Hone is an online medical clinic at the forefront of transforming healthcare and enhancing longevity. We use cutting-edge scientific advancements to empower men and women to take control of their health and unlock their full potential. Our people are the heart of everything we do and drive our success. We approach every project through our brand values: - Fight for the Customer - Execute Ruthlessly - Communicate Candidly, Clearly, and Kindly - Collaborate Selflessly - Practice Calculated Risk-Taking - Maximize Joy and Gratitude Hone has been fully virtual from day one and will continue to be a remote-first employer. Our Ideal Candidate Our ideal candidate is a mission-driven, motivated multi-tasker who is invested in work that is fulfilling and impactful. They embrace change and tackle challenges with enthusiasm. They have an “all-in” disposition towards work, understanding that we are a fast-paced, high-growth organization with evolving priorities. They can excel at both independent tasks and collaborative work, leading with clear and candid communication. They exhibit humble leadership—the ability to drive initiatives forward while remaining excited about continuous learning and development opportunities. They feel strongly about being part of a team that advocates for people to live longer and better lives. The Role Hone is looking for a RN Clinical Navigator to join our team. As someone with a clinical background, you are responsible for supporting doctors and their patients with their medical care. You will review, triage, and escalate physician and patient issues in collaboration with the customer service, clinical, and operations teams so that patients have the best experience with Hone. You must thrive in a fast-paced environment that requires excelling in an unstructured setting and using clinical judgment to make decisions. We are currently seeking a compassionate and reliable weekend nurse to join our clinical team. Hone offers virtual care for both men and women seeking support for hormone replacement therapy, weight loss, thyroid concerns, and longevity medicine. Clinical experience in these areas is not required, however we are seeking candidates who are passionate about helping patients live long, healthy lives.

Description Logistics: CGS –one of BlueCross BlueShield's South Carolina subsidiary companies. Location This position is full time (40 hours/week) Monday-Friday from 8:00am – 5:00pm and will be fully remote. What You’ll Do: - Documents the basis of the appeal or retrospective review in an accurate and timely manner and in accordance with applicable regulations or standards. - Performs thorough research of the substance of service appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies and procedures, while adhering to confidentiality regulations regarding protected health information. - Performs appeal and retrospective reviews demonstrating ability to define and determine precedence of pertinent issues in application of policies and procedures to clinical information and or application to benefit or policy provisions. - Performs special projects including reviews of clinical information to identify quality of care issues. To Qualify for This Position, You'll Need the Following: - Required Education:  Associate's in a job-related field   - Degree Equivalency: Graduate of Accredited School of Nursing - Required Work Experience: 2 years clinical experience plus 1 year utilization/medical review, quality assurance, or home health, OR, 3 years clinical. FOR PALMETTO GBA (CO. 033) ONLY: 2 years clinical experience plus 2 years utilization/medical review, quality assurance, or home health experience or a combination of experience in clinical, utilization/medical review, quality assurance or home health experience totaling four years. -  Required Skills and Abilities: Working knowledge of word processing software.  Ability to work independently, prioritize effectively, and make sound decisions.  Working knowledge of managed care and various forms of health care delivery systems. Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.  Knowledge of specific criteria/protocol sets and the use of the same.  Good judgment skills.  Demonstrated customer service, organizational, oral and written communication skills.  Ability to persuade, negotiate, or influence others.  Analytical or critical thinking skills.  Ability to handle confidential or sensitive information with discretion.   - Required Software and Tools:  Microsoft Office.                                                                                                                                                                          - Required License and Certificate:  An active, unrestricted RN license from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).

Department Name: Prior Authorization Work Shift: Day Job Category: Clinical Care Estimated Pay Range: $35.43 - $59.05 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained. The future is full of possibilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you. Banner Health has been recognized by Becker’s Healthcare as one of the 150 top places to work in health care. In addition, we recently made Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity. These recognitions reflect Banner Health's investment in team members' professional development, wellness benefits, and continued education. It highlights our commitment to advocating for diversity in the workplace, promoting work-life balance, and boosting employee engagement. In this role of RN Medical Management Services, you are required to be technologically savvy when it comes to research for the plans you will help manage. Sites to aid in that research include CMS, Noridian, Optum360 Encoder Pro, (a provider lookup tool for contracted and noncontracted status,) and more. You will review plans and receive case reviews via fax and a non-clinical team data enters into the system for determinations. The variety of cases received is based on the Prior Authorization Grid for services that must be reviewed for determination. You are required to phone providers, vendors, and members for certain aspects within Banner's processes. An ideal candidate would possess experience in prior authorization. This is a remote opportunity, with hours of Monday-Friday 8AM-5PM, including Saturday rotations. Must reside in AZ.

- Part-Time Benefits Eligible - USD $34.00/H - USD $36.00/H - 51510 Job Description Overview PT Benefitted 30-32 hours a weekly Hourly Position/Remote Position Most Holidays required annually Every weekend required-Day Time Hours (Schedule/Hours direct to Triage Leadership) Hours may be variable depending on licensure (No Overnights shifts available) Compact Licensure with ability to pick up additional licensure including CA, MA, and OR Bilingual Needed, Not Required Hospice Experience 1-2 years preferred Compact Licensure Required, and fall under NCL guidance Are you looking for a rewarding career in homecare? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S. Attractive pay - $34.00- $36.00 What's in it for you - A full benefits package with choice of affordable PPO or HSA medical plans. - Paid time off. - Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan. - Up to $500 in wellness rewards for completing activities during the year. Use these rewards to support your wellbeing with spa services, gym memberships, sports, hobbies, pets and more.* - Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program. - 401(k) with a company match. - Family support with infertility treatment coverage*, adoption reimbursement, paid parental and family caregiver leave. - Fleet vehicle program (restrictions apply) and mileage reimbursement. - And more. Please note: Benefit eligibility can vary by position depending on shift status. *To participate, you must be enrolled in an Amedisys medical plan. Responsibilities - Assesses physical, environmental, and emotional factors telephonically to determine hospice needs. - Utilizes EHR, including the patient's plan of care to develop recommendations. - Provides recommendations, patient/caregiver education/instructions and hospice support telephonically based on the situation and the plan of care. - Collaborates with pharmacies, DME vendors and other agencies for effective patient management. - Facilitates delivery or maintenance of provided medical equipment to meet patient needs. - Assigns all visits, admissions and follow-up calls to on-call field staff (RN, LPN, HA, CH, SW) as needed. - Submits accurate and detailed documentation in real-time to promote continuity of care. - Utilizes a combination of agency resources and nationally recognized standards of practice to achieve excellent pain and symptom management and high-quality end-of-life care. - Participates in agency performance improvement initiatives. - Performs other duties as assigned.