaboration with the physician reviewer panel, and monitors timeliness, decision-making, and processing of appeals, EMRs, and State Fair Hearings in accordance with regulatory and accrediting standards

B. Performs all necessary communication and documentation functions

• Communicates with internal staff, Members/LARs, physicians, hospital representatives, and other
• Providers regarding case status, due process, rationale, and regulatory requirements
• Coordinates Fair Hearing requests through TIERS when a Member/LAR or Provider requests an EMR or Fair Hearing
• Utilizes an Independent Review Organization as needed for specialty or external reviews
• Oversees documentation and recordkeeping of all case communications in compliance with accrediting requirements
• Documents all activities and interactions in electronic and event tracking systems
  Generates appeal determination letters as appropriate

C. Collaborates with clinical reviewers, medical directors, external physician reviewers, and network Providers

• Communicates with physicians on each case to establish the most appropriate course of action
• Provides education to nurse and therapist reviewers regarding appeal updates and process changes
• Maintains flexibility in scheduling, including evenings and weekends, to address pharmacy-related denials
• Educates physician reviewers and clinical review staff on managed care and Medicaid policies and procedures

D. Conducts staff and medical director audits on appeal activities

• Assists with appeal file preparation for NCQA file reviews
• Supports the development of corrective action plans based on trended audit findings

E. Provides data for internal and external reporting

• Analyzes quarterly trends in appeal types and sources
• Reports appeal activity, type, and resolution, ensuring timely communication standards are met
• Assists with state reporting in the required format and ensures timely submission to HHSC to avoid financial penalties

Knowledge and Skills

• Demonstrates proficiency in applying advanced principles, concepts, and techniques central to nursing and ancillary therapy services within managed care, with emphasis on complex pediatrics and obstetrics
• Ability to comprehensively assess Member and family medical needs, develop and implement plans of care, provide ongoing evaluation and monitoring, and deliver education to Members, families, Providers, and staff
• Exemplary verbal and written communication skills, with proficiency in computer operation, word processing programs, fax machines, photocopiers, and multi-line telephones
• Strong customer service orientation and advanced interpersonal communication skills with all levels of internal and external stakeholders, including medical staff, patients and families, clinical personnel, support staff, outside agencies, and community partners

Qualifications

• RN license in an eNLC (Enhanced Nurse Licensure Compact) state with multistate privileges
• 3+ years Nursing experience
• 1+ years’ Utilization Management experience
• Familiarity with medical terminology, utilization management guidelines, and clinical documentation standards
• Proficiency in Microsoft Office and experience working with healthcare systems or electronic medical records
• Strong organizational and time management skills with the ability to work independently
• Excellent written and verbal communication skills

At BroadPath, a Sagility Company, we believe that transparency, authenticity, and collaboration are the keys to building strong, connected remote teams. If you are someone who values open communication, connection, and teamwork, you will thrive in our environment where showing up authentically matters.

Benefits:

• Medical, Dental, and Vision coverage.
• Life Insurance.
• Short-Term and Long-Term Disability options.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• 401(k) with employer contribution.
• Paid Time Off (PTO).
• Tuition Reimbursement.

BroadPath, a Sagility Company, may conduct background checks, previous employment verifications, and education verifications, based on position requirements

Diversity Statement

At BroadPath, a Sagility Company, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!

Equal Employment Opportunity/Disability/Veterans

If you need accommodation due to a disability, please email us at . This information will be held in confidence and used only to determine an appropriate accommodation for the application process

BroadPath, a Sagility Company is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.

Compensation: BroadPath a Sagility Company has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Location:

USAUnited States of America
Remote working/work at home options are available for this role.