QM Specialty NP / PA

🏢 Summary: Full-time permanent Nurse Practitioner or Physician Assistant opportunity in Sleep Medicine near Houston, TX. The role involves joining a collaborative, growth-focused clinic operating Monday through Friday with a comprehensive benefits package. Candidates must have prior NP experience, an active Texas license, DEA certification, and a background in pulmonology, neurology, or primary care. 🗂️ Requirements: 3 years experience, Active Texas license, DEA certification, Experience as a Nurse Practitioner in similar environments, Background in pulmonology, neurology, or primary care, Ability to work full-time Monday-Friday 📃 Skills: Sleep, Pulmonology, Neurology, PrimaryCare, DEA 🏢 Description: Quick Facts - Full-time permanent position - Seeking growth-minded provider to join a collaborative team - 3 years experience required - Clinic is open Monday-Friday - Benefits package includes medical, retirement, CME, and more - Seeking provider with pulmonology, neurology or primary care background - Outside of Houston, TX Description We have a full-time permanent opportunity for an NP or PA in Katy, TX. The clinic operates Monday-Friday, and they focus on Sleep Medicine. This group has a growth mindset and prides itself on innovation and collaboration. The ideal provider will have an active Texas license and DEA and have experience as a Nurse Practitioner in similar environments.

🏢 Summary: Full-time permanent Sleep Medicine NP/PA opportunity in Katy, Texas, with a Monday–Friday clinic schedule and a collaborative, growth-focused team. The role seeks an experienced provider with a pulmonology, neurology, or primary care background and offers a comprehensive benefits package. 🗂️ Requirements: 3 years experience required, Active Texas license, DEA certification, Experience as a Nurse Practitioner or Physician Assistant in similar environments, Background in pulmonology, neurology, or primary care 📃 Skills: Pulmonology, Neurology, PrimaryCare, SleepMedicine, DEA 🏢 Description: Quick Facts - Full-time permanent position - Seeking growth-minded provider to join a collaborative team - 3 years experience required - Clinic is open Monday-Friday - Benefits package includes medical, retirement, CME, and more - Seeking provider with pulmonology, neurology or primary care background - Outside of Houston, TX Description We have a full-time permanent opportunity for an NP or PA in Katy, TX. The clinic operates Monday through Friday and focuses on Sleep Medicine. This group has a growth mindset and prides itself on innovation and collaboration. The ideal provider will have an active Texas license and DEA and have experience as a Nurse Practitioner or Physician Assistant in similar environments.

🏢 Summary: Full-time in-office LPN CoCM Behavioral Health Care Manager role focused on chronic care management and behavioral health coordination in a long-term care setting. The position involves patient chart review, care planning, administering validated rating scales, and collaboration with clinical teams and psychiatric consultants. Offers comprehensive benefits and the opportunity to support seniors through integrated, team-based care. 🗂️ Requirements: LPN degree or certificate, Active LPN licensure, Experience in long-term care, Experience in behavioral health, Ability to administer validated rating scales, Care planning and care plan modification experience 📃 Skills: LPN, BehavioralHealth, CareManagement, ChronicCare, PatientAssessment, RatingScales, CarePlanning, PsychosocialInterventions, RegistryManagement, InterdisciplinaryCollaboration 🏢 Description: LPN CoCM Care Coordinator Location: Hollywood, FL (In Office) Schedule: Full-Time Salary per annum: $64,000 to $70,000 per year Job Summary We are seeking a dedicated LPN CoCM Behavioral Health Care Manager to join our team. In this role, you will be responsible for reviewing patient charts and communicating with the Clinical department and providers about any irregularities as part of chronic care management. Responsibilities Provide assessment and care management services, including: - Administration of validated rating scales. - Initiation of behavioral health care planning concerning behavioral or psychiatric health problems. - Revision and modification of care plans for patients not progressing or whose status changes. - Brief psychosocial interventions as needed. - Engage in ongoing collaboration with the billing practitioner. - Maintain the registry/tracking sheets. - Consult with the psychiatric consultant. - Maintain a continuous relationship with patients. - Foster collaborative, integrated relationships with the rest of the care team. - Conduct interdisciplinary care plan meetings to review patient beneficiaries. Requirements - LPN degree/ certificate required. - Experience in long-term care preferred. - Experience in behavioral health preferred. Benefits - Health - Dental - Vision - 401K - Company-Sponsored Life Insurance - Paid Time Off

🏢 Summary: Medical Director role focused on delivering high-quality in-home and community-based care for high-need patients through clinical leadership, direct patient care, and interdisciplinary collaboration. The position is primarily remote with approximately 20% direct patient care responsibilities and requires experience in population health, quality improvement, and healthcare leadership. 🗂️ Requirements: Doctor of Medicine degree, Current unrestricted medical license, Board certification in Internal Medicine, Family Medicine, or related specialty, Minimum 3 years of direct patient care experience, Experience in population-based medicine, Experience managing complex patients with behavioral health and substance use diagnoses, Healthcare management knowledge, Ability to work in a fast-paced evolving environment, Strong communication and problem-solving skills, Experience with EMR systems 📃 Skills: EMR, Athena, Medicine, Leadership, PopulationHealth, QualityImprovement, BehavioralHealth, Telehealth 🏢 Description: Company Overview: Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. Job Title & Role Description: The Medical Director will partner with cross-functional teams and senior leaders to deliver innovative and high-quality care in the home and community for high-need, high-risk, high-utilizing patients. Job requires a leader with a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. The candidate has a proactive role in the marketplace and with our patients: delivering care directly and providing clinical oversight to the members of our Interdisciplinary Care Team. The ideal candidate must be flexible and willing to work in a high growth, fast paced company where the scope of services and protocols will evolve. This is a dynamic environment requiring flexibility, dedication, and commitment to improve care for underserved populations. The role is primary remote, but residence in the state of interest is required. Approximately 20% of your time will be doing direct patient care. Skills Required: - Doctor of Medicine degree from a recognized medical school program - Must possess a current, unrestricted medical license in the State(s) of interest - Board Certified in Internal Medicine, Family Medicine or in related primary/specialty care - Minimum three years of experience practicing in a direct patient care environment - Previous medical leadership and teaching experience preferred - Expertise in population-based medicine and quality improvement principles - Experience with managing patients with complex needs, including behavioral health and substance use diagnoses - Strong healthcare management acumen, including working knowledge of current U.S. payer and provider landscape - Must be able to positively interact with clinicians, senior management, patients and families, and medical and non-medical professionals - High sense of urgency and can-do attitude - Strong communication and problem-solving skills - Technical acumen with EMR systems (Athena experience a plus) Key Behaviors: - Proactive Leadership - Collaboration - Flexibility and Adaptability - Accountability - Empathy - Effective Communication - Patient-Centered Approach Competencies: - Clinical Expertise - Leadership - Problem-Solving and Critical Thinking - Interdisciplinary Collaboration - Healthcare System Knowledge - Quality Improvement - Technology Proficiency - Stakeholder Engagement Compensation: NY pay range: $250,000 — $250,000 USD

🏢 Summary: Senior Risk Management role focused on overseeing general liability and property claims while managing and optimizing the RMIS system. The position supports real estate operations through claims adjudication, TPA oversight, risk transfer, compliance, and cross-functional collaboration. It combines technical claims expertise with system management and reporting responsibilities. 🗂️ Requirements: Bachelor's degree in Business, Insurance and Risk Management or related field (or equivalent experience), Minimum 7 years of experience in claims-heavy environment, At least 4 years of litigated claims experience, Experience as claims supervisor at TPA, insurance carrier, or broker, Experience with commercial real estate or construction claims, Strong knowledge of claims handling processes and insurance regulations, Experience managing claims systems (preferably Riskonnect), Proficiency in RIMIS software, Experience working with TPAs, Advanced Excel skills 📃 Skills: Riskonnect, RIMIS, Excel, RMIS, Claims, Litigation, Insurance, Reporting 🏢 Description: POSITION PURPOSE: An integral member of the Risk Management team supporting the Operations team in managing real estate assets. This position is primarily focused on general liability claims and RMIS system management (60%) and provides general risk management support (40%), including generating COIs, working with lenders, obtaining quotes for new assets, processing invoices, and reviewing contract language. ESSENTIAL FUNCTIONS: Work closely with the IT department and external vendors to enhance and optimize the RMIS system, ensuring it meets company requirements and industry best practices. Manage relationships with TPAs, ensuring effective communication, adherence to service level agreements, and quality control. Oversee evaluation, investigation, and adjudication of complex claims, including commercial general liability and property claims. Provide guidance and support to adjusters and defense attorneys in claim resolution and settlement strategies. Assess risk transfer opportunities to third parties and draft tender documents when risk transfer is identified. Prepare and provide claim data for monthly and quarterly reports. Monitor TPA performance, establish performance metrics, conduct evaluations, and implement corrective measures. Provide ongoing training to improve effectiveness and efficiency. Ensure compliance with industry regulations, legal requirements, and company policies, including timely reporting, documentation, and adherence to claims handling protocols. Promote prompt and accurate FNOL, coverage analysis, claim investigations, timely litigation response, and effective communication. Collaborate with investments, development, legal, operations, and IT teams to optimize department performance and provide insights to the SVP of Risk Management. NON-ESSENTIAL FUNCTIONS: Support the Risk Management team on various tasks and provide coverage during team member absences. EDUCATION/EXPERIENCE REQUIREMENTS: Bachelor's degree in Business, Insurance and Risk Management, or related field (equivalent experience may be considered). Minimum 7 years of experience in a claims-heavy organization, including 4 years of litigated claims experience, or experience as a claims supervisor at a TPA, insurance carrier, or broker, with a focus on commercial real estate or construction, general liability litigation, and property. Strong knowledge of claims handling processes, insurance regulations, and best practices. Experience managing claims systems (preferably Riskonnect). Proficiency in RIMIS software and related tools. Experience working with TPAs is highly desirable. Relevant professional certifications (e.g., AIC, CPCU) are a plus. KNOWLEDGE, SKILLS AND ABILITIES: Proven experience with advanced Excel functions and data management. Ability to work independently and manage time effectively. Exceptional organizational skills and proactive mindset. WHAT CIM OFFERS: Competitive compensation package including eligibility for bonus pay. Comprehensive medical, dental, and vision plans. Health Savings Account with employer contribution. Company-paid life and disability insurance. 401(k) savings plan with company match. Paid time off including vacation, 10 designated holidays, sick time, and bereavement leave. Up to 16 hours of volunteer time off. Up to 16 weeks of Paid Parental Leave. Ongoing professional development programs. Wellness program with monthly and quarterly prizes. Actual base salary considers factors such as geography, job-related knowledge, experience, and budget. The anticipated base salary range for this position in New York, NY is $100,000 - $125,000.

🏢 Summary: Full-time remote Registered Nurse position focused on conducting pre- and post-payment medical reviews to ensure compliance with clinical guidelines and reimbursement policies. The role involves assessing medical necessity, reviewing complex claims and appeals, and documenting determinations in accordance with regulatory standards. This position requires strong clinical expertise and experience in utilization or medical review environments. 🗂️ Requirements: Active unrestricted RN license (U.S. state of hire) or compact multistate RN license, Associate Degree in Nursing or graduation from accredited School of Nursing, Minimum 2 years of clinical experience, Minimum 2 years of experience in Home Health, Utilization/Medical Review, or Quality Assurance, Ability to interpret and apply medical review criteria and clinical guidelines, Proficiency in Microsoft Office and word processing software, Strong analytical and decision-making skills, Ability to work independently and manage priorities, Ability to handle confidential information 📃 Skills: Nursing, MedicalReview, UtilizationReview, QualityAssurance, ManagedCare, HomeHealth, Rehabilitation, MedicalSurgical, MicrosoftOffice, Documentation, ClaimsReview, Preauthorization, AppealsReview 🏢 Description: Job Type: Full-time (40 hours/week) Schedule: Monday–Friday, 8:00 AM – 5:00 PM Max Salary: W-2 ($60,000–$63,000) Location: Remote (U.S. – Work from home) Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office. Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed. About the Role We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriiateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements. Key Responsibilities - Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals. - Assess payment determinations using clinical information and established guidelines. - Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement. - Provide clear, well-documented rationales for service approvals or denials. - Educate internal and external teams on medical review processes, coverage determinations, and coding requirements. - Support quality control activities to meet corporate and team objectives. - Provide guidance to LPN team members and support non-clinical staff through training and discussions. - Assist with special projects and additional responsibilities as assigned. Minimum Qualifications Licensure: - Active, unrestricted RN license in the U.S. and in the state of hire OR - Active compact multistate RN license (as defined by the Nurse Licensure Compact). Education: - Associate Degree in Nursing OR - Graduate of an accredited School of Nursing. Experience: - Two years of clinical experience plus at least two years in one of the following: - Home Health - Utilization/Medical Review - Quality Assurance Skills & Competencies: - Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings. - Ability to interpret and apply medical review criteria and clinical guidelines. - Proficiency in Microsoft Office and word processing software. - Strong analytical, organizational, and decision-making skills. - Ability to work independently while managing priorities effectively. - Excellent customer service, communication, and critical thinking skills. - Ability to handle confidential information with discretion. Preferred Qualifications - Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or Quality Assurance (strongly preferred). - Proficiency in using multiple screens and software programs simultaneously.

🏢 Summary: Temporary remote medical claims processor role supporting the World Trade Center Health Program through November, with potential follow-on work. The position focuses on reviewing, adjudicating, and processing complex medical claims while ensuring compliance with healthcare regulations and program policies. Candidates must have extensive medical claims processing experience, coding knowledge, and the ability to manage high claim volumes accurately. 🗂️ Requirements: High school diploma or equivalent, 5+ years of medical claims processing experience, Experience with professional, facility, complex, and high-dollar claims, Knowledge of ICD-10 coding, Knowledge of CPT coding, Knowledge of HCPCS coding, Understanding of medical terminology and insurance procedures, Ability to interpret insurance policies and government regulations, Proficiency with Microsoft Office Suite, Experience with claim denial resolution and appeals, Ability to manage high claim volumes, Strong attention to detail and accuracy, Ability to work independently and in a team, Availability to work Monday–Friday, 8 AM–5 PM EST 📃 Skills: ICD-10, CPT, HCPCS, HIPAA, Excel, Word, Outlook 🏢 Description: This role is Temp thru November with a chance for follow-on work. Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. Work Schedule Remote Monday through Friday, 8:30 AM to 5:00 PM EST Must be able to work 8am - 5pm Eastern Standard Time Responsibilities Claims Review and Processing - Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. Critical Analysis - Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. Timely Processing - Ensure prompt claims processing to meet client standards and regulatory requirements. - Identify and resolve any barriers using effective problem-solving strategies. Issue Resolution - Collaborate with internal departments to proactively resolve discrepancies and issues. - Use analytical skills to identify root causes and implement solutions. Confidentiality Maintenance - Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. Detailed Record Keeping - Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. Trend Monitoring - Analyze and report trends in claim issues or irregularities to management. - Assist Team Leads with reporting to contribute to continuous process improvements. Audit Participation - Engage in audits and compliance reviews to ensure adherence to internal and external regulations. - Critically evaluate and recommend process improvements when necessary. Mentoring - Mentor and train new claims processors as needed. Requirements - High school diploma or equivalent. - Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims. - Billing experience doesn't count towards years of experience qualification. - Familiarity with ICD-10, CPT, and HCPCS coding systems. - Understanding of medical terminology, healthcare services, and insurance procedures. - Strong attention to detail and accuracy. - Ability to interpret and apply insurance program policies and government regulations effectively. - Excellent written and verbal communication skills. - Proficiency in Microsoft Office Suite (Word, Excel, Outlook). - Ability to work independently and collaboratively within a team environment. - Commitment to ongoing education and staying current with industry standards and technology advancements. - Experience with claim denial resolution and the appeals process. - Ability to manage a high volume of claims efficiently. - Strong problem-solving capabilities and a customer service-oriented mindset. - Flexibility to adjust to the evolving needs of the client and program changes. Benefits: $20-$23/hr - 401(k) with employer matching - Health insurance - Dental insurance - Vision insurance - Life insurance - Flexible Paid Time Off (PTO) - Paid Holidays

🏢 Summary: Full-time LPN CoCM Behavioral Health Care Manager role focused on chronic care management and behavioral health coordination in an office setting. The position involves reviewing patient charts, administering validated rating scales, developing and modifying care plans, and collaborating with clinical staff and psychiatric consultants. Candidates will manage patient registries, conduct interdisciplinary care meetings, and support integrated, team-based care for long-term care patients. 🗂️ Requirements: LPN degree or certificate, Experience in long-term care, Experience in behavioral health, Ability to administer validated rating scales, Ability to develop and modify behavioral health care plans, Ability to conduct psychosocial interventions, Ability to maintain patient registries and tracking sheets, Ability to collaborate with billing practitioners and psychiatric consultants 📃 Skills: LPN, BehavioralHealth, CareManagement, ChartReview, RatingScales, CarePlanning, PsychosocialInterventions, RegistryManagement, InterdisciplinaryCare, ChronicCareManagement 🏢 Description: Job Summary We are seeking a dedicated LPN CoCM Behavioral Health Care Manager to join our team. In this role, you will be responsible for reviewing patient charts and communicating with the Clinical department and providers about any irregularities as part of chronic care management. Responsibilities Provide assessment and care management services, including: - Administration of validated rating scales. - Initiation of behavioral health care planning concerning behavioral or psychiatric health problems. - Revision and modification of care plans for patients not progressing or whose status changes. - Brief psychosocial interventions as needed. - Engage in ongoing collaboration with the billing practitioner. - Maintain the registry/tracking sheets. - Consult with the psychiatric consultant. - Maintain a continuous relationship with patients. - Foster collaborative, integrated relationships with the rest of the care team. - Conduct interdisciplinary care plan meetings to review patient beneficiaries. Requirements - LPN degree/certificate required. - Experience in long-term care preferred. - Experience in behavioral health preferred. Benefits - Health - Dental - Vision - 401K - Company-Sponsored Life Insurance - Paid Time Off

🏢 Summary: Full-time in-office LPN CoCM Behavioral Health Care Manager role focused on chronic care management and behavioral health coordination. The position involves reviewing patient charts, administering validated rating scales, developing and revising care plans, and collaborating with providers and psychiatric consultants. Offers comprehensive benefits and the opportunity to support seniors through integrated, team-based care. 🗂️ Requirements: LPN degree or certificate, Experience in long-term care, Experience in behavioral health 📃 Skills: LPN, BehavioralHealth, CareManagement, ChronicCare, RatingScales, CarePlanning, PsychosocialInterventions, RegistryManagement, InterdisciplinaryCare 🏢 Description: Job Summary We are seeking a dedicated LPN CoCM Behavioral Health Care Manager to join our team. In this role, you will be responsible for reviewing patient charts and communicating with the Clinical department and providers about any irregularities as part of chronic care management. Responsibilities Provide assessment and care management services, including: - Administration of validated rating scales. - Initiation of behavioral health care planning concerning behavioral or psychiatric health problems. - Revision and modification of care plans for patients not progressing or whose status changes. - Brief psychosocial interventions as needed. - Engage in ongoing collaboration with the billing practitioner. - Maintain the registry/tracking sheets. - Consult with the psychiatric consultant. - Maintain a continuous relationship with patients. - Foster collaborative, integrated relationships with the rest of the care team. - Conduct interdisciplinary care plan meetings to review patient beneficiaries. Requirements - LPN degree/ certificate required. - Experience in long-term care preferred. - Experience in behavioral health preferred. Benefits - Health - Dental - Vision - 401K - Company-Sponsored Life Insurance - Paid Time Off

🏢 Summary: Medical Director role focused on delivering and overseeing high-quality in-home and community-based care for high-risk patient populations. The position combines clinical leadership, interdisciplinary collaboration, and direct patient care in a primarily remote environment. Candidates must have strong experience in population health, healthcare systems, and EMR technologies. 🗂️ Requirements: Doctor of Medicine degree, Current unrestricted medical license in relevant state, Board certification in Internal Medicine, Family Medicine, or related specialty, Minimum 3 years of direct patient care experience, Experience in population-based medicine, Experience managing complex patients with behavioral health and substance use conditions, Knowledge of U.S. payer and provider landscape, Ability to work in a fast-paced, high-growth environment, Strong communication and problem-solving skills, Experience with EMR systems 📃 Skills: EMR, Athena, Medicine, Healthcare, PopulationHealth, Leadership, QualityImprovement 🏢 Description: Company Overview: Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. Job Title & Role Description: The Medical Director will partner with cross-functional teams and senior leaders to deliver innovative and high-quality care in the home and community for high-need, high-risk, high-utilizing patients. Job requires a leader with a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. The candidate has a proactive role in the marketplace and with our patients: delivering care directly and providing clinical oversight to the members of our Interdisciplinary Care Team. The ideal candidate must be flexible and willing to work in a high growth, fast paced company where the scope of services and protocols will evolve. This is a dynamic environment requiring flexibility, dedication, and commitment to improve care for underserved populations. The role is primary remote, but residence in the state of interest is required. Approximately 20% of your time will be doing direct patient care. Skills Required: - Doctor of Medicine degree from a recognized medical school program - Must possess a current, unrestricted medical license in the State(s) of interest - Board Certified in Internal Medicine, Family Medicine or in related primary/specialty care - Minimum three years of experience practicing in a direct patient care environment - Previous medical leadership and teaching experience preferred - Expertise in population-based medicine and quality improvement principles - Experience with managing patients with complex needs, including behavioral health and substance use diagnoses - Strong healthcare management acumen, including working knowledge of current U.S. payer and provider landscape - Must be able to positively interact with clinicians, senior management, patients and families, and medical and non-medical professionals - High sense of urgency and can-do attitude - Strong communication and problem-solving skills - Technical acumen with EMR systems (Athena experience a plus) Key Behaviors: - Proactive Leadership - Collaboration - Flexibility and Adaptability - Accountability - Empathy - Effective Communicator - Patient-Centered Approach Competencies: - Clinical Expertise - Leadership - Problem-Solving and Critical Thinking - Interdisciplinary Collaboration - Healthcare System Knowledge - Quality Improvement - Technology Proficiency - Stakeholder Engagement Compensation: - NY pay range: $250,000—$250,000 USD