AMN Healthcare Services (AMN) 10-Q 4 Nov 22 2022 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2022	Nov. 02, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2022
Document Transition Report	false
Entity File Number	001-16753
Entity Registrant Name	AMN HEALTHCARE SERVICES, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	06-1500476
Entity Address, Address Line One	8840 Cypress Waters Boulevard
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Dallas
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75019
City Area Code	866
Local Phone Number	871-8519
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	AMN
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (excluding treasury shares)		43,335,911
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 155,723	$ 180,928
Accounts receivable, net of allowances of $15,194 and $6,838 at September 30, 2022 and December 31, 2021, respectively	724,966	789,131
Accounts receivable, subcontractor	253,954	239,719
Prepaid expenses	17,019	72,460
Other current assets	54,504	66,830
Total current assets	1,206,166	1,349,068
Restricted cash, cash equivalents and investments	64,883	64,482
Fixed assets, net of accumulated depreciation of $212,702 and $189,954 at September 30, 2022 and December 31, 2021, respectively	140,995	127,114
Operating lease right-of-use assets	18,505	27,771
Other assets	152,970	156,670
Goodwill	935,675	892,341
Intangible assets, net of accumulated amortization of $339,092 and $278,249 at September 30, 2022 and December 31, 2021, respectively	499,067	514,460
Total assets	3,018,261	3,131,906
Current liabilities:
Accounts payable and accrued expenses	459,237	425,257
Accrued compensation and benefits	338,833	354,381
Current portion of operating lease liabilities	8,226	11,383
Deferred revenue	15,060	15,950
Other current liabilities	69,890	162,419
Total current liabilities	891,246	969,390
Notes payable, net of unamortized fees and premium	843,210	842,322
Deferred income taxes, net	42,159	47,814
Operating lease liabilities	10,785	13,364
Other long-term liabilities	98,228	96,989
Total liabilities	1,885,628	1,969,879
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at September 30, 2022 and December 31, 2021	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 50,087 issued and 43,327 outstanding at September 30, 2022 and 49,849 issued and 47,263 outstanding at December 31, 2021	501	498
Additional paid-in capital	497,744	486,709
Treasury stock, at cost; 6,760 and 2,586 shares at September 30, 2022 and December 31, 2021, respectively	(523,722)	(121,831)
Retained earnings	1,159,199	796,946
Accumulated other comprehensive loss	(1,089)	(295)
Total stockholders’ equity	1,132,633	1,162,027
Total liabilities and stockholders’ equity	$ 3,018,261	$ 3,131,906

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 15,194	$ 6,838
Accumulated depreciation - fixed assets	212,702	189,954
Accumulated amortization	$ 339,092	$ 278,249
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	50,087,000	49,849,000
Common stock, shares outstanding (in shares)	43,327,000	47,263,000
Treasury stock (in shares)	6,760,000	2,586,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Statement of Comprehensive Income [Abstract]
Revenue	$ 1,138,586	$ 877,800	$ 4,117,731	$ 2,621,190
Cost of revenue	753,560	571,935	2,776,300	1,745,914
Gross profit	385,026	305,865	1,341,431	875,276
Operating expenses:
Selling, general and administrative	215,419	173,932	717,428	491,773
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	33,239	26,104	96,169	74,098
Total operating expenses	248,658	200,036	813,597	565,871
Income from operations	136,368	105,829	527,834	309,405
Interest expense, net, and other	8,961	5,223	28,630	24,278
Income before income taxes	127,407	100,606	499,204	285,127
Income tax expense	34,962	26,583	136,951	73,956
Net income	92,445	74,023	362,253	211,171
Other comprehensive income (loss):
Unrealized gains (losses) on available-for-sale securities, net, and other	(219)	11	(794)	(10)
Other comprehensive income (loss)	(219)	11	(794)	(10)
Comprehensive income	$ 92,226	$ 74,034	$ 361,459	$ 211,161
Net income per common share:
Basic (in dollars per share)	$ 2.11	$ 1.55	$ 8.04	$ 4.43
Diluted (in dollars per share)	$ 2.10	$ 1.54	$ 7.99	$ 4.40
Weighted average common shares outstanding:
Basic (in shares)	43,785	47,737	45,056	47,666
Diluted (in shares)	44,039	48,080	45,332	48,022

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings	Accumulated Other Comprehensive Income
Beginning balance (in shares) at Dec. 31, 2020		49,614
Beginning balance at Dec. 31, 2020	$ 819,677	$ 496	$ 468,726	$ (119,143)	$ 469,558	$ 40
Beginning balance (in shares) at Dec. 31, 2020				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		132
Equity awards vested, net of shares withheld for taxes	(5,258)	$ 1	(5,259)
Share-based compensation	9,287		9,287
Comprehensive income (loss)	70,354				70,378	(24)
Ending balance (in shares) at Mar. 31, 2021		49,746
Ending balance at Mar. 31, 2021	894,060	$ 497	472,754	$ (119,143)	539,936	16
Ending balance (in shares) at Mar. 31, 2021				(2,561)
Beginning balance (in shares) at Dec. 31, 2020		49,614
Beginning balance at Dec. 31, 2020	819,677	$ 496	468,726	$ (119,143)	469,558	40
Beginning balance (in shares) at Dec. 31, 2020				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	211,161
Ending balance (in shares) at Sep. 30, 2021		49,836
Ending balance at Sep. 30, 2021	1,042,478	$ 498	480,364	$ (119,143)	680,729	30
Ending balance (in shares) at Sep. 30, 2021				(2,561)
Beginning balance (in shares) at Mar. 31, 2021		49,746
Beginning balance at Mar. 31, 2021	894,060	$ 497	472,754	$ (119,143)	539,936	16
Beginning balance (in shares) at Mar. 31, 2021				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		78
Equity awards vested, net of shares withheld for taxes	(470)	$ 1	(471)
Share-based compensation	6,019		6,019
Comprehensive income (loss)	66,773				66,770	3
Ending balance (in shares) at Jun. 30, 2021		49,824
Ending balance at Jun. 30, 2021	966,382	$ 498	478,302	$ (119,143)	606,706	19
Ending balance (in shares) at Jun. 30, 2021				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		12
Equity awards vested, net of shares withheld for taxes	(527)		(527)
Share-based compensation	2,589		2,589
Comprehensive income (loss)	74,034				74,023	11
Ending balance (in shares) at Sep. 30, 2021		49,836
Ending balance at Sep. 30, 2021	$ 1,042,478	$ 498	480,364	$ (119,143)	680,729	30
Ending balance (in shares) at Sep. 30, 2021				(2,561)
Beginning balance (in shares) at Dec. 31, 2021	47,263	49,849
Beginning balance at Dec. 31, 2021	$ 1,162,027	$ 498	486,709	$ (121,831)	796,946	(295)
Beginning balance (in shares) at Dec. 31, 2021	(2,586)			(2,586)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(2,298)
Repurchase of common stock into treasury	$ (228,024)			$ (228,024)
Equity awards vested, net of shares withheld for taxes (in shares)		164
Equity awards vested, net of shares withheld for taxes	(9,431)	$ 2	(9,433)
Share-based compensation	11,259		11,259
Comprehensive income (loss)	145,101				146,008	(907)
Ending balance (in shares) at Mar. 31, 2022		50,013
Ending balance at Mar. 31, 2022	$ 1,080,932	$ 500	488,535	$ (349,855)	942,954	(1,202)
Ending balance (in shares) at Mar. 31, 2022				(4,884)
Beginning balance (in shares) at Dec. 31, 2021	47,263	49,849
Beginning balance at Dec. 31, 2021	$ 1,162,027	$ 498	486,709	$ (121,831)	796,946	(295)
Beginning balance (in shares) at Dec. 31, 2021	(2,586)			(2,586)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	$ 361,459
Ending balance (in shares) at Sep. 30, 2022	43,327	50,087
Ending balance at Sep. 30, 2022	$ 1,132,633	$ 501	497,744	$ (523,722)	1,159,199	(1,089)
Ending balance (in shares) at Sep. 30, 2022	(6,760)			(6,760)
Beginning balance (in shares) at Mar. 31, 2022		50,013
Beginning balance at Mar. 31, 2022	$ 1,080,932	$ 500	488,535	$ (349,855)	942,954	(1,202)
Beginning balance (in shares) at Mar. 31, 2022				(4,884)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(1,876)
Repurchase of common stock into treasury	(173,867)			$ (173,867)
Equity awards vested, net of shares withheld for taxes (in shares)		19
Equity awards vested, net of shares withheld for taxes	(366)		(366)
Share-based compensation	8,513		8,513
Comprehensive income (loss)	124,132				123,800	332
Ending balance (in shares) at Jun. 30, 2022		50,032
Ending balance at Jun. 30, 2022	1,039,344	$ 500	496,682	$ (523,722)	1,066,754	(870)
Ending balance (in shares) at Jun. 30, 2022				(6,760)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		55
Equity awards vested, net of shares withheld for taxes	(3,835)	$ 1	(3,836)
Share-based compensation	4,898		4,898
Comprehensive income (loss)	$ 92,226				92,445	(219)
Ending balance (in shares) at Sep. 30, 2022	43,327	50,087
Ending balance at Sep. 30, 2022	$ 1,132,633	$ 501	$ 497,744	$ (523,722)	$ 1,159,199	$ (1,089)
Ending balance (in shares) at Sep. 30, 2022	(6,760)			(6,760)

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Cash flows from operating activities:
Net income	$ 362,253	$ 211,171
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (inclusive of depreciation included in cost of revenue)	99,087	75,871
Non-cash interest expense and other	1,427	(4,541)
Write-off of fees on credit facilities and senior notes	0	158
Change in fair value of contingent consideration	(1,190)	0
Increase in allowance for credit losses and sales credits	22,199	2,103
Provision for deferred income taxes	(5,364)	(4,328)
Share-based compensation	24,670	17,895
Loss on disposal or sale of fixed assets	571	386
Net loss (gain) on investments in available-for-sale securities	652	(41)
Net loss (gain) on deferred compensation balances	(1,324)	96
Non-cash lease expense	4,818	(257)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	44,532	(196,342)
Accounts receivable, subcontractor	(14,235)	(67,641)
Income taxes receivable	(1,426)	5,472
Prepaid expenses	55,495	(5,695)
Other current assets	12,399	3,411
Other assets	(608)	780
Accounts payable and accrued expenses	31,855	112,183
Accrued compensation and benefits	2,937	96,666
Other liabilities	(99,534)	(26,268)
Deferred revenue	(809)	6,276
Restricted investments balance	0	16
Net cash provided by operating activities	538,405	227,371
Cash flows from investing activities:
Purchase and development of fixed assets	(51,229)	(38,710)
Purchase of investments	(13,152)	(32,437)
Proceeds from sale and maturity of investments	12,549	40,000
Purchase of equity investment	0	(500)
Proceeds from sale of equity investment	68	78
Payments to fund deferred compensation plan	(21,411)	(6,094)
Cash paid for acquisitions, net of cash and restricted cash received	(69,801)	(41,264)
Cash paid for other intangibles	(5,091)	(90)
Net cash used in investing activities	(148,067)	(79,017)
Cash flows from financing activities:
Payments on term loans	0	(21,875)
Payments on revolving credit facility	0	(70,000)
Proceeds from revolving credit facility	0	70,000
Repurchase of common stock	(401,891)	0
Earn-out payments to settle contingent consideration liabilities for prior acquisitions	0	(3,100)
Cash paid for shares withheld for taxes	(13,632)	(6,255)
Net cash used in financing activities	(415,523)	(31,230)
Effect of exchange rate changes on cash	0	(10)
Net increase (decrease) in cash, cash equivalents and restricted cash	(25,185)	117,114
Cash, cash equivalents and restricted cash at beginning of period	246,714	83,990
Cash, cash equivalents and restricted cash at end of period	221,529	201,104
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	10,700	35,066
Cash paid for interest (net of $452 and $248 capitalized for the nine months ended September 30, 2022 and 2021, respectively)	18,950	19,301
Cash paid for income taxes	164,757	72,863
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	2,731	1,906
Goodwill	43,301	28,135
Intangible assets	40,200	12,440
Liabilities assumed	(8,431)	(1,217)
Contingent consideration liabilities	(8,000)	0
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 5,187	$ 5,080

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Statement of Cash Flows [Abstract]
Interest capitalized	$ 452	$ 248

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	BASIS OF PRESENTATION The condensed consolidated balance sheets and related condensed consolidated statements of comprehensive income and cash flows contained in this Quarterly Report on Form 10-Q (this “Quarterly Report”), which are unaudited, include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries (collectively, the “Company”). All significant intercompany balances and transactions have been eliminated in consolidation. In the opinion of management, all entries necessary for a fair presentation of such unaudited condensed consolidated financial statements have been included. These entries consisted of all normal recurring items. The results of operations for the interim period are not necessarily indicative of the results to be expected for any other interim period or for the entire fiscal year or for any future period. The unaudited condensed consolidated financial statements do not include all information and notes necessary for a complete presentation of financial position, results of operations and cash flows in conformity with accounting principles generally accepted in the United States (“U.S. GAAP”). Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2021, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2021, filed with the Securities and Exchange Commission on February 24, 2022 (the “2021 Annual Report”). The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, contingent consideration liabilities associated with acquisitions, and income taxes. Actual results could differ from those estimates under different assumptions or conditions. Cash, Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. Restricted cash and cash equivalents primarily includes cash, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (6), “Fair Value Measurement” for additional information. The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. September 30, 2022 December 31, 2021 Cash and cash equivalents $ 155,723 $ 180,928 Restricted cash and cash equivalents (included in other current assets) 27,764 29,262 Restricted cash, cash equivalents and investments 64,883 64,482 Total cash, cash equivalents and restricted cash and investments 248,370 274,672 Less restricted investments (26,841) (27,958) Total cash, cash equivalents and restricted cash $ 221,529 $ 246,714 Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions. The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable: 2022 2021 Balance as of January 1, $ 6,838 $ 7,043 Provision for expected credit losses 10,129 325 Amounts written off charged against the allowance (1,773) (1,220) Balance as of September 30, $ 15,194 $ 6,148

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Acquisitions	ACQUISITIONS As set forth below, the Company completed two acquisitions during the period of January 1, 2021 through September 30, 2022, which were accounted for using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. Since the applicable date of acquisition, the Company has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through September 30, 2022. The allocations will continue to be updated through the measurement period, if necessary. The goodwill recognized for these acquisitions is attributable to expected growth as the Company leverages its brand and diversifies its services offered to clients, including potential revenue growth and margin expansion. For each acquisition, the Company did not incur any material acquisition-related costs. Connetics Acquisition On May 13, 2022, the Company completed its acquisition of Connetics Communications, LLC (“Connetics”), which specializes in the direct hire recruitment and permanent placement of international nurse and allied health professionals with healthcare facilities in the United States. The initial purchase price of $78,764 included (1) $70,764 cash consideration paid upon acquisition, funded through cash on hand, and (2) contingent consideration (earn-out payment) of up to $12,500 with an estimated fair value of $8,000 as of the acquisition date. The contingent earn-out payment is based on the operating results of Connetics for the twelve months ending May 31, 2023. The results of Connetics have been included in the Company’s nurse and allied solutions segment since the date of acquisition. The preliminary allocation of the $78,764 consisted of (1) $3,694 of fair value of tangible assets acquired, which included $963 cash received, (2) $8,431 of liabilities assumed, (3) $40,200 of identified intangible assets, and (4) $43,301 of goodwill, of which $35,317 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately thirteen years. The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date: Fair Value Useful Life (in years) Identifiable intangible assets Customer relationships $ 32,800 15 Staffing database 4,200 5 Tradenames and trademarks 3,200 5 $ 40,200 Synzi and SnapMD Acquisition On April 7, 2021, the Company completed its acquisition of Synzi Holdings, Inc. (“Synzi”) and its wholly-owned subsidiary, SnapMD, LLC (“SnapMD”). Synzi is a virtual care communication platform that enables organizations to conduct virtual visits and use secure messaging, text, and email for clinician-to-patient and clinician-to-clinician communications. SnapMD is a full-service virtual care management company, specializing in providing software to enable healthcare providers to better engage with their patients. The initial purchase price of $42,240 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through borrowings under the Company’s $400,000 senior secured revolving credit facility (the “Senior Credit Facility”). See additional information regarding the Senior Credit Facility in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report. The results of Synzi and SnapMD have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2021, $92 was returned to the Company in respect of the final working capital settlement. The allocation of the $42,148 purchase price, which was reduced by the final working capital settlement and was finalized during the second quarter of 2022, consisted of (1) $2,757 of fair value of tangible assets acquired, which included $884 cash received, (2) $275 of liabilities assumed, (3) $12,440 of identified intangible assets, and (4) $27,226 of goodwill, of which $6,044 is deductible for tax purposes. The fair value of intangible assets primarily includes $10,890 of developed technology and $1,220 of trademarks with a weighted average useful life of approximately seven years.

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Revenue Recognition	REVENUE RECOGNITION Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration that the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration that the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation. See Note (5), “Segment Information,” for additional information regarding the Company’s revenue disaggregated by service type.

Net Income Per Common Share

Net Income Per Common Share	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Net Income Per Common Share	NET INCOME PER COMMON SHARE Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. The following table sets forth the computation of basic and diluted net income per common share: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Net income $ 92,445 $ 74,023 $ 362,253 $ 211,171 Net income per common share - basic $ 2.11 $ 1.55 $ 8.04 $ 4.43 Net income per common share - diluted $ 2.10 $ 1.54 $ 7.99 $ 4.40 Weighted average common shares outstanding - basic 43,785 47,737 45,056 47,666 Plus dilutive effect of potential common shares 254 343 276 356 Weighted average common shares outstanding - diluted 44,039 48,080 45,332 48,022 Share-based awards to purchase 14 and 15 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2022, respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 21 and 26 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2021, respectively, because the effect of these instruments was anti-dilutive.

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Segment Information	SEGMENT INFORMATION The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. The Company has three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing (including international nurse staffing and rapid response nurse staffing), labor disruption staffing, local staffing, international nurse and allied permanent placement, allied staffing and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language services, vendor management systems, workforce optimization, virtual care, credentialing solutions, and outsourced solutions businesses. The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed. The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Revenue Nurse and allied solutions $ 828,317 $ 627,049 $ 3,157,834 $ 1,908,195 Physician and leadership solutions 175,152 150,663 530,355 430,523 Technology and workforce solutions 135,117 100,088 429,542 282,472 $ 1,138,586 $ 877,800 $ 4,117,731 $ 2,621,190 Segment operating income Nurse and allied solutions $ 115,182 $ 92,564 $ 471,141 $ 283,768 Physician and leadership solutions 23,904 19,301 64,280 62,366 Technology and workforce solutions 71,145 47,210 232,526 131,952 210,231 159,075 767,947 478,086 Unallocated corporate overhead 34,635 23,867 116,356 74,915 Depreciation and amortization 33,239 26,104 96,169 74,098 Depreciation (included in cost of revenue) 1,091 686 2,918 1,773 Share-based compensation 4,898 2,589 24,670 17,895 Interest expense, net, and other 8,961 5,223 28,630 24,278 Income before income taxes $ 127,407 $ 100,606 $ 499,204 $ 285,127 The following tables present the Company’s revenue disaggregated by service type. Prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment. Three Months Ended September 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 583,463 $ — $ — $ 583,463 Labor disruption services 19,479 — — 19,479 Local staffing 31,814 — — 31,814 Allied staffing 190,044 — — 190,044 Locum tenens staffing — 106,055 — 106,055 Interim leadership staffing — 47,559 — 47,559 Temporary staffing 824,800 153,614 — 978,414 Permanent placement 3,517 21,538 — 25,055 Language services — — 55,502 55,502 Vendor management systems — — 60,304 60,304 Other technologies — — 7,290 7,290 Technology-enabled services — — 123,096 123,096 Talent planning and acquisition — — 12,021 12,021 Total revenue $ 828,317 $ 175,152 $ 135,117 $ 1,138,586 Three Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 444,803 $ — $ — $ 444,803 Labor disruption services 22,573 — — 22,573 Local staffing 23,272 — — 23,272 Allied staffing 136,401 — — 136,401 Locum tenens staffing — 88,994 — 88,994 Interim leadership staffing — 43,814 — 43,814 Temporary staffing 627,049 132,808 — 759,857 Permanent placement — 17,855 — 17,855 Language services — — 47,135 47,135 Vendor management systems — — 33,467 33,467 Other technologies — — 7,819 7,819 Technology-enabled services — — 88,421 88,421 Talent planning and acquisition — — 11,667 11,667 Total revenue $ 627,049 $ 150,663 $ 100,088 $ 877,800 Nine Months Ended September 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 2,329,240 $ — $ — $ 2,329,240 Labor disruption services 102,549 — — 102,549 Local staffing 109,265 — — 109,265 Allied staffing 611,226 — — 611,226 Locum tenens staffing — 324,663 — 324,663 Interim leadership staffing — 139,519 — 139,519 Temporary staffing 3,152,280 464,182 — 3,616,462 Permanent placement 5,554 66,173 — 71,727 Language services — — 158,031 158,031 Vendor management systems — — 210,470 210,470 Other technologies — — 21,787 21,787 Technology-enabled services — — 390,288 390,288 Talent planning and acquisition — — 39,254 39,254 Total revenue $ 3,157,834 $ 530,355 $ 429,542 $ 4,117,731 Nine Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 1,400,629 $ — $ — $ 1,400,629 Labor disruption services 25,126 — — 25,126 Local staffing 80,932 — — 80,932 Allied staffing 401,508 — — 401,508 Locum tenens staffing — 253,190 — 253,190 Interim leadership staffing — 126,584 — 126,584 Temporary staffing 1,908,195 379,774 — 2,287,969 Permanent placement — 50,749 — 50,749 Language services — — 133,706 133,706 Vendor management systems — — 96,086 96,086 Other technologies — — 21,791 21,791 Technology-enabled services — — 251,583 251,583 Talent planning and acquisition — — 30,889 30,889 Total revenue $ 1,908,195 $ 430,523 $ 282,472 $ 2,621,190 The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Balance, January 1, 2022 $ 339,015 $ 152,800 $ 400,526 $ 892,341 Goodwill adjustment for Synzi and SnapMD acquisition — — 33 33 Goodwill from Connetics acquisition 43,301 — — 43,301 Balance, September 30, 2022 $ 382,316 $ 152,800 $ 400,559 $ 935,675 Accumulated impairment loss as of December 31, 2021 and September 30, 2022 $ 154,444 $ 60,495 $ — $ 214,939

Fair Value Measurement

Fair Value Measurement	9 Months Ended
	Sep. 30, 2022
Fair Value Disclosures [Abstract]
Fair Value Measurement	FAIR VALUE MEASUREMENT The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (3), Fair Value Measurement” of the 2021 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the nine months ended September 30, 2022. Assets and Liabilities Measured on a Recurring Basis The Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company has a deferred compensation plan for certain executives and employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company include commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The Company’s cash equivalents also include commercial paper classified as Level 2 in the fair value hierarchy. Of the $29,296 commercial paper issued and outstanding as of September 30, 2022, none had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $80,596 commercial paper issued and outstanding, of which none had original maturities greater than three months and were considered available-for-sale securities. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company also include corporate bonds that are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. As of September 30, 2022, the Company had $26,841 corporate bonds issued and outstanding, all of which had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $29,159 corporate bonds issued and outstanding, of which $27,958 had original maturities greater than three months and were considered available-for-sale securities. The Company’s contingent consideration liabilities associated with acquisitions are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income. The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of September 30, 2022 Fair Value Measurements as of December 31, 2021 Assets (Liabilities) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Money market funds $ 125,859 $ — $ — $ 125,859 $ 91,454 $ — $ — $ 91,454 Deferred compensation (116,922) — — (116,922) (119,617) — — (119,617) Corporate bonds — 26,841 — 26,841 — 29,159 — 29,159 Commercial paper — 29,296 — 29,296 — 80,596 — 80,596 Acquisition contingent consideration liabilities — — (6,810) (6,810) — — — — Level 3 Information The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Beginning balance $ (8,580) $ — $ — $ (8,000) Settlement of b4health contingent consideration liability for year ended December 31, 2020 — — — 8,000 Contingent consideration liability from Connetics acquisition on May 13, 2022 — — (8,000) — Change in fair value of contingent consideration liability from Connetics acquisition 1,770 — 1,190 — Ending balance $ (6,810) $ — $ (6,810) $ — Assets Measured on a Non-Recurring Basis The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs. The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs, and other information available to the Company such as the rights and obligations of the securities. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the condensed consolidated statements of comprehensive income. The balance of the equity investment was $22,633 as of both September 30, 2022 and December 31, 2021. There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the nine months ended September 30, 2022 and 2021. Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report. As of September 30, 2022 As of December 31, 2021 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 447,500 $ 500,000 $ 517,500 2029 Notes 350,000 294,000 350,000 353,500

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	INCOME TAXES The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of September 30, 2022, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2011, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2018. The Company believes its liability for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments. CARES Act On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) was enacted and signed into law in response to the COVID-19 pandemic. Among other things, the CARES Act contains significant business tax provisions, including a deferral of payment of employer payroll taxes and an employer retention credit for employer payroll taxes. The Company deferred payment of the employer’s share of payroll taxes of $48,452. Approximately half of such taxes was paid during 2021 and the other half is to be paid by the end of 2022, which is included in accrued compensation and benefits in the consolidated balance sheets as of both September 30, 2022 and December 31, 2021. The Company claimed an employee retention tax credit of $1,756.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	COMMITMENTS AND CONTINGENCIES Legal Proceedings From time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company accrues for contingencies and records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be considered wages and included in the regular rate of pay for purposes of calculating overtime rates. On May 26, 2016, former travel nurse Verna Maxwell Clarke filed a complaint against AMN Services, LLC, in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:16-cv-04132-DSF-KS) (the “Clarke Matter”). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. On June 26, 2018, the district court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the plaintiffs’ per diem and overtime claims. The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals (the “Ninth Circuit”). On February 8, 2021, the Ninth Circuit issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the plaintiffs. On August 26, 2021, the Company filed a Petition for Writ of Certiorari in the United States Supreme Court seeking review of the Ninth Circuit’s decision, which was denied on December 13, 2021. This case is proceeding in the United States District Court. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The Company has reached an agreement to settle this matter in its entirety and is awaiting court approval. Final approval of the settlement is expected in late 2022 or early 2023. Because of the inherent uncertainty of litigation, the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company. The Company has recorded accruals in connection with the matters described above amounting to $37,225. The Company is currently unable to estimate the possible loss or range of loss beyond amounts already accrued. Loss contingencies accrued as of both September 30, 2022 and December 31, 2021 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. Operating Leases In the first quarter of 2022, the Company entered into a lease agreement for an office building located in Dallas, Texas, with future undiscounted lease payments of approximately $29,514, excluding lease incentives. Because the Company does not control the underlying asset during the construction period, the Company is not considered the owner of the asset under construction for accounting purposes. The lease will commence upon completion of the construction of the office building which is expected be in the first quarter of 2023. The initial term of the lease is approximately eleven years with options to renew the lease during the lease term. A right-of-use asset and lease liability will be recognized in the consolidated balance sheet in the period the lease commences.

Balance Sheet Details

Balance Sheet Details	9 Months Ended
	Sep. 30, 2022
Balance Sheet Related Disclosures [Abstract]
Balance Sheet Details	BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows: September 30, 2022 December 31, 2021 Other current assets: Restricted cash and cash equivalents $ 27,764 $ 29,262 Income taxes receivable 1,426 — Other 25,314 37,568 Other current assets $ 54,504 $ 66,830 Prepaid expenses: Prepaid payroll deposits $ — $ 60,014 Other 17,019 12,446 Prepaid expenses 17,019 72,460 Fixed assets: Furniture and equipment $ 47,618 $ 43,134 Software 303,197 265,137 Leasehold improvements 2,882 8,797 353,697 317,068 Accumulated depreciation (212,702) (189,954) Fixed assets, net $ 140,995 $ 127,114 Other assets: Life insurance cash surrender value $ 110,279 $ 115,095 Other 42,691 41,575 Other assets $ 152,970 $ 156,670 Accounts payable and accrued expenses: Trade accounts payable $ 84,334 $ 77,325 Subcontractor payable 254,697 261,689 Accrued expenses 89,196 61,220 Loss contingencies 14,933 10,400 Professional liability reserve 7,712 7,127 Other 8,365 7,496 Accounts payable and accrued expenses $ 459,237 $ 425,257 Accrued compensation and benefits: Accrued payroll $ 93,495 $ 98,817 Accrued bonuses and commissions 90,640 105,155 Accrued travel expense 2,312 3,058 Health insurance reserve 7,685 6,041 Workers compensation reserve 11,500 12,384 Deferred compensation 116,922 119,617 Other 16,279 9,309 Accrued compensation and benefits $ 338,833 $ 354,381 Other current liabilities: Acquisition related liabilities $ 6,810 $ — Income taxes payable — 21,162 Client deposits 61,319 141,102 Other 1,761 155 Other current liabilities $ 69,890 $ 162,419 September 30, 2022 December 31, 2021 Other long-term liabilities: Workers compensation reserve $ 22,633 $ 24,130 Professional liability reserve 38,163 34,544 Unrecognized tax benefits 4,785 4,633 Other 32,647 33,682 Other long-term liabilities $ 98,228 $ 96,989

Basis of Presentation (Policies

Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Use of Estimates	The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, contingent consideration liabilities associated with acquisitions, and income taxes. Actual results could differ from those estimates under different assumptions or conditions.
Cash, Cash Equivalents and Restricted Cash	Cash, Cash Equivalents and Restricted Cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. Restricted cash and cash equivalents primarily includes cash, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (6), “Fair Value Measurement” for additional information.
Accounts Receivable	Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.
Revenue Recognition	Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration that the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration that the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.
Net Income per Common Share	Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period.
Segment Information	The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.
Fair Value of Assets and Liabilities	Assets and Liabilities Measured on a Recurring Basis The Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company has a deferred compensation plan for certain executives and employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company include commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The Company’s cash equivalents also include commercial paper classified as Level 2 in the fair value hierarchy. Of the $29,296 commercial paper issued and outstanding as of September 30, 2022, none had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $80,596 commercial paper issued and outstanding, of which none had original maturities greater than three months and were considered available-for-sale securities. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company also include corporate bonds that are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. As of September 30, 2022, the Company had $26,841 corporate bonds issued and outstanding, all of which had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $29,159 corporate bonds issued and outstanding, of which $27,958 had original maturities greater than three months and were considered available-for-sale securities. The Company’s contingent consideration liabilities associated with acquisitions are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income. Assets Measured on a Non-Recurring Basis The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs. Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report. As of September 30, 2022 As of December 31, 2021 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 447,500 $ 500,000 $ 517,500 2029 Notes 350,000 294,000 350,000 353,500

Basis of Presentation (Tables)

Basis of Presentation (Tables)	9 Months Ended
	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Reconciliation of Cash, Cash Equivalents and Restricted Cash	The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. September 30, 2022 December 31, 2021 Cash and cash equivalents $ 155,723 $ 180,928 Restricted cash and cash equivalents (included in other current assets) 27,764 29,262 Restricted cash, cash equivalents and investments 64,883 64,482 Total cash, cash equivalents and restricted cash and investments 248,370 274,672 Less restricted investments (26,841) (27,958) Total cash, cash equivalents and restricted cash $ 221,529 $ 246,714
Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable	The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable: 2022 2021 Balance as of January 1, $ 6,838 $ 7,043 Provision for expected credit losses 10,129 325 Amounts written off charged against the allowance (1,773) (1,220) Balance as of September 30, $ 15,194 $ 6,148

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Finite-Lived and Indefinite-Lived Intangible Assets Acquired as Part of Business Combination	The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date: Fair Value Useful Life (in years) Identifiable intangible assets Customer relationships $ 32,800 15 Staffing database 4,200 5 Tradenames and trademarks 3,200 5 $ 40,200

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Computation of Basic and Diluted Net Income Per Common Share	The following table sets forth the computation of basic and diluted net income per common share: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Net income $ 92,445 $ 74,023 $ 362,253 $ 211,171 Net income per common share - basic $ 2.11 $ 1.55 $ 8.04 $ 4.43 Net income per common share - diluted $ 2.10 $ 1.54 $ 7.99 $ 4.40 Weighted average common shares outstanding - basic 43,785 47,737 45,056 47,666 Plus dilutive effect of potential common shares 254 343 276 356 Weighted average common shares outstanding - diluted 44,039 48,080 45,332 48,022

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Reconciliation of Revenue and Segment Operating Income by Reportable Segment	The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Revenue Nurse and allied solutions $ 828,317 $ 627,049 $ 3,157,834 $ 1,908,195 Physician and leadership solutions 175,152 150,663 530,355 430,523 Technology and workforce solutions 135,117 100,088 429,542 282,472 $ 1,138,586 $ 877,800 $ 4,117,731 $ 2,621,190 Segment operating income Nurse and allied solutions $ 115,182 $ 92,564 $ 471,141 $ 283,768 Physician and leadership solutions 23,904 19,301 64,280 62,366 Technology and workforce solutions 71,145 47,210 232,526 131,952 210,231 159,075 767,947 478,086 Unallocated corporate overhead 34,635 23,867 116,356 74,915 Depreciation and amortization 33,239 26,104 96,169 74,098 Depreciation (included in cost of revenue) 1,091 686 2,918 1,773 Share-based compensation 4,898 2,589 24,670 17,895 Interest expense, net, and other 8,961 5,223 28,630 24,278 Income before income taxes $ 127,407 $ 100,606 $ 499,204 $ 285,127
Disaggregation of Revenue	The following tables present the Company’s revenue disaggregated by service type. Prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment. Three Months Ended September 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 583,463 $ — $ — $ 583,463 Labor disruption services 19,479 — — 19,479 Local staffing 31,814 — — 31,814 Allied staffing 190,044 — — 190,044 Locum tenens staffing — 106,055 — 106,055 Interim leadership staffing — 47,559 — 47,559 Temporary staffing 824,800 153,614 — 978,414 Permanent placement 3,517 21,538 — 25,055 Language services — — 55,502 55,502 Vendor management systems — — 60,304 60,304 Other technologies — — 7,290 7,290 Technology-enabled services — — 123,096 123,096 Talent planning and acquisition — — 12,021 12,021 Total revenue $ 828,317 $ 175,152 $ 135,117 $ 1,138,586 Three Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 444,803 $ — $ — $ 444,803 Labor disruption services 22,573 — — 22,573 Local staffing 23,272 — — 23,272 Allied staffing 136,401 — — 136,401 Locum tenens staffing — 88,994 — 88,994 Interim leadership staffing — 43,814 — 43,814 Temporary staffing 627,049 132,808 — 759,857 Permanent placement — 17,855 — 17,855 Language services — — 47,135 47,135 Vendor management systems — — 33,467 33,467 Other technologies — — 7,819 7,819 Technology-enabled services — — 88,421 88,421 Talent planning and acquisition — — 11,667 11,667 Total revenue $ 627,049 $ 150,663 $ 100,088 $ 877,800 Nine Months Ended September 30, 2022 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 2,329,240 $ — $ — $ 2,329,240 Labor disruption services 102,549 — — 102,549 Local staffing 109,265 — — 109,265 Allied staffing 611,226 — — 611,226 Locum tenens staffing — 324,663 — 324,663 Interim leadership staffing — 139,519 — 139,519 Temporary staffing 3,152,280 464,182 — 3,616,462 Permanent placement 5,554 66,173 — 71,727 Language services — — 158,031 158,031 Vendor management systems — — 210,470 210,470 Other technologies — — 21,787 21,787 Technology-enabled services — — 390,288 390,288 Talent planning and acquisition — — 39,254 39,254 Total revenue $ 3,157,834 $ 530,355 $ 429,542 $ 4,117,731 Nine Months Ended September 30, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Travel nurse staffing $ 1,400,629 $ — $ — $ 1,400,629 Labor disruption services 25,126 — — 25,126 Local staffing 80,932 — — 80,932 Allied staffing 401,508 — — 401,508 Locum tenens staffing — 253,190 — 253,190 Interim leadership staffing — 126,584 — 126,584 Temporary staffing 1,908,195 379,774 — 2,287,969 Permanent placement — 50,749 — 50,749 Language services — — 133,706 133,706 Vendor management systems — — 96,086 96,086 Other technologies — — 21,791 21,791 Technology-enabled services — — 251,583 251,583 Talent planning and acquisition — — 30,889 30,889 Total revenue $ 1,908,195 $ 430,523 $ 282,472 $ 2,621,190
Summary of Goodwill by Reportable Segment	The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Balance, January 1, 2022 $ 339,015 $ 152,800 $ 400,526 $ 892,341 Goodwill adjustment for Synzi and SnapMD acquisition — — 33 33 Goodwill from Connetics acquisition 43,301 — — 43,301 Balance, September 30, 2022 $ 382,316 $ 152,800 $ 400,559 $ 935,675 Accumulated impairment loss as of December 31, 2021 and September 30, 2022 $ 154,444 $ 60,495 $ — $ 214,939

Fair Value Measurement (Tables)

Fair Value Measurement (Tables)	9 Months Ended
	Sep. 30, 2022
Fair Value Disclosures [Abstract]
Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis	The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of September 30, 2022 Fair Value Measurements as of December 31, 2021 Assets (Liabilities) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Money market funds $ 125,859 $ — $ — $ 125,859 $ 91,454 $ — $ — $ 91,454 Deferred compensation (116,922) — — (116,922) (119,617) — — (119,617) Corporate bonds — 26,841 — 26,841 — 29,159 — 29,159 Commercial paper — 29,296 — 29,296 — 80,596 — 80,596 Acquisition contingent consideration liabilities — — (6,810) (6,810) — — — —
Reconciliations of Changes in the Fair Value of Contingent Consideration Liabilities	The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Beginning balance $ (8,580) $ — $ — $ (8,000) Settlement of b4health contingent consideration liability for year ended December 31, 2020 — — — 8,000 Contingent consideration liability from Connetics acquisition on May 13, 2022 — — (8,000) — Change in fair value of contingent consideration liability from Connetics acquisition 1,770 — 1,190 — Ending balance $ (6,810) $ — $ (6,810) $ —
Schedule of Fair Value of Financial Instruments	See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report. As of September 30, 2022 As of December 31, 2021 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 447,500 $ 500,000 $ 517,500 2029 Notes 350,000 294,000 350,000 353,500

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	9 Months Ended
	Sep. 30, 2022
Balance Sheet Related Disclosures [Abstract]
Schedule of Supplemental Balance Sheet Disclosures	The consolidated balance sheets detail is as follows: September 30, 2022 December 31, 2021 Other current assets: Restricted cash and cash equivalents $ 27,764 $ 29,262 Income taxes receivable 1,426 — Other 25,314 37,568 Other current assets $ 54,504 $ 66,830 Prepaid expenses: Prepaid payroll deposits $ — $ 60,014 Other 17,019 12,446 Prepaid expenses 17,019 72,460 Fixed assets: Furniture and equipment $ 47,618 $ 43,134 Software 303,197 265,137 Leasehold improvements 2,882 8,797 353,697 317,068 Accumulated depreciation (212,702) (189,954) Fixed assets, net $ 140,995 $ 127,114 Other assets: Life insurance cash surrender value $ 110,279 $ 115,095 Other 42,691 41,575 Other assets $ 152,970 $ 156,670 Accounts payable and accrued expenses: Trade accounts payable $ 84,334 $ 77,325 Subcontractor payable 254,697 261,689 Accrued expenses 89,196 61,220 Loss contingencies 14,933 10,400 Professional liability reserve 7,712 7,127 Other 8,365 7,496 Accounts payable and accrued expenses $ 459,237 $ 425,257 Accrued compensation and benefits: Accrued payroll $ 93,495 $ 98,817 Accrued bonuses and commissions 90,640 105,155 Accrued travel expense 2,312 3,058 Health insurance reserve 7,685 6,041 Workers compensation reserve 11,500 12,384 Deferred compensation 116,922 119,617 Other 16,279 9,309 Accrued compensation and benefits $ 338,833 $ 354,381 Other current liabilities: Acquisition related liabilities $ 6,810 $ — Income taxes payable — 21,162 Client deposits 61,319 141,102 Other 1,761 155 Other current liabilities $ 69,890 $ 162,419 September 30, 2022 December 31, 2021 Other long-term liabilities: Workers compensation reserve $ 22,633 $ 24,130 Professional liability reserve 38,163 34,544 Unrecognized tax benefits 4,785 4,633 Other 32,647 33,682 Other long-term liabilities $ 98,228 $ 96,989

Basis of Presentation - Reconci

Basis of Presentation - Reconciliation of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021	Sep. 30, 2021	Dec. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash and cash equivalents	$ 155,723	$ 180,928
Restricted cash and cash equivalents (included in other current assets)	27,764	29,262
Restricted cash, cash equivalents and investments	64,883	64,482
Total cash, cash equivalents and restricted cash and investments	248,370	274,672
Less restricted investments	(26,841)	(27,958)
Total cash, cash equivalents and restricted cash	$ 221,529	$ 246,714	$ 201,104	$ 83,990

Basis of Presentation - Recon_2

Basis of Presentation - Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 6,838	$ 7,043
Provision for expected credit losses	10,129	325
Amounts written off charged against the allowance	(1,773)	(1,220)
Ending balance	$ 15,194	$ 6,148

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details)	21 Months Ended
	Sep. 30, 2022 acquisition
Business Combination and Asset Acquisition [Abstract]
Number of acquisitions	2

Acquisitions - Connetics Acquis

Acquisitions - Connetics Acquisition (Details) - USD ($) $ in Thousands	May 13, 2022	Sep. 30, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Fair value of contingent earn-out		$ 6,810	$ 0
Goodwill		$ 935,675	$ 892,341
Connetics Communications, LLC
Business Acquisition [Line Items]
Initial purchase price	$ 78,764
Cash consideration	70,764
Contingent earn-out based on future operating performance (up to)	12,500
Fair value of contingent earn-out	8,000
Fair value of tangible assets acquired	3,694
Cash received	963
Liabilities assumed	8,431
Identifiable intangible assets	40,200
Goodwill	43,301
Goodwill expected to be deductible for tax purposes	$ 35,317
Intangible assets acquired, weighted average useful life	13 years
Connetics Communications, LLC | Customer relationships
Business Acquisition [Line Items]
Identifiable intangible assets	$ 32,800
Useful Life	15 years
Connetics Communications, LLC | Staffing database
Business Acquisition [Line Items]
Identifiable intangible assets	$ 4,200
Useful Life	5 years
Connetics Communications, LLC | Tradenames and trademarks
Business Acquisition [Line Items]
Identifiable intangible assets	$ 3,200
Useful Life	5 years

Acquisitions - Synzi and SnapMD

Acquisitions - Synzi and SnapMD Acquisition (Details) - USD ($)			3 Months Ended
	May 13, 2022	Apr. 07, 2021	Jun. 30, 2022	Jun. 30, 2021	Sep. 30, 2022	Dec. 31, 2021	Feb. 09, 2018
Business Acquisition [Line Items]
Goodwill					$ 935,675,000	$ 892,341,000
Synzi
Business Acquisition [Line Items]
Cash consideration		$ 42,240,000
Cash returned to the Company for final working capital settlement				$ 92,000
Purchase price, net of working capital adjustment			$ 42,148,000
Fair value of tangible assets acquired			2,757,000
Cash received			884,000
Liabilities assumed			275,000
Identifiable intangible assets			12,440,000
Goodwill			27,226,000
Goodwill expected to be deductible for tax purposes			$ 6,044,000
Intangible assets acquired, weighted average useful life			7 years
Synzi | Developed Technology Rights
Business Acquisition [Line Items]
Identifiable intangible assets			$ 10,890,000
Synzi | Trademarks
Business Acquisition [Line Items]
Identifiable intangible assets			$ 1,220,000
Connetics Communications, LLC
Business Acquisition [Line Items]
Cash consideration	$ 70,764,000
Cash received	963,000
Liabilities assumed	8,431,000
Identifiable intangible assets	40,200,000
Goodwill	43,301,000
Goodwill expected to be deductible for tax purposes	$ 35,317,000
Intangible assets acquired, weighted average useful life	13 years
Revolving Credit Facility | Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity							$ 400,000,000

Net Income Per Common Share (De

Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Earnings Per Share [Abstract]
Net income	$ 92,445	$ 74,023	$ 362,253	$ 211,171
Net income per common share - basic (in dollars per share)	$ 2.11	$ 1.55	$ 8.04	$ 4.43
Net income per common share - diluted (in dollars per share)	$ 2.10	$ 1.54	$ 7.99	$ 4.40
Weighted average common shares outstanding - basic (in shares)	43,785	47,737	45,056	47,666
Plus dilutive effect of potential common shares (in shares)	254	343	276	356
Weighted average common shares outstanding - diluted (in shares)	44,039	48,080	45,332	48,022
Common stock excluded from calculation of EPS (in shares)	14	21	15	26

Segment Information - Narrative

Segment Information - Narrative (Details)	9 Months Ended
	Sep. 30, 2022 segment
Segment Reporting [Abstract]
Number of reportable segments	3

Segment Information - Reconcili

Segment Information - Reconciliation of Revenue and Segment Operating Income by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 1,138,586	$ 877,800	$ 4,117,731	$ 2,621,190
Segment operating income	136,368	105,829	527,834	309,405
Depreciation and amortization	33,239	26,104	96,169	74,098
Depreciation (included in cost of revenue)	1,091	686	2,918	1,773
Share-based compensation	4,898	2,589	24,670	17,895
Interest expense, net, and other	8,961	5,223	28,630	24,278
Income before income taxes	127,407	100,606	499,204	285,127
Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	828,317	627,049	3,157,834	1,908,195
Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	175,152	150,663	530,355	430,523
Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	135,117	100,088	429,542	282,472
Operating segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	1,138,586	877,800	4,117,731	2,621,190
Segment operating income	210,231	159,075	767,947	478,086
Operating segments | Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	828,317	627,049	3,157,834	1,908,195
Segment operating income	115,182	92,564	471,141	283,768
Operating segments | Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	175,152	150,663	530,355	430,523
Segment operating income	23,904	19,301	64,280	62,366
Operating segments | Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	135,117	100,088	429,542	282,472
Segment operating income	71,145	47,210	232,526	131,952
Unallocated corporate overhead
Segment Reporting, Revenue Reconciling Item [Line Items]
Unallocated corporate overhead	$ 34,635	$ 23,867	$ 116,356	$ 74,915

Segment Information - Disaggreg

Segment Information - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Segment Reporting Information [Line Items]
Revenue	$ 1,138,586	$ 877,800	$ 4,117,731	$ 2,621,190
Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	828,317	627,049	3,157,834	1,908,195
Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	175,152	150,663	530,355	430,523
Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	135,117	100,088	429,542	282,472
Travel nurse staffing
Segment Reporting Information [Line Items]
Revenue	583,463	444,803	2,329,240	1,400,629
Travel nurse staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	583,463	444,803	2,329,240	1,400,629
Travel nurse staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Travel nurse staffing | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Labor disruption services
Segment Reporting Information [Line Items]
Revenue	19,479	22,573	102,549	25,126
Labor disruption services | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	19,479	22,573	102,549	25,126
Labor disruption services | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Labor disruption services | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Local staffing
Segment Reporting Information [Line Items]
Revenue	31,814	23,272	109,265	80,932
Local staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	31,814	23,272	109,265	80,932
Local staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Local staffing | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Allied staffing
Segment Reporting Information [Line Items]
Revenue	190,044	136,401	611,226	401,508
Allied staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	190,044	136,401	611,226	401,508
Allied staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Allied staffing | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Locum tenens staffing
Segment Reporting Information [Line Items]
Revenue	106,055	88,994	324,663	253,190
Locum tenens staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Locum tenens staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	106,055	88,994	324,663	253,190
Locum tenens staffing | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Interim leadership staffing
Segment Reporting Information [Line Items]
Revenue	47,559	43,814	139,519	126,584
Interim leadership staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Interim leadership staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	47,559	43,814	139,519	126,584
Interim leadership staffing | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Temporary staffing
Segment Reporting Information [Line Items]
Revenue	978,414	759,857	3,616,462	2,287,969
Temporary staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	824,800	627,049	3,152,280	1,908,195
Temporary staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	153,614	132,808	464,182	379,774
Temporary staffing | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Permanent placement
Segment Reporting Information [Line Items]
Revenue	25,055	17,855	71,727	50,749
Permanent placement | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	3,517	0	5,554	0
Permanent placement | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	21,538	17,855	66,173	50,749
Permanent placement | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Language services
Segment Reporting Information [Line Items]
Revenue	55,502	47,135	158,031	133,706
Language services | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Language services | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Language services | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	55,502	47,135	158,031	133,706
Vendor management systems
Segment Reporting Information [Line Items]
Revenue	60,304	33,467	210,470	96,086
Vendor management systems | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Vendor management systems | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Vendor management systems | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	60,304	33,467	210,470	96,086
Other technologies
Segment Reporting Information [Line Items]
Revenue	7,290	7,819	21,787	21,791
Other technologies | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Other technologies | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Other technologies | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	7,290	7,819	21,787	21,791
Technology-enabled services
Segment Reporting Information [Line Items]
Revenue	123,096	88,421	390,288	251,583
Technology-enabled services | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Technology-enabled services | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Technology-enabled services | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	123,096	88,421	390,288	251,583
Talent planning and acquisition
Segment Reporting Information [Line Items]
Revenue	12,021	11,667	39,254	30,889
Talent planning and acquisition | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Talent planning and acquisition | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Talent planning and acquisition | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	$ 12,021	$ 11,667	$ 39,254	$ 30,889

Segment Information - Summary o

Segment Information - Summary of Goodwill by Reportable Segment (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 892,341
Goodwill, ending balance	935,675
Accumulated impairment loss	214,939	$ 214,939
Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	33
Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	43,301
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	339,015
Goodwill, ending balance	382,316
Accumulated impairment loss	154,444	154,444
Nurse and Allied Solutions | Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	0
Nurse and Allied Solutions | Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	43,301
Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	152,800
Goodwill, ending balance	152,800
Accumulated impairment loss	60,495	60,495
Physician and Leadership Solutions | Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	0
Physician and Leadership Solutions | Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	0
Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	400,526
Goodwill, ending balance	400,559
Accumulated impairment loss	0	$ 0
Technology and Workforce Solutions | Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	33
Technology and Workforce Solutions | Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	$ 0

Fair Value Measurement - Narrat

Fair Value Measurement - Narrative (Details) - USD ($)	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021	Oct. 20, 2020	Aug. 13, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Asset impairment charges	$ 0	$ 0
2027 Notes | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate					4.625%
2029 Notes | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4%
Fair Value, Measurements, Nonrecurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	22,633,000		$ 22,633,000
Commercial paper | Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	29,296,000		80,596,000
Commercial paper | Fair Value, Measurements, Recurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	29,296,000		80,596,000
Securities classified as available-for-sale	0		0
Corporate bonds | Fair Value, Measurements, Recurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	26,841,000		29,159,000
Securities classified as available-for-sale	$ 26,841,000		$ 27,958,000

Fair Value Measurement - Financ

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Deferred compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ (116,922)	$ (119,617)
Deferred compensation | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(116,922)	(119,617)
Deferred compensation | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Deferred compensation | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Acquisition contingent consideration liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(6,810)	0
Acquisition contingent consideration liabilities | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Acquisition contingent consideration liabilities | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Acquisition contingent consideration liabilities | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(6,810)	0
Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	125,859	91,454
Money market funds | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	125,859	91,454
Money market funds | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Money market funds | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	26,841	29,159
Corporate bonds | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Corporate bonds | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	26,841	29,159
Corporate bonds | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	29,296	80,596
Commercial paper | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Commercial paper | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	29,296	80,596
Commercial paper | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ 0	$ 0

Fair Value Measurement - Reconc

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Fair Value, Measurements, Recurring
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (8,580)	$ 0	$ 0	$ (8,000)
Ending balance	(6,810)	0	(6,810)	0
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of b4health contingent consideration liability for year ended December 31, 2020	0	0	0	8,000
Connetics Communications, LLC
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration liability from Connetics acquisition on May 13, 2022	0	0	(8,000)	0
Change in fair value of contingent consideration liability from Connetics acquisition	$ 1,770	$ 0	$ 1,190	$ 0

Fair Value Measurement - Fair V

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000	$ 500,000
Estimated Fair Value	447,500	517,500
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000	350,000
Estimated Fair Value	$ 294,000	$ 353,500

Income Taxes (Details)

Income Taxes (Details) $ in Thousands	Sep. 30, 2022 USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,452
Employee retention tax credit, CARES Act	$ 1,756

Commitments and Contingencies (

Commitments and Contingencies (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Mar. 31, 2022
Commitments and Contingencies [Line Items]
Future undiscounted lease payments		$ 29,514
Lease term		11 years
Wage and Hour claims | Pending Litigation
Commitments and Contingencies [Line Items]
Litigation matters accrual	$ 37,225

Balance Sheet Details (Details)

Balance Sheet Details (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Other current assets:
Restricted cash and cash equivalents	$ 27,764	$ 29,262
Income taxes receivable	1,426	0
Other	25,314	37,568
Other current assets	54,504	66,830
Prepaid expenses:
Prepaid payroll deposits	0	60,014
Other	17,019	12,446
Prepaid expenses	17,019	72,460
Fixed assets:
Furniture and equipment	47,618	43,134
Software	303,197	265,137
Leasehold improvements	2,882	8,797
Fixed assets, gross	353,697	317,068
Accumulated depreciation	(212,702)	(189,954)
Fixed assets, net	140,995	127,114
Other assets:
Life insurance cash surrender value	110,279	115,095
Other	42,691	41,575
Other assets	152,970	156,670
Accounts payable and accrued expenses:
Trade accounts payable	84,334	77,325
Subcontractor payable	254,697	261,689
Accrued expenses	89,196	61,220
Loss contingencies	14,933	10,400
Professional liability reserve	7,712	7,127
Other	8,365	7,496
Accounts payable and accrued expenses	459,237	425,257
Accrued compensation and benefits:
Accrued payroll	93,495	98,817
Accrued bonuses and commissions	90,640	105,155
Accrued travel expense	2,312	3,058
Health insurance reserve	7,685	6,041
Workers compensation reserve	11,500	12,384
Deferred compensation	116,922	119,617
Other	16,279	9,309
Accrued compensation and benefits	338,833	354,381
Other current liabilities:
Acquisition related liabilities	6,810	0
Income taxes payable	0	21,162
Client deposits	61,319	141,102
Other	1,761	155
Other current liabilities	69,890	162,419
Other long-term liabilities:
Workers compensation reserve	22,633	24,130
Professional liability reserve	38,163	34,544
Unrecognized tax benefits	4,785	4,633
Other	32,647	33,682
Other long-term liabilities	$ 98,228	$ 96,989