Nurse

• Review and make medical determinations as to whether pre-claim reviews and/or claims meet the member’s benefits
• Assess the necessity and reasonableness of items supplied in valid claims
• Use medical policy and other materials to make determinations
• Clearly articulate health information based on medical policy and criteria
• Complete required in-person training and onboarding activities
• Follow Government Business Division policies, procedures, guidelines, training, monitoring, and sensitive-data handling requirements when applicable

Clinical review nurse assessing claims for Elevance Health’s federal healthcare programs

Clinical Review Nurse I

Clinical review nurse assessing medical necessity and benefits coverage for Wellpoint Federal claims. Supporting Elevance Health’s federal healthcare programs through policy-based determinations.

• Review and make complex medical determinations about whether claims meet the member’s benefits
• Assess the necessity and reasonableness of items supplied in valid claims using medical policy
• Comprehend medical policy and criteria and clearly articulate health information
• Support federal programs through claims administration, data, and care delivery solutions
• Follow Government Business Division policies, procedures, guidelines, training, monitoring, and sensitive data handling requirements where applicable

Clinical Review Nurse II reviewing medical claims for Elevance Health’s federal healthcare programs

Clinical Review Nurse II

Clinical Review Nurse II making complex medical-necessity determinations for Elevance Health’s federal healthcare programs. Reviewing claims against member benefits and medical policy.

• Determine clinical and service needs for established and new accounts and referrals
• Communicate with referral sources, branches, physicians, and families to coordinate and facilitate patients’ plans of care
• Market therapies, services, and products to referral sources
• Provide in-services and continuing education programs for hospital case managers, referral sources, and support staff
• Identify and pull through appropriate specialty infusion referrals
• Assist in maximizing revenue within the local and regional market
• Partner with leadership to identify relationship-building and business-expansion opportunities
• Provide patient education and continuing education programs
• Problem-solve and resolve questions and issues for referral sources and patients
• Travel to client sites or designated locations as required

Clinical Hemophilia Nurse Liaison coordinating specialty infusion care for Paragon Healthcare

Clinical Hemophilia Nurse Liaison

Clinical Hemophilia Nurse Liaison coordinating specialty infusion referrals and patient care for Paragon Healthcare.
Providing education, referral development, and field-based support to healthcare partners and families.

• Provide holistic nursing care using the nursing process at individual and community levels
• Address social determinants of health by identifying and mitigating barriers to access and equity
• Integrate clinical and spiritual care into care delivery
• Conduct health assessments and implement education, counseling, and preventive interventions
• Coordinate care and connect individuals and families to healthcare providers and community resources
• Build and maintain partnerships with churches, local organizations, and community stakeholders
• Apply evidence-based and relationship-based care approaches, including health education, advocacy, and motivational interviewing
• Identify community health needs and coordinate outreach and wellness programming
• Advocate for systemic and policy changes that improve health outcomes
• Maintain professional competency and participate in continuing education
• Serve as the primary Methodist Healthcare Ministries representative within assigned communities
• Collaborate with the District Manager, Wesley Nurses, Community Health Workers, Community-Based Counselors, Strategy Department, and external community partners
• Travel frequently within assigned communities and occasionally across MHM’s 74-county service area
• Provide mentorship, guidance, and collaboration without direct supervisory responsibility

Wesley Nurse providing holistic community care for Methodist Healthcare Ministries in Cuero

RN – Wesley Nurse

Wesley Nurse delivering holistic clinical, spiritual, and community-based care for Methodist Healthcare Ministries in Cuero, Texas. Connecting underserved individuals with health education, resources, and advocacy.

• Perform physical examinations and establish medical history to determine donor suitability
• Build rapport with donors to ensure overall customer satisfaction
• Ensure donor and staff confidentiality
• Provide donor awareness regarding potential hazards
• Provide donor education regarding general health and counsel donors regarding unacceptable test results
• Evaluate and manage donor injuries and adverse events
• Evaluate illness and medication history to ensure continued donor suitability
• Assist in employee training
• Administer the employee Hepatitis Vaccine program

LPN/LVN providing donor suitability and care at Grifols plasma donation center

LPN, LVN

LPN/LVN assessing donor suitability and managing donor care at Grifols’ plasma donation center.
Providing health education, injury management, employee training, and vaccination support.

• Provide professional nursing care in collaboration with bedside nurses through two-way audio/visual technology
• Assess vital signs and monitoring data through specialized software
• Provide direct patient nursing care to a diverse patient population
• Conduct nursing assessments and assist with examinations and treatments
• Maintain medical records
• Coach and mentor department staff in clinical and professional practice
• Lead unit and shared governance activities and serve as charge nurse as needed
• Assess unit practice and improvement needs and serve as a clinical resource
• Coordinate unit and hospital-wide education with management
• Develop, update, communicate, and audit patient plans of care, including discharge planning
• Prioritize care and advocate for patients and families regarding clinical and ethical concerns
• Develop and implement patient teaching strategies
• Lead care for complex patients and coordinate the interprofessional healthcare team
• Recognize and respond to patient deterioration, rapid responses, CERTs, and emergency codes
• Lead quality, safety, evidence-based practice, and performance-improvement initiatives
• Manage resources, patient throughput, documentation, and unit financial targets
• Serve as a clinical resource and develop educational materials and programs

Virtual ICU Registered Nurse providing remote-monitoring care for Houston Methodist health system

Registered Nurse – Virtual ICU

Virtual ICU RN providing technology-enabled critical care for Houston Methodist’s eight-hospital health system.
Leading complex patient care, staff development, safety initiatives, and interprofessional coordination.

• Provide appropriate nursing care as directed by an RN on the nursing unit
• Gather and report data, carry out orders, and perform therapeutic procedures on patients in an age and population-appropriate manner
• Perform other related duties as assigned or requested

Licensed Vocational Nurse providing nursing care at PAM Health in Corpus Christi

Licensed Vocational Nurse – LVN

Licensed Vocational Nurse providing appropriate nursing care under RN supervision at PAM Health facility. Engaging with various tasks including patient data reporting and therapeutic procedures in a caring environment.

• Provide telephonic clinical assessment, health education and utilization management services across the life span
• Care coordination for patients, including prior authorization; identifying and seeking solutions for barriers to care
• Provide telephonic triage for patients seeking care with multiple complaints
• Assessment and provision of care using telecommunication devices
• Application of the nursing process in telehealth care
• Delivery of culturally sensitive, age-specific care to identified populations
• Use of clinical decision support tools
• Provide effective therapeutic communication, counsel and crisis management
• Handle multiple in bound calls and ability to complete out-bound calls
• Other duties as assigned.

Virtual RN providing telephonic clinical assessment for general care

Nurse, Virtual RN

Virtual RN providing telephonic clinical assessment and health education in a community-based setting for Westside Family Healthcare. Participate in care coordination and telehealth services for diverse patient needs.

• Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
• Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
• Collaborates with healthcare partners to ensure timely review of services and care.
• Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
• Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
• Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
• Triages and prioritizes cases and other assigned duties to meet required turnaround times.
• Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
• Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
• Duties as assigned.

Utilization Management Nurse performing clinical reviews for health services.

Utilization Management Nurse

Utilization Management Nurse providing evaluations of medical necessity for healthcare services. Collaborates with healthcare partners and handles clinical documentation remotely.

• Assist with bathing, dressing, grooming, toileting, and mobility
• Monitor and document vital signs
• Provide medication reminders and assistance
• Prepare light meals and encourage proper nutrition
• Perform light housekeeping and errands
• Offer companionship and emotional support
• Document patient care accurately and timely in our EHR system
• Communicate changes in patient condition to the supervising nurse

CNA providing in-home care in San Antonio area for Prime Home Health

CNA, Certified Nurses Aide – Adult Home Health

CNA providing compassionate in-home care for patients in San Antonio area. Assisting with daily living activities and monitoring health at Prime Home Health.

• Deliver inpatient dialysis therapies, including hemodialysis, peritoneal dialysis, CRRT, and apheresis
• Collaborate with hospital teams and DaVita clinical staff
• Monitor patients, adjust treatment, and ensure quality outcomes
• Support and oversee patient care with the help of PCTs
• Adapt quickly in a dynamic hospital environment

Acute Dialysis Registered Nurse providing dialysis care in a hospital setting

Registered Nurse

Acute Dialysis Registered Nurse delivering dialysis treatments for patients with kidney conditions in hospital settings. Join a clinical leader in kidney care providing critical patient support.

• On label education to non-physician health care providers (e.g., Nurse Practitioners) and health care professionals (e.g., Nurses, pharmacists) to support the treatment of patients and support the safe and effective use of Gilead products
• Apply Oncology Nurse Educator role-specific knowledge to engage in clinical discussions around product and disease state content, terminology, and concepts with customers
• Deliver education in an accurate, succinct, and impactful manor that engages audience and meets the needs of the individual account and always within the guidelines of the role of the Oncology Nurse Educator
• Demonstrate deep insight into customer, geographical, and healthcare industry challenges
• Demonstrate an understanding of the various customer segments (e.g. different nursing specialties) and environments (e.g. Community Oncology, Academic Institutions)
• Build credibility and trust during customer interactions by understanding individual operational practices, decision-making processes, standards of care, priorities, potential changes in needs, and patient management challenges
• Consider the patient journey and account educational needs and utilizes approved Gilead resources to address these needs
• Develop meaningful educational account plans with clear objectives, actions, responsibilities, timelines, and allocation of resources
• Demonstrate commitment to the One Oncology matrix process by appropriately engaging cross-functional team members in a highly integrated way through sharing of perspectives and linking customer needs and insights
• Develop and execute a routing plan to maximize time and impact in the field
• Strong presentation skills with ability to tailor presentations to different sized audiences and levels of clinical expertise
• Maintain the highest level of professional standards in all interactions with internal colleagues and external customers and other business contacts and always within the expectations of the role of Oncology Nurse Educator
• Demonstrates sound judgment regarding utilization of time and financial resources, such as travel and expenses
• Completes all necessary administrative tasks promptly (e.g., updating customer database, expenses, etc.)

Oncology Nurse Educator providing education on disease state and product knowledge at Gilead.

Clinical Nurse Educator

Oncology Nurse Educator providing education to healthcare professionals on Gilead products. Supporting patient management strategy and positive outcomes in oncology settings through clinical education.

• Own patient assessments and skilled visit documentation including OASIS.
• Deliver high-acuity home health care, with a focus on wound care and infusion therapy.
• Build and maintain a clear plan of care through consistent communication with physicians, care team members, patients, and families.
• Serve as the patients advocate and ensure continuity of care across disciplines.
• Drive case management responsibilities including care coordination, timely follow-ups, and barrier resolution to keep patients progressing toward goals.
• Communicate changes in condition, obtain/track orders, and coordinate services (PT/OT/ST/MSW/HHA) to ensure the plan of care is executed.
• Administer medications and treatments as ordered, and provide patient and caregiver teaching.
• Coordinate with internal clinical and operational support teams so that care is delivered reliably and safely.
• Provide supervision and guidance to LVNs and HHAs when applicable.
• Participate in case conferences and in-services to align on quality, safety, and clinical outcomes.

Registered Nurse providing high-acuity home health care in Texas

Registered Nurse, RN

Registered Nurse (RN) delivering skilled home health care in Texas. Supporting patients with wound care and infusion therapy with strong clinical judgment.

• 12 month transition-to-practice program
• Support new nurses to a competent level of practice
• Grow and develop nursing skills in a supportive setting
• Develop in leadership, quality outcomes, and professional role

Nurse Residency Program providing support for new graduate nurses

New Grad RN – Nurse Residency Program

Nurse Residency Program at Memorial Hermann supporting new graduate nurses through a comprehensive evidence-based curriculum. Fostering leadership and professional role development with a supportive cohort model.

• Track and respond to calls for a multi-state nurse triage telephone service.
• Provide clinical assessment based on established protocols and triage patients by phone or through patient portal.
• Provide administrative support and perform clinical tasks.
• Facilitate referrals and collaborate on addressing prior authorization requests.
• Participate in Remote Patient Monitoring (RPM) initiatives.
• Screen and qualify patients for clinical trials.

Registered Nurse providing remote telephone triage support for various states

RN Telephone Triage Nurse – Compact License, IL, MA, NY, MN, DC

Registered Nurse providing remote telephone triage support. Handling clinical assessments and administrative tasks for multi-state telehealth services.

• Support an engagement with The Veterans Integrated Services Network 17 (VISN 17).
• Support the current expanded operations and post-COVID operations to restore the healthcare systems to pre-Pandemic operations.
• Perform nursing services at the Texas Valley Costal Bend Health Care System.
• Foster teamwork collaboratively as a participant, and effectively as a team leader.
• Exercise judgment and organization in managing projects and prioritizing tasks.
• Participate in patient and family teaching and provide hand-off documentation.

Registered Nurse supporting Veterans Integrated Services Network 17 operations.

Critical Care Registered Nurse

Registered Nurse supporting Veterans Integrated Services Network 17 operations in Texas. Responsible for expanded and post-COVID healthcare services restoration.

Nurse jobs in Texas

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