0001628280-24-006454 | 10-K | XBRL Viewer | Cross Country Healthcare INC

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Debt - Note Payable (Details) $ in Thousands		3 Months Ended				12 Months Ended
Debt - Note Payable (Details) $ in Thousands	Oct. 30, 2015 installment liability	Mar. 31, 2022 USD ($)	Mar. 31, 2021 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($) installment	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Debt Instrument [Line Items]
Payment for contingent liability						$ 7,500	$ 7,500	$ 0
Payments of notes payable						$ 0	$ 2,426	$ 2,426
Mediscan
Debt Instrument [Line Items]
Number of contingent liabilities assumed \| liability	2
Recognition of earnout payment liability					$ 7,400
Payment for contingent liability					$ 100
Mediscan \| Earnout Notes Payable
Debt Instrument [Line Items]
Note payable, number of payment installments \| installment	3				3
Earnout performance criterion, conversion to note payable					$ 7,300
Payments of notes payable		$ 2,600	$ 2,400	$ 2,400
Stated interest rate (percent)		2.00%

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Acquisitions

12 Months Ended

Dec. 31, 2023

Business Combination and Asset Acquisition [Abstract]

Acquisitions

HireUp

On December 13, 2022, the Company purchased and acquired substantially all of the assets and assumed certain liabilities of HireUp Leadership Inc. (HireUp) for a purchase price of $6.0 million in cash, subject to adjustment, and $0.8 million in shares (or 29,811 shares) of the Company's common stock. The transaction was treated as a purchase of assets for income tax purposes.

The sellers were eligible to receive up to an additional $8.0 million total in earnout cash consideration based on HireUp's revenues and Adjusted EBITDA for each of the twelve-month periods ending on the first and second anniversaries of the first day after the closing date. Quarterly throughout 2023, the Company performed analyses using multiple updated forecast scenarios and determined that the earnout would only be partially achieved. As a result, the Company recognized a decrease in the fair value of the related liabilities in the second and third quarters of 2023. The liability of $1.9 million is included in the current portion of earnout liability on the consolidated balance sheets. See Note 10 - Fair Value Measurements.

During the quarter ended March 31, 2023, the Company assigned the following values to other identifiable intangible assets: (i) $0.9 million to trade names with a weighted average estimated useful life of 2 years; (ii) $2.5 million to a customer list with a weighted average estimated useful life of 10 years; and (iii) $3.5 million to a database with a weighted average estimated useful life of 7 years, for a total of $6.9 million in definite life intangible assets with a weighted average estimated useful life of 7 years.

The remaining excess purchase price over the fair value of net assets acquired of $1.6 million was recorded as goodwill on the Company's consolidated balance sheets. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

Mint

On October 3, 2022, the Company purchased and acquired substantially all of the assets and assumed certain liabilities of Mint Medical Physician Staffing, LP and Lotus Medical Staffing LLC (collectively, Mint) for a purchase price of $27.0 million in cash, subject to adjustment, and $3.6 million in shares (or 114,278 shares) of the Company's common stock. The transaction was treated as a purchase of assets for income tax purposes.

The sellers are eligible to receive up to an additional $10.0 million in earnout cash consideration based on Mint's revenues and gross profit for each of the twelve-month periods ending on the first and second anniversaries of the first day of the calendar month following the closing date. In the fourth quarter of 2023, the Company performed the earnout calculation for the first measurement period, resulting in an earnout of $4.9 million, which is included in the current portion of earnout liability, and the long-term portion of the liability of $5.0 million is included in the non-current portion of earnout liability on the consolidated balance sheets. The earnout for the first measurement period was paid in the first quarter of 2024. See Note 10 - Fair Value Measurements.

During the quarter ended March 31, 2023, the Company assigned the following values to other identifiable intangible assets: (i) $0.4 million to trade names with a weighted average estimated useful life of 1 year; (ii) $2.3 million to a customer list with a weighted average estimated useful life of 11 years; and (iii) $12.4 million to a database with a weighted average estimated useful life of 7 years, for a total of $15.1 million in definite life intangible assets with a weighted average estimated useful life of 7 years.

The remaining excess purchase price over the fair value of net assets acquired of $20.1 million was recorded as goodwill on the Company's consolidated balance sheets. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

Local Business

On December 15, 2022, the Company purchased and acquired certain assets and assumed certain liabilities of an Ohio based business for a purchase price of $2.0 million in cash, subject to customary post-closing adjustments. The transaction was treated as a purchase of assets for income tax purposes.

During the quarter ended March 31, 2023, an immaterial amount was recorded as goodwill on the Company's consolidated balance sheets. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

The above acquisitions made in 2022, HireUp, Mint, and a local business, both individually and in the aggregate, were not significant and have been accounted for using the acquisition method of accounting. The pro-forma impact on the Company's consolidated revenue from services and net income, including the pro forma effect of events that are directly attributable to the acquisitions, was not significant.

Selected

On December 16, 2021, the Company purchased and acquired substantially all of the assets and assumed certain liabilities of Selected, Inc. (Selected) for a purchase price of $3.5 million in cash, subject to adjustment, and $1.5 million in shares (or 59,429 shares) of the Company's common stock. The transaction was treated as a purchase of assets for income tax purposes.

The sellers were eligible to receive up to an additional $1.5 million in earnout cash consideration, based on Selected's revenues for each of the twelve-month periods ending on the first and second anniversaries of the first day after the closing date. In the second quarter of 2022, the Company determined that the contingent consideration earnout related to the Selected acquisition would not be achieved for 2022 and 2023 and, as a result, the entire liability was reversed.

During the quarter ended June 30, 2022, the Company assigned the following values to other identifiable intangible assets: (i) an immaterial amount to trade names with a weighted average estimated useful life of 2 years; (ii) $1.7 million to software with a weighted average estimated useful life of 5 years; and (iii) $2.9 million to a database, consisting of education professionals, with a weighted average estimated useful life of 5 years, for a total of $4.6 million in definite life intangible assets with a weighted average estimated useful life of 5 years.

The remaining excess purchase price over the fair value of net assets acquired of $0.4 million was recorded as goodwill on the Company's consolidated balance sheets. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

The acquisition was not significant and has been accounted for using the acquisition method of accounting. The pro-forma impact on the Company's consolidated revenue from services and net income, including the pro forma effect of events that are directly attributable to the acquisition, was not significant.

Cross Country Workforce Solutions Group (CCWSG)

On June 8, 2021, the Company purchased and acquired substantially all of the assets and assumed certain liabilities of Workforce Solutions Group, Inc. (WSG) for a purchase price of $25.0 million in cash and $5.0 million in shares (or 307,730 shares) of the Company's common stock. The parties agreed to a final net working capital reduction of $1.1 million which was received in the fourth quarter of 2021. Included in the amount paid at closing and held in an escrow account was $2.0 million related to potential wage and hour indemnification claims. On December 16, 2022, this amount was released from escrow to the seller. The transaction was treated as a purchase of assets for income tax purposes.

The sellers were eligible to receive an earnout based on the business’ performance through three years after the acquisition date that could provide up to an additional $15.0 million in cash. In the third quarter of 2022, the Company determined that the contingent consideration earnout was achieved for the 2021 through 2022 period and, as a result, the Company made a $7.5 million earnout payment. In the third quarter of 2023, the Company determined that the contingent consideration earnout was achieved for the 2022 through 2023 period and, as a result, the Company made the final $7.5 million earnout payment. See Note 10 - Fair Value Measurements.

The following table summarizes the fair value of the assets acquired and liabilities assumed on June 8, 2021:


	(amounts in thousands)
Cash and cash equivalents	$	957
Accounts receivable	11,991
Other current assets	59
Property and equipment	10
Right-of-use assets	1,078
Goodwill	22,066
Other intangible assets	14,200
Total assets acquired	50,361
Accounts payable and accrued expenses	3,562
Accrued compensation and benefits	1,387
Lease liability - current	316
Lease liability - non-current	762
Earnout liability	15,000
Total liabilities assumed	21,027
Net assets acquired	$	29,334

During the quarter ended September 30, 2021, the Company assigned a value to other identifiable intangible assets of $14.2 million in customer relationships with a weighted average estimated useful life of 11.5 years.

The remaining excess purchase price over the fair value of net assets acquired of $22.1 million was recorded as goodwill on the Company's consolidated balance sheets. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

Acquisition-related costs

Acquisition-related costs associated with the Company's acquisitions of $1.1 million for the year ended December 31, 2021, and an immaterial amount for the years ended December 31, 2023 and 2022, have been included in selling, general and administrative expenses on its consolidated statements of operations and comprehensive income.

Mediscan

In the first quarter of 2020, the Company entered into a note payable of $7.3 million related to contingent consideration assumed as part of the Mediscan acquisition, payable in three installments. The first two installments of $2.4 million each were paid in the second quarter of 2020 and in the first quarter of 2021, respectively. The third and final installment of $2.6 million, including interest, was paid in the first quarter of 2022.

Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Property and equipment	$ 43,147	$ 37,344
Less accumulated depreciation and amortization	(15,808)	(17,682)
Property and equipment, net of accumulated depreciation and amortization	27,339	19,662
Computer equipment
Property, Plant and Equipment [Line Items]
Property and equipment	5,236	6,167
Computer software
Property, Plant and Equipment [Line Items]
Property and equipment	$ 34,531	22,518
Office equipment
Property, Plant and Equipment [Line Items]
Estimated useful life	5 years
Property and equipment	$ 467	473
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Estimated useful life	7 years
Property and equipment	$ 703	2,078
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment	998	3,462
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment	$ 1,212	$ 2,646
Minimum
Property, Plant and Equipment [Line Items]
Estimated useful life	1 year
Minimum \| Computer equipment
Property, Plant and Equipment [Line Items]
Estimated useful life	3 years
Minimum \| Computer software
Property, Plant and Equipment [Line Items]
Estimated useful life	1 year
Maximum
Property, Plant and Equipment [Line Items]
Estimated useful life	10 years
Maximum \| Computer equipment
Property, Plant and Equipment [Line Items]
Estimated useful life	5 years
Maximum \| Computer software
Property, Plant and Equipment [Line Items]
Estimated useful life	10 years

Cover - USD ($)	12 Months Ended
Cover - USD ($)	Dec. 31, 2023	Feb. 14, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	0-33169
Entity Registrant Name	Cross Country Healthcare, Inc
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	13-4066229
Entity Address, Address Line One	6551 Park of Commerce Boulevard, N.W.
Entity Address, City or Town	Boca Raton
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33487
City Area Code	561
Local Phone Number	998-2232
Title of 12(b) Security	Common Stock, par value $0.0001 per share
Trading Symbol	CCRN
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
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
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 926,700,597
Entity Common Stock, Shares Outstanding		34,725,677
Documents Incorporated by Reference	Portions of the Registrant’s definitive proxy statement for the 2023 Annual Meeting of Stockholders, which statement will be filed pursuant to Regulation 14A not later than 120 days after the end of the fiscal year covered by this report, are incorporated by reference into Part III hereof.
Entity Central Index Key	0001141103
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Amendment Flag	false

Schedule II - Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Allowances for Accounts Receivable
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	$ 14,696	$ 6,881	$ 4,021
Charged to (Released from) Operations	17,355	15,327	6,499
Write-Offs, Net of Recoveries	(11,504)	(7,512)	(3,639)
Other Changes	0	0	0
Balance at End of Period	20,547	14,696	6,881
Valuation Allowance for Deferred Tax Assets
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	2	20	37,472
Charged to (Released from) Operations	0	0	(37,449)
Write-Offs, Net of Recoveries	0	(18)	0
Other Changes	0	0	(3)
Balance at End of Period	$ 2	$ 2	$ 20

Segment Data (Tables)

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Schedule of Information on Operating Segments and Reconciliation to Income From Operations

Information on operating segments and a reconciliation to income from operations for the periods indicated are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Revenues from services:
Nurse and Allied Staffing	$	1,841,428	$	2,700,383	$	1,605,781
Physician Staffing	178,300		106,226		70,871
	$	2,019,728	$	2,806,609	$	1,676,652
Contribution income:
Nurse and Allied Staffing	$	196,777	$	355,447	$	205,738
Physician Staffing	9,788		5,508		4,328
	206,565		360,955		210,066

Corporate overhead(a)	71,049		67,087		55,142
Depreciation and amortization	18,347		12,576		9,852


Restructuring costs	2,553		1,861		2,630
Legal settlement charges	1,125		—		—
Impairment charges	719		5,597		2,070
Other costs(b)	59		726		1,068
Income from operations	$	112,713	$	273,108	$	139,304

_______________

(a) Corporate overhead includes unallocated executive leadership and other centralized corporate functional support costs such as finance, IT, legal, human resources, and marketing, as well as public company expenses and corporate-wide projects (initiatives).

(b) Other costs include acquisition and integration-related costs.

Goodwill, Trade Names, and Other Intangible Assets - Goodwill Rollforward (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)
Goodwill balances
Aggregate goodwill acquired, beginning of period	$ 473,740
Accumulated impairment loss, beginning of period	(310,472)
Goodwill, net of impairment loss, beginning of period	163,268
Goodwill acquisition adjustments	(27,838)
Aggregate goodwill acquired, end of period	445,902
Accumulated impairment loss, end of period	(310,472)
Goodwill, net of impairment loss, end of period	135,430
Nurse And Allied Staffing
Goodwill balances
Aggregate goodwill acquired, beginning of period	395,119
Accumulated impairment loss, beginning of period	(269,874)
Goodwill, net of impairment loss, beginning of period	125,245
Goodwill acquisition adjustments	(12,738)
Aggregate goodwill acquired, end of period	382,381
Accumulated impairment loss, end of period	(269,874)
Goodwill, net of impairment loss, end of period	112,507
Physician Staffing
Goodwill balances
Aggregate goodwill acquired, beginning of period	78,621
Accumulated impairment loss, beginning of period	(40,598)
Goodwill, net of impairment loss, beginning of period	38,023
Goodwill acquisition adjustments	(15,100)
Aggregate goodwill acquired, end of period	63,521
Accumulated impairment loss, end of period	(40,598)
Goodwill, net of impairment loss, end of period	$ 22,923

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

Earnings Per Share - Antidilutive Securities (Details) - shares shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	2	55	6

Leases - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
Leases - Narrative (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Right of use impairment charge	$ 0.0	$ 2.8	$ 1.7
Impairment of long-lived assets held-for-use	$ 0.0	$ 0.9	$ 0.0
Impairment, Long Lived Asset, Held For Use, Statement Of Income Or Comprehensive Income Extensible Enumeration Not Disclosed Flag	leasehold improvements	leasehold improvements	leasehold improvements

Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Schedule of Components of Numerator and Denominator for Computation of Basic and Diluted Earnings per Share

The following table sets forth the components of the numerator and denominator for the computation of the basic and diluted earnings per share:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands, except per share data)
Numerator:



Net income attributable to common stockholders - Basic and Diluted	$	72,631	$	188,461	$	132,002

Denominator:
Weighted average common shares - Basic	35,158		37,012		36,689
Effective of diluted shares:
Share-based awards	318		524		703

Weighted average common shares - Diluted	35,476		37,536		37,392

Net income per share attributable to common stockholders - Basic	$	2.07	$	5.09	$	3.60

Net income per share attributable to common stockholders - Diluted	$	2.05	$	5.02	$	3.53

Schedule of Antidilutive Securities

The following table represents the share-based awards that could potentially dilute net income per share attributable to common stockholders in the future that were not included in the computation of diluted net income per share attributable to common stockholders because to do so would have been anti-dilutive for the periods presented.


	Year Ended December 31,
	2023	2022	2021
	(amounts in thousands)
Share-based awards	2	55	6

Leases - Operating Lease Liability Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
2024	$ 2,850
2025	2,185
2026	318
2027	180
2028	114
Total minimum lease payments	5,647
Less: amount of lease payments representing interest	(380)
Present value of future minimum lease payments	5,267
Less: operating lease liabilities - current	(2,604)	$ (4,132)
Operating lease liabilities - non-current	$ 2,663	$ 4,880

Property and Equipment

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Property and Equipment

The Company’s property and equipment consists of the following:


		December 31,
	Useful Lives	2023		2022
		(amounts in thousands)
Computer equipment	3-5 years	$	5,236	$	6,167
Computer software	1-10 years	34,531		22,518
Office equipment	5 years	467		473
Furniture and fixtures	7 years	703		2,078
Construction in progress	(a)	998		3,462
Leasehold improvements	(b)	1,212		2,646
		43,147		37,344
Less accumulated depreciation and amortization		(15,808)		(17,682)
		$	27,339	$	19,662

_______________

(a) Primarily related to software development.

(b) See Note 2 – Summary of Significant Accounting Policies.

Contingencies (Details) $ in Millions	Dec. 31, 2023 state	Sep. 30, 2021 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Legal fees to be recovered \| $		$ 1.6
Number of states operated in \| state	50

Leases

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Leases

The Company’s lease population of its right-of-use assets and lease liabilities is substantially related to the rental of office space. The Company enters into lease agreements as a lessee that may include options to extend or terminate early. Some of these real estate leases require variable payments of property taxes, insurance, and common area maintenance, in addition to base rent. Certain of the leases have provisions for free rent months during the lease term and/or escalating rent payments and, particularly for the Company’s longer-term leases for its corporate offices, it has received incentives to enter into the leases, such as receiving up to a specified dollar amount to construct tenant improvements. These leases do not include residual value guarantees, covenants, or other restrictions. See Note 2 - Summary of Significant Accounting Policies.

Beginning in the second quarter of 2020, in connection with the global pandemic, the Company expedited restructuring plans and either reduced or fully vacated leased office space. The decision and change in the use of space resulted in a right-of-use asset impairment charge of $2.8 million and $1.7 million for the years ended December 31, 2022 and 2021, respectively, and an immaterial right-of-use asset impairment charge for the year ended December 31, 2023. These losses were determined by comparing the fair value of the impacted right-of-use assets to the carrying value of the assets as of the impairment measurement date. The fair value of the right-of-use assets was based on the estimated sublease income for the space taking into consideration the time period it will take to obtain a subtenant, the applicable discount rate, and the sublease rate. For the year ended December 31, 2022, the Company wrote off a total of $0.9 million of leasehold improvements and other property and equipment related to these locations, and wrote off an immaterial amount in 2023 and 2021. The measurement of the right-of-use asset impairments, using the assumptions described, is a Level 3 fair value measurement. See Note 10 - Fair Value Measurements for a description of Level 3 inputs.

The table below presents the lease-related assets and liabilities included on the consolidated balance sheets:


Classification on Consolidated Balance Sheets:	December 31, 2023			December 31, 2022
	(amounts in thousands)
Operating lease right-of-use assets	$	2,599		$	3,254
Operating lease liabilities - current	$	2,604		$	4,132
Operating lease liabilities - non-current	$	2,663		$	4,880

	December 31, 2023			December 31, 2022
Weighted average remaining lease term	2.2 years			2.3 years
Weighted average discount rate	6.36		%	6.31		%

The table below reconciles the undiscounted cash flows for each of, and total of, the remaining years to the operating lease liabilities (which do not include short-term leases) recorded on the consolidated balance sheets as of December 31, 2023:


Years Ending December 31:	(amounts in thousands)
2024	$	2,850
2025	2,185
2026	318
2027	180
2028	114

Total minimum lease payments	5,647
Less: amount of lease payments representing interest	(380)
Present value of future minimum lease payments	5,267
Less: operating lease liabilities - current	(2,604)
Operating lease liabilities - non-current	$	2,663

Other Information

The table below provides information regarding supplemental cash flows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Supplemental Cash Flow Information:
Cash paid for amounts included in the measurement of operating lease liabilities	$	4,859	$	5,753	$	6,150
Right-of-use assets acquired under operating lease	$	1,040	$	473	$	1,059

The components of lease expense are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Amounts Included in Consolidated Statements of Operations and Comprehensive Income:
Operating lease expense	$	1,681	$	2,550	$	3,538
Short-term lease expense	$	3,209	$	5,114	$	3,695
Variable and other lease costs	$	724	$	2,195	$	1,957

Operating lease expense, short-term lease expense, and variable and other lease costs are included in selling, general and administrative expenses, direct operating expenses, and restructuring costs in the consolidated statements of operations and comprehensive income, depending on the nature of the leased asset. Operating lease expense is reported net of sublease income, which is not material. Variable and other lease costs for the year ended December 31, 2022 include a benefit associated with the early termination of a lease for one of the Company's corporate offices which was previously restructured.

As of December 31, 2023, the Company did not have any material operating leases which had not yet commenced. The Company had an immaterial amount of finance lease contracts related to other equipment rentals for the years ended December 31, 2022 and 2021, which are not included in the above disclosures, and no finance lease contracts for the year ended December 31, 2023.

Revenue Recognition

12 Months Ended

Dec. 31, 2023

Revenue from Contract with Customer [Abstract]

Revenue Recognition

The Company's revenues from customer contracts are generated from temporary staffing services and other services. Revenue is disaggregated by segment in the following table. See Note 2 - Summary of Significant Accounting Policies.


	Year Ended December 31, 2023
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	1,794,489	$	169,077	$	1,963,566
Other Services	46,939		9,223		56,162
Total	$	1,841,428	$	178,300	$	2,019,728


	Year Ended December 31, 2022
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	2,629,088	$	101,440	$	2,730,528
Other Services	71,295		4,786		76,081
Total	$	2,700,383	$	106,226	$	2,806,609









	Year Ended December 31, 2021
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	1,568,974	$	67,843	$	1,636,817
Other Services	36,807		3,028		39,835
Total	$	1,605,781	$	70,871	$	1,676,652

See Note 17 - Segment Data.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-9

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-10

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-15

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-13

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 606
-Publisher FASB
-URI https://asc.fasb.org//606/tableOfContent

+ Details

Related Party Transactions	12 Months Ended
Related Party Transactions	Dec. 31, 2023
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions The Company has entered into an arrangement for digital marketing services provided by a firm that is related to Mr. Kevin C. Clark, the Company's non-executive Chairman of the Board of Directors since April 1, 2022, and the Company's Co-Founder & Chief Executive Officer through March 31, 2022. Mr. Clark is a minority shareholder in the firm's parent company and is a member of the parent company's Board of Directors. Management believes the terms of the arrangement are equivalent to those prevailing in an arm's-length transaction and have been approved by the Company through its related party process. The digital marketing firm manages a limited number of digital publishers covering various Company brands for a monthly management fee. In 2023, 2022, and 2021, the Company incurred an immaterial amount in expenses. The Company had an immaterial payable balance at December 31, 2023 and 2022. The Company provides services to entities which are affiliated with certain members of the Company’s Board of Directors. Management believes the services were conducted on terms equivalent to those prevailing in an arm's-length transaction. Revenue related to these transactions was $1.2 million, $1.8 million and $0.7 million, respectively, for the years ended December 31, 2023, 2022 and 2021. Accounts receivable due from these entities was an immaterial amount at December 31, 2023 and 2022. Following the WSG acquisition on June 8, 2021, the Company continued to rent WSG's headquarters. The Chief Executive Officer and Founder of WSG, who is currently a business unit president with the Company, was an agent of the lessor. The lease for WSGs headquarters was terminated at the end of the first quarter of 2023. The Company paid an immaterial amount in rent expense for these premises for the years ended December 31, 2023, 2022 and 2021, and had no payable balance at December 31, 2023 or 2022. In the first quarter of 2020, the Company entered into a note payable of $7.3 million related to contingent consideration assumed as part of a prior period acquisition, payable in three equal installments. The payees of the note are controlled by an employee of the sellers who remained with the Company. The third and final installment of $2.6 million, including interest, was paid in the first quarter of 2022. See Note 4 - Acquisitions.

- Definition

The entire disclosure for related party transactions. Examples of related party transactions include transactions between (a) a parent company and its subsidiary; (b) subsidiaries of a common parent; (c) and entity and its principal owners; and (d) affiliates.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-2

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 5
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-5

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-6

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(2)(g)(3))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483575/946-220-S99-1

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(2)(c))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483575/946-220-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(2)(e))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483575/946-220-S99-1

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//850/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-6

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

+ Details

Segment Data - Narrative (Details)	3 Months Ended
Segment Data - Narrative (Details)	Mar. 31, 2021 segment
Segment Reporting [Abstract]
Number of reportable segments	2

Acquisitions - Mediscan (Details) $ in Thousands		3 Months Ended			12 Months Ended
Acquisitions - Mediscan (Details) $ in Thousands	Oct. 30, 2015 installment liability	Mar. 31, 2022 USD ($)	Mar. 31, 2021 USD ($)	Jun. 30, 2020 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Mar. 31, 2020 USD ($) installment
Business Acquisition [Line Items]
Payments of notes payable					$ 0	$ 2,426	$ 2,426
Mediscan
Business Acquisition [Line Items]
Number of contingent liabilities assumed \| liability	2
Mediscan \| Earnout Notes Payable
Business Acquisition [Line Items]
Notes payable								$ 7,300
Note payable, number of payment installments \| installment	3							3
Payments of notes payable		$ 2,600	$ 2,400	$ 2,400

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Schedule of Components of Loss Before Income Taxes

The components of the Company's income before income taxes are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
United States	$	102,200	$	255,661	$	132,809
Foreign	694		664		399
Income before income taxes	$	102,894	$	256,325	$	133,208

Schedule of Components of Income Tax Expense (Benefit)

The components of the Company’s income tax expense are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Current:
Federal	$	19,871	$	48,664	$	5,165
State	8,940		13,919		5,638
Foreign	148		219		330
Total	28,959		62,802		11,133
Deferred:
Federal	554		383		892
State	596		4,623		(10,648)
Foreign	154		56		(171)
Total	1,304		5,062		(9,927)
Income tax expense	$	30,263	$	67,864	$	1,206

Schedule of Significant Components of Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities are as follows:


	December 31,
	2023		2022
	(amounts in thousands)




























Deferred Tax Assets:
Accrued other and prepaid expenses	$	912	$	96
Allowance for doubtful accounts	5,321		3,471
Intangible assets	7,072		7,518
Net operating loss carryforwards	1,054		1,389

Accrued professional liability	851		1,118
Accrued workers’ compensation	3,097		3,631
Share-based compensation	1,197		992
Operating lease liabilities	1,319		2,228

Credit carryforwards	—		1
Other	1,016		630
Gross deferred tax assets	21,839		21,074
Valuation allowance	(2)		(2)
	21,837		21,072
Deferred Tax Liabilities:
Depreciation	(967)		(1,411)

Indefinite-lived intangibles	(14,296)		(11,829)
Operating lease right-of-use assets	(620)		(740)
Tax on unrepatriated earnings	(401)		(247)

	(16,284)		(14,227)
Net deferred taxes	$	5,553	$	6,845

Schedule of Reconciliation of Income Tax Computed At U. S. Federal Statutory Rate to Income Tax (Benefit) Expense

The reconciliation of income tax computed at the U.S. federal statutory rate to income tax expense is as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Tax at U.S. statutory rate	$	21,608	$	53,828	$	27,974
State taxes, net of federal benefit	6,834		15,423		8,573
Noncontrolling interest	—		—		(5)
Non-deductible items(a)	573		179		550
Foreign tax expense	155		136		76
Valuation allowances	1		1		(37,450)
Uncertain tax positions	2,771		(1,694)		1,891


Officers' compensation	(275)		404		344


Return to provision	(482)		(169)		44
Other	(922)		(244)		(791)
Income tax expense	$	30,263	$	67,864	$	1,206

________________

(a) Includes non-deductible meals and incidentals and other miscellaneous non-deductible items.

Schedule of Reconciliation of Beginning and Ending Amounts of Unrecognized Tax Benefits

A reconciliation of the beginning and ending amounts of unrecognized tax benefits is as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Balance at January 1	$	7,581	$	9,179	$	6,891
Additions based on tax positions related to the current year	2,737		349		1,873

Additions (reductions) based on tax positions related to prior years	59		(1,947)		—
Reductions as a result of a lapse of applicable statute of limitations	—		—		(47)

Other	—		—		462
Balance at December 31	$	10,377	$	7,581	$	9,179

Debt - 2019 Asset-Based Loan Agreement (Details) - USD ($)			12 Months Ended
	Mar. 21, 2022	Oct. 25, 2019	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Nov. 18, 2021	Mar. 08, 2021	Jun. 30, 2020
Line of Credit Facility [Line Items]
Debt issuance costs		$ 1,300,000	$ 0	$ 3,237,000	$ 6,098,000
Amount of indebtedness permitted from other sources						$ 175,000,000
August 2017 Credit Facility
Line of Credit Facility [Line Items]
Repayments of outstanding debt		$ 75,400,000
Senior Secured Asset-Based Loan
Line of Credit Facility [Line Items]
Line of credit term	5 years	5 years
Maximum borrowing capacity	$ 300,000,000	$ 120,000,000					$ 150,000,000	$ 130,000,000
Letters of credit outstanding		$ 21,200,000	13,800,000
Borrowing base, percentage of assets		85.00%
Borrowing base availability			220,600,000
Remaining borrowing capacity			$ 206,800,000
Unused commitment fee percentage			0.375%
Senior Secured Asset-Based Loan \| SOFR
Line of Credit Facility [Line Items]
Credit spread adjustment	0.10%
Interest margin (percent)			1.60%
Senior Secured Asset-Based Loan \| Base Rate
Line of Credit Facility [Line Items]
Interest margin (percent)			0.50%
Senior Secured Asset-Based Loan \| Swingline Sublimit
Line of Credit Facility [Line Items]
Maximum borrowing capacity		$ 15,000,000
Senior Secured Asset-Based Loan \| Standby Letters of Credit Sublimit
Line of Credit Facility [Line Items]
Maximum borrowing capacity		$ 35,000,000.0

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Revenue from Contract with Customer, Product and Service [Extensible List]	Service	Service	Service
Revenue from services	$ 2,019,728	$ 2,806,609	$ 1,676,652
Operating expenses:
Direct operating expenses	1,569,318	2,178,923	1,301,653
Selling, general and administrative expenses	300,391	324,935	216,360
Bad debt expense	14,562	9,609	4,783
Depreciation and amortization	18,347	12,576	9,852
Restructuring costs	2,553	1,861	2,630
Legal settlement charges	1,125	0	0
Impairment charges	719	5,597	2,070
Total operating expenses	1,907,015	2,533,501	1,537,348
Income from operations	112,713	273,108	139,304
Other expenses (income):
Interest expense	8,094	14,391	6,866
Loss on early extinguishment of debt	1,723	3,728	0
Other expense (income), net	2	(1,336)	(770)
Income before income taxes	102,894	256,325	133,208
Income tax expense	30,263	67,864	1,206
Net income attributable to common stockholders	72,631	188,461	132,002
Other comprehensive income:
Unrealized foreign currency translation income (loss), net of tax	2	(94)	(13)
Comprehensive income (loss) attributable to common stockholders	$ 72,633	$ 188,367	$ 131,989
Net income per share attributable to common stockholders - Basic (usd per share)	$ 2.07	$ 5.09	$ 3.60
Net income per share attributable to common stockholders - Diluted (usd per share)	$ 2.05	$ 5.02	$ 3.53
Weighted average common shares outstanding:
Basic (in shares)	35,158	37,012	36,689
Diluted (in shares)	35,476	37,536	37,392

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2023

Business Combination and Asset Acquisition [Abstract]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the fair value of the assets acquired and liabilities assumed on June 8, 2021:


	(amounts in thousands)
Cash and cash equivalents	$	957
Accounts receivable	11,991
Other current assets	59
Property and equipment	10
Right-of-use assets	1,078
Goodwill	22,066
Other intangible assets	14,200
Total assets acquired	50,361
Accounts payable and accrued expenses	3,562
Accrued compensation and benefits	1,387
Lease liability - current	316
Lease liability - non-current	762
Earnout liability	15,000
Total liabilities assumed	21,027
Net assets acquired	$	29,334

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Schedule of Restricted Stock Award Activity

The following table summarizes restricted stock awards and performance stock awards activity issued under the Plans for the year ended December 31, 2023:


	Restricted Stock Awards			Performance Stock Awards
	Number of Shares	Weighted Average Grant Date Fair Value		Number of Target Shares	Weighted Average Grant Date Fair Value
Unvested restricted stock awards, January 1, 2023	674,508	$	14.53	476,086	$	12.56
Granted	319,312	$	22.87	200,487	$	19.23
Vested	(404,873)	$	12.51	(238,253)	$	6.74
Forfeited	(41,413)	$	20.70	(21,123)	$	19.28
Unvested restricted stock awards, December 31, 2023	547,534	$	20.42	417,197	$	18.75

Income Taxes - Narrative (Details) - USD ($)	12 Months Ended
Income Taxes - Narrative (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2023	Dec. 31, 2020
Income Tax Contingency [Line Items]
Valuation allowance	$ 2,000		$ 2,000
Unrecognized tax benefits	7,581,000	$ 9,179,000	10,377,000	$ 6,891,000
Long-term unrecognized tax benefits	7,646,000		10,603,000
Unrecognized tax benefits, which would affect the effective tax rate	7,200,000		10,000,000
Unrecognized tax benefits, amount reclassified from deferred tax assets to noncurrent liabilities	400,000
Deferred tax assets, amount reclassified from unrecognized tax benefits		$ 500,000
Other Current Liabilities
Income Tax Contingency [Line Items]
Unrecognized tax benefits	$ 0		0
State
Income Tax Contingency [Line Items]
Net operating loss carryforwards			22,900,000
Foreign Tax Authority
Income Tax Contingency [Line Items]
Net operating loss carryforwards			$ 0

Acquisitions - HireUp (Details) - USD ($) $ in Thousands		3 Months Ended
Acquisitions - HireUp (Details) - USD ($) $ in Thousands	Dec. 13, 2022	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Earnout liability			$ 6,794	$ 7,500
Goodwill			135,430	$ 163,268
HireUp
Business Acquisition [Line Items]
Cash consideration, gross	$ 6,000
Equity consideration for acquisition value	$ 800
Equity consideration for acquisition (in shares)	29,811
Contingent consideration liabilities	$ 8,000
Earnout liability			$ 1,900
Other intangible assets		$ 6,900
Weighted average useful life of assets acquired		7 years
Goodwill	$ 1,600
HireUp \| Trade names
Business Acquisition [Line Items]
Other intangible assets		$ 900
Weighted average useful life of assets acquired		2 years
HireUp \| Customer Lists
Business Acquisition [Line Items]
Other intangible assets		$ 2,500
Weighted average useful life of assets acquired		10 years
HireUp \| Databases
Business Acquisition [Line Items]
Other intangible assets		$ 3,500
Weighted average useful life of assets acquired		7 years

Employee Benefit Plans (Details) - USD ($) $ in Thousands	12 Months Ended
Employee Benefit Plans (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Company contribution net of forfeitures	$ 2,600	$ 2,600	$ 1,000
Employer match vesting duration	3 years
Deferred compensation liabilities	$ 3,343	$ 2,507

Organization and Basis of Presentation	12 Months Ended
Organization and Basis of Presentation	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Basis of Presentation	Organization and Basis of Presentation Nature of Business Cross Country Healthcare, Inc. (the Company) provides total talent management services, including strategic workforce solutions, contingent staffing, permanent placement, and consultative services for healthcare customers. The Company places highly qualified healthcare professionals in virtually every specialty and area of expertise. Its diverse customer base includes both clinical and nonclinical settings, servicing both public and private acute care and non-acute care hospitals, outpatient clinics, ambulatory-care centers, single and multi-specialty physician practices, rehabilitation facilities, Program of All-Inclusive Care for the Elderly (PACE) programs, urgent care centers, local and national healthcare systems, managed care providers, public and charter schools, correctional facilities, government facilities, pharmacies, and many other healthcare providers. The consolidated financial statements include the accounts of the Company and its direct and indirect wholly-owned subsidiaries, as well as Cross Country Talent Acquisition Group, LLC, which was a joint venture controlled by the Company but not wholly owned. The Company recorded the ownership interest of the noncontrolling shareholder as noncontrolling interest in subsidiary. Effective December 31, 2020, the sole professional staffing services agreement held by this joint venture was terminated and, as a result, the Company dissolved Cross Country Talent Acquisition Group, LLC in the third quarter of 2021. All intercompany transactions and balances have been eliminated in consolidation. Certain prior year amounts have been reclassified to conform to the current year presentation. See the consolidated balance sheets and statements of operations and comprehensive income, Note 5 - Goodwill, Trade Names, and Other Intangible Assets, Note 7 - Balance Sheet Details, and Note 17 - Segment Data.

Acquisitions - Acquisition-related costs (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Combination and Asset Acquisition [Abstract]
Acquisition related costs	$ 0.0	$ 0.0	$ 1.1

Employee Benefit Plans	12 Months Ended
Employee Benefit Plans	Dec. 31, 2023
Retirement Benefits [Abstract]
Employee Benefit Plans	Employee Benefit Plans The Company maintains a voluntary defined contribution 401(k) profit-sharing plan covering all eligible employees as defined in the plan documents. The plan provides for a discretionary matching contribution, which is equal to a percentage of each eligible contributing participant’s elective deferral, which the Company, at its sole discretion, determines from year to year. Contributions by the Company, net of forfeitures, under this plan were $2.6 million for the years ended December 31, 2023 and 2022, and $1.0 million for the year ended December 31, 2021. Eligible employees who elect to participate in the plan are generally vested in any existing matching contribution after three years of service with the Company. The Company maintains a 2003 Deferred Compensation Plan, which was frozen effective December 31, 2017, and a 2017 Nonqualified Deferred Compensation Plan, each a non-qualified deferred compensation arrangement, intended to comply with Section 409A of the Internal Revenue Code of 1986, as amended, or the Code. Under the deferred compensation plans, certain designated key employees may elect to defer the receipt of a portion of their annual base salary, bonus and commission to the deferred compensation plans. Generally, payments under the deferred compensation plans automatically commence upon a participant’s retirement, termination of employment, or death during employment. Under certain circumstances described in the deferred compensation plans, participants may receive distributions during employment. In connection with the deferred compensation plans, the Company elected to invest in amounts consistent with the participants' choices of allocations to funds. Participants of the deferred compensation plans are the Company’s unsecured general creditors with respect to the deferred compensation plan benefits. The liability for the deferred compensation is included in other long-term liabilities in the consolidated balance sheets and was $3.3 million and $2.5 million at December 31, 2023 and 2022, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 70
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480794/715-70-50-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 17
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480482/715-20-55-17

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(iv)(03)
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-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-Name Accounting Standards Codification
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-URI https://asc.fasb.org//715/tableOfContent

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (o)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (p)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (r)(1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (r)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480126/715-20-S99-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 60
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480266/715-60-50-3

+ Details

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts receivable, allowance for credit losses	$ 20,547	$ 14,696
Common stock, par value (usd per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	34,384,905	36,302,618
Common stock, shares outstanding (in shares)	34,384,905	36,302,618

Balance Sheet Details (Tables)

12 Months Ended

Dec. 31, 2023

Balance Sheet Related Disclosures [Abstract]

Schedule of Balance Sheet Details


	December 31,
	2023		2022
	(amounts in thousands)
Insurance recovery receivable - current:
Health	$	886	$	1,143
Workers’ compensation	2,687		3,117
Professional liability	5,524		3,174
	$	9,097	$	7,434

Insurance recovery receivable - non-current:
Workers’ compensation	$	8,037	$	5,831
Professional liability	17,677		17,227
	$	25,714	$	23,058

Other assets:
Security deposits	$	720	$	724

Deferred compensation	3,298		2,477
Net debt issuance costs	2,623		3,437
Finance lease right-of-use assets	—		11
Post employment benefit	32		—
	$	6,673	$	6,649
Accounts payable and accrued expenses:
Trade accounts payable	$	3,040	$	12,863
Subcontractor payable	66,347		145,587
Accrued expenses	15,946		27,057
	$	85,333	$	185,507
Accrued compensation and benefits:
Salaries and payroll taxes	$	27,042	$	40,983
Bonuses and commissions	2,893		11,798
Workers’ compensation	8,476		9,147
Professional liability	6,252		3,426
Health care	6,550		6,179
Vacation	1,084		1,072
	$	52,297	$	72,605
Accrued claims:
Workers’ compensation	$	14,798	$	14,699
Professional liability	20,055		21,182
	$	34,853	$	35,881
Other liabilities:
Restructuring	$	474	$	1,084
Deferred taxes	401		247
Deferred compensation	3,343		2,507




	$	4,218	$	3,838

Balance Sheet Details

12 Months Ended

Dec. 31, 2023

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details


	December 31,
	2023		2022
	(amounts in thousands)
Insurance recovery receivable - current:
Health	$	886	$	1,143
Workers’ compensation	2,687		3,117
Professional liability	5,524		3,174
	$	9,097	$	7,434

Insurance recovery receivable - non-current:
Workers’ compensation	$	8,037	$	5,831
Professional liability	17,677		17,227
	$	25,714	$	23,058

Other assets:
Security deposits	$	720	$	724

Deferred compensation	3,298		2,477
Net debt issuance costs	2,623		3,437
Finance lease right-of-use assets	—		11
Post employment benefit	32		—
	$	6,673	$	6,649
Accounts payable and accrued expenses:
Trade accounts payable	$	3,040	$	12,863
Subcontractor payable	66,347		145,587
Accrued expenses	15,946		27,057
	$	85,333	$	185,507
Accrued compensation and benefits:
Salaries and payroll taxes	$	27,042	$	40,983
Bonuses and commissions	2,893		11,798
Workers’ compensation	8,476		9,147
Professional liability	6,252		3,426
Health care	6,550		6,179
Vacation	1,084		1,072
	$	52,297	$	72,605
Accrued claims:
Workers’ compensation	$	14,798	$	14,699
Professional liability	20,055		21,182
	$	34,853	$	35,881
Other liabilities:
Restructuring	$	474	$	1,084
Deferred taxes	401		247
Deferred compensation	3,343		2,507




	$	4,218	$	3,838

Fair Value Measurements

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Fair Value Measurements

Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. A fair value hierarchy was established which requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. There are three levels of inputs that may be used to measure fair value:

Level 1—Quoted prices in active markets for identical assets or liabilities.

Level 2—Observable inputs other than Level 1 prices, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.

Items Measured at Fair Value on a Recurring Basis:

The Company’s financial assets/liabilities required to be measured at fair value on a recurring basis were primarily its: (i) deferred compensation asset included in other assets; and (ii) deferred compensation liability included in other liabilities on its consolidated balance sheets.

Deferred compensation—The Company utilizes Level 1 inputs to value its deferred compensation assets and liabilities. The Company’s deferred compensation assets and liabilities are measured using publicly available indices, as per the plan documents.

The estimated fair value of the Company’s financial assets and liabilities measured on a recurring basis is as follows:

Fair Value Measurements


	December 31, 2023		December 31, 2022
	(amounts in thousands)
Financial Assets:
(Level 1)
Deferred compensation asset	$	3,298	$	2,477
Financial Liabilities:
(Level 1)
Deferred compensation liability	$	3,343	$	2,507

Items Measured at Fair Value on a Non-recurring Basis:

The Company's non-financial assets, such as goodwill, trade names, other intangible assets, right-of-use assets, and property and equipment, are measured at fair value when there is an indicator of impairment and are recorded at fair value only when an impairment charge is recognized. During the years ended December 31, 2023, 2022, and 2021, certain IT projects were written off and leases were vacated resulting in an impairment of the related IT assets and right-of-use assets along with related property and equipment, respectively, using Level 3 inputs to determine remeasured fair value of these assets. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets and Note 9 - Leases for more information about these impairments.

Other Fair Value Disclosures:

Financial instruments not measured or recorded at fair value in the consolidated balance sheets consist of cash and cash equivalents, accounts receivable, and accounts payable and accrued expenses. The estimated fair value of accounts receivable and accounts payable and accrued expenses approximate their carrying amount due to the short-term nature of these instruments. Other financial instruments not measured or recorded at fair value include: (i) ABL, (ii) term loan, and (iii) through (v) earnout liabilities related to the WSG, Selected, Mint, and HireUp acquisitions, as discussed below.

(i) The carrying amount of the Company's ABL approximates fair value because the interest rates are variable and reflective of market rates.

(ii) On June 30, 2023, the Company repaid all outstanding obligations of $73.9 million under the term loan and terminated the Term Loan Agreement. See Note 8 - Debt. Prior to termination, the estimated fair value of the Company’s term loan was calculated applying an interest rate lattice model using Level 2 inputs from available market information.

(iii) Potential earnout payments related to the WSG acquisition were contingent upon meeting certain performance requirements based on 2021 through 2023 performance. The Company performed an analysis using multiple forecasted scenarios to determine the fair value of the earnout liability. In the third quarter of 2022, the Company determined that the contingent consideration earnout related to the WSG acquisition was achieved for the 2021 through 2022 period and, as a result, the Company made a $7.5 million earnout payment. In the third quarter of 2023, the Company determined that the contingent consideration earnout related to the WSG acquisition was also achieved for the 2022 through 2023 period and, as a result, the Company made the final $7.5 million earnout payment. See Note 4 - Acquisitions.

(iv) Potential earnout payments related to the Mint acquisition are contingent upon meeting certain performance requirements based on 2022 through 2024 performance. The Company performed an analysis using multiple forecasted scenarios to determine the fair value of the earnout liability. In the fourth quarter of 2023, the Company performed the earnout calculation for the first measurement period, resulting in an earnout of $4.9 million included in the current portion of earnout liability, which was paid in the first quarter of 2024. The long-term portion of the liability of $5.0 million is included in the non-current portion of earnout liability on the consolidated balance sheets. The earnout liability's carrying amount approximates fair value. See Note 4 - Acquisitions.

(v) Potential earnout payments related to the HireUp acquisition are contingent upon meeting certain performance requirements based on 2022 through 2024 performance. Quarterly throughout 2023, the Company performed analyses using multiple updated forecast scenarios and determined that the earnout would only be partially achieved. As a result, the Company recognized a decrease in the fair value of the related liabilities in the second and third quarters of 2023. The liability of $1.9 million is included in the current portion of earnout liability on the consolidated balance sheets. See Note 4 - Acquisitions.

The carrying amounts and estimated fair value of the Company’s significant financial instruments that were not measured at fair value are as follows:


	December 31, 2023				December 31, 2022
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
	(amounts in thousands)
Financial Liabilities:
(Level 2)
Senior Secured Asset-Based Loan	$	—	$	—	$	76,800	$	76,800
Term Loan, net	$	—	$	—	$	78,375	$	71,221
Earnout Liability (WSG)	$	—	$	—	$	7,500	$	7,500
Earnout Liability (Mint)	$	9,884	$	9,884	$	10,000	$	10,000
Earnout Liability (HireUp)	$	1,910	$	1,910	$	8,000	$	8,000

Concentration of Credit Risk:

See discussion of credit losses and allowance for doubtful accounts in Note 2 - Summary of Significant Accounting Policies. Overall, based on the large number of customers in differing geographic areas, primarily throughout the United States and its territories, the Company believes the concentration of credit risk is limited.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

Schedule of Allowance for Credit Loss

The opening balance of the allowance for doubtful accounts is reconciled to the closing balance for expected credit losses as follows:


	2023		2022
Allowance for Doubtful Accounts	(amounts in thousands)
Balance at January 1	$	13,058	$	6,087
Bad Debt Expense	4,908		2,369
Write-Offs, net of Recoveries	54		(365)
Balance at March 31	18,020		8,091
Bad Debt Expense	3,134		3,192
Write-Offs, net of Recoveries	(4,240)		(426)
Balance at June 30	16,914		10,857
Bad Debt Expense	2,355		1,101
Write-Offs, net of Recoveries	(1,394)		(593)
Balance at September 30	17,875		11,365
Bad Debt Expense	4,166		2,947
Write-Offs, net of Recoveries	(2,401)		(1,254)
Balance at December 31	$	19,640	$	13,058

Schedule of Restructuring and Related Costs

Reconciliations of the employee termination costs and lease-related exit costs beginning and ending liability balance is presented below:


	Year Ended December 31,
	2023				2022				2021
	(amounts in thousands)
	Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs
Balance at beginning of period	$	799	$	2,196	$	160	$	2,423	$	499	$	2,687
Charged to restructuring	2,491		62		792		765		814		544
Payments and adjustments	(2,395)		(1,074)		(153)		(992)		(1,153)		(808)
Balance at end of period	$	895	$	1,184	$	799	$	2,196	$	160	$	2,423

Income Taxes - Reconciliation of Beginning and Ending Balance of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at January 1	$ 7,581	$ 9,179	$ 6,891
Additions based on tax positions related to the current year	2,737	349	1,873
Additions based on tax positions related to prior years	59		0
(Reductions) based on tax positions related to prior years		(1,947)
Reductions as a result of a lapse of applicable statute of limitations	0	0	(47)
Other	0	0	462
Balance at December 31	$ 10,377	$ 7,581	$ 9,179

Quarterly Financial Data (Unaudited)

12 Months Ended

Dec. 31, 2023

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Data (Unaudited)

The following tables contain selected unaudited statements of operations and comprehensive income information for each quarter of 2023 and 2022. The following information reflects all normal recurring adjustments necessary for a fair presentation of the information for the periods presented. The operating results for any quarter are not necessarily indicative of results for any future period.


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2023	(amounts in thousands, except per share data)
Revenue from services	$	622,707	$	540,695	$	442,291	$	414,035

Gross profit(a)	139,423		123,139		97,359		90,489






Net income attributable to common stockholders	29,436		21,345		12,812		9,038




Net income per share attributable to common stockholders - Basic(b)	$	0.82	$	0.60	$	0.37	$	0.26




Net income per share attributable to common stockholders - Diluted(b)	$	0.81	$	0.60	$	0.36	$	0.26


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2022	(amounts in thousands, except per share data)
Revenue from services	$	788,732	$	753,561	$	636,098	$	628,218

Gross profit(a)	174,794		170,405		143,545		138,942






Net income attributable to common stockholders	61,983		52,894		34,793		38,791




Net income per share attributable to common stockholders - Basic(b)	$	1.67	$	1.41	$	0.94	$	1.06




Net income per share attributable to common stockholders - Diluted (b)	$	1.63	$	1.40	$	0.93	$	1.05

________________

(a) Excludes depreciation and amortization.

(b) The sum of the quarterly per share amounts may not equal amounts reported for year-to-date due to the effects of rounding and changes in the number of weighted average shares outstanding used in the calculation.

The following items are the most significant items that impact the comparability and presentation of our consolidated data:

•During the first and third quarters of 2022, the Company recorded impairment charges of $1.7 million and $2.0 million, respectively, related to right-of-use assets and related property in connection with vacated leases, and $1.9 million related to the write-off of an IT project in the third quarter. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets and Note 9 - Leases.

•On December 13, 2022, the Company acquired Hireup Leadership Inc. and on October 3, 2022, the Company acquired Mint Medical Physician Staffing, LP and Lotus Medical Staffing LLC. The acquisitions were not material and have been accounted for using the acquisition method. The results of the acquisitions' operations have been included in the consolidated statements of operations and comprehensive income from their dates of acquisition. See Note 4 - Acquisitions.

•The Company incurred restructuring costs primarily comprised of employee termination costs, lease-related exit costs, and reorganization costs as part of planned cost savings initiatives. The Company recorded expenses of $0.9 million in both the second and fourth quarters of 2023. In 2022, the Company recorded a benefit of $1.1 million associated with the early termination of the lease for one of the Company's corporate offices in the second quarter, which was previously restructured, and recorded expenses in the third quarter of $2.5 million.

•The Company recorded loss on early extinguishment of debt of $1.7 million in the second quarter of 2023, consisting of the write-off of debt issuance costs related to the payoff and termination of the term loan on June 30, 2023. In the second and fourth quarters of 2022, the Company recorded loss on early extinguishment of debt of $1.9 million and $1.8 million, respectively, consisting of a prepayment premium and the write-off of debt issuance costs related to the optional prepayments on its term loan. See Note 8 - Debt.

•During the second quarter of 2022, the Company recognized a gain on lease termination of $1.1 million as a result of the early termination of the lease for one of the Company's corporate offices.

•During the first quarter of 2023, the Company incurred $1.1 million, including legal fees, to settle a wage and hour class action lawsuit.

Segment Data - Operating Segments (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting, Reconciling Item for Operating Profit (Loss) from Segment to Consolidated [Line Items]
Revenues from services:	$ 414,035	$ 442,291	$ 540,695	$ 622,707	$ 628,218	$ 636,098	$ 753,561	$ 788,732	$ 2,019,728	$ 2,806,609	$ 1,676,652
Contribution income:									206,565	360,955	210,066
Corporate overhead									71,049	67,087	55,142
Depreciation and amortization									18,347	12,576	9,852
Restructuring costs	$ 900		$ 900			$ 2,500			2,553	1,861	2,630
Legal settlement charges				$ 1,100					1,125	0	0
Impairment charges									719	5,597	2,070
Other costs									59	726	1,068
Income from operations									112,713	273,108	139,304
Nurse And Allied Staffing
Segment Reporting, Reconciling Item for Operating Profit (Loss) from Segment to Consolidated [Line Items]
Revenues from services:									1,841,428	2,700,383	1,605,781
Contribution income:									196,777	355,447	205,738
Physician Staffing
Segment Reporting, Reconciling Item for Operating Profit (Loss) from Segment to Consolidated [Line Items]
Revenues from services:									178,300	106,226	70,871
Contribution income:									$ 9,788	$ 5,508	$ 4,328

Acquisitions - Cross Country Workforce Solutions Group (Details) - USD ($) $ in Thousands		3 Months Ended				12 Months Ended
	Jun. 08, 2021	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2021	Sep. 30, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Asset Acquisition [Line Items]
Payment for contingent liability						$ 7,500	$ 7,500	$ 0
Earnout liability						6,794	7,500
Goodwill						$ 135,430	$ 163,268
Workforce Solutions Group, Inc.
Asset Acquisition [Line Items]
Cash consideration, gross	$ 25,000
Equity consideration for acquisition value	$ 5,000
Equity consideration for acquisition (in shares)	307,730
Net working capital adjustment				$ 1,100
Escrow account	$ 2,000
Business performance, term	3 years
Contingent consideration liabilities	$ 15,000
Payment for contingent liability		$ 7,500	$ 7,500
Other intangible assets	14,200
Goodwill	$ 22,066
Workforce Solutions Group, Inc. \| Customer relationships
Asset Acquisition [Line Items]
Other intangible assets					$ 14,200
Weighted average useful life of assets acquired					11 years 6 months

Quarterly Financial Data (Unaudited) (Tables)

12 Months Ended

Dec. 31, 2023

Quarterly Financial Information Disclosure [Abstract]

Schedule of Quarterly Financial Data


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2023	(amounts in thousands, except per share data)
Revenue from services	$	622,707	$	540,695	$	442,291	$	414,035

Gross profit(a)	139,423		123,139		97,359		90,489






Net income attributable to common stockholders	29,436		21,345		12,812		9,038




Net income per share attributable to common stockholders - Basic(b)	$	0.82	$	0.60	$	0.37	$	0.26




Net income per share attributable to common stockholders - Diluted(b)	$	0.81	$	0.60	$	0.36	$	0.26


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2022	(amounts in thousands, except per share data)
Revenue from services	$	788,732	$	753,561	$	636,098	$	628,218

Gross profit(a)	174,794		170,405		143,545		138,942






Net income attributable to common stockholders	61,983		52,894		34,793		38,791




Net income per share attributable to common stockholders - Basic(b)	$	1.67	$	1.41	$	0.94	$	1.06




Net income per share attributable to common stockholders - Diluted (b)	$	1.63	$	1.40	$	0.93	$	1.05

________________

(a) Excludes depreciation and amortization.

Leases (Tables)

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Schedule of Supplemental Balance Sheet Information

The table below presents the lease-related assets and liabilities included on the consolidated balance sheets:


Classification on Consolidated Balance Sheets:	December 31, 2023			December 31, 2022
	(amounts in thousands)
Operating lease right-of-use assets	$	2,599		$	3,254
Operating lease liabilities - current	$	2,604		$	4,132
Operating lease liabilities - non-current	$	2,663		$	4,880

	December 31, 2023			December 31, 2022
Weighted average remaining lease term	2.2 years			2.3 years
Weighted average discount rate	6.36		%	6.31		%

Schedule of Operating Lease Maturity


Years Ending December 31:	(amounts in thousands)
2024	$	2,850
2025	2,185
2026	318
2027	180
2028	114

Total minimum lease payments	5,647
Less: amount of lease payments representing interest	(380)
Present value of future minimum lease payments	5,267
Less: operating lease liabilities - current	(2,604)
Operating lease liabilities - non-current	$	2,663

Schedule of Lease Costs

The table below provides information regarding supplemental cash flows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Supplemental Cash Flow Information:
Cash paid for amounts included in the measurement of operating lease liabilities	$	4,859	$	5,753	$	6,150
Right-of-use assets acquired under operating lease	$	1,040	$	473	$	1,059

The components of lease expense are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Amounts Included in Consolidated Statements of Operations and Comprehensive Income:
Operating lease expense	$	1,681	$	2,550	$	3,538
Short-term lease expense	$	3,209	$	5,114	$	3,695
Variable and other lease costs	$	724	$	2,195	$	1,957

Acquisitions - Selected (Details) - USD ($) $ in Thousands		3 Months Ended
Acquisitions - Selected (Details) - USD ($) $ in Thousands	Dec. 16, 2021	Jun. 30, 2022	Dec. 31, 2023	Dec. 31, 2022
Asset Acquisition [Line Items]
Goodwill			$ 135,430	$ 163,268
Selected, Inc
Asset Acquisition [Line Items]
Cash consideration, gross	$ 3,500
Equity consideration for acquisition value	$ 1,500
Equity consideration for acquisition (in shares)	59,429
Contingent consideration liabilities	$ 1,500
Other intangible assets		$ 4,600
Weighted average useful life of assets acquired		5 years
Goodwill	$ 400
Selected, Inc \| Trade names
Asset Acquisition [Line Items]
Other intangible assets		$ 0
Weighted average useful life of assets acquired		2 years
Selected, Inc \| Software
Asset Acquisition [Line Items]
Other intangible assets		$ 1,700
Weighted average useful life of assets acquired		5 years
Selected, Inc \| Databases
Asset Acquisition [Line Items]
Other intangible assets		$ 2,900
Weighted average useful life of assets acquired		5 years

Schedule II - Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2023

SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]

Schedule II - Valuation and Qualifying Accounts

Schedule II

CROSS COUNTRY HEALTHCARE, INC.

VALUATION AND QUALIFYING ACCOUNTS

FOR THE YEARS ENDED DECEMBER 31, 2023, 2022, AND 2021


	Balance at Beginning of Period		Charged to (Released from) Operations		Write-Offs, Net of Recoveries			Other Changes		Balance at End of Period
	(amounts in thousands)
Allowances for Accounts Receivable
Year Ended December 31, 2023	$	14,696	$	17,355	$	(11,504)	(a)	$	—	$	20,547
Year Ended December 31, 2022	$	6,881	$	15,327	$	(7,512)	(a)	$	—	$	14,696
Year Ended December 31, 2021	$	4,021	$	6,499	$	(3,639)	(a)	$	—	$	6,881

Valuation Allowance for Deferred Tax Assets
Year Ended December 31, 2023	$	2	$	—	$	—		$	—	$	2
Year Ended December 31, 2022	$	20	$	—	$	(18)		$	—	$	2
Year Ended December 31, 2021	$	37,472	$	(37,449)	$	—		$	(3)	$	20

________________

(a) Uncollectible accounts written off, net of recoveries.

Stockholders' Equity - Stock Repurchase Program (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	May 01, 2023	Aug. 16, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchase and retirement	$ 57,654	$ 35,285
Common stock, shares outstanding (in shares)	34,384,905	36,302,618
ABL Credit Agreement
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum annual repurchase amount	$ 5,000
New Repurchase Program
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchase program, authorized amount					$ 100,000
Additional authorized amount				$ 59,000
Common shares amount left remaining to repurchase under the plan (up to)	$ 77,300			$ 100,000
Stock repurchase and retirement (in shares)	2,343,583	1,364,815	0
Stock repurchase and retirement	$ 57,600	$ 35,300
Average market price (in usd per share)	$ 24.58	$ 25.83

Acquisitions - Mint (Details) - USD ($) $ in Thousands		3 Months Ended
Acquisitions - Mint (Details) - USD ($) $ in Thousands	Oct. 03, 2022	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Earnout liability			$ 6,794	$ 7,500
Non-current portion of earnout liability			5,000	18,000
Goodwill			135,430	$ 163,268
Mint
Business Acquisition [Line Items]
Cash consideration, gross	$ 27,000
Equity consideration for acquisition value	$ 3,600
Equity consideration for acquisition (in shares)	114,278
Contingent consideration liabilities	$ 10,000
Earnout liability			4,900
Non-current portion of earnout liability			$ 5,000
Other intangible assets		$ 15,100
Weighted average useful life of assets acquired		7 years
Goodwill	$ 20,100
Mint \| Trade names
Business Acquisition [Line Items]
Other intangible assets		$ 400
Weighted average useful life of assets acquired		1 year
Mint \| Customer Lists
Business Acquisition [Line Items]
Other intangible assets		$ 2,300
Weighted average useful life of assets acquired		11 years
Mint \| Databases
Business Acquisition [Line Items]
Other intangible assets		$ 12,400
Weighted average useful life of assets acquired		7 years

Income Taxes - Reconciliation of Income Tax Computed At U. S. Federal Statutory Rate to Income Tax (Benefit) Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Tax at U.S. statutory rate	$ 21,608	$ 53,828	$ 27,974
State taxes, net of federal benefit	6,834	15,423	8,573
Noncontrolling interest	0	0	(5)
Non-deductible items	573	179	550
Foreign tax expense	155	136	76
Valuation allowances	1	1	(37,450)
Uncertain tax positions	2,771	(1,694)	1,891
Officers' compensation	(275)	404	344
Return to provision	(482)	(169)	44
Other	(922)	(244)	(791)
Income tax expense	$ 30,263	$ 67,864	$ 1,206

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2023
Accounting Policies [Abstract]
Nature of Business	Nature of Business Cross Country Healthcare, Inc. (the Company) provides total talent management services, including strategic workforce solutions, contingent staffing, permanent placement, and consultative services for healthcare customers. The Company places highly qualified healthcare professionals in virtually every specialty and area of expertise. Its diverse customer base includes both clinical and nonclinical settings, servicing both public and private acute care and non-acute care hospitals, outpatient clinics, ambulatory-care centers, single and multi-specialty physician practices, rehabilitation facilities, Program of All-Inclusive Care for the Elderly (PACE) programs, urgent care centers, local and national healthcare systems, managed care providers, public and charter schools, correctional facilities, government facilities, pharmacies, and many other healthcare providers.
Basis of Accounting	The consolidated financial statements include the accounts of the Company and its direct and indirect wholly-owned subsidiaries, as well as Cross Country Talent Acquisition Group, LLC, which was a joint venture controlled by the Company but not wholly owned. The Company recorded the ownership interest of the noncontrolling shareholder as noncontrolling interest in subsidiary. Effective December 31, 2020, the sole professional staffing services agreement held by this joint venture was terminated and, as a result, the Company dissolved Cross Country Talent Acquisition Group, LLC in the third quarter of 2021. All intercompany transactions and balances have been eliminated in consolidation. Certain prior year amounts have been reclassified to conform to the current year presentation. See the consolidated balance sheets and statements of operations and comprehensive income, Note 5 - Goodwill, Trade Names, and Other Intangible Assets, Note 7 - Balance Sheet Details, and Note 17 - Segment Data.
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with United States generally accepted accounting principles (U.S. GAAP) requires management to make estimates and assumptions that affect the reported amounts in the consolidated financial statements and accompanying notes. Management has assessed various accounting estimates and other matters, including those that require consideration of forecasted financial information, using information that is reasonably available to the Company at the time. Significant estimates and assumptions are used for, but not limited to: (i) the valuation of accounts receivable; (ii) goodwill, trade names, and other intangible assets; (iii) other long-lived assets; (iv) revenue recognition; (v) accruals for health, workers’ compensation, and professional liability claims; (vi) valuation of deferred tax assets; (vii) legal contingencies, and (viii) income taxes. Accrued insurance claims and reserves include estimated settlements from known claims and actuarial estimates for claims incurred but not reported. As additional information becomes available to the Company, its future assessment of these estimates could materially and adversely impact the Company's consolidated financial statements in future reporting periods. Actual results could differ from those estimates.
Risks and Uncertainties	Risks and Uncertainties The Company’s future results of operations and liquidity could be materially adversely affected by macroeconomic factors contributing to delays in payments from customers and inflationary pressure, uncertain or reduced demand, and the impact of any initiatives or programs that the Company may undertake to address financial and operational challenges faced by its customers. See associated risk factors in Item 1A. Risk Factors in this Annual Report on Form 10-K.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all investments with original maturities of three months or less to be cash and cash equivalents. Interest income on cash and cash equivalents was immaterial for the years ended December 31, 2023, 2022, and 2021, and is included in other income (expense), net, in the consolidated statements of operations and comprehensive income.
Accounts Receivable, Allowance for Doubtful Accounts, and Concentration of Credit Risk	Accounts Receivable, Allowance for Doubtful Accounts, and Concentration of Credit Risk Accounts receivable potentially subject the Company to concentrations of credit risk. The Company generally does not require collateral and mitigates its credit risk by performing credit evaluations and monitoring at-risk accounts. The allowance for doubtful accounts is established for losses expected to be incurred on accounts receivable balances. Accounts receivable are written off against the allowance for doubtful accounts when the Company determines amounts are no longer collectible. Judgment is required in the estimation of the allowance and the Company evaluates the collectability of its accounts receivable based on a combination of factors. The Company bases its allowance for doubtful account estimates on its historical write-off experience, current conditions, an analysis of the aging of outstanding receivable and customer payment patterns, and specific reserves for customers in adverse condition adjusted for current expectations for the customers or industry. Based on the information currently available, the Company also considered expectations of future economic conditions when estimating its allowance for doubtful accounts. In addition to the allowance for doubtful accounts, the Company maintains a sales allowance for billing-related adjustments which may arise in the ordinary course of business and adjustments to the reserve are recorded as contra-revenue. The sales allowance balance as of December 31, 2023 and December 31, 2022 was $0.9 million and $1.6 million, respectively. The Company’s contract terms typically require payment between 30 to 60 days from the date of invoice and are considered past due based on the particular negotiated contract terms. The majority of the Company's customers are healthcare systems with a significant percentage in acute-care facilities.
Property and Equipment	Property and Equipment Property and equipment are stated at cost, less accumulated depreciation. Depreciation is determined on a straight-line basis over the estimated useful lives of the assets, which generally range from one to ten years. Leasehold improvements are depreciated over the shorter of 10 years or the term of the individual lease. On an annual basis, the Company reviews its property and equipment listings and disposes of assets that are no longer in use. Certain software development costs have been capitalized. Such costs include charges for consulting services and costs for Company personnel associated with programming, coding, and testing such software. Amortization of capitalized software costs is included in depreciation and amortization expense in the consolidated statements of operations and comprehensive income and begins when the software is ready for use.
Cloud Computing Arrangements	Cloud Computing Arrangements Implementation costs associated with cloud computing arrangements are capitalized when incurred during the application development phase. In connection with the licensing of software products, the Company has entered into arrangements in which it does not take possession of the software; rather, the software application resides on the vendor's or a third-party's hardware, and the Company accesses and uses the software on an as-needed basis over the Internet or via a dedicated line. Therefore, the cloud computing arrangement does not give rise to an intangible asset. Costs are capitalized in accordance with the Company’s policies for other capitalizable service costs. Amortization is calculated over the contractual term of the cloud computing arrangement and is included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive income. As of December 31, 2023 and 2022, the Company has a current asset of $0.5 million included in prepaid expenses and a non-current asset of $6.0 million and $4.5 million, respectively, included in cloud computing in the consolidated balance sheets that have been capitalized in conjunction with implementations. Amortization of the cloud computing assets was $0.5 million, $0.6 million, and $0.4 million for the years ended December 31, 2023, 2022, and 2021, respectively.
Leases	Leases The Company determines whether an arrangement constitutes a lease at commencement. Operating leases are included in operating lease right-of-use assets, operating lease liabilities - current, and operating lease liabilities - non-current in the consolidated balance sheets. Finance leases are included in other assets, other current liabilities, and other liabilities in the consolidated balance sheets. See Note 9 - Leases. Right-of-use assets are measured based on the corresponding lease liability adjusted for: (i) payments made to the lessor at or before the commencement date; (ii) initial direct costs; and (iii) tenant incentives under the lease. Rent expense commences when the lessor makes the underlying asset available to the Company. Lease liabilities are measured based on the present value of the total lease payments not yet paid discounted based on its incremental borrowing rate, as the rate implicit in the lease is not determinable. The Company estimates its incremental borrowing rate based on an analysis of publicly-traded debt securities of companies with credit and financial profiles similar to its own. The variable portion of the lease payments is not included in the right-of-use assets or lease liabilities. Rather, variable payments, other than those dependent upon an index or rate, are expensed when the obligation for those payments is incurred and are included in lease expense in selling, general and administrative expense in the consolidated statements of operations and comprehensive income. Rent expense for operating lease payments is recognized on a straight-line basis over the lease term. The Company does not assume renewals or early terminations unless it is reasonably certain to exercise these options at commencement. The Company has elected the practical expedient to not separate non-lease components from the lease components to which they relate, and instead account for each as a single lease component, for all of its underlying asset classes. Accordingly, all expenses associated with a lease contract are accounted for as lease expenses. The Company leases apartments for eligible field employees under short-term agreements (typically three to six months), which generally coincide with each employee’s staffing contract. Costs relating to these leases are included in direct operating expenses in the consolidated statements of operations and comprehensive income.
Business Combinations	Business Combinations Historically, business combinations have been accounted for at fair value using the acquisition method of accounting. Effective January 1, 2023, the Company accounts for business combinations in accordance with updated Business Combinations Topic 805. Contract assets and contract liabilities acquired in a business combination are recognized in accordance with Revenue from Contracts with Customers Topic 606. At the acquisition date, related revenue contracts with customers are accounted for as if the Company had originated the contracts. The acquired contract assets and liabilities are recognized and measured consistent with how they were recognized and measured in the acquiree's financial statements, if those financial statements were prepared in accordance with GAAP. Contract assets and contract liabilities from other contracts to which Topic 606 applies are similarly recognized and measured. In circumstances where it is unable to assess whether the financial statements were prepared in accordance with GAAP, the Company considers contract terms and specifications to determine what should be recorded at the acquisition date. Other assets or liabilities that arise from revenue contracts with customers in accordance with Topic 606 are accounted for at fair value. The associated acquisition costs are expensed as incurred and recorded as acquisition and integration-related costs. Restructuring costs associated with a business combination are expensed. The results of the acquired businesses' operations are included in the consolidated statements of operations and comprehensive income of the combined entity beginning on the date of acquisition. See Note 4 - Acquisitions.
Goodwill, Trade Names, and Other Intangible Assets	Goodwill, Trade Names, and Other Intangible Assets Goodwill represents the excess of purchase price and related costs over the fair value assigned to the net tangible and identifiable intangible assets of businesses acquired. Other identifiable intangible assets with definite lives are being amortized using the straight-line method over their estimated useful lives which have ranged from 1 to 16 years. Goodwill and certain intangible assets with indefinite lives are not amortized. Instead, these assets are reviewed for impairment annually at the beginning of the fourth quarter, and whenever circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying amount. When reviewed, the Company has the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, as a basis for determining whether it is necessary to perform the quantitative testing. If it is determined that a quantitative test is necessary or more efficient than a qualitative approach, the Company measures the fair value of its reporting units using a combination of income and market approaches. The Company performs its annual review on October 1. If the quantitative analysis is performed and the reporting unit’s carrying value exceeds its fair value, an impairment charge is recognized for the amount by which the carrying amount exceeds the reporting unit’s fair value not to exceed the total amount of goodwill allocated to that reporting unit. Additionally, income tax effects from any tax-deductible goodwill on the carrying amount of the reporting unit when measuring the goodwill impairment loss is considered, if applicable. The Company determines its reporting units by identifying its operating segments and any component businesses and aggregates the component businesses if they have similar economic characteristics. Management considers historical experience and all available information at the time the fair values of its reporting units are estimated. However, fair values that could be realized in an actual transaction may have differed from those used to evaluate the potential impairment of goodwill. Long-lived assets and identifiable intangible assets with definite lives are evaluated for impairment. Long-lived assets and definite-lived intangible assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount may not be recoverable. Recoverability of long-lived assets is measured by a comparison of the carrying amount of the asset group to the future undiscounted net cash flow that is expected to be generated by those assets. If such assets are considered to be impaired, the impairment charge recognized is the amount by which the carrying amount of the assets exceeds the fair value of the assets. Any related impairment losses are recognized in earnings and included in the caption impairment charges in the consolidated statements of operations and comprehensive income. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.
Debt Discount and Debt Issuance Costs	Debt Discount and Debt Issuance Costs Stated discounts on proceeds and other fees reimbursed to lenders were treated as a discount associated with the respective debt instrument and presented in the balance sheet as an offset to the carrying amount of the debt. Debt issuance costs associated with the revolving line-of-credit are presented as an asset, included in other assets on the balance sheet. Discounts are amortized to interest expense using the effective interest rate method, or a method that approximates the effective interest rate method, over the expected life of the debt.
Sales and Other State Non-Income Tax Liabilities	Sales and Other State Non-Income Tax Liabilities The Company's sales and other state non-income tax filings are subject to routine audits by authorities in the jurisdictions where it conducts business in the United States which may result in assessments of additional taxes. The Company accrues sales and other state non-income tax liabilities based on the Company’s best estimate of its probable liability utilizing currently available information and interpretation of relevant tax regulations. Given the nature of the Company’s business, significant subjectivity exists as to both whether sales and other state non-income taxes can be assessed on its activity and how the sales tax will ultimately be measured by the relevant jurisdictions. The Company makes a determination for each reporting period whether the estimates for sales and other non-income taxes in certain states should be revised. The expense is included in selling, general and administrative expenses on its consolidated statements of operations and comprehensive income and the liability is reflected in sales tax payable within other current liabilities in the consolidated balance sheets.
Insurance Claims	Insurance Claims The Company provides workers’ compensation insurance coverage, professional liability coverage, and healthcare benefits for eligible employees. The Company records its estimate of the ultimate cost of, and reserves for, workers' compensation and professional liability benefits based on actuarial models prepared or reviewed by an independent actuary using the Company’s loss history as well as industry statistics. The healthcare insurance accrual is for estimated claims that have occurred but have not been reported and is based on the Company’s historical claim submission patterns. Furthermore, in determining its reserves, the Company includes reserves for estimated claims incurred but not reported as well as unfavorable claims development. Under circumstances such as in the Company’s insured professional liability and workers' compensation policies, since a right of legal offset does not exist due to the fact that there are three parties to an incurred claim, the insured, the insurer, and the claimant, the related liability to the claimant should be classified separately on a gross basis with a separate related receivable from the insurer recognized as being due from insurance carriers. Accordingly, the Company’s consolidated balance sheets as of December 31, 2023 and 2022 reflect the related short-term liabilities in accrued compensation and benefits and the related long-term liabilities as accrued claims, and the short-term and long-term receivable portion as insurance recovery receivable - current and insurance recovery receivable - non-current, respectively. See Note 7 - Balance Sheet Details. The ultimate cost of workers’ compensation, professional liability, and health insurance claims will depend on actual amounts incurred to settle those claims and may differ from the amounts reserved by the Company for those claims. Workers’ compensation benefits are provided under a partially self-insured plan. The Company has letters of credit to guarantee payments of claims. At December 31, 2023 and 2022, the Company had outstanding approximately $13.5 million and $17.7 million, respectively, of standby letters of credit as collateral to secure the self-insured portion of this plan. Currently, the Company has claims-made primary professional liability policies that provide the Company and each working professional in its nurse and allied healthcare business with coverage. The Company has a claims-made professional liability policy for its physicians and advanced practitioners. At December 31, 2023 and 2022, the Company had outstanding $0.3 million and $0.4 million, respectively, of standby letters of credit as collateral to secure reimbursement of expenses under the existing plan. Subject to certain limitations, the Company also has umbrella liability coverage for its working nurses and allied healthcare professionals. While this umbrella coverage does not extend to professional liability claims against its independent contractor physicians and advanced practitioners, it does cover claims brought against all of the Company’s subsidiaries for non-patient general liability.
Revenue Recognition	Revenue Recognition Revenue from the Company’s services is recognized when control of the promised services is transferred to the Company’s customers, in an amount that reflects the consideration it expects to receive in exchange for the service. The Company has concluded that transfer of control of its staffing services, which represents the majority of its revenues, occurs over time as the services are provided. The following is a description of the nature, amount, timing, and uncertainty of revenue and cash flows from which the Company generates revenue. Temporary Staffing Revenue Revenue from temporary staffing is recognized as control of the services is transferred over time and is based on hours worked by the Company’s field staff. The Company recognizes the majority of its revenue at the contractual amount the Company has the right to invoice for services completed to date. Generally, billing to customers occurs weekly, bi-weekly, or monthly and is aligned with the payment of services to the temporary staff. Accounts receivable includes estimated revenue for employees’ and independent contractors’ time worked but not yet invoiced. At December 31, 2023 and 2022, the Company's estimate of amounts that had been worked but had not been billed totaled $89.9 million and $152.4 million, respectively, and are included in accounts receivable in the consolidated balance sheets. Other Services Revenue The Company offers other optional services to its customers that are transferred over time including: managed service programs (MSP) providing agency services (as further described below in Gross Versus Net Policies), recruitment process outsourcing (RPO), other outsourcing services, and retained search services, as well as separately billable travel and housing costs, which in total amount to less than 5% of its consolidated revenue for the years ended December 31, 2023, 2022, and 2021. Generally, billing and payment terms for MSP agency services are consistent with temporary staffing as the customers are similar or the same. Revenue from these services is recognized based on the contractual amount for services completed to date which best depicts the transfer of control of services. The Company does not, in the ordinary course of business, offer warranties or refunds. Gross Versus Net Policies The Company records revenue on a gross basis as a principal or on a net basis as an agent depending on the contracted arrangement, as follows: Managed Service Programs (MSP) The Company has certain contracts with healthcare facilities to provide comprehensive services through its MSPs. Under these contractual arrangements, the customer’s orders are filled with either one of the Company’s healthcare professionals or a third party’s healthcare professionals (subcontractors). When its healthcare professional is staffed, the Company determined that it acts as a principal in the arrangement, as it is considered the employer of record. Accordingly, revenue is reported on a gross basis in the consolidated statements of operations and comprehensive income. Alternatively, the Company determined that it acts as an agent in the arrangement when a subcontracted healthcare professional is staffed, as the Company does not control the services before they are transferred to the customer. Accordingly, revenue is reported on a net basis in the consolidated statements of operations and comprehensive income. The customer is invoiced for the hours worked by the subcontracted healthcare professional multiplied by the hourly bill rate. A subcontractor liability is recognized as a reduction of revenue, net of an administrative fee, and is generally payable after the Company has received payment from its customer. The Company’s administrative fee is calculated as a percentage of the customer’s invoice and is recognized over time as the services are rendered by the subcontracted healthcare professional. The Company does not collect or recognize an upfront placement fee. Physician Staffing The Physician Staffing business has contracts with its healthcare customers to provide temporary staffing services. The Company uses independent contractors for these services. The Company determined that it acts as a principal in these arrangements and, therefore, revenue is reported on a gross basis in the consolidated statements of operations and comprehensive income. See Note 3 - Revenue Recognition for the Company’s revenues disaggregated by revenue source. Sales and usage-based taxes are excluded from revenue. Contract Costs All contract fulfillment costs are expensed as incurred to direct operating expenses. There were no contract assets or material contract liabilities as of December 31, 2023 and 2022. Practical Expedients and Exemptions For the Company’s contracts that have an original duration of one year or less, the Company uses the practical expedients and has elected to recognize any incremental costs of obtaining these contracts as expensed when incurred. Further, the Company does not disclose the value of unsatisfied performance obligations for: (i) contracts with an original expected length of one year or less; and (ii) contracts for which it recognizes revenue at the amount to which it has the right to invoice for services performed.
Share-Based Compensation	Share-Based Compensation For the years ended December 31, 2023, 2022, and 2021, the Company granted performance-based stock awards and restricted stock for a fixed number of common shares to employees. The Company values its restricted stock awards and the fair value of its performance-based stock awards by reference to its stock price on the date of grant. The Company has elected to recognize compensation expense on a straight-line basis over the requisite service period of the entire award. The Company granted performance-based stock awards to certain key personnel pursuant to its 2014 Omnibus Incentive Plan, amended and restated on May 23, 2017 (2017 Plan), and replaced by the 2020 Omnibus Incentive Plan, effective for awards granted after May 19, 2020, as described in Note 14 - Stockholders' Equity. Pursuant to the plans, the number of target shares that vest are determined based on the level of attainment of the targets. If a minimum level of performance is attained for the awards, restricted stock is issued based on the level of attainment. The Company recognizes performance-based restricted stock as compensation expense based on the most likely probability of attaining the prescribed performance and over the requisite service period beginning at its grant date and through the date the restricted stock vests. Compensation expense related to share-based payments is included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive income, and totaled $6.6 million, $7.4 million, and $6.9 million during the years ended December 31, 2023, 2022, and 2021, respectively. See Note 14 - Stockholders’ Equity.
Advertising	Advertising The Company’s advertising expense consists of programmatic advertising, display, search, internet, social media, video, and promotional aids and materials. Advertising costs are expensed as incurred and totaled $11.5 million, $16.1 million, and $9.5 million for the years ended December 31, 2023, 2022, and 2021, respectively, and are included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive income.
Restructuring Costs	Restructuring Costs The Company considers restructuring activities to be programs whereby it fundamentally changes its operations, such as closing and consolidating facilities, reducing headcount, and realigning operations in response to changing market conditions. As a result, restructuring costs on the consolidated statements of operations and comprehensive income primarily include employee termination costs and lease-related exit costs.
Income Taxes	Income Taxes Deferred income tax assets and liabilities are determined based upon differences between the financial reporting and tax basis of assets and liabilities, and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. The Company recognizes in its financial statements the impact of a tax position if that position is more likely than not of being sustained on audit, based on the technical merits of the position. The Company recognizes interest and penalties related to unrecognized tax benefits in the provision for income taxes. The Company determines the need for a valuation allowance by assessing the probability of realizing deferred tax assets, taking into consideration all available positive and negative evidence, including historical operating results, expectations of future taxable income, carryforward periods available to the Company for tax reporting purposes, the evaluation of various income tax planning strategies, and other relevant factors. The Company maintains a valuation allowance when it is more likely than not that all or a portion of a deferred tax asset will not be realized based on consideration of all available evidence. Adjustments to the deferred tax valuation allowances are made to earnings in the period when such assessments are made. Significant judgment is required in making this assessment. See Note 13 - Income Taxes.
Comprehensive Income (Loss)	Comprehensive Income (Loss) Total comprehensive income includes net income or loss and foreign currency translation adjustments, net of any related deferred taxes, and is included within the accompanying consolidated statements of operations and comprehensive income. Certain of the Company’s foreign subsidiaries use their respective local currency as their functional currency. Assets and liabilities of these operations are translated at the exchange rates in effect on the balance sheet date. Income statement items are translated at the average exchange rates for the period. The cumulative impact of currency fluctuations related to the balance sheet translation is included in accumulated other comprehensive loss in the accompanying consolidated balance sheets and was an unrealized loss of $1.5 million at December 31, 2023 and 2022. The income tax impact related to components of other comprehensive income for the years ended December 31, 2023, 2022 and 2021 is included in unrealized foreign currency translation income (loss), net of tax in the consolidated statements of operations and comprehensive income.
Fair Value Measurements	Fair Value Measurements Financial Accounting Standards Board (FASB) guidance defines fair value, establishes a framework for measuring fair value under U.S. GAAP, and expands disclosures about fair value measurements. The Company’s financial assets and liabilities required to be measured at fair value on a recurring basis were its: (i) deferred compensation asset and (ii) deferred compensation liability as of December 31, 2023. See Note 10 - Fair Value Measurements.
Earnings Per Share	Earnings Per Share Basic earnings per share is computed by dividing net income available to common stockholders (numerator) by the weighted average number of vested unrestricted common shares outstanding during the period (denominator). Diluted earnings per share gives effect to all dilutive potential common shares outstanding during the period including stock appreciation rights and options and unvested restricted stock, as calculated utilizing the treasury stock method. See Note 15 - Earnings Per Share.
Recently Adopted Accounting Pronouncements and Recent Accounting Pronouncements	Recently Adopted Accounting Pronouncements On October 28, 2021, the FASB issued Accounting Standards Update (ASU) No. 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, which requires contract assets and contract liabilities such as deferred revenue acquired in a business combination to be recognized and measured by the acquirer on the acquisition date in accordance with ASC 606, Revenue from Contracts with Customers. Generally, this amendment will result in the acquirer recognizing contract assets and contract liabilities at the same amounts recorded by the acquiree. Historically such amounts were recognized by the acquirer at fair value in acquisition accounting. This guidance is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. The amendments should be applied prospectively to business combinations occurring on or after the effective date of the amendments. Early adoption is permitted, including adoption in an interim period. The Company adopted this standard in the first quarter of 2023 and will apply the guidance to future acquisitions. Recent Accounting Pronouncements On December 14, 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which requires that public business entities, on an annual basis, (1) disclose specific categories in the rate reconciliation and (2) provide additional information for reconciling items that meet a quantitative threshold (if the effect of those reconciling items is equal to or greater than five percent of the amount computed by multiplying pretax income (or loss) by the applicable statutory income tax rate). The amendments also require that all entities disclose, on an annual basis, disaggregated information regarding income taxes paid and income tax expense. This guidance is effective for annual periods beginning after December 15, 2024. The amendments should be applied prospectively, but retrospective application is permitted. Early adoption is permitted for annual financial statements that have not yet been issued or made available for issuance. The Company expects to adopt this standard for its fiscal year ended December 31, 2025. The Company expects this ASU to only impact its disclosures with no impacts to results of operations, cash flows, and financial condition. On November 27, 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses, enhances interim disclosure requirements, clarifies circumstances in which an entity can disclose multiple segment measures of profit or loss, provides new segment disclosure requirements for entities with a single reportable segment, and requires certain disclosures related to the chief operating decision maker. This guidance is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. The amendments should be applied retrospectively to all prior periods presented in the financial statements. Early adoption is permitted. The Company expects to adopt this standard for its fiscal year ended December 31, 2024. The Company expects this ASU to only impact its disclosures with no impacts to results of operations, cash flows, and financial condition.

Debt -2021 Term Loan Credit Agreement (Details) - USD ($)					3 Months Ended			4 Months Ended	9 Months Ended	12 Months Ended
	Jun. 30, 2023	Oct. 26, 2022	Jun. 23, 2022	Jun. 08, 2021	Jun. 30, 2023	Dec. 31, 2022	Jun. 30, 2022	Oct. 26, 2022	Dec. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Nov. 18, 2021
Debt Instrument [Line Items]
Repayment of outstanding obligations										$ 73,875,000	$ 100,438,000	$ 688,000
2021 Term Loan Credit Agreement \| Secured Debt
Debt Instrument [Line Items]
Payment for debt prepayment		$ 50,000,000	$ 50,000,000					$ 100,000,000	$ 100,000,000
Debt term				6 years
Face amount				$ 100,000,000
Extinguishment fees					$ 0				$ 1,000,000
Write off of debt issuance costs					$ 1,700,000	$ 1,300,000	$ 1,400,000
Repayment of outstanding obligations	$ 73,900,000
2021 Term Loan Credit Agreement \| Secured Debt \| LIBOR
Debt Instrument [Line Items]
Interest margin (percent)				5.75%
Interest margin floor (percent)				0.75%
2021 Term Loan Credit Agreement, Incremental Term Loan \| Secured Debt
Debt Instrument [Line Items]
Face amount													$ 75,000,000
2021 Term Loan Credit Agreement, Aggregate Amount of all Increases \| Secured Debt
Debt Instrument [Line Items]
Face amount													$ 115,000,000

Related Party Transactions (Details)	3 Months Ended								12 Months Ended
Related Party Transactions (Details)	Dec. 31, 2023 USD ($)	Sep. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)	Mar. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Sep. 30, 2022 USD ($)	Jun. 30, 2022 USD ($)	Mar. 31, 2022 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Mar. 31, 2020 USD ($) installment
Related Party Transaction [Line Items]
Revenue from services	$ 414,035,000	$ 442,291,000	$ 540,695,000	$ 622,707,000	$ 628,218,000	$ 636,098,000	$ 753,561,000	$ 788,732,000	$ 2,019,728,000	$ 2,806,609,000	$ 1,676,652,000
Accounts payable and accrued expenses	85,333,000				185,507,000				85,333,000	185,507,000
Payments of notes payable									0	2,426,000	2,426,000
Related Party \| Services Provided Entities Affiliated with Board Members
Related Party Transaction [Line Items]
Revenue from services									1,200,000	1,800,000	$ 700,000
Related Party \| Rental of WSG's Headquarters
Related Party Transaction [Line Items]
Accounts payable and accrued expenses	$ 0				$ 0				$ 0	$ 0
Affiliated Entity \| Acquisition with Mediscan \| Earnout Notes Payable
Related Party Transaction [Line Items]
Notes payable												$ 7,300,000
Note payable, number of payment installments \| installment												3
Payments of notes payable								$ 2,600,000

Earnings Per Share - Components of Numerator and Denominator for Computation of Basic and Diluted Earnings per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Numerator:
Net income attributable to common stockholders - Basic									$ 72,631	$ 188,461	$ 132,002
Net income attributable to common stockholders - Diluted									$ 72,631	$ 188,461	$ 132,002
Denominator:
Weighted average common shares - Basic (in shares)									35,158	37,012	36,689
Effective of diluted shares:
Share-based awards (shares)									318	524	703
Weighted average common shares - Diluted (in shares)									35,476	37,536	37,392
Net income per share attributable to common stockholders - Basic (usd per share)	$ 0.26	$ 0.37	$ 0.60	$ 0.82	$ 1.06	$ 0.94	$ 1.41	$ 1.67	$ 2.07	$ 5.09	$ 3.60
Net income per share attributable to common stockholders - Diluted (usd per share)	$ 0.26	$ 0.36	$ 0.60	$ 0.81	$ 1.05	$ 0.93	$ 1.40	$ 1.63	$ 2.05	$ 5.02	$ 3.53

Quarterly Financial Data (Unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Quarterly Financial Information Disclosure [Abstract]
Revenue from services	$ 414,035	$ 442,291	$ 540,695	$ 622,707	$ 628,218	$ 636,098	$ 753,561	$ 788,732	$ 2,019,728	$ 2,806,609	$ 1,676,652
Gross profit	90,489	97,359	123,139	139,423	138,942	143,545	170,405	174,794
Net income attributable to common stockholders	$ 9,038	$ 12,812	$ 21,345	$ 29,436	$ 38,791	$ 34,793	$ 52,894	$ 61,983	$ 72,631	$ 188,461	$ 132,002
Net income per share attributable to common stockholders - Basic (usd per share)	$ 0.26	$ 0.37	$ 0.60	$ 0.82	$ 1.06	$ 0.94	$ 1.41	$ 1.67	$ 2.07	$ 5.09	$ 3.60
Net income per share attributable to common stockholders - Diluted (usd per share)	$ 0.26	$ 0.36	$ 0.60	$ 0.81	$ 1.05	$ 0.93	$ 1.40	$ 1.63	$ 2.05	$ 5.02	$ 3.53
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charges									$ 719	$ 5,597	$ 2,070
Restructuring costs	$ 900		$ 900			$ 2,500			2,553	1,861	2,630
Gain on lease termination							$ 1,100
Loss on early extinguishment of debt			$ 1,700		$ 1,800		$ 1,900		1,723	3,728	0
Legal settlement charges				$ 1,100					$ 1,125	$ 0	$ 0
Leased Property
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charges						2,000		$ 1,700
IT Project
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charges						$ 1,900

Goodwill, Trade Names, and Other Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Acquired Intangible Assets

The Company had the following acquired intangible assets:


	December 31, 2023						December 31, 2022
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
	(amounts in thousands)
Intangible assets subject to amortization:
Databases	$	45,930	$	24,971	$	20,959	$	33,430	$	22,033	$	11,397
Customer relationships	52,538		26,286		26,252		47,738		21,672		26,066
Non-compete agreements	—		—		—		4		3		1
Trade names	900		548		352		30		16		14
Software	1,700		695		1,005		1,700		355		1,345
Other intangible assets, net	$	101,068	$	52,500	$	48,568	$	82,902	$	44,079	$	38,823
Intangible assets not subject to amortization:
Trade names, indefinite-lived					$	5,900					$	5,900

Schedule of Estimated Annual Amortization Expense

As of December 31, 2023, estimated annual amortization expense was as follows:


Years Ending December 31:	(amounts in thousands)
2024	$	10,481
2025	9,570
2026	8,362
2027	6,191
2028	4,790
Thereafter	9,174
	$	48,568

Schedule of Changes in Carrying Amount of Goodwill by Segment

The changes in the carrying amount of goodwill by reportable segment are as follows:


	Nurse And Allied Staffing		Physician Staffing		Total
	(amounts in thousands)
Balances as of December 31, 2022
Aggregate goodwill acquired	$	395,119	$	78,621	$	473,740
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	125,245		38,023		163,268

Changes to aggregate goodwill in 2023
Goodwill acquisition adjustments(a)	(12,738)		(15,100)		(27,838)


Balances as of December 31, 2023
Aggregate goodwill acquired	382,381		63,521		445,902
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	$	112,507	$	22,923	$	135,430

________________

(a) Represents adjustments to the fair value of the identifiable net assets acquired, with a corresponding offset to goodwill, made during the measurement periods related to the acquisitions of HireUp, Mint, and a local business. The measurement periods have concluded, and no further adjustments are anticipated. See Note 4 - Acquisitions.

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

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+ Details

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net income attributable to common stockholders	$ 9,038	$ 12,812	$ 21,345	$ 29,436	$ 38,791	$ 34,793	$ 52,894	$ 61,983	$ 72,631	$ 188,461	$ 132,002

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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-URI https://asc.fasb.org//1943274/2147483621/220-10-S99-2

Reference 39: http://fasb.org/us-gaap/role/ref/legacyRef
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-Paragraph 1
-Subparagraph (SX 210.9-04(22))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483589/942-220-S99-1

+ Details

Earnings Per Share

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Earnings Per Share

The following table sets forth the components of the numerator and denominator for the computation of the basic and diluted earnings per share:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands, except per share data)
Numerator:



Net income attributable to common stockholders - Basic and Diluted	$	72,631	$	188,461	$	132,002

Denominator:
Weighted average common shares - Basic	35,158		37,012		36,689
Effective of diluted shares:
Share-based awards	318		524		703

Weighted average common shares - Diluted	35,476		37,536		37,392

Net income per share attributable to common stockholders - Basic	$	2.07	$	5.09	$	3.60

Net income per share attributable to common stockholders - Diluted	$	2.05	$	5.02	$	3.53


	Year Ended December 31,
	2023	2022	2021
	(amounts in thousands)
Share-based awards	2	55	6

Stockholders' Equity - Share-Based Payments (Details) - USD ($)					3 Months Ended			12 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Mar. 31, 2021	May 19, 2020	Mar. 31, 2023	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance attainment percentage					120.00%
Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vested (in shares)								404,873
Performance Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vested (in shares)	238,253							238,253
Omnibus Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares reserved for future issuance (in shares)				3,000,000
Performance shares, attainment level certification period								30 days
Omnibus Plan \| Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock vesting period								3 years
Pretax of total unrecognized compensation cost related to non-vested restricted stock awards								$ 6,800,000
Pretax total unrecognized compensation cost related to share options- period								1 year 5 months 15 days
Fair value of shares vested								$ 9,300,000	$ 12,100,000	$ 8,900,000
Omnibus Plan \| Performance Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued (in shares)	160,782	126,576	160,416			16,921	7,908
Pretax of total unrecognized compensation cost related to non-vested restricted stock awards								$ 1,700,000
Pretax total unrecognized compensation cost related to share options- period								1 year 3 months 3 days
Fair value of shares vested								$ 5,300,000	$ 3,700,000	$ 0
Omnibus Plan \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock vesting period				1 year

Stockholders' Equity - Restricted Stock Activity (Details) - $ / shares		12 Months Ended
	Mar. 31, 2023	Dec. 31, 2023
Restricted Stock Awards
Number of Shares
Unvested restricted stock awards, beginning balance (in shares)		674,508
Granted (in shares)		319,312
Vested (in shares)		(404,873)
Forfeited (in shares)		(41,413)
Unvested restricted stock awards, ending balance (in shares)		547,534
Weighted Average Grant Date Fair Value
Unvested restricted stock awards, beginning balance (usd per share)		$ 14.53
Granted (usd per share)		22.87
Vested (usd per share)		12.51
Forfeited (usd per share)		20.70
Unvested restricted stock awards, ending balance (usd per share)		$ 20.42
Performance Stock Awards
Number of Shares
Unvested restricted stock awards, beginning balance (in shares)		476,086
Granted (in shares)		200,487
Vested (in shares)	(238,253)	(238,253)
Forfeited (in shares)		(21,123)
Unvested restricted stock awards, ending balance (in shares)		417,197
Weighted Average Grant Date Fair Value
Unvested restricted stock awards, beginning balance (usd per share)		$ 12.56
Granted (usd per share)		19.23
Vested (usd per share)		6.74
Forfeited (usd per share)		19.28
Unvested restricted stock awards, ending balance (usd per share)		$ 18.75

Segment Data

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Segment Data

In the first quarter of 2021, the Company modified its disclosures of reportable segments to better align with its management structure and to reflect how the operating results are regularly reviewed by the chief operating decision maker, resulting in two reportable segments, Nurse and Allied Staffing and Physician Staffing. The Company’s segments offer services to its customers as described below:

•Nurse and Allied Staffing - Nurse and Allied Staffing provides traditional staffing, recruiting, and value-added total talent solutions including: temporary and permanent placement of travel and local nurse and allied professionals, and healthcare leaders within nursing, allied, physician, human resources, and finance, MSP services, education healthcare services, in-home care services, and outsourcing services. In addition, Nurse and Allied Staffing provides executive search services for healthcare professionals, as well as contingent search and recruitment process outsourcing services, and offers the Company's SaaS-based, proprietary, vendor management technology, Intellify® to facilities to manage all or a portion of their agency services. Its customers include: public and private acute-care and non-acute care hospitals, government facilities, local and national healthcare plans, managed care providers, public schools and charter schools, academic medical centers, Programs of All-Inclusive Care for the Elderly (PACE) programs, outpatient clinics, ambulatory care facilities, physician practice groups, and many other healthcare providers throughout the United States.

•Physician Staffing - Physician Staffing provides physicians in many specialties, as well as certified registered nurse anesthetists, nurse practitioners, and physician assistants as independent contractors on temporary assignments throughout the United States at various healthcare facilities, such as acute and non-acute care facilities, medical group practices, government facilities, and managed care organizations.

The Company evaluates performance of each segment primarily based on revenue and contribution income. The Company defines contribution income as income (loss) from operations before depreciation and amortization, acquisition and integration-related (benefits) costs, restructuring (benefits) costs, legal settlement charges, impairment charges, and corporate overhead. The Company does not evaluate, manage, or measure performance of segments using asset information; accordingly, total asset information by segment is not prepared or disclosed. The information in the following table is derived from the segments’ internal financial information as used for corporate management purposes. Certain corporate expenses are not allocated to and/or among the operating segments.

Information on operating segments and a reconciliation to income from operations for the periods indicated are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Revenues from services:
Nurse and Allied Staffing	$	1,841,428	$	2,700,383	$	1,605,781
Physician Staffing	178,300		106,226		70,871
	$	2,019,728	$	2,806,609	$	1,676,652
Contribution income:
Nurse and Allied Staffing	$	196,777	$	355,447	$	205,738
Physician Staffing	9,788		5,508		4,328
	206,565		360,955		210,066

Corporate overhead(a)	71,049		67,087		55,142
Depreciation and amortization	18,347		12,576		9,852


Restructuring costs	2,553		1,861		2,630
Legal settlement charges	1,125		—		—
Impairment charges	719		5,597		2,070
Other costs(b)	59		726		1,068
Income from operations	$	112,713	$	273,108	$	139,304

_______________

(b) Other costs include acquisition and integration-related costs.

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-15

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Name Accounting Standards Codification
-Section 50
-Paragraph 31
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-31

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Paragraph 32
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 40
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//280/tableOfContent

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 26
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-26

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 34
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-34

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

+ Details

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Loss, net	(Accumulated Deficit) Retained Earnings	Noncontrolling Interest in Subsidiary
Beginning balance (in shares) at Dec. 31, 2020		36,177,000
Beginning balance at Dec. 31, 2020	$ 154,909	$ 4	$ 310,388	$ (1,280)	$ (154,737)	$ 534
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Vesting of restricted stock (in shares)		479,000
Vesting of restricted stock	(2,230)		(2,230)
Equity compensation	6,894		6,894
Foreign currency translation adjustment, net of taxes	(13)			(13)
Acquisitions (in shares)		368,000
Acquisitions	6,500		6,500
Dissolution of noncontrolling interest	(324)					(324)
Distribution to noncontrolling shareholder	(210)					(210)
Net income	132,002				132,002
Ending balance (in shares) at Dec. 31, 2021		37,024,000
Ending balance at Dec. 31, 2021	297,528	$ 4	321,552	(1,293)	(22,735)	0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Vesting of restricted stock (in shares)		499,000
Vesting of restricted stock	(5,267)		(5,267)
Equity compensation	7,393		7,393
Stock repurchase and retirement (in shares)		(1,365,000)
Stock repurchase and retirement	(35,285)		(35,285)
Foreign currency translation adjustment, net of taxes	(94)			(94)
Acquisitions (in shares)		145,000
Acquisitions	4,483		4,483
Net income	$ 188,461				188,461
Ending balance (in shares) at Dec. 31, 2022	36,302,618	36,303,000
Ending balance at Dec. 31, 2022	$ 457,219	$ 4	292,876	(1,387)	165,726	0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Vesting of restricted stock (in shares)		426,000
Vesting of restricted stock	(4,905)		(4,905)
Equity compensation	6,579		6,579
Stock repurchase and retirement (in shares)		(2,344,000)
Stock repurchase and retirement	(57,654)		(57,654)
Stock repurchase excise tax	(479)		(479)
Foreign currency translation adjustment, net of taxes	2			2
Net income	$ 72,631				72,631
Ending balance (in shares) at Dec. 31, 2023	34,384,905	34,385,000
Ending balance at Dec. 31, 2023	$ 473,393	$ 4	$ 236,417	$ (1,385)	$ 238,357	$ 0

Leases - Other Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities	$ 4,859	$ 5,753	$ 6,150
Right-of-use assets acquired under operating lease	1,040	473	1,059
Operating lease expense	1,681	2,550	3,538
Short-term lease expense	3,209	5,114	3,695
Variable and other lease costs	$ 724	$ 2,195	$ 1,957

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 17,094	$ 3,604
Accounts receivable, net of allowances of $20,547 in 2023 and $14,696 in 2022	372,352	641,611
Income taxes receivable	6,898	10,915
Prepaid expenses	7,681	11,067
Insurance recovery receivable	9,097	7,434
Other current assets	2,031	1,042
Total current assets	415,153	675,673
Property and equipment, net	27,339	19,662
Operating lease right-of-use assets	2,599	3,254
Goodwill	135,430	163,268
Other intangible assets, net	54,468	44,723
Deferred tax assets	5,954	7,092
Insurance recovery receivable	25,714	23,058
Cloud computing	5,987	4,460
Other assets	6,673	6,649
Total assets	679,317	947,839
Current liabilities:
Accounts payable and accrued expenses	85,333	185,507
Accrued compensation and benefits	52,297	72,605
Operating lease liabilities	2,604	4,132
Earnout liability	6,794	7,500
Other current liabilities	1,559	1,896
Total current liabilities	148,587	271,640
Debt	0	148,735
Operating lease liabilities	2,663	4,880
Accrued claims	34,853	35,881
Earnout liability	5,000	18,000
Uncertain tax positions	10,603	7,646
Other liabilities	4,218	3,838
Total liabilities	205,924	490,620
Commitments and contingencies
Stockholders' equity:
Common stock—$0.0001 par value; 100,000,000 shares authorized; 34,384,905 and 36,302,618 shares issued and outstanding at December 31, 2023 and 2022, respectively	4	4
Additional paid-in capital	236,417	292,876
Accumulated other comprehensive loss	(1,385)	(1,387)
Retained earnings	238,357	165,726
Total stockholders' equity	473,393	457,219
Total liabilities and stockholders' equity	$ 679,317	$ 947,839

Contingencies	12 Months Ended
Contingencies	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies Legal Proceedings From time to time, the Company is involved in various litigation, claims, investigations, and other proceedings that arise in the ordinary course of its business. These proceedings primarily relate to employee-related matters that include individual and collective claims, professional liability, tax, and payroll practices. The Company establishes reserves when available information indicates that a loss is probable and an amount or range of loss can be reasonably estimated. These assessments are performed at least quarterly and are based on the information available to management at the time and involve significant management judgment to determine the probability and estimated amount of potential losses, if any. Based on the available information considered in its reviews, the Company adjusts its loss contingency accruals and its disclosures as may be required. Actual outcomes or losses may differ materially from those estimated by the Company’s current assessments, including available insurance recoveries, which would impact the Company’s profitability. Adverse developments in existing litigation claims or legal proceedings involving the Company or new claims could require management to establish or increase litigation reserves or enter into unfavorable settlements or satisfy judgments for monetary damages for amounts in excess of current reserves, which could adversely affect the Company’s financial results. During the third quarter of 2021, the Company entered into an agreement providing for the reimbursement of $1.6 million in legal fees relating to a grand jury subpoena disclosed in a previous Annual Report on Form 10-K, which was collected in the fourth quarter of 2021. The Company believes the outcome of any outstanding loss contingencies as of December 31, 2023 will not have a material adverse effect on its business, financial condition, results of operations, or cash flows. Sales and Other State Non-Income Tax Liabilities The Company operates in all 50 states and numerous local jurisdictions, some of which assess sales and other state non-income taxes on our services. In the past, it has been subject to routine audits by authorities in the jurisdictions which have resulted in assessments of additional taxes, interest and penalties. The Company accrues sales and other state non-income tax liabilities based on its best estimate of the probable liability utilizing currently available information and interpretation of relevant tax regulations. Given the nature of the Company’s services offered, subjectivity exists as to both whether sales and other state non-income taxes can be assessed. The Company makes a determination for each reporting period whether the estimates for sales and other non-income taxes in certain states and local jurisdictions are materially accurate. The expense is included in selling, general and administrative expenses in its consolidated statements of operations and comprehensive income and the liability is reflected in sales tax payable within other current liabilities in the consolidated balance sheets.

Debt

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Debt

The Company's debt consists of the following:


	December 31, 2023				December 31, 2022
	Principal		Debt Issuance Costs		Principal		Debt Issuance Costs
	(amounts in thousands)
Term Loan, interest of 10.14% at December 31, 2022	$	—	$	—	$	73,875	$	(1,940)
Senior Secured Asset-Based Loan, interest of 6.99% and 5.90% at December 31, 2023 and 2022, respectively	—		(2,623)		76,800		(3,437)
Debt	$	—	$	(2,623)	$	150,675	$	(5,377)

As of December 31, 2023 and 2022, all debt is considered non-current debt on the consolidated balance sheets.The Company has elected to present the debt issuance costs associated with its revolving line-of-credit as an asset, which is included in other assets on the consolidated balance sheets. As a result, the debt in the above table will not agree to debt on the consolidated balance sheets herein.

In addition to its scheduled payments, the Company made optional prepayments of $50.0 million on its term loan on June 23, 2022 and October 26, 2022, totaling $100.0 million, to reduce interest costs. The Company was entitled to determine the application of the prepayments, which were applied to all future amortization payments, with the balance applied to the remaining balloon payment in 2027. On June 30, 2023, the Company repaid all outstanding obligations under the term loan and terminated the Term Loan Agreement (as defined below).

2021 Term Loan Credit Agreement

On June 8, 2021, the Company entered into a Term Loan Credit Agreement (Term Loan Agreement) with certain lenders identified therein (collectively, the Lenders) and Wilmington Trust, National Association as administrative agent and collateral agent, pursuant to which the Lenders extended to the Company a six-year second lien subordinated term loan in the amount of $100.0 million (term loan). The term loan had an interest rate of one-month London Inter-Bank Offered Rate (LIBOR) plus 5.75% per annum, subject to a 0.75% LIBOR floor. The borrowings under the Term Loan Agreement generally bore interest at a variable rate based on either LIBOR or Base Rate (as defined in the Term Loan Agreement) and were subject to mandatory prepayments of principal payable in quarterly installments.

The term loan was secured by a second-priority security interest in the collateral as defined in the Loan Agreement (as defined below). The lien priority, relative rights, and other creditors’ rights issues in respect of the collateral lenders are set forth in the Intercreditor Agreement, dated June 8, 2021 (Intercreditor Agreement).

On November 18, 2021, the Company amended its Term Loan Agreement (Term Loan First Amendment), which provided the Company an incremental term loan in an aggregate amount equal to $75.0 million. Additionally, the Term Loan First Amendment increased the aggregate amount of all increases (as defined in the Term Loan Agreement) to be no greater than $115.0 million. In conjunction with the Term Loan First Amendment, the Company entered into the Term Loan First Amendment to the Intercreditor Agreement effective as of November 18, 2021.

On April 14, 2023, the Company amended its Term Loan Agreement (Term Loan Second Amendment), which provided the option for all or a portion of the borrowings to bear interest at a rate based on the Secured Overnight Financing Rate (SOFR) or the Base Rate, at the election of the borrowers, plus an applicable margin. With respect to any SOFR loan, the rate per annum was equal to the Term SOFR (as defined in the Term Loan Second Amendment) for the interest period plus an adjustment of basis points due to the credit spread associated with the transition to SOFR.

In the second and fourth quarters of 2022, the Company made early prepayments totaling $100.0 million, and incurred prepayment premiums of $1.0 million pursuant to the Term Loan Agreement. Debt issuance costs of $1.4 million and $1.3 million were written off in the second and fourth quarters of 2022, respectively.

On June 30, 2023, the Company repaid all outstanding obligations of $73.9 million under the term loan and terminated the Term Loan Agreement. As a result, debt issuance costs of $1.7 million were written off in the second quarter of 2023. There were no prepayment premiums associated with the payoff and all subsidiary guarantees of the term loan were automatically released.

Any prepayment premiums and write-off of debt issuance costs are included as loss on early extinguishment of debt in the consolidated statements of operations and comprehensive income.

2019 Asset-Based Loan Agreement

Effective October 25, 2019, the Company terminated its prior senior credit facility and entered into an asset-based loan agreement, by and among the Company and certain of its domestic subsidiaries, as borrowers or guarantors, Wells Fargo, PNC Bank N.A., as well as other Lenders (as defined therein) from time to time parties thereto (Loan Agreement). The Loan Agreement provides for a five-year revolving senior secured asset-based credit facility (ABL) in the aggregate principal amount of up to $120.0 million, including a sublimit for swing loans up to $15.0 million and a $35.0 million sublimit for standby letters of credit. The initial amounts drawn on the ABL included funds to repay the Company’s then outstanding borrowings of $75.4 million under its August 2017 Credit Facility and $1.3 million for the payment of fees, expenses, and accrued interest, as well as to backstop $21.2 million for outstanding letters of credit.

On June 30, 2020, the Company amended its Loan Agreement (First Amendment), which increased the current aggregate committed size of the ABL from $120.0 million to $130.0 million. All other terms, conditions, covenants, and pricing of the Loan Agreement remained the same.

On March 8, 2021, the Company amended its Loan Agreement (Second Amendment), which increased the current aggregate committed size of the ABL from $130.0 million to $150.0 million, increased certain borrowing base sub-limits, and decreased both the cash dominion event and financial reporting triggers.

On June 8, 2021, the Company amended its Loan Agreement (Third Amendment), which permits the incurrence of indebtedness and grant of security as set forth in the Loan Agreement and in accordance with the Intercreditor Agreement, and provides mechanics relating to a transition away from LIBOR as a benchmark interest rate to a replacement alternative benchmark rate or mechanism for loans made in U.S. dollars.

On November 18, 2021, the Company amended its Loan Agreement (Fourth Amendment), whereby the permitted indebtedness (as defined in the Loan Agreement), was increased to $175.0 million.

On March 21, 2022, the Company amended its Loan Agreement (Fifth Amendment), which increased the current aggregate committed size of the ABL from $150.0 million to $300.0 million, extended the credit facility for an additional five years through March 21, 2027, and increased certain borrowing base sub-limits. In addition, the agreement provides the option for all or a portion of the borrowings to bear interest at a rate based on the SOFR or Base Rate, at the election of the borrowers, plus an applicable margin. The applicable margin will increase 10 basis points due to the credit spread associated with the transition to SOFR.

On September 29, 2023, the Company amended its Loan Agreement (Sixth Amendment), which changed the minimum fixed charge coverage ratio from a maintenance covenant to a springing covenant based on excess availability, which provides for compliance with the covenant only during a compliance period (any time that excess availability falls below a certain threshold), and in such case, the financial covenant shall be tested during this period.

These amendments were treated as modifications of debt and, as a result, the associated fees and costs were included in debt issuance costs and will be amortized ratably over the remaining term of the Loan Agreement.

Availability of the ABL commitments is subject to a borrowing base of up to 85% of secured eligible accounts receivable, subject to adjustment at certain quality levels, minus customary reserves and subject to customary adjustments. Revolving loans and letters of credit issued under the Loan Agreement reduce availability under the ABL on a dollar-for-dollar basis. Availability under the ABL will be used for general corporate purposes. At December 31, 2023, borrowing base availability under the ABL was $220.6 million. The Company had no borrowings drawn, and $13.8 million of letters of credit outstanding

related to workers' compensation and professional liability policies (See Note 2 - Summary of Significant Accounting Policies), leaving $206.8 million of excess availability.

As of December 31, 2023, the interest rate spreads and fees under the Loan Agreement were based on SOFR plus 1.60% for the revolving portion of the borrowing base. The Base Rate (as defined by the Loan Agreement) margin would have been 0.50% for the revolving portion. The SOFR and Base Rate margins are subject to monthly pricing adjustments, pursuant to a pricing matrix based on the Company’s excess availability under the revolving credit facility. In addition, the facility is subject to an unused line fee, letter of credit fees, and an administrative fee. The unused line fee is 0.375% of the average daily unused portion of the revolving credit facility.

The Loan Agreement contains various restrictions applicable to the Company and its subsidiaries. Obligations under the ABL are secured by substantially all the assets of the borrowers and guarantors (as defined therein), subject to customary exceptions.

The Loan Agreement also contains customary events of default. If an event of default under the Loan Agreement occurs and remains uncured, then the administrative agent or the requisite lenders may declare any outstanding obligations to be immediately due and payable. In addition, if the Company or any of its subsidiaries becomes the subject of voluntary or involuntary proceedings under any bankruptcy, insolvency or similar law, then any outstanding obligations under the Agreement will automatically become due and payable.

Note Payable

On October 30, 2015, in connection with the Mediscan acquisition, the Company assumed two contingent purchase price liabilities for a previously acquired business, one that was payable annually based on certain performance criteria for the years 2016 through 2019, and a second performance criterion related to 2019 payable in three equal installments. In the first quarter of 2020, the total earnout amount related to both 2019 performance criteria of $7.4 million was determined, and the Company paid $0.1 million on the first earnout related to the year 2019. The remaining $7.3 million, related to the second earnout, was converted to a subordinated promissory note payable.

The first two installments of $2.4 million each were paid in the second quarter of 2020 and in the first quarter of 2021, respectively. The third and final installment of $2.6 million, including interest of 2% per annum, accruing from April 1, 2020, was paid in the first quarter of 2022. See Note 4 - Acquisitions.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-Publisher FASB
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Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI https://asc.fasb.org//470/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2023
Audit Information [Abstract]
Auditor Name	Deloitte & Touche LLP
Auditor Firm ID	34
Auditor Location	Boca Raton, Florida

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands		3 Months Ended		12 Months Ended
	Jun. 30, 2023	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Fair Value Measurement [Line Items]
Repayment of outstanding obligations				$ 73,875	$ 100,438	$ 688
Payment for contingent liability				7,500	7,500	$ 0
Current portion of earnout liability				6,794	7,500
Non-current portion of earnout liability				5,000	$ 18,000
Workforce Solutions Group, Inc.
Fair Value Measurement [Line Items]
Payment for contingent liability		$ 7,500	$ 7,500
Mint
Fair Value Measurement [Line Items]
Current portion of earnout liability				4,900
Non-current portion of earnout liability				5,000
HireUp
Fair Value Measurement [Line Items]
Current portion of earnout liability				$ 1,900
2021 Term Loan Credit Agreement \| Secured Debt
Fair Value Measurement [Line Items]
Repayment of outstanding obligations	$ 73,900

Acquisitions - Local Business (Details) - USD ($) $ in Thousands	Dec. 15, 2022	Dec. 31, 2023	Mar. 31, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Goodwill		$ 135,430		$ 163,268
Ohio Based Business
Business Acquisition [Line Items]
Cash consideration, gross	$ 2,000
Goodwill			$ 0

- Definition

+ References + Details

Goodwill, Trade Names, and Other Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Intangible assets subject to amortization:
Gross Carrying Amount	$ 101,068	$ 82,902
Accumulated Amortization	52,500	44,079
Net Carrying Amount	48,568	38,823
Intangible assets not subject to amortization:
Trade names, indefinite-lived	5,900	5,900
Databases
Intangible assets subject to amortization:
Gross Carrying Amount	45,930	33,430
Accumulated Amortization	24,971	22,033
Net Carrying Amount	20,959	11,397
Customer relationships
Intangible assets subject to amortization:
Gross Carrying Amount	52,538	47,738
Accumulated Amortization	26,286	21,672
Net Carrying Amount	26,252	26,066
Non-compete agreements
Intangible assets subject to amortization:
Gross Carrying Amount	0	4
Accumulated Amortization	0	3
Net Carrying Amount	0	1
Trade names
Intangible assets subject to amortization:
Gross Carrying Amount	900	30
Accumulated Amortization	548	16
Net Carrying Amount	352	14
Software
Intangible assets subject to amortization:
Gross Carrying Amount	1,700	1,700
Accumulated Amortization	695	355
Net Carrying Amount	$ 1,005	$ 1,345

Income Taxes - Significant Components of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Deferred Tax Assets:
Accrued other and prepaid expenses	$ 912	$ 96
Allowance for doubtful accounts	5,321	3,471
Intangible assets	7,072	7,518
Net operating loss carryforwards	1,054	1,389
Accrued professional liability	851	1,118
Accrued workers’ compensation	3,097	3,631
Share-based compensation	1,197	992
Operating lease liabilities	1,319	2,228
Credit carryforwards	0	1
Other	1,016	630
Gross deferred tax assets	21,839	21,074
Valuation allowance	(2)	(2)
Deferred tax assets	21,837	21,072
Deferred Tax Liabilities:
Depreciation	(967)	(1,411)
Indefinite-lived intangibles	(14,296)	(11,829)
Operating lease right-of-use assets	(620)	(740)
Tax on unrepatriated earnings	(401)	(247)
Deferred tax liabilities	(16,284)	(14,227)
Net deferred taxes	$ 5,553	$ 6,845

Summary of Significant Accounting Policies - Restructuring (Benefits) Costs (Details) - USD ($) $ in Thousands	3 Months Ended			12 Months Ended
	Dec. 31, 2023	Jun. 30, 2023	Sep. 30, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Restructuring Reserve [Roll Forward]
Charged to restructuring	$ 900	$ 900	$ 2,500	$ 2,553	$ 1,861	$ 2,630
Employee Termination Costs
Restructuring Reserve [Roll Forward]
Balance at beginning of period				799	160	499
Charged to restructuring				2,491	792	814
Payments and adjustments				(2,395)	(153)	(1,153)
Balance at end of period	895			895	799	160
Lease-Related Exit Costs
Restructuring Reserve [Roll Forward]
Balance at beginning of period				2,196	2,423	2,687
Charged to restructuring				62	765	544
Payments and adjustments				(1,074)	(992)	(808)
Balance at end of period	$ 1,184			$ 1,184	$ 2,196	$ 2,423

Goodwill, Trade Names, and Other Intangible Assets

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill, Trade Names, and Other Intangible Assets

The Company had the following acquired intangible assets:


	December 31, 2023						December 31, 2022
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
	(amounts in thousands)
Intangible assets subject to amortization:
Databases	$	45,930	$	24,971	$	20,959	$	33,430	$	22,033	$	11,397
Customer relationships	52,538		26,286		26,252		47,738		21,672		26,066
Non-compete agreements	—		—		—		4		3		1
Trade names	900		548		352		30		16		14
Software	1,700		695		1,005		1,700		355		1,345
Other intangible assets, net	$	101,068	$	52,500	$	48,568	$	82,902	$	44,079	$	38,823
Intangible assets not subject to amortization:
Trade names, indefinite-lived					$	5,900					$	5,900

During 2023, fully amortized intangible assets of $3.4 million related to databases, and immaterial amounts related to non-compete agreements and trade names, along with the related accumulated amortization, were removed from the table above.

As of December 31, 2023, estimated annual amortization expense was as follows:


Years Ending December 31:	(amounts in thousands)
2024	$	10,481
2025	9,570
2026	8,362
2027	6,191
2028	4,790
Thereafter	9,174
	$	48,568

The changes in the carrying amount of goodwill by reportable segment are as follows:


	Nurse And Allied Staffing		Physician Staffing		Total
	(amounts in thousands)
Balances as of December 31, 2022
Aggregate goodwill acquired	$	395,119	$	78,621	$	473,740
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	125,245		38,023		163,268

Changes to aggregate goodwill in 2023
Goodwill acquisition adjustments(a)	(12,738)		(15,100)		(27,838)


Balances as of December 31, 2023
Aggregate goodwill acquired	382,381		63,521		445,902
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	$	112,507	$	22,923	$	135,430

________________

Goodwill, Trade Names, and Other Intangible Assets Impairment

The Company tests reporting units’ goodwill and intangible assets with indefinite lives for impairment annually during the fourth quarter and more frequently if impairment indicators exist. The Company performs quarterly qualitative assessments of significant events and circumstances such as reporting units’ historical and current results, assumptions regarding future performance, strategic initiatives and overall economic factors, and macro-economic developments, to determine the existence of potential indicators of impairment and assess if it is more likely than not that the fair value of reporting units or intangible assets is less than their carrying value. If indicators of impairments are identified a quantitative impairment test is performed.

The Company performed its annual quantitative impairment test of goodwill and its indefinite-lived trade name as of October 1, 2023 and 2022 and determined that the estimated fair value of its reporting units and its indefinite-lived trade name exceeded their respective carrying values. Although management believes that the Company’s current estimates and assumptions utilized in its quantitative testing are reasonable and supportable, there can be no assurance that the estimates and assumptions management used for purposes of its assessment as of December 31, 2023 will prove to be accurate predictions of future performance.

For its long-lived assets and definite-lived intangible assets, the Company reviews for impairment whenever events or changes in circumstances indicate the carrying amount may not be recoverable. The Company wrote off certain IT projects and recorded immaterial impairment charges during the year ended December 31, 2023, and impairment charges of $1.9 million during the year ended December 31, 2022.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Use of Estimates

The preparation of consolidated financial statements in conformity with United States generally accepted accounting principles (U.S. GAAP) requires management to make estimates and assumptions that affect the reported amounts in the consolidated financial statements and accompanying notes. Management has assessed various accounting estimates and other matters, including those that require consideration of forecasted financial information, using information that is reasonably available to the Company at the time. Significant estimates and assumptions are used for, but not limited to: (i) the valuation of accounts receivable; (ii) goodwill, trade names, and other intangible assets; (iii) other long-lived assets; (iv) revenue recognition; (v) accruals for health, workers’ compensation, and professional liability claims; (vi) valuation of deferred tax assets; (vii) legal contingencies, and (viii) income taxes. Accrued insurance claims and reserves include estimated settlements from known claims and actuarial estimates for claims incurred but not reported. As additional information becomes available to the Company, its future assessment of these estimates could materially and adversely impact the Company's consolidated financial statements in future reporting periods. Actual results could differ from those estimates.

Risks and Uncertainties

The Company’s future results of operations and liquidity could be materially adversely affected by macroeconomic factors contributing to delays in payments from customers and inflationary pressure, uncertain or reduced demand, and the impact of any initiatives or programs that the Company may undertake to address financial and operational challenges faced by its customers. See associated risk factors in Item 1A. Risk Factors in this Annual Report on Form 10-K.

Cash and Cash Equivalents

The Company considers all investments with original maturities of three months or less to be cash and cash equivalents. Interest income on cash and cash equivalents was immaterial for the years ended December 31, 2023, 2022, and 2021, and is included in other income (expense), net, in the consolidated statements of operations and comprehensive income.

Accounts Receivable, Allowance for Doubtful Accounts, and Concentration of Credit Risk

Accounts receivable potentially subject the Company to concentrations of credit risk. The Company generally does not require collateral and mitigates its credit risk by performing credit evaluations and monitoring at-risk accounts. The allowance for doubtful accounts is established for losses expected to be incurred on accounts receivable balances. Accounts receivable are written off against the allowance for doubtful accounts when the Company determines amounts are no longer collectible. Judgment is required in the estimation of the allowance and the Company evaluates the collectability of its accounts receivable based on a combination of factors. The Company bases its allowance for doubtful account estimates on its historical write-off experience, current conditions, an analysis of the aging of outstanding receivable and customer payment patterns, and specific reserves for customers in adverse condition adjusted for current expectations for the customers or industry. Based on the information currently available, the Company also considered expectations of future economic conditions when estimating its allowance for doubtful accounts.

The opening balance of the allowance for doubtful accounts is reconciled to the closing balance for expected credit losses as follows:


	2023		2022
Allowance for Doubtful Accounts	(amounts in thousands)
Balance at January 1	$	13,058	$	6,087
Bad Debt Expense	4,908		2,369
Write-Offs, net of Recoveries	54		(365)
Balance at March 31	18,020		8,091
Bad Debt Expense	3,134		3,192
Write-Offs, net of Recoveries	(4,240)		(426)
Balance at June 30	16,914		10,857
Bad Debt Expense	2,355		1,101
Write-Offs, net of Recoveries	(1,394)		(593)
Balance at September 30	17,875		11,365
Bad Debt Expense	4,166		2,947
Write-Offs, net of Recoveries	(2,401)		(1,254)
Balance at December 31	$	19,640	$	13,058

In addition to the allowance for doubtful accounts, the Company maintains a sales allowance for billing-related adjustments which may arise in the ordinary course of business and adjustments to the reserve are recorded as contra-revenue. The sales allowance balance as of December 31, 2023 and December 31, 2022 was $0.9 million and $1.6 million, respectively.

The Company’s contract terms typically require payment between 30 to 60 days from the date of invoice and are considered past due based on the particular negotiated contract terms. The majority of the Company's customers are healthcare systems with a significant percentage in acute-care facilities. No single customer accounted for more than 10% of the Company's revenue for the years ended December 31, 2023, 2022, and 2021, or accounts receivable balance as of December 31, 2023 and 2022. In 2023 there was an increase in bad debt expense primarily driven by a deterioration in our accounts receivable aging stemming from a single MSP customer. Although the Company expects to recover the remaining balance, further reserves may be required in the event this customer does not continue making payments or experiences a material deterioration in their financial condition.

Property and Equipment

Property and equipment are stated at cost, less accumulated depreciation. Depreciation is determined on a straight-line basis over the estimated useful lives of the assets, which generally range from one to ten years. Leasehold improvements are depreciated over the shorter of 10 years or the term of the individual lease. On an annual basis, the Company reviews its property and equipment listings and disposes of assets that are no longer in use.

Certain software development costs have been capitalized. Such costs include charges for consulting services and costs for Company personnel associated with programming, coding, and testing such software. Amortization of capitalized software costs is included in depreciation and amortization expense in the consolidated statements of operations and comprehensive income and begins when the software is ready for use. See Note 6 - Property and Equipment.

Cloud Computing Arrangements

Implementation costs associated with cloud computing arrangements are capitalized when incurred during the application development phase. In connection with the licensing of software products, the Company has entered into arrangements in which it does not take possession of the software; rather, the software application resides on the vendor's or a third-party's hardware, and the Company accesses and uses the software on an as-needed basis over the Internet or via a dedicated line. Therefore, the cloud computing arrangement does not give rise to an intangible asset. Costs are capitalized in accordance with the Company’s policies for other capitalizable service costs. Amortization is calculated over the contractual term of the cloud computing arrangement and is included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive income. As of December 31, 2023 and 2022, the Company has a current asset of $0.5 million included in prepaid expenses and a non-current asset of $6.0 million and $4.5 million, respectively, included in cloud computing in the consolidated balance sheets that have been capitalized in conjunction with implementations. Amortization of the cloud computing assets was $0.5 million, $0.6 million, and $0.4 million for the years ended December 31, 2023, 2022, and 2021, respectively.

Leases

The Company determines whether an arrangement constitutes a lease at commencement. Operating leases are included in operating lease right-of-use assets, operating lease liabilities - current, and operating lease liabilities - non-current in the consolidated balance sheets. Finance leases are included in other assets, other current liabilities, and other liabilities in the consolidated balance sheets. See Note 9 - Leases.

Right-of-use assets are measured based on the corresponding lease liability adjusted for: (i) payments made to the lessor at or before the commencement date; (ii) initial direct costs; and (iii) tenant incentives under the lease. Rent expense commences when the lessor makes the underlying asset available to the Company. Lease liabilities are measured based on the present value of the total lease payments not yet paid discounted based on its incremental borrowing rate, as the rate implicit in the lease is not determinable. The Company estimates its incremental borrowing rate based on an analysis of publicly-traded debt securities of companies with credit and financial profiles similar to its own. The variable portion of the lease payments is not included in the right-of-use assets or lease liabilities. Rather, variable payments, other than those dependent upon an index or rate, are expensed when the obligation for those payments is incurred and are included in lease expense in selling, general and administrative expense in the consolidated statements of operations and comprehensive income. Rent expense for operating lease payments is recognized on a straight-line basis over the lease term. The Company does not assume renewals or early terminations unless it is reasonably certain to exercise these options at commencement. The Company has elected the practical expedient to not separate non-lease components from the lease components to which they relate, and instead account for each as a single lease component, for all of its underlying asset classes. Accordingly, all expenses associated with a lease contract are accounted for as lease expenses.

The Company leases apartments for eligible field employees under short-term agreements (typically three to six months), which generally coincide with each employee’s staffing contract. Costs relating to these leases are included in direct operating expenses in the consolidated statements of operations and comprehensive income.

Business Combinations

Historically, business combinations have been accounted for at fair value using the acquisition method of accounting. Effective January 1, 2023, the Company accounts for business combinations in accordance with updated Business Combinations Topic 805. Contract assets and contract liabilities acquired in a business combination are recognized in accordance with Revenue from Contracts with Customers Topic 606. At the acquisition date, related revenue contracts with customers are accounted for as if the Company had originated the contracts. The acquired contract assets and liabilities are recognized and measured consistent with how they were recognized and measured in the acquiree's financial statements, if those financial statements were prepared in accordance with GAAP. Contract assets and contract liabilities from other contracts to which Topic 606 applies are similarly recognized and measured. In circumstances where it is unable to assess whether the financial statements were prepared in

accordance with GAAP, the Company considers contract terms and specifications to determine what should be recorded at the acquisition date. Other assets or liabilities that arise from revenue contracts with customers in accordance with Topic 606 are accounted for at fair value.

The associated acquisition costs are expensed as incurred and recorded as acquisition and integration-related costs. Restructuring costs associated with a business combination are expensed. The results of the acquired businesses' operations are included in the consolidated statements of operations and comprehensive income of the combined entity beginning on the date of acquisition. See Note 4 - Acquisitions.

Goodwill, Trade Names, and Other Intangible Assets

Goodwill represents the excess of purchase price and related costs over the fair value assigned to the net tangible and identifiable intangible assets of businesses acquired. Other identifiable intangible assets with definite lives are being amortized using the straight-line method over their estimated useful lives which have ranged from 1 to 16 years. Goodwill and certain intangible assets with indefinite lives are not amortized. Instead, these assets are reviewed for impairment annually at the beginning of the fourth quarter, and whenever circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying amount.

When reviewed, the Company has the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, as a basis for determining whether it is necessary to perform the quantitative testing. If it is determined that a quantitative test is necessary or more efficient than a qualitative approach, the Company measures the fair value of its reporting units using a combination of income and market approaches.

The Company performs its annual review on October 1. If the quantitative analysis is performed and the reporting unit’s carrying value exceeds its fair value, an impairment charge is recognized for the amount by which the carrying amount exceeds the reporting unit’s fair value not to exceed the total amount of goodwill allocated to that reporting unit. Additionally, income tax effects from any tax-deductible goodwill on the carrying amount of the reporting unit when measuring the goodwill impairment loss is considered, if applicable.

The Company determines its reporting units by identifying its operating segments and any component businesses and aggregates the component businesses if they have similar economic characteristics.

Management considers historical experience and all available information at the time the fair values of its reporting units are estimated. However, fair values that could be realized in an actual transaction may have differed from those used to evaluate the potential impairment of goodwill.

Long-lived assets and identifiable intangible assets with definite lives are evaluated for impairment. Long-lived assets and definite-lived intangible assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount may not be recoverable.

Recoverability of long-lived assets is measured by a comparison of the carrying amount of the asset group to the future undiscounted net cash flow that is expected to be generated by those assets. If such assets are considered to be impaired, the impairment charge recognized is the amount by which the carrying amount of the assets exceeds the fair value of the assets.

Any related impairment losses are recognized in earnings and included in the caption impairment charges in the consolidated statements of operations and comprehensive income. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

Debt Discount and Debt Issuance Costs

Stated discounts on proceeds and other fees reimbursed to lenders were treated as a discount associated with the respective debt instrument and presented in the balance sheet as an offset to the carrying amount of the debt. Debt issuance costs associated with the revolving line-of-credit are presented as an asset, included in other assets on the balance sheet. Discounts are amortized to interest expense using the effective interest rate method, or a method that approximates the effective interest rate method, over the expected life of the debt.

Sales and Other State Non-Income Tax Liabilities

The Company's sales and other state non-income tax filings are subject to routine audits by authorities in the jurisdictions where it conducts business in the United States which may result in assessments of additional taxes. The Company accrues sales and other state non-income tax liabilities based on the Company’s best estimate of its probable liability utilizing currently available information and interpretation of relevant tax regulations. Given the nature of the Company’s business, significant subjectivity exists as to both whether sales and other state non-income taxes can be assessed on its activity and how the sales tax will ultimately be measured by the relevant jurisdictions. The Company makes a determination for each reporting period whether the estimates for sales and other non-income taxes in certain states should be revised. The expense is included in selling, general and administrative expenses on its consolidated statements of operations and comprehensive income and the liability is reflected in sales tax payable within other current liabilities in the consolidated balance sheets.

Insurance Claims

The Company provides workers’ compensation insurance coverage, professional liability coverage, and healthcare benefits for eligible employees. The Company records its estimate of the ultimate cost of, and reserves for, workers' compensation and professional liability benefits based on actuarial models prepared or reviewed by an independent actuary using the Company’s loss history as well as industry statistics. The healthcare insurance accrual is for estimated claims that have occurred but have not been reported and is based on the Company’s historical claim submission patterns. Furthermore, in determining its reserves, the Company includes reserves for estimated claims incurred but not reported as well as unfavorable claims development.

Under circumstances such as in the Company’s insured professional liability and workers' compensation policies, since a right of legal offset does not exist due to the fact that there are three parties to an incurred claim, the insured, the insurer, and the claimant, the related liability to the claimant should be classified separately on a gross basis with a separate related receivable from the insurer recognized as being due from insurance carriers. Accordingly, the Company’s consolidated balance sheets as of December 31, 2023 and 2022 reflect the related short-term liabilities in accrued compensation and benefits and the related long-term liabilities as accrued claims, and the short-term and long-term receivable portion as insurance recovery receivable - current and insurance recovery receivable - non-current, respectively. See Note 7 - Balance Sheet Details. The ultimate cost of workers’ compensation, professional liability, and health insurance claims will depend on actual amounts incurred to settle those claims and may differ from the amounts reserved by the Company for those claims.

Workers’ compensation benefits are provided under a partially self-insured plan. The Company has letters of credit to guarantee payments of claims. At December 31, 2023 and 2022, the Company had outstanding approximately $13.5 million and $17.7 million, respectively, of standby letters of credit as collateral to secure the self-insured portion of this plan.

Currently, the Company has claims-made primary professional liability policies that provide the Company and each working professional in its nurse and allied healthcare business with coverage. The Company has a claims-made professional liability policy for its physicians and advanced practitioners. At December 31, 2023 and 2022, the Company had outstanding $0.3 million and $0.4 million, respectively, of standby letters of credit as collateral to secure reimbursement of expenses under the existing plan.

Subject to certain limitations, the Company also has umbrella liability coverage for its working nurses and allied healthcare professionals. While this umbrella coverage does not extend to professional liability claims against its independent contractor physicians and advanced practitioners, it does cover claims brought against all of the Company’s subsidiaries for non-patient general liability.

Revenue Recognition

Revenue from the Company’s services is recognized when control of the promised services is transferred to the Company’s customers, in an amount that reflects the consideration it expects to receive in exchange for the service. The Company has concluded that transfer of control of its staffing services, which represents the majority of its revenues, occurs over time as the services are provided.

The following is a description of the nature, amount, timing, and uncertainty of revenue and cash flows from which the Company generates revenue.

Temporary Staffing Revenue

Revenue from temporary staffing is recognized as control of the services is transferred over time and is based on hours worked by the Company’s field staff. The Company recognizes the majority of its revenue at the contractual amount the Company has the right to invoice for services completed to date. Generally, billing to customers occurs weekly, bi-weekly, or monthly and is aligned with the payment of services to the temporary staff. Accounts receivable includes estimated revenue for employees’ and independent contractors’ time worked but not yet invoiced. At December 31, 2023 and 2022, the Company's estimate of amounts that had been worked but had not been billed totaled $89.9 million and $152.4 million, respectively, and are included in accounts receivable in the consolidated balance sheets.

Other Services Revenue

The Company offers other optional services to its customers that are transferred over time including: managed service programs (MSP) providing agency services (as further described below in Gross Versus Net Policies), recruitment process outsourcing (RPO), other outsourcing services, and retained search services, as well as separately billable travel and housing costs, which in total amount to less than 5% of its consolidated revenue for the years ended December 31, 2023, 2022, and 2021. Generally, billing and payment terms for MSP agency services are consistent with temporary staffing as the customers are similar or the same. Revenue from these services is recognized based on the contractual amount for services completed to date which best depicts the transfer of control of services. The Company does not, in the ordinary course of business, offer warranties or refunds.

Gross Versus Net Policies

The Company records revenue on a gross basis as a principal or on a net basis as an agent depending on the contracted arrangement, as follows:

Managed Service Programs (MSP)

The Company has certain contracts with healthcare facilities to provide comprehensive services through its MSPs. Under these contractual arrangements, the customer’s orders are filled with either one of the Company’s healthcare professionals or a third party’s healthcare professionals (subcontractors).

When its healthcare professional is staffed, the Company determined that it acts as a principal in the arrangement, as it is considered the employer of record. Accordingly, revenue is reported on a gross basis in the consolidated statements of operations and comprehensive income.

Alternatively, the Company determined that it acts as an agent in the arrangement when a subcontracted healthcare professional is staffed, as the Company does not control the services before they are transferred to the customer. Accordingly, revenue is reported on a net basis in the consolidated statements of operations and comprehensive income. The customer is invoiced for the hours worked by the subcontracted healthcare professional multiplied by the hourly bill rate. A subcontractor liability is recognized as a reduction of revenue, net of an administrative fee, and is generally payable after the Company has received payment from its customer. The Company’s administrative fee is calculated as a percentage of the customer’s invoice and is recognized over time as the services are rendered by the subcontracted healthcare professional. The Company does not collect or recognize an upfront placement fee.

Physician Staffing

The Physician Staffing business has contracts with its healthcare customers to provide temporary staffing services. The Company uses independent contractors for these services. The Company determined that it acts as a principal in these arrangements and, therefore, revenue is reported on a gross basis in the consolidated statements of operations and comprehensive income.

See Note 3 - Revenue Recognition for the Company’s revenues disaggregated by revenue source. Sales and usage-based taxes are excluded from revenue.

Contract Costs

All contract fulfillment costs are expensed as incurred to direct operating expenses. There were no contract assets or material contract liabilities as of December 31, 2023 and 2022.

Practical Expedients and Exemptions

For the Company’s contracts that have an original duration of one year or less, the Company uses the practical expedients and has elected to recognize any incremental costs of obtaining these contracts as expensed when incurred. Further, the Company does not disclose the value of unsatisfied performance obligations for: (i) contracts with an original expected length of one year or less; and (ii) contracts for which it recognizes revenue at the amount to which it has the right to invoice for services performed.

Share-Based Compensation

For the years ended December 31, 2023, 2022, and 2021, the Company granted performance-based stock awards and restricted stock for a fixed number of common shares to employees. The Company values its restricted stock awards and the fair value of its performance-based stock awards by reference to its stock price on the date of grant. The Company has elected to recognize compensation expense on a straight-line basis over the requisite service period of the entire award.

The Company granted performance-based stock awards to certain key personnel pursuant to its 2014 Omnibus Incentive Plan, amended and restated on May 23, 2017 (2017 Plan), and replaced by the 2020 Omnibus Incentive Plan, effective for awards granted after May 19, 2020, as described in Note 14 - Stockholders' Equity. Pursuant to the plans, the number of target shares that vest are determined based on the level of attainment of the targets. If a minimum level of performance is attained for the awards, restricted stock is issued based on the level of attainment. The Company recognizes performance-based restricted stock as compensation expense based on the most likely probability of attaining the prescribed performance and over the requisite service period beginning at its grant date and through the date the restricted stock vests.

Compensation expense related to share-based payments is included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive income, and totaled $6.6 million, $7.4 million, and $6.9 million during the years ended December 31, 2023, 2022, and 2021, respectively. See Note 14 - Stockholders’ Equity.

Advertising

The Company’s advertising expense consists of programmatic advertising, display, search, internet, social media, video, and promotional aids and materials. Advertising costs are expensed as incurred and totaled $11.5 million, $16.1 million, and $9.5 million for the years ended December 31, 2023, 2022, and 2021, respectively, and are included in selling, general and administrative expenses in the consolidated statements of operations and comprehensive income.

Restructuring Costs

The Company considers restructuring activities to be programs whereby it fundamentally changes its operations, such as closing and consolidating facilities, reducing headcount, and realigning operations in response to changing market conditions. As a result, restructuring costs on the consolidated statements of operations and comprehensive income primarily include employee termination costs and lease-related exit costs.

Reconciliations of the employee termination costs and lease-related exit costs beginning and ending liability balance is presented below:


	Year Ended December 31,
	2023				2022				2021
	(amounts in thousands)
	Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs
Balance at beginning of period	$	799	$	2,196	$	160	$	2,423	$	499	$	2,687
Charged to restructuring	2,491		62		792		765		814		544
Payments and adjustments	(2,395)		(1,074)		(153)		(992)		(1,153)		(808)
Balance at end of period	$	895	$	1,184	$	799	$	2,196	$	160	$	2,423

Income Taxes

Deferred income tax assets and liabilities are determined based upon differences between the financial reporting and tax basis of assets and liabilities, and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse.

The Company recognizes in its financial statements the impact of a tax position if that position is more likely than not of being sustained on audit, based on the technical merits of the position. The Company recognizes interest and penalties related to unrecognized tax benefits in the provision for income taxes.

The Company determines the need for a valuation allowance by assessing the probability of realizing deferred tax assets, taking into consideration all available positive and negative evidence, including historical operating results, expectations of future taxable income, carryforward periods available to the Company for tax reporting purposes, the evaluation of various income tax planning strategies, and other relevant factors. The Company maintains a valuation allowance when it is more likely than not that all or a portion of a deferred tax asset will not be realized based on consideration of all available evidence. Adjustments to the deferred tax valuation allowances are made to earnings in the period when such assessments are made. Significant judgment is required in making this assessment. See Note 13 - Income Taxes.

Comprehensive Income (Loss)

Total comprehensive income includes net income or loss and foreign currency translation adjustments, net of any related deferred taxes, and is included within the accompanying consolidated statements of operations and comprehensive income. Certain of the Company’s foreign subsidiaries use their respective local currency as their functional currency. Assets and liabilities of these operations are translated at the exchange rates in effect on the balance sheet date. Income statement items are translated at the average exchange rates for the period. The cumulative impact of currency fluctuations related to the balance sheet translation is included in accumulated other comprehensive loss in the accompanying consolidated balance sheets and was an unrealized loss of $1.5 million at December 31, 2023 and 2022.

The income tax impact related to components of other comprehensive income for the years ended December 31, 2023, 2022 and 2021 is included in unrealized foreign currency translation income (loss), net of tax in the consolidated statements of operations and comprehensive income.

Fair Value Measurements

Financial Accounting Standards Board (FASB) guidance defines fair value, establishes a framework for measuring fair value under U.S. GAAP, and expands disclosures about fair value measurements. The Company’s financial assets and liabilities required to be measured at fair value on a recurring basis were its: (i) deferred compensation asset and (ii) deferred compensation liability as of December 31, 2023. See Note 10 - Fair Value Measurements.

Earnings Per Share

Basic earnings per share is computed by dividing net income available to common stockholders (numerator) by the weighted average number of vested unrestricted common shares outstanding during the period (denominator). Diluted earnings per share gives effect to all dilutive potential common shares outstanding during the period including stock appreciation rights and options and unvested restricted stock, as calculated utilizing the treasury stock method. See Note 15 - Earnings Per Share.

Recently Adopted Accounting Pronouncements

On October 28, 2021, the FASB issued Accounting Standards Update (ASU) No. 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, which requires contract assets and contract liabilities such as deferred revenue acquired in a business combination to be recognized and measured by the acquirer on the acquisition date in accordance with ASC 606, Revenue from Contracts with Customers. Generally, this amendment will result in the acquirer recognizing contract assets and contract liabilities at the same amounts recorded by the acquiree. Historically such amounts were recognized by the acquirer at fair value in acquisition accounting. This guidance is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. The amendments should be applied prospectively to business combinations occurring on or after the effective date of the amendments. Early adoption is permitted, including adoption in an interim period. The Company adopted this standard in the first quarter of 2023 and will apply the guidance to future acquisitions.

Recent Accounting Pronouncements

On December 14, 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which requires that public business entities, on an annual basis, (1) disclose specific categories in the rate reconciliation and (2) provide additional information for reconciling items that meet a quantitative threshold (if the effect of those reconciling items is equal to or greater than five percent of the amount computed by multiplying pretax income (or loss) by the applicable statutory income tax rate). The amendments also require that all entities disclose, on an annual basis, disaggregated information regarding income taxes paid and income tax expense. This guidance is effective for annual periods beginning after December 15, 2024. The amendments should be applied prospectively, but retrospective application is permitted. Early adoption is permitted for annual financial statements that have not yet been issued or made available for issuance. The Company expects to adopt this standard for its fiscal year ended December 31, 2025. The Company expects this ASU to only impact its disclosures with no impacts to results of operations, cash flows, and financial condition.

On November 27, 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses, enhances interim disclosure requirements, clarifies circumstances in which an entity can disclose multiple segment measures of profit or loss, provides new segment disclosure requirements for entities with a single reportable segment, and requires certain disclosures related to the chief operating decision maker. This guidance is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. The amendments should be applied retrospectively to all prior periods presented in the financial statements. Early adoption is permitted. The Company expects to adopt this standard for its fiscal year ended December 31, 2024. The Company expects this ASU to only impact its disclosures with no impacts to results of operations, cash flows, and financial condition.

Income Taxes - Components of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current:
Federal	$ 19,871	$ 48,664	$ 5,165
State	8,940	13,919	5,638
Foreign	148	219	330
Total	28,959	62,802	11,133
Deferred:
Federal	554	383	892
State	596	4,623	(10,648)
Foreign	154	56	(171)
Total	1,304	5,062	(9,927)
Income tax expense	$ 30,263	$ 67,864	$ 1,206

Stockholders' Equity

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Stockholders' Equity

Stockholders’ Equity

Stock Repurchase Program

On August 16, 2022, the Company’s Board of Directors authorized a new stock repurchase program (the New Repurchase Program), whereby the Company may repurchase up to $100.0 million of its shares of common stock, subject to the terms of its current credit agreements. The shares may be repurchased from time-to-time in the open market or in privately negotiated transactions. The New Repurchase Program was effective immediately and may be discontinued at any time at the Board of Directors’ discretion. In addition to the repurchase of $100.0 million of its shares of common stock under the New Repurchase Program, the Company was authorized to continue to repurchase any remaining shares available for repurchase under the Company’s previous stock repurchase program, which was approved by the Board of Directors on February 28, 2008 (the Prior Repurchase Program). Upon completion of the authorized number of shares available for repurchase under the Prior Repurchase Program, the Company commenced repurchases under the New Repurchase Program during the third quarter of 2022. During the fourth quarter of 2022, the Company entered into a Rule 10b5-1 Repurchase Plan to allow for share repurchases during the Company’s blackout periods, effective through November 2, 2023.

On May 1, 2023, the Company’s Board of Directors authorized approximately $59.0 million in additional share repurchases, such that, effective for trades made after May 3, 2023, the aggregate amount available for stock repurchases under the New Repurchase Program was set at $100.0 million. The shares can be repurchased from time-to-time in the open market or in privately negotiated transactions. Decisions regarding the amount and the timing of repurchases under the New Repurchase Program will be subject to the Company’s available liquidity and cash on hand, applicable legal requirements, the terms of the Company’s Loan Agreement, general market conditions, and other factors. The New Repurchase Program does not obligate the Company to repurchase any particular number of shares of common stock and may be discontinued by the Board of Directors at any time. During the third quarter of 2023, the Company entered into a new Rule 10b5-1 Repurchase Plan to allow for share repurchases during the Company's blackout periods, beginning on January 2, 2024.

During the year ended December 31, 2023, the Company repurchased and retired a total of 2,343,583 shares of common stock for $57.6 million, at an average market price of $24.58 per share. During the year ended December 31, 2022, the Company repurchased and retired, under both programs, a total of 1,364,815 shares of common stock for $35.3 million, at an average market price of $25.83 per share. During the year ended December 31, 2021, the Company did not repurchase any shares of its common stock.

As of December 31, 2023, the Company had $77.3 million remaining for share repurchase under the New Repurchase Program, subject to certain conditions in the Company's Loan Agreement. At December 31, 2023, the Company had 34,384,905 unrestricted shares of common stock outstanding. The Company may repurchase up to an aggregate amount not to exceed $5.0 million pursuant to its Loan Agreement, in any fiscal year, or an unlimited amount if the Company meets certain conditions as described in the agreement. In 2023, the conditions were met to repurchase an unlimited number of shares.

Share-Based Payments

On May 19, 2020, the Company’s stockholders approved the Cross Country Healthcare, Inc. 2020 Omnibus Incentive Plan (2020 Plan), which replaced the Cross Country Healthcare, Inc. 2017 Omnibus Incentive Plan (2017 Plan), and applies to awards granted after May 19, 2020. The remaining shares available for grant under the 2017 Plan were cancelled and no further awards will be granted under that plan. The 2020 Plan generally mirrors the terms of the 2017 Plan and includes the following provisions: (i) an aggregate share reserve of 3,000,000 shares; (2) annual dollar and share limits of awards granted to employees and consultants, as well as non-employee directors, based on type of award; (3) awards granted generally will be subject to a minimum one-year vesting schedule; and (4) awards may be granted under the 2020 Plan until March 24, 2030.

The Company’s 2017 Plan and 2020 Plan (Plans) provide for the issuance of stock options, stock appreciation rights, restricted stock, performance shares, and performance-based cash awards that may be granted with the intent to comply with the “performance-based compensation” exception under Section 162(m) of the Internal Revenue Code, and other stock-based awards, all as defined by the Plans, to eligible employees, consultants and non-employee Directors. The Plans include Section 162(m) performance goals so that certain incentive awards granted to certain executive officers of the Company may qualify as exempt performance-based compensation. However, Section 162(m) of the Internal Revenue Code updated in conjunction with

the 2017 Tax Act in November 2018 limits a publicly-held corporation’s federal tax deduction for compensation paid to “covered employees” to $1.0 million per year, for non-performance and performance shares.

Restricted stock awards granted under the Company’s Plans entitle the holder to receive, at the end of a vesting period, a specified number of shares of the Company’s common stock. Share-based compensation expense is measured by the market value of the Company’s stock on the date of grant. The shares vest ratably over a three-year period ending on the anniversary date of the grant, and vesting is subject to the employee’s continuing employment. There is no partial vesting, and any unvested portion is forfeited. Pursuant to the Plans, the number of target shares that are issued for performance-based stock awards are determined based on the level of attainment of the targets.

The following table summarizes restricted stock awards and performance stock awards activity issued under the Plans for the year ended December 31, 2023:


	Restricted Stock Awards			Performance Stock Awards
	Number of Shares	Weighted Average Grant Date Fair Value		Number of Target Shares	Weighted Average Grant Date Fair Value
Unvested restricted stock awards, January 1, 2023	674,508	$	14.53	476,086	$	12.56
Granted	319,312	$	22.87	200,487	$	19.23
Vested	(404,873)	$	12.51	(238,253)	$	6.74
Forfeited	(41,413)	$	20.70	(21,123)	$	19.28
Unvested restricted stock awards, December 31, 2023	547,534	$	20.42	417,197	$	18.75

Awards granted to non-employee directors under the 2020 Plan will vest on the first anniversary of such grant date, or earlier subject to retirement eligibility. In addition, effective for the three months ended June 30, 2020, the Company implemented modified guidelines that provide for accelerated vesting of restricted stock grants on the last date of service when a retirement-eligible director retires.

On March 31, 2023, 2022, and 2021, the Company awarded performance stock totaling 160,782, 126,576, and 160,416, respectively. The Company awarded an additional 16,921 and 7,908 shares of performance stock in the second quarter of 2022 and 2021, respectively. If the minimum level of performance is attained for the 2023, 2022, and 2021 awards, restricted stock will be issued with a vesting date of the third anniversary of such grant date. The level of attainment will be certified within 30 days of the vest date. During the first quarter of 2023, the Company's Compensation Committee of the Board of Directors approved a 120% level of attainment for the 2020 performance-based share awards, resulting in the issuance of 238,253 performance shares that vested on March 31, 2023.

As of December 31, 2023, the Company had approximately $6.8 million of total unrecognized compensation cost related to non-vested restricted stock awards which may be adjusted for future changes in forfeitures. The Company expects to recognize such cost over a weighted average period of 1.46 years. The fair value of shares vested was approximately $9.3 million, $12.1 million, and $8.9 million for the years ended December 31, 2023, 2022, and 2021, respectively.

As of December 31, 2023, the Company had approximately $1.7 million of total unrecognized compensation cost related to performance stock awards which may be adjusted for future changes in forfeitures. The Company expects to recognize such cost over a weighted average period of 1.26 years, the remaining service period. The fair value of shares vested was approximately $5.3 million and $3.7 million for the years ended December 31, 2023 and 2022. No shares vested for the year ended December 31, 2021.

Summary of Significant Accounting Policies - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Significant Accounting Policies [Line Items]
Sales allowance, billing-related adjustments	$ 0.9	$ 1.6
Prepaid implementation costs	0.5	0.5
Capitalized implementation costs	6.0	4.5
Implementation costs, amortization	0.5	0.6	$ 0.4
Outstanding standby letters of credit as collateral	13.5	17.7
Unbilled contracts receivable	89.9	152.4
Equity compensation	6.6	7.4	6.9
Advertising costs	11.5	16.1	$ 9.5
Cumulative impact of currency fluctuations	1.5	1.5
Claims-Based Liability Insurance \| MDA Holdings Inc
Significant Accounting Policies [Line Items]
Letter of credit for malpractice claims	$ 0.3	$ 0.4
Revenue Benchmark \| Service \| Services
Significant Accounting Policies [Line Items]
Concentration risk percentage	5.00%	5.00%	5.00%
Minimum
Significant Accounting Policies [Line Items]
Threshold period, past due for payment of services provided	30 days
Estimated useful life of assets	1 year
Short term leases period	3 months
Intangible assets- useful life	1 year
Maximum
Significant Accounting Policies [Line Items]
Threshold period, past due for payment of services provided	60 days
Estimated useful life of assets	10 years
Short term leases period	6 months
Intangible assets- useful life	16 years
Maximum \| Leasehold improvements
Significant Accounting Policies [Line Items]
Short term leases period	10 years

Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Revenue from services	$ 414,035	$ 442,291	$ 540,695	$ 622,707	$ 628,218	$ 636,098	$ 753,561	$ 788,732	$ 2,019,728	$ 2,806,609	$ 1,676,652
Temporary Staffing Services
Disaggregation of Revenue [Line Items]
Revenue from services									1,963,566	2,730,528	1,636,817
Other Services
Disaggregation of Revenue [Line Items]
Revenue from services									56,162	76,081	39,835
Nurse And Allied Staffing
Disaggregation of Revenue [Line Items]
Revenue from services									1,841,428	2,700,383	1,605,781
Nurse And Allied Staffing \| Temporary Staffing Services
Disaggregation of Revenue [Line Items]
Revenue from services									1,794,489	2,629,088	1,568,974
Nurse And Allied Staffing \| Other Services
Disaggregation of Revenue [Line Items]
Revenue from services									46,939	71,295	36,807
Physician Staffing
Disaggregation of Revenue [Line Items]
Revenue from services									178,300	106,226	70,871
Physician Staffing \| Temporary Staffing Services
Disaggregation of Revenue [Line Items]
Revenue from services									169,077	101,440	67,843
Physician Staffing \| Other Services
Disaggregation of Revenue [Line Items]
Revenue from services									$ 9,223	$ 4,786	$ 3,028

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 924
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479941/924-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 5
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-5

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-30

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-4

+ Details

Fair Value Measurements - Carrying Amounts and Estimated Fair Values of Significant Financial Instrument that were not Measured at Fair Value (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 13, 2022	Oct. 03, 2022	Jun. 08, 2021
Workforce Solutions Group, Inc.
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability					$ 15,000
Mint
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability				$ 10,000
HireUp
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability			$ 8,000
Level 2 \| Carrying Amount \| Workforce Solutions Group, Inc.
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability	$ 0	$ 7,500
Level 2 \| Carrying Amount \| Mint
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability	9,884	10,000
Level 2 \| Carrying Amount \| HireUp
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability	1,910	8,000
Level 2 \| Fair Value \| Workforce Solutions Group, Inc.
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability	0	7,500
Level 2 \| Fair Value \| Mint
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability	9,884	10,000
Level 2 \| Fair Value \| HireUp
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liability	1,910	8,000
Senior Secured Asset-Based Loan \| Level 2 \| Carrying Amount
Fair Value, Option, Quantitative Disclosures [Line Items]
Senior Secured Asset-Based Loan	0	76,800
Senior Secured Asset-Based Loan \| Level 2 \| Fair Value
Fair Value, Option, Quantitative Disclosures [Line Items]
Senior Secured Asset-Based Loan	0	76,800
Secured Debt \| Level 2 \| Carrying Amount
Fair Value, Option, Quantitative Disclosures [Line Items]
Term Loan, net	0	78,375
Secured Debt \| Level 2 \| Fair Value
Fair Value, Option, Quantitative Disclosures [Line Items]
Term Loan, net	$ 0	$ 71,221

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities
Consolidated net income	$ 72,631	$ 188,461	$ 132,002
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Depreciation and amortization	18,347	12,576	9,852
Provision for allowances	17,355	15,328	6,499
Deferred income tax expense (benefit)	1,304	5,062	(9,927)
Non-cash lease expense	1,111	1,850	2,424
Impairment charges	719	5,597	2,070
Loss on early extinguishment of debt	1,723	3,728	0
Equity compensation	6,579	7,393	6,894
Other non-cash costs	1,252	199	1,828
Changes in operating assets and liabilities:
Accounts receivable	251,427	(153,229)	(318,420)
Prepaid expenses and other assets	268	(6,915)	(3,364)
Income taxes	6,955	(20,111)	7,488
Accounts payable and accrued expenses	(126,611)	79,712	83,286
Operating lease liabilities	(4,371)	(4,962)	(6,753)
Other	(191)	(639)	503
Net cash provided by (used in) operating activities	248,498	134,050	(85,618)
Cash flows from investing activities
Acquisitions, net of cash acquired	0	(35,182)	(27,970)
Acquisition-related settlements	199	94	1,094
Purchases of property and equipment	(13,974)	(8,786)	(7,170)
Net cash used in investing activities	(13,775)	(43,874)	(34,046)
Cash flows from financing activities
Proceeds from term loan	0	0	175,000
Principal payments on term loan	(73,875)	(100,438)	(688)
Principal payments on note payable	0	(2,426)	(2,426)
Debt issuance costs	0	(3,237)	(6,098)
Borrowings under Senior Secured Asset-Based revolving credit facility	720,991	1,700,030	443,544
Repayments on Senior Secured Asset-Based revolving credit facility	(797,791)	(1,632,430)	(487,753)
Cash paid for shares withheld for taxes	(4,904)	(5,267)	(2,230)
Payment of contingent consideration	(7,500)	(7,500)	0
Stock repurchase and retirement	(57,654)	(35,285)	0
Other	(508)	(1,046)	(255)
Net cash (used in) provided by financing activities	(221,241)	(87,599)	119,094
Effect of exchange rate changes on cash	8	(9)	6
Change in cash and cash equivalents	13,490	2,568	(564)
Cash and cash equivalents at beginning of year	3,604	1,036	1,600
Cash and cash equivalents at end of year	17,094	3,604	1,036
Supplemental disclosure of cash flow information:
Interest paid	7,534	12,859	5,773
Income taxes paid	$ 21,986	$ 82,893	$ 3,608

Revenue Recognition (Tables)

12 Months Ended

Dec. 31, 2023

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue


	Year Ended December 31, 2023
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	1,794,489	$	169,077	$	1,963,566
Other Services	46,939		9,223		56,162
Total	$	1,841,428	$	178,300	$	2,019,728


	Year Ended December 31, 2022
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	2,629,088	$	101,440	$	2,730,528
Other Services	71,295		4,786		76,081
Total	$	2,700,383	$	106,226	$	2,806,609









	Year Ended December 31, 2021
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	1,568,974	$	67,843	$	1,636,817
Other Services	36,807		3,028		39,835
Total	$	1,605,781	$	70,871	$	1,676,652

Balance Sheet Details (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Insurance recovery receivable - current:
Health	$ 886	$ 1,143
Workers’ compensation	2,687	3,117
Professional liability	5,524	3,174
Insurance recovery receivable (current)	9,097	7,434
Insurance recovery receivable - non-current:
Workers’ compensation	8,037	5,831
Professional liability	17,677	17,227
Insurance recovery receivable (noncurrent)	25,714	23,058
Other assets:
Security deposits	720	724
Deferred compensation	3,298	2,477
Net debt issuance costs	$ 2,623	$ 3,437
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Other assets	Other assets
Finance lease right-of-use assets	$ 0	$ 11
Post employment benefit	32	0
Other assets	6,673	6,649
Accounts payable and accrued expenses:
Trade accounts payable	3,040	12,863
Subcontractor payable	66,347	145,587
Accrued expenses	15,946	27,057
Accounts payable and accrued expenses	85,333	185,507
Accrued compensation and benefits:
Salaries and payroll taxes	27,042	40,983
Bonuses and commissions	2,893	11,798
Workers’ compensation	8,476	9,147
Professional liability	6,252	3,426
Health care	6,550	6,179
Vacation	1,084	1,072
Accrued compensation and benefits	52,297	72,605
Accrued claims:
Workers’ compensation	14,798	14,699
Professional liability	20,055	21,182
Accrued claims	34,853	35,881
Other liabilities:
Restructuring	474	1,084
Deferred taxes	401	247
Deferred compensation	3,343	2,507
Other liabilities	$ 4,218	$ 3,838

Goodwill, Trade Names, and Other Intangible Assets - Estimated Annual Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
2024	$ 10,481
2025	9,570
2026	8,362
2027	6,191
2028	4,790
Thereafter	9,174
Net Carrying Amount	$ 48,568	$ 38,823

Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Income Taxes

The components of the Company's income before income taxes are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
United States	$	102,200	$	255,661	$	132,809
Foreign	694		664		399
Income before income taxes	$	102,894	$	256,325	$	133,208

The components of the Company’s income tax expense are as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Current:
Federal	$	19,871	$	48,664	$	5,165
State	8,940		13,919		5,638
Foreign	148		219		330
Total	28,959		62,802		11,133
Deferred:
Federal	554		383		892
State	596		4,623		(10,648)
Foreign	154		56		(171)
Total	1,304		5,062		(9,927)
Income tax expense	$	30,263	$	67,864	$	1,206

Deferred income taxes reflect the Company's net tax effect of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes.

Significant components of the Company’s deferred tax assets and liabilities are as follows:


	December 31,
	2023		2022
	(amounts in thousands)




























Deferred Tax Assets:
Accrued other and prepaid expenses	$	912	$	96
Allowance for doubtful accounts	5,321		3,471
Intangible assets	7,072		7,518
Net operating loss carryforwards	1,054		1,389

Accrued professional liability	851		1,118
Accrued workers’ compensation	3,097		3,631
Share-based compensation	1,197		992
Operating lease liabilities	1,319		2,228

Credit carryforwards	—		1
Other	1,016		630
Gross deferred tax assets	21,839		21,074
Valuation allowance	(2)		(2)
	21,837		21,072
Deferred Tax Liabilities:
Depreciation	(967)		(1,411)

Indefinite-lived intangibles	(14,296)		(11,829)
Operating lease right-of-use assets	(620)		(740)
Tax on unrepatriated earnings	(401)		(247)

	(16,284)		(14,227)
Net deferred taxes	$	5,553	$	6,845

As of December 31, 2023 and 2022, the Company had immaterial valuation allowances on its deferred tax assets.

As of December 31, 2023, the Company had approximately $22.9 million of state net operating loss carryforwards, and an immaterial amount of foreign net operating loss carryforwards. The NOLs expire as follows: state between 2024 and 2041 and foreign between 2024 and 2028. As a result of the 2017 Tax Act, certain state NOLs generated in 2020, 2019, and 2018 carry forward indefinitely.

The reconciliation of income tax computed at the U.S. federal statutory rate to income tax expense is as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Tax at U.S. statutory rate	$	21,608	$	53,828	$	27,974
State taxes, net of federal benefit	6,834		15,423		8,573
Noncontrolling interest	—		—		(5)
Non-deductible items(a)	573		179		550
Foreign tax expense	155		136		76
Valuation allowances	1		1		(37,450)
Uncertain tax positions	2,771		(1,694)		1,891


Officers' compensation	(275)		404		344


Return to provision	(482)		(169)		44
Other	(922)		(244)		(791)
Income tax expense	$	30,263	$	67,864	$	1,206

________________

(a) Includes non-deductible meals and incidentals and other miscellaneous non-deductible items.

A reconciliation of the beginning and ending amounts of unrecognized tax benefits is as follows:


	Year Ended December 31,
	2023		2022		2021
	(amounts in thousands)
Balance at January 1	$	7,581	$	9,179	$	6,891
Additions based on tax positions related to the current year	2,737		349		1,873

Additions (reductions) based on tax positions related to prior years	59		(1,947)		—
Reductions as a result of a lapse of applicable statute of limitations	—		—		(47)

Other	—		—		462
Balance at December 31	$	10,377	$	7,581	$	9,179

There were no short-term unrecognized tax benefits as of December 31, 2023 and 2022. Long-term unrecognized tax benefits, including interest, are presented in uncertain tax positions in the consolidated balance sheets and were $10.6 million and $7.6 million as of December 31, 2023 and 2022, respectively. As of December 31, 2023 and 2022, the Company had unrecognized tax benefits, which would affect the effective tax rate if recognized, of $10.0 million and $7.2 million, respectively.

The Company recognizes interest and penalties related to unrecognized tax benefits in the provision for income taxes. During the years ended December 31, 2023, 2022, and 2021, accruals for the payment of interest and penalties were immaterial. Tax years 2012 through 2023 remain open to examination by certain taxing jurisdictions.

An unrecognized tax benefit should be presented in the financial statements as a reduction to a deferred tax asset for a net operating loss carryforward if such carryforward would offset the disallowance of the tax position. As a result of the Company’s utilization of its federal net operating loss carryforward and a material amount of state net operating loss carryforwards, the Company reclassified $0.4 million of unrecognized tax benefits from deferred tax assets to long-term liabilities in the year ended December 31, 2022. Further, for the year ended December 31, 2021, the Company reclassified $0.5 million, representing the federal benefit of state unrecognized tax benefits, in the tabular rollforward from unrecognized tax benefits to deferred tax assets.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
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-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
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-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Goodwill, Trade Names, and Other Intangible Assets - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Line Items]
Impairment charges for intangible assets	$ 0.0	$ 1.9
Databases
Goodwill and Intangible Assets Disclosure [Line Items]
Assets fully amortized and removed during period	3.4
Non-compete agreements
Goodwill and Intangible Assets Disclosure [Line Items]
Assets fully amortized and removed during period	0.0
Trade names
Goodwill and Intangible Assets Disclosure [Line Items]
Assets fully amortized and removed during period	$ 0.0

Fair Value Measurements (Tables)

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Schedule of Estimated Fair Values of Financial Assets and Liabilities Measured on a Recurring Basis

The estimated fair value of the Company’s financial assets and liabilities measured on a recurring basis is as follows:

Fair Value Measurements


	December 31, 2023		December 31, 2022
	(amounts in thousands)
Financial Assets:
(Level 1)
Deferred compensation asset	$	3,298	$	2,477
Financial Liabilities:
(Level 1)
Deferred compensation liability	$	3,343	$	2,507

Schedule of Carrying Amounts and Estimated Fair Values of Significant Financial Instrument that were not Measured at Fair Value

The carrying amounts and estimated fair value of the Company’s significant financial instruments that were not measured at fair value are as follows:


	December 31, 2023				December 31, 2022
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
	(amounts in thousands)
Financial Liabilities:
(Level 2)
Senior Secured Asset-Based Loan	$	—	$	—	$	76,800	$	76,800
Term Loan, net	$	—	$	—	$	78,375	$	71,221
Earnout Liability (WSG)	$	—	$	—	$	7,500	$	7,500
Earnout Liability (Mint)	$	9,884	$	9,884	$	10,000	$	10,000
Earnout Liability (HireUp)	$	1,910	$	1,910	$	8,000	$	8,000

DEBT - Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt	$ 0	$ 150,675
Debt Issuance Costs	(2,623)	$ (5,377)
Secured Debt \| 2021 Term Loan Credit Agreement
Debt Instrument [Line Items]
Effective interest rate percentage		10.14%
Debt	0	$ 73,875
Debt Issuance Costs	$ 0	$ (1,940)
Line of Credit \| Senior Secured Asset-Based Loan
Debt Instrument [Line Items]
Effective interest rate percentage	6.99%	5.90%
Debt	$ 0	$ 76,800
Debt Issuance Costs	$ (2,623)	$ (3,437)

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 835
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482900/835-30-50-1

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+ Details

Leases - Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Operating lease right-of-use assets	$ 2,599	$ 3,254
Operating lease liabilities	2,604	4,132
Operating lease liabilities	$ 2,663	$ 4,880
Weighted average remaining lease term	2 years 2 months 12 days	2 years 3 months 18 days
Weighted average discount rate	6.36%	6.31%

Debt (Tables)

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Schedule of Long-term Debt

The Company's debt consists of the following:


	December 31, 2023				December 31, 2022
	Principal		Debt Issuance Costs		Principal		Debt Issuance Costs
	(amounts in thousands)
Term Loan, interest of 10.14% at December 31, 2022	$	—	$	—	$	73,875	$	(1,940)
Senior Secured Asset-Based Loan, interest of 6.99% and 5.90% at December 31, 2023 and 2022, respectively	—		(2,623)		76,800		(3,437)
Debt	$	—	$	(2,623)	$	150,675	$	(5,377)

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

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+ Details

Fair Value Measurements - Estimated Fair Values of Financial Assets and Liabilities Measured on a Recurring Basis (Details) - Level 1 - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Deferred Compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Deferred compensation liability	$ 3,343	$ 2,507
Deferred Compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Deferred compensation asset	$ 3,298	$ 2,477

Income Taxes - Components of Income (Loss) Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
United States	$ 102,200	$ 255,661	$ 132,809
Foreign	694	664	399
Income before income taxes	$ 102,894	$ 256,325	$ 133,208

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

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+ Details

Acquisitions - Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Jun. 08, 2021
Business Acquisition [Line Items]
Goodwill	$ 135,430	$ 163,268
Workforce Solutions Group, Inc.
Business Acquisition [Line Items]
Cash and cash equivalents			$ 957
Accounts receivable			11,991
Other current assets			59
Property and equipment			10
Right-of-use assets			1,078
Goodwill			22,066
Other intangible assets			14,200
Total assets acquired			50,361
Accounts payable and accrued expenses			3,562
Accrued compensation and benefits			1,387
Lease liability - current			316
Lease liability - non-current			762
Earnout liability			15,000
Total liabilities assumed			21,027
Net assets acquired			$ 29,334

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

The Company’s property and equipment consists of the following:


		December 31,
	Useful Lives	2023		2022
		(amounts in thousands)
Computer equipment	3-5 years	$	5,236	$	6,167
Computer software	1-10 years	34,531		22,518
Office equipment	5 years	467		473
Furniture and fixtures	7 years	703		2,078
Construction in progress	(a)	998		3,462
Leasehold improvements	(b)	1,212		2,646
		43,147		37,344
Less accumulated depreciation and amortization		(15,808)		(17,682)
		$	27,339	$	19,662

_______________

(a) Primarily related to software development.

(b) See Note 2 – Summary of Significant Accounting Policies.

Summary of Significant Accounting Policies - Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 17,875	$ 16,914	$ 18,020	$ 13,058	$ 11,365	$ 10,857	$ 8,091	$ 6,087	$ 13,058	$ 6,087
Bad Debt Expense	4,166	2,355	3,134	4,908	2,947	1,101	3,192	2,369	14,562	9,609	$ 4,783
Write-Offs, net of Recoveries	(2,401)	(1,394)	(4,240)	54	(1,254)	(593)	(426)	(365)
Ending balance	$ 19,640	$ 17,875	$ 16,914	$ 18,020	$ 13,058	$ 11,365	$ 10,857	$ 8,091	$ 19,640	$ 13,058	$ 6,087