Registered Nurse Manager jobs at Aetna

Become a part of our caring community and help us put health first Enjoy a rewarding career with a true work/life balance-no nights or weekends, giving you more time for what matters most. Humana is currently seeking RN Case Managers to join our teams in the La Crosse and Sparta offices, serving members in the Wisconsin Family Care (FC) program. In this vital role, you will collaborate with dedicated colleagues to ensure exceptional care coordination for our members, providing crucial support and education to help them thrive in their daily lives. Take the next step in your nursing career and make a meaningful difference with Humana.Key responsiblities: Partner with a Care Coach (also referred to as a Case Manager), taking the lead on health-related needs, to collaborate on an ongoing basis regarding the member and their care plan. Conduct regular health assessments for members and implement appropriate strategies and services to develop individualized care plans that support their continued health and safety. Contribute to the creation, continuous evaluation, and coordination of the member's plan of care, including coordinating with outside providers to provide support with medication administration, assistance with home care, skilled nursing visits, and related services to ensure comprehensive care. Contact and coordinate with acute and primary care providers. Promote health and wellness through patient education on disease prevention, nutrition, exercise and lifestyle modifications. Provide members with education and information about disease processes and related risks, supporting informed decision-making while respecting each individual's autonomy. Daily documentation in member files within required DHS contract timeframes. Participate in member monthly phone contacts and attend in person visits in members setting. Traveling will be required and eligible for mileage reimbursement. Use your skills to make an impact Required Qualifications Associate degree in nursing. Must be a Registered Nurse, licensed in the state of Wisconsin in good standing. Demonstrated intermediate computer proficiency, including experience with Microsoft Office applications. Preferred Qualifications Bachelor degree in nursing. One (1)+ years of experience with Family Care target group: frail elders and adults with intellectual, developmental, or physical disabilities. Care Management experience Additional Information Workstyle: This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Work Location: Either La Crosse WI or Sparta WI and surrounding area. Travel: up to 40% throughout assigned area and surrounding areas Typical Work Days/Hours: Monday through Friday, 8:00 am - 4:30 pm CST. WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Driving This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. TB This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Modern Hire As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Become a part of our caring community and help us put health first Humana Healthy Horizons in Virginia is looking for RN, Field Care Managers (Field Care Manager Nurse 2) who performs primarily face to face and telephonic assessments to adult and pediatric members. The RN, Field Care Manager (Field Care Manager Nurse 2) will evaluate member's needs to achieve and/or maintain optimal wellness. This position employs a variety of strategies, approaches, and techniques to manage a member's health issues and identifies and resolves barriers that hinder effective care. They ensure members are progressing towards desired outcomes by continuously monitoring care through use of assessment, data, conversations with member, and active care planning. The RN, Field Care Manager (Field Care Manager, Nurse 2) understands professional concepts, regulations, strategies, and operating standards. They make decisions regarding work approach/priorities and follows direction. Responsible for managing a case load and completing assessments with members in their home or community-based setting, as well as telephonically. Provides clinical support and guidance, particularly for members with medical complexity. Develops and coordinates care plans ensuring that patients receive appropriate services to manage their health needs effectively. Addresses barriers to health care and advocating for optimal member outcomes. Reviews, assesses, and completes medical complexity attestations and clinical oversights. Ensures members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs. Develops and modifies Individual Care Plan and involve applicable members of the care team in care planning (Informal caregiver, coach, PCP, etc.). Focuses on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs. Collaborates with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs. Primary point of contact for the ICT and shall be responsible for coordinating with the member, ICT participants, and outside resources to ensure the member's needs are met. Use your skills to make an impact Required Qualifications Must reside in the Commonwealth of Northern Virginia Active Registered Nurse (RN) license in the Commonwealth of Virginia without disciplinary action. Two (2) years of prior experience in health care and/or case management. One (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria (adults, pediatrics populations at risk for chronic medical conditions and high social needs). Strong advocate and respect for members at all levels of care. Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook. Ability to use a variety of electronic information applications/software programs including electronic medical records. Exceptional oral and written communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders. Ability to work with minimal supervision within the role and scope. Ability to work a full-time schedule. Preferred Qualifications Prior experience with Medicare, Medicaid and dual eligible populations. Bachelor's Degree Nursing (BSN). Case Management Certification (CCM). Experience with health promotion, coaching and wellness. Knowledge of community health and social service agencies and additional community resources. Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. See “Additional Information” section for more information. Additional Information Workstyle: Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Travel: 50 - 75% field interactions with members, and their families and providers. May need to attend onsite meetings occasionally in Humana Healthy Horizons office in Glen Allen, VA. Workdays and Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST). Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert Statement Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. TB Screening This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Driving Statement This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Become a part of our caring community and help us put health first The Compact licensed telephonic Care Manager works from home in a call center environment. They assess and evaluate members' needs and requirements to achieve or maintain optimal wellness by providing care coordination and facilitating member or family interaction with resources appropriate for the care and wellbeing of the member. Job Description Humana Care Support is a division of Humana dedicated to helping adults remain independent in their homes. Our nurses are called Care Managers, because our case management services are centered on the person rather than the condition. The Care Manager uses a range of strategies and techniques to manage a member's physical, environmental, and psycho-social health issues. They identify and resolve barriers to effective care and continuously monitor progress through assessments and evaluations to ensure members achieve their desired health outcomes. Role Overview The nature of the work requires telephonic interaction with members during the majority of the business day, primarily through an auto dialer system. This role operates in a fast-paced environment, requiring the ability to quickly engage with members while navigating multiple computer applications simultaneously. To maintain compliance and support the auto-dialer process critical to our operations, care managers follow structured daily schedules, which limits day-to-day flexibility. All our RN Care Managers are work at home associates, working from a dedicated home office space (see Work at Home Guidance below). Remote Care Managers are expected to achieve established outcomes, quality, and productivity benchmarks and demonstrate advanced communication and interpersonal skills. Duties Include Telephonically working with Medicare members with transitional needs and complex chronic conditions. Assessing members' physical, environmental, and psychosocial health needs, collaborating with a multidisciplinary team, and implementing timely clinical interventions to manage risks, coordinate care, and help prevent avoidable hospitalizations. Collaboration with members who face multiple chronic conditions, along with financial and functional challenges, to support them in achieving and sustaining optimal health. May develop individualized member care plans. Success in this position requires that you Understand department, segment, and organizational strategies and objectives, and how they connect to related areas. Exercise judgement regarding own work methods, even in ambiguous situations, with minimal direction and occasional guidance where needed. Demonstrate flexibility and ability to promptly adapt to new processes and workflows. Adhere to established guidelines/procedures. Use your skills to make an impact Required Qualifications Active Registered Nurse (R.N.) license with no disciplinary action on any license. Must hold an active Compact nursing license and reside in the state that holds your compact license. 3+ years of clinical acute care experience with case management, discharge planning, and patient education for adult acute care Demonstrated clinical expertise in managing chronic conditions through individualized care planning, supported by strong assessment and critical thinking skills Proficiency in Microsoft Office applications including Word, Excel, and Outlook. Demonstrated proficiency in navigating multiple systems using dual monitors, with strong computer skills and the ability to quickly learn new applications. Skilled in autonomous decision-making, troubleshooting, and problem-solving system-related issues Preferred Qualifications BSN or MSN degree Case Management experience Managed care experience Certified Case Manager (CCM) Bilingual in English and Spanish (see Language Proficiency Testing below) Training and Work Schedule The first 4 weeks of training work hours will be from 8:30AM to 5:00PM EST. No time off is permitted during the first month of training. Following training, work hours are: If you live in the Eastern Time Zone (EST): Work hours are 9:00 AM to 5:30 PM EST. If you live in the Central Time Zone (CST): work hours are 10:00 AM to 6:30 PM EST Work at Home Guidance To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is also required. Satellite, cellular and microwave connection is not allowed. On occasion, the personal level of internet service a Home or Hybrid Home/Office associate provides-despite meeting the minimum requirement above-proves to be insufficient to maintain an optimal connection through Humana's VPN and thereby interferes with the Home or Hybrid Home/Office associate's ability to work effectively. When this happens, Humana reserves the right to require the associate to upgrade the level of his/her personal internet service as a condition of employment. Based on system requirements, you may need a download speed of up to 200 Mbps and an upload speed of 20 Mbps. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Language Proficiency Testing Any Humana associate who wishes to communicate with members in a language other than English must complete a language proficiency assessment, administered by an approved external vendor, to ensure fluency and competency in that language Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Please note during the screening process, you will be asked to provide your Compact Nursing license number and your internet upload and download speeds from ****************** These items will be required prior to scheduling an interview. Social Security Task Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of South Carolina and or compact license. Care Manager RN will work with Medicaid/Medicare SC population completing assessments, care plans, educating, and connecting to community resources. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members and providers on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Preferred experience working with a Behavioral Health population and/or Waiver program Home office with internet connectivity of high speed required. This is a remote position. Schedule: Monday thru Friday 8:00AM to 5:00PM EST. (Flexibility to work 1 to 2 nights a week to 6 PM EST) (No Weekends or Holidays) Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

For this position we are seeking a (RN) Registered Nurse who must live and have a current active unrestricted RN license in the state of OH Case Manager RN will work in remote and field setting supporting Medicare and Medicaid l health population. This role will be supporting our FIDE-SNP population, completing face to face assessments, care plans, and providing education and support to our members. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Home office with internet connectivity of high speed required. Schedule: Monday thru Friday 8:00AM to 5:00PM Field Travel (Up to 50%) - Union, Delaware, Franklin, Madison, and Pickaway (Columbus OH). (Mileage is reimbursed) JOB DESCRIPTION Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

The Care Manager, LTSS provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. This position will support our Moline One Care plan. Molina One Care is a community-based health care organization with national operations support delivering government funded health plans for members who reside in Massachusetts. We are looking for nurses with strong geriatric and chronic disease management experience, comprehensive assessment, person-centered care planning, and effective care coordination across interdisciplinary teams. Familiarity with Medicare/Medicaid integration, LTSS, and SCO regulations is a plus, Strong communication, documentation, EMR skills, and knowledge of community resources. Cultural competence, time management, and the ability to work independently. Previous SCO/ case management experience. Bilingual candidates that speak Cape Verdean Creole, Spanish, Haitian Creole are encouraged to apply to support our diverse communities! Work Hours: Monday - Friday 8:00am - 5:00pm EST Remote position with field travel in Brockton, Plymouth County, MA Essential Job Duties Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Ability to operate proactively and demonstrate detail-oriented work. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications • Certified Case Manager (CCM). • Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

For this position we are seeking a (RN) Registered Nurse who lives in OHIO and must be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program. This position will have a case load and manage members enrolled in this program. We are looking for Registered Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. This position requires field work doing assessments with members face to face in homes. TRAVEL in the field to do member visits in the surrounding areas will be required: Cincinnati OH - (Mileage is reimbursed) Schedule - Monday thru Friday 800 AM to 5 PM EST (No weekends or Holidays JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Ability to operate proactively and demonstrate detail-oriented work. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications • Certified Case Manager (CCM). • Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Become a part of our caring community and help us put health first The Care Manager, Telephonic Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. Work schedule can be between 8am-6:30pm EST. The Care Manager Telephonic Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures The Care Manager Telephonic Nurse employs a variety of strategies, approaches and techniques to assess, intervene, and resolve Access to Care (ATC) barriers related to immediate medical services. The nurse will facilitate verified eligible Humana benefits to a provider and/or member while effectively documenting through assessments and/or evaluations while maintaining compliance with CMS regulations. The Care Manager Telephonic Nurse must also assess for member physical, environmental, and psycho-social health issues and intervene appropriately. Use your skills to make an impact Required Qualifications Minimum of an Associate's degree in Nursing Licensed Registered Nurse (RN) with no disciplinary action Must have a valid Compact RN license in the state where they reside. Candidates must reside in a Compact state (excluding CA, IL, MI, NY, OR, AK, DC (District of Columbia), HI, NV, MA, MN, and PR). 3 years or more of clinical acute care experience Comprehensive knowledge of all Microsoft programs including but not limited to Word, Outlook, PowerPoint, SharePoint, OneNote and Excel Preferred Qualifications Bachelor's degree - BSN Experience with case management, discharge planning, and patient education for adult acute care Managed care experience Previous Medicare/Medicaid experience Bilingual English/Spanish Additional Information Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. Work schedule can be between 8am-6:30pm EST. Work At Home / Internet Statement: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert Statement: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-04-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Become a part of our caring community and help us put health first We are seeking a dedicated and compassionate Registered Nurse with a Bachelor of Science in Nursing (BSN) to join our team as a Care Manager, Telephonic Nurse 2. In this pivotal role, you will play a crucial part in our Patient Management Program, focusing on individuals with specialized and complex health conditions, including autoimmune disorders, pulmonary diseases, neuromuscular disorders, infectious diseases, cancer(s), and other rare ailments. As a Care Manager, Telephonic Nurse your primary responsibility will be to assess and evaluate the conditions of our members, with a particular emphasis on medication therapy, through telephonic interactions to ensure they achieve and maintain optimal wellness. Additionally, you will develop and implement comprehensive care plans, monitor patient progress through regular assessments, and utilize advanced telecommunication systems to provide medication education. The ideal candidate will demonstrate strong clinical expertise, exceptional communication skills, and the ability to work independently while adhering to established protocols and guidelines. This position offers the opportunity to make a significant impact on the lives of patients with serious and rare health conditions within a supportive and professional environment. Use your skills to make an impact This position is a call center based environment. There is a set schedule that is provided daily with inbound and outbound tasks to perform. This position is for 10am-6:30pm EST three days a week M-F, and two days a week hours of 11:30am-8pm EST. There will be a Friday late night requirement on a rotation of 11:30am-8pm. There will be a Saturday rotation hours of 8:30am-12:30pm EST. Overtime is required on an as needed basis. There is a Holiday rotation that will be worked. Workable holidays for the pharmacy include Martin Luther King Day, Memorial Day, Juneteenth, 4th of July, Labor Day, The day after Thanksgiving, and New Years Day. Required Qualifications Must have Completed Bachelor's Degree in Nursing 3 - 5 years of clinical acute care experience Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action Must live in OH, KY, FL, AZ, TX. Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Preferred Qualifications Experience with care management, patient education for adult care, auto dialer experience Bilingual English/Spanish Auto Dialer Experience Additional Information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

**Become a part of our caring community and help us put health first** The Care Manager, Telephonic Nurse utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. Work schedule can be between 8am-6:30pm EST. The Care Manager Telephonic Nurse uses clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures The Care Manager Telephonic Nurse employs a variety of strategies, approaches and techniques to assess, intervene, and resolve Access to Care (ATC) barriers related to immediate medical services. The nurse will facilitate verified eligible Humana benefits to a provider and/or member while effectively documenting through assessments and/or evaluations while maintaining compliance with CMS regulations. The Care Manager Telephonic Nurse must also assess for member physical, environmental, and psycho-social health issues and intervene appropriately. **Use your skills to make an impact** **Required Qualifications** + Minimum of an Associate's degree in Nursing + Licensed Registered Nurse (RN) with no disciplinary action + Must have a valid Compact RN license in the state where they reside. **Candidates must reside in a Compact state (excluding CA, IL, MI, NY, OR, AK, DC (District of Columbia), HI, NV, MA, MN, and PR).** + 3 years or more of clinical acute care experience + Comprehensive knowledge of all Microsoft programs including but not limited to Word, Outlook, PowerPoint, SharePoint, OneNote and Excel **Preferred Qualifications** + Bachelor's degree - BSN + Experience with case management, discharge planning, and patient education for adult acute care + Managed care experience + Previous Medicare/Medicaid experience + Bilingual English/Spanish **Additional Information** + Associate will be expected to participate in weekend rotation a minimum of one hour each on Saturday and Sunday once every 17 weeks. + Work schedule can be between 8am-6:30pm EST. **Work At Home / Internet Statement:** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **SSN Alert Statement:** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-04-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

**EXPECTATIONS:** This role partners with the sales team and requires travel to client offices based on location. **GENERAL PURPOSE:** + Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance. **OVERVIEW:** + The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost. **RESPONSIBILITIES** + Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders. + Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition. + Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding. + Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes. + Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions. + Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability. + In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition. + Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests. + **Ideal candidate must reside in one of the following locations:** Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR. **QUALIFICATIONS** + Active and unrestricted nursing license in your state of residence (required). + BSN is required + Advanced degree (preferred). + Minimum of three (3) years of clinical practice experience. + Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus). + Strong leadership, organizational, critical thinking, and execution skills. + Broad-based thinker with a solid understanding of overall approach to population health for employers. + Ability to work effectively in a matrixed environment. + Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders. + Excellent oral and written communication skills. + Proficient in multiple forum presentations internally and externally. + Skilled in using Microsoft and technology/software applications. + Requires intermittent travel up to 50% of the time. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here (********************************************** . **About Cigna Healthcare** Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._

**EXPECTATIONS:** This role partners with the sales team and requires travel to client offices based on location. **GENERAL PURPOSE:** + Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance. **OVERVIEW:** + The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost. **RESPONSIBILITIES** + Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders. + Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition. + Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding. + Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes. + Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions. + Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability. + In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition. + Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests. + **Ideal candidate must reside in one of the following locations:** Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR. **QUALIFICATIONS** + Active and unrestricted nursing license in your state of residence (required). + BSN is required + Advanced degree (preferred). + Minimum of three (3) years of clinical practice experience. + Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus). + Strong leadership, organizational, critical thinking, and execution skills. + Broad-based thinker with a solid understanding of overall approach to population health for employers. + Ability to work effectively in a matrixed environment. + Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders. + Excellent oral and written communication skills. + Proficient in multiple forum presentations internally and externally. + Skilled in using Microsoft and technology/software applications. + Requires intermittent travel up to 50% of the time. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here (********************************************** . **About Cigna Healthcare** Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._

EXPECTATIONS: This role partners with the sales team and requires travel to client offices based on location. GENERAL PURPOSE: Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance. OVERVIEW: The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost. RESPONSIBILITIES Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders. Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition. Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding. Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes. Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions. Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability. In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition. Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests. Ideal candidate must reside in one of the following locations: Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR. QUALIFICATIONS Active and unrestricted nursing license in your state of residence (required). BSN is required Advanced degree (preferred). Minimum of three (3) years of clinical practice experience. Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus). Strong leadership, organizational, critical thinking, and execution skills. Broad-based thinker with a solid understanding of overall approach to population health for employers. Ability to work effectively in a matrixed environment. Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders. Excellent oral and written communication skills. Proficient in multiple forum presentations internally and externally. Skilled in using Microsoft and technology/software applications. Requires intermittent travel up to 50% of the time. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

EXPECTATIONS: This role partners with the sales team and requires travel to client offices based on location. GENERAL PURPOSE: Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance. OVERVIEW: The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost. RESPONSIBILITIES Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders. Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition. Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding. Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes. Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions. Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability. In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition. Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests. Ideal candidate must reside in one of the following locations: Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR. QUALIFICATIONS Active and unrestricted nursing license in your state of residence (required). BSN is required Advanced degree (preferred). Minimum of three (3) years of clinical practice experience. Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus). Strong leadership, organizational, critical thinking, and execution skills. Broad-based thinker with a solid understanding of overall approach to population health for employers. Ability to work effectively in a matrixed environment. Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders. Excellent oral and written communication skills. Proficient in multiple forum presentations internally and externally. Skilled in using Microsoft and technology/software applications. Requires intermittent travel up to 50% of the time. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Specialty Biologics Clinical Reviewer is responsible for managing high-risk patient population(s) to streamline patient access to therapy and facilitate communication between FlexCare, the referring provider's office, and the patient. They are also responsible for monitoring and leading the intake department in accordance with the key business initiatives and growth. This position is hands-on and will be responsible for oversight of all intake functions, as well as communication with internal and external resources. This is a full-time position with typical working hours of Monday through Friday, 8:00 a.m. to 5:00 p.m. Hours and work shifts may change in accordance with business needs. Exempt employees must have the ability to be on-call and available, as business needs required. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform essential functions. + Serves as the clinical expert on a subset of high-risk and/or high-volume specialty medications. + Serves as a drug specific liaison and facilitates ongoing communication regarding their active patient's education as needed. + Tracks patients from initial notification of referral, through the intake process and throughout their course of treatment to ensure all barriers to care are identified and addressed promptly. + Completes clinical reviews to ensure the appropriateness of therapy/prescription per company protocol, Medicare, Medicaid, and commercial payers in multiple states. + Assists the Intake department in reviewing and gathering all supporting documents to ensure prior authorization approval. + Composes letters of medical necessity (LMNs) and appeals to advocate for patient access to therapy, as supported by provider documentation, clinical trials, and other medically supported resources. + Collaborates with manufacturer Patient Services teams to ensure all manufacturer resources are being utilized effectively to support the patient prior to and during treatment. + Communicates frequently with patients to ensure they are receiving optimal service and to address any reported problems with care. + Serves as an active member of the Quality Assurance program to identify high-risk/high-volume QA initiatives. + Works closely with Intake, Reimbursement, and Sales to identify areas of program improvement. + Tracks and reports drug/program-specific KPIs to company leadership on a monthly basis You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Active unrestricted RN license in the state of employment + Proficient in Microsoft Suite + Ability to travel in and out of the state up to 25% of the time **Preferred Qualifications:** + Bachelors of Nursing (BSN) + Experience in the management patients on specialty medications + Experience composing or assisting in medical writing + 2+ years of customer service or healthcare sales experience + 2+ years experience Specialty Biologic Clinical review + Experience with prior authorizations approval process *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances) + Clinical Interface/Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, program definition and clarification) + Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits) + Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services) + Generally work is self-directed and not prescribed + Works with less structured, more complex issues + Solves moderately complex problems and/or conducts moderately complex analyses + Translates concepts into practice + Assesses and interprets customer needs and requirements + Identifies solutions to non-standard requests and problems + Works with minimal guidance; seeks guidance on only the most complex tasks + Provides explanations and information to others on difficult issues + Coaches, provides feedback, and guides others + Acts as a resource for others with less experience You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current, valid and unrestricted RN licensure in your state of residence + 5+ years of clinical experience in an acute care or an outpatient setting + 1+ year of Utilization Review or Medical Appeal Review experience + Solid Microsoft Office (Word, Excel & Outlook) + Have access to high speed internet + Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime, including Saturdays **Preferred Qualifications:** + Undergraduate degree + 3+ years of Utilization Review, Case Management or Medical Appeal experience + Experience working in a Managed Care environment + ICD9 and CPT coding experience + Experience in telephonic role + Background in Appeals and Grievances + Solid analytical and research skills + Solid organizational skills + Solid oral and written communication skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances) * Clinical Interface/Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, program definition and clarification) * Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits) * Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services) * Generally work is self-directed and not prescribed * Works with less structured, more complex issues * Solves moderately complex problems and/or conducts moderately complex analyses * Translates concepts into practice * Assesses and interprets customer needs and requirements * Identifies solutions to non-standard requests and problems * Works with minimal guidance; seeks guidance on only the most complex tasks * Provides explanations and information to others on difficult issues * Coaches, provides feedback, and guides others * Acts as a resource for others with less experience You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current, valid and unrestricted RN licensure in your state of residence * 5+ years of clinical experience in an acute care or an outpatient setting * 1+ year of Utilization Review or Medical Appeal Review experience * Solid Microsoft Office (Word, Excel & Outlook) * Have access to high speed internet * Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime, including Saturdays Preferred Qualifications: * Undergraduate degree * 3+ years of Utilization Review, Case Management or Medical Appeal experience * Experience working in a Managed Care environment * ICD9 and CPT coding experience * Experience in telephonic role * Background in Appeals and Grievances * Solid analytical and research skills * Solid organizational skills * Solid oral and written communication skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. If you are located within Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. Primary Responsibilities: * Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid * Identify if additional information is required to process an appeal * Ability to adapt to changes that require cross training on appeal types as they are identified * Ability to work independently * Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to make decision on administrative nurse level cases * Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current, valid, and unrestricted RN licensure in your state of residence * 2+ years of clinical experience in an acute care or an outpatient setting * 1+ years of direct experience within one (or more) of the following areas: * Utilization Review * Medicaid and/or Medicare appeals experience * LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC * Proven experience/understanding of billable services and claims in a managed care environment * Solid Microsoft Office (Word, Excel & Outlook) Basic computer skills * Access to high-speed internet * Ability to work 8-5 within EST (Eastern standard time zone) Preferred Qualifications: * 5+ years of Medical Appeal experience working with Medicare and Medicaid * Solid coding experience or Certified Coder (CPC) * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Specialty Biologics Clinical Reviewer is responsible for managing high-risk patient population(s) to streamline patient access to therapy and facilitate communication between FlexCare, the referring provider's office, and the patient. They are also responsible for monitoring and leading the intake department in accordance with the key business initiatives and growth. This position is hands-on and will be responsible for oversight of all intake functions, as well as communication with internal and external resources. This is a full-time position with typical working hours of Monday through Friday, 8:00 a.m. to 5:00 p.m. Hours and work shifts may change in accordance with business needs. Exempt employees must have the ability to be on-call and available, as business needs required. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform essential functions. * Serves as the clinical expert on a subset of high-risk and/or high-volume specialty medications. * Serves as a drug specific liaison and facilitates ongoing communication regarding their active patient's education as needed. * Tracks patients from initial notification of referral, through the intake process and throughout their course of treatment to ensure all barriers to care are identified and addressed promptly. * Completes clinical reviews to ensure the appropriateness of therapy/prescription per company protocol, Medicare, Medicaid, and commercial payers in multiple states. * Assists the Intake department in reviewing and gathering all supporting documents to ensure prior authorization approval. * Composes letters of medical necessity (LMNs) and appeals to advocate for patient access to therapy, as supported by provider documentation, clinical trials, and other medically supported resources. * Collaborates with manufacturer Patient Services teams to ensure all manufacturer resources are being utilized effectively to support the patient prior to and during treatment. * Communicates frequently with patients to ensure they are receiving optimal service and to address any reported problems with care. * Serves as an active member of the Quality Assurance program to identify high-risk/high-volume QA initiatives. * Works closely with Intake, Reimbursement, and Sales to identify areas of program improvement. * Tracks and reports drug/program-specific KPIs to company leadership on a monthly basis You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Active unrestricted RN license in the state of employment * 2+ years of customer service or healthcare sales experience * Experience in the management of patients on specialty medications * Experience composing or assisting in medical writing * Proficient in Microsoft Suite * Ability to travel in and out of the state up to 25% of the time Preferred Qualifications: * Bachelors of Nursing (BSN) * 2+ years experience Specialty Biologic Clinical review * Experience with prior authorizations approval process * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.