American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com.
If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!
Benefits and Perks include:
* Affordable Medical/Dental/Vision insurance options
* Generous paid time-off program and paid holidays for full time staff
* TeleMedicine 24/7/365 access to doctors
* Optional short- and long-term disability plans
* Employee Assistance Plan (EAP)
* 401K retirement accounts
* Employee Referral Bonus Program
ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
* Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
* Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
* Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
* Work assigned claim projects to completion
* Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
* Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
* Maintain production and quality standards as established by management
* Participate in and support ad-hoc audits as needed
* Other duties as assigned
JOB REQUIREMENTS:
* Proficient in processing/auditing claims for Medicare and Medicaid plans
* Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
* Current experience with both Institutional and Professional claim payments
* Knowledge of automated claims processing systems
* Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.
REQUIRED QUALIFICATIONS:
* Experience:
* Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
* Two (2) years' experience in managed healthcare environment related to claims processing/audit
* Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
* Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
* Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans
* License/Certification(s):
* Coding certification preferred
EQUAL OPPORTUNITY EMPLOYER
Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.
This employer participates in E-Verify.
$36k-45k yearly est. 18d ago
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Senior Counsel - Healthcare IT and AI Technology Contracts
Akron Children's Hospital 4.8
Akron, OH jobs
Full-Time, 40 hours/week
Monday - Friday 8 am - 5 pm
Onsite
The Senior Associate Counsel provides legal support for hospital information technology operations, including comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence. This position reports to the Vice President, Senior Associate Counsel with a reporting matrix to the Chief Information Officer.
Responsibilities:
Advise hospital leadership and procurement teams on the legal implications of acquiring new technologies, such as electronic health records (EHR), telemedicine platforms, cybersecurity tools, and medical devices and the implementation of artificial intelligence tools.
Draft, review, and negotiate a broad array of information technology contracts-such as software-as-a-service (SaaS) agreements, cloud hosting terms, data processing addenda, and business associate agreements. Identify and address legal risks in vendor offerings and technology solutions.
Advise hospital leadership on legal considerations surrounding digital transformation initiatives, innovation adoption, and strategic partnerships with technology providers.
Collaborate with hospital IT and security teams to develop policies and protocols for safeguarding patient data and critical systems. Advise on incident response plans, breach notification procedures, and risk mitigation strategies. Stay abreast of emerging threats and evolving best practices.
Provide legal support for hospital-wide policies on technology use, social media, device management, remote work, mobile access to sensitive information, and enterprise risk for information technology. Ensure policies reflect current legal requirements and operational needs.
Support the hospital in managing disputes or litigation related to technology vendors, data breaches, intellectual property claims, and other technology-related matters. Coordinate with litigation counsel as needed.
Education and Training: Provide ongoing education to staff and leadership on legal implications of technology adoption, emerging regulatory requirements, and evolving risks in the health technology landscape.
Identify and assess legal, operational, and compliance risks in IT contract.
Other duties as assigned.
Other information:
Technical Expertise
Openness to learning and keeping pace with rapid changes in both healthcare delivery and technological innovation.
Aptitude for working effectively with clinicians, IT professionals, administrators, vendors, and regulators.
Capacity to guide organizational leadership through complex legal and strategic decisions regarding technology investments.
Resourcefulness and creativity in navigating novel legal challenges emerging from digital health transformation.
Education and Experience
Education: Juris Doctor (JD) degree from an accredited law school; Ohio bar admission or ability to obtain admission prior to start date.
Experience: Minimum of 5 years of legal practice advising in healthcare Information technology contracts is required.
Technical Knowledge: Familiarity with healthcare IT systems, data privacy and security laws, and emerging technologies (such as artificial intelligence, cloud computing, and IoT).
Skills: Strong contract negotiation, drafting, and analytical skills. Excellent verbal and written communication abilities. Competency in risk assessment and strategic thinking.
Demonstrated integrity, discretion, and ability to work collaboratively with multidisciplinary teams.
Full Time
FTE: 1.000000
Status: Onsite
$97k-148k yearly est. 17d ago
Registered Dietitian - Multiple Positions
Lee Health 3.1
Gainesville, FL jobs
Work Type:Full and Part time Available
Minimum to Midpoint Pay Rate:$27.57 - $35.84 / hour
Hiring Incentives:$5,000 Sign-on bonus; plus $7,500 Relocation Incentive (if relocating from greater than 50 miles away). One-half for Part-time roles.
Make a Lasting Impact on Lives - Join Lee Health as a Registered Dietitian in the greater Fort Myers, Florida area!
Are you passionate about helping the community thrive through nutrition? AtLee Health, we're looking for compassionate Registered Dietitiansto join our collaborative interdisciplinary care teams. In these rewarding roles, you'll provide specialized nutrition interventions tailored to the unique needs of our patients. Whether you're drawn to the challenge of clinical nutrition in specialized populations or the joy of coordinating nutrition care plans with patients and their families, this is your opportunity to make a real difference.
Current opportunities may include:
Pediatrics:Full and Part-time inpatient; outpatient areas in GI and Endocrinology
Adult:Full-time Inpatient; Full-time Outpatient (Cape Coral and Fort Myers); Part-time Community Outreach (Cape Coral)
Cancer Support(RDOncology experience preferred):Full-time Outpatient;Partially remote(2 days remote; 3 days onsite in Bonita and Fort Myers)
What We Offer You:
Competitive pay
Up to $12,500 in hiring incentives
Room for growth & career development
A team of supportive, collaborative professionals
Top-tier health coverage, including no-cost services at Employee Health Clinics
Education reimbursement (after 90 days)
Up to 5% retirement match
Supplemental benefits including Pet Insurance, Legal Insurance, and more!
"I chose Lee Health because of its strong commitment to its employees and its clear set of values. I believe a fulfilling career is built on continuous growth, and Lee Health supports this through opportunities for ongoing education and professional development. This focus on learning, combined with the organization's core values, creates a workplace I'm excited to be a part of."-
Maria A., RD @ Lee Health
Educational Requirements Degree/Diploma ObtainedProgram of StudyRequired/
Preferredand/or Bachelor'sDietetics / Human Nutrition and FoodsRequired
Experience Requirements Minimum Years RequiredArea of ExperienceRequired/
Preferredand/or1 YearClinical NutritionPreferred
State of Florida Licensure Requirements LicensesRequired/
Preferredand/or Dietitian LicensePreferred
Certifications/Registration Requirements Certificates/RegistrationsRequired/
Preferredand/or RD (Registered Dietitian) Required
Additional Requirements
Florida Licensure (LD) through the Florida Department of Profession Regulations (DPR) Optional
US:FL:Cape Coral
$27.6-35.8 hourly 4d ago
Executive Assistant 2, Baptist Health Innovations, HYBRID, FT, 08A-4:30P
Baptist Health South Florida 4.5
Miami, FL jobs
The Executive Assistant 2 is advanced and highly responsible executive clerical and related administrative work reporting to a Corporate VP (Entire Function) or Entity CEO. Employees in this position perform a variety of complex clerical, special projects and administrative duties. Emphasis of the work is on the performance of advanced clerical and administrative duties requiring considerable knowledge of the executive(s) responsibilities and an understanding of the policies, programs, procedures and regulations in effect in the entity. Duties typically include arranging for and attending conferences, independently answering inquiries where there is established policy or precedent action, taking and transcribing dictation, composing and typing correspondence and performing research to compile data for special reports and other purposes. Incumbents utilize a variety of office skills and considerable independent judgement in relieving supervisor of administrative details. General supervision is received from the employee's leader who reviews work for satisfactory performance of executive clerical and administrative duties and for attainment of desired goals and objectives. Estimated pay range for this position is $26.90 - $32.55 / hour depending on experience.
Degrees:
* High School,Cert,GED,Trn,Exper.
Additional Qualifications:
Associates degree preferred.
Clerical/administrative experience.
Advanced computer knowledge, to include knowledge of MS Office Tools and Internet.
Ability to operate office equipment (i.e
.
: copiers, fax machines, printers etc.)
Work requires written and verbal communication skills.
General knowledge of company policies, practices and operations.
Must be able to maintain confidentiality.
Minimum Required Experience: 4 Years
$26.9-32.6 hourly 5d ago
Medical Physicist
Saint Luke's Hospital of Kansas City 4.6
Kansas City, MO jobs
The Medical Physicist position at Saint Luke's Hospital involves providing clinical medical physics services in a radiation therapy environment, supporting multiple treatment centers and advanced technologies. The role includes technical leadership, optimizing clinical practices, ensuring compliance with policies and regulations, and supporting specialized treatment procedures. Candidates must have relevant certification or be board eligible, with a focus on delivering high-quality patient care within a collaborative healthcare organization.
Saint Luke's Hospital of Kansas City is currently seeking a motivated radiation therapy physicist to join our team serving the Kansas City region. This full-time position will collaborate with our team of 6 physicist and 5 dosimetrist team supporting 3 treatment centers treating 110 patients per day. The successful candidate shows initiative and commitment to clinical practice consistent with the ASTRO Accreditation Program for Excellence.
** Hybrid Schedule- 4 days onsite and 1 day remote work schedule with additional flexibility as needed.**
Job Description :
Clinical medical physics to our all-Varian integrated environment that includes 4 TrueBeam, 1 Clinac, 3 CT Simulators, 1 Bravos HDR, ARIA. and Eclipse treatment planning.
Provide technical leadership to our clinics and assist the Chief Medical Physicist in optimizing clinical practice and implementing new programs.
Additionally supports special treatment procedures including frameless stereotactic radiosurgery with AlignRT, SBRT, VMAT, LDR and Radiopharmaceuticals.
Ensure adherence to departmental policy and state and federal requirements.
Qualifications :
The Qualified Medical Physicist as defined by the AAPM with current ABR Therapeutic Medical Physicist certification.
We will consider candidates who have completed Part I of the ABR certification process and are currently board eligible.
Kansas City offers vibrant cultural opportunities coupled with desirable cost of living and nationally ranked educational opportunities. The successful candidate can look forward to joining a dedicated team providing outstanding medical physics services while maintaining a comfortable work/life balance.
BJC Health System is one of the largest nonprofit health care organizations in the United States and the largest in the state of Missouri, serving urban, suburban, and rural communities across Missouri, southern Illinois, eastern Kansas, and the greater Midwest region. One of the largest employers in Missouri, BJC operates as BJC HealthCare in its East Region and as Saint Luke's Health System in its West Region. BJC comprises 24 hospitals and over 250 clinics and service organizations all committed to providing extraordinary patient care and advancing medical breakthroughs. BJC's nationally recognized academic hospitals-Barnes-Jewish and St. Louis Children's hospitals-are affiliated with Washington University School of Medicine.
Equal Opportunity Employer.
Job Requirements
Applicable Experience:
1 year
Therapeutic Medical Physics (ABR) - American Board of Radiology
Master's Degree
Job Details
Full Time
Day (United States of America)
The best place to get care. The best place to give care . Saint Luke's 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke's means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.
Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.
Keywords:
medical physicist, radiation therapy, therapeutic medical physics, clinical physics, radiation oncology, ABR certification, radiopharmaceuticals, stereotactic radiosurgery, healthcare jobs Kansas City, medical physics services
$143k-213k yearly est. 5d ago
Manager, Accounts Payable
Axsome Therapeutics, Inc. 3.6
New York, NY jobs
Axsome Therapeutics is a biopharmaceutical company leading a new era in the treatment of central nervous system (CNS) conditions. We deliver scientific breakthroughs by identifying critical gaps in care and develop differentiated products with a focus on novel mechanisms of action that enable meaningful advancements in patient outcomes. Our industry-leading neuroscience portfolio includes FDA-approved treatments for major depressive disorder, excessive daytime sleepiness associated with narcolepsy and obstructive sleep apnea, and migraine, and multiple late-stage development programs addressing a broad range of serious neurological and psychiatric conditions that impact over 150 million people in the United States. Together, we are on a mission to solve some of the brain's biggest problems so patients and their loved ones can flourish. For more information, please visit us at ************** and follow us on LinkedIn and X.
About This Role:
Axsome Therapeutics is seeking a Manager, Accounts Payable who will be responsible for managing the company's financial obligations by processing invoices, managing and processing employee expense reports, issuing payments to vendors and expense report reimbursements, reconciling vendor accounts to ensure timely and accurate payments, and managing the 1099 process. This position will be a trusted business partner across all functional departments within the company. The Manager Specialist, Accounts Payable will report directly to the Assistant Controller.
This role is based at Axsome's HQ in New York City with an on-site requirement of at least three days per week. We are unable to consider candidates who are looking for fully remote roles.
Job Responsibilities and Duties include, but are not limited to, the following:
Own and manage the accounts payable process ensuring timely and accurate invoice processing and payments, proper coding, reconcile vendor accounts, and manage vendor relationships
Own and manage expense reports and corporate card process ensuring timely and accurate reimbursements, and compliance with company policies, procedures and IRS requirements for expense reimbursement
Ensure compliance with IRS regulations by maintaining proper documentation and executing the annual 1099 reporting process for eligible vendors and filing the required 1099's and the transmittal Form with the IRS by the mandated deadline
Assist with monthly and quarterly financial close including preparing journal entries, preparing and reviewing general ledger account reconciliation and analysis, review of financial statements 10-Q, 10-K
Support process reviews for automation, system enhancements, and implementation including ERP, FP&A tools, procure to pay, order to cash systems
Collaborate with departments, support internal and external auditor quarterly reviews and annual audits by providing necessary documentation related to accounts payable and 1099 filings and responding to audit inquiries
Participate in the development of control evidence expectations, detailed SOX testing plans and reviewing test guidance/scripts for completeness, and accuracy, and SOX walkthroughs
Requirements / Qualifications
Minimum of an associate's degree in accounting, finance or business
10+ years of experience in a full-cycle accounts payable role
Ability to work on site Monday, Tuesday & Thursday. We are unable to consider candidates who are looking for fully remote roles
Experience, Knowledge and Skills
Proven experience in a full-cycle accounts payable role, with direct involvement in the 1099 process
Strong knowledge of IRS regulations related to 1099 reporting
Excellent attention to detail and a high degree of accuracy
Possess a problem-solving mindset with demonstrated "lean-forward" approach and the ability to think critically
Strong planning and organization skills, attention to detail, execution, and follow-through
Salary & Benefits
The anticipated salary range for this role is $85,000 - $110,000. We encourage candidates of all levels to apply as there may be flexibility on final job title and responsibilities. The salary offer will be based on a variety of factors, including experience, qualifications, internal equity and location. Axsome offers a competitive employment package that includes an annual bonus, significant equity and a generous benefits package.
Axsome is committed to equal employment opportunity and providing reasonable accommodations to applicants with physical and/or mental disabilities. We value and encourage diversity and solicit applications from all qualified applicants without regard to race, color, gender, sex, age, religion, creed, national origin, sexual orientation, gender identity, ancestry, citizenship, marital status, physical or mental disability, medical condition, veteran status, genetic information, or any other characteristic protected by federal, state, or local law.
Axsome Therapeutics does not accept unsolicited resumes from recruiters or third-party recruitment agencies and will not pay placement fees for unsolicited candidates that are sent to hiring managers, the HR team or other Axsome team members. Only approved vendors who have been explicitly asked to support a specific search will receive access to our Applicant Tracking System to submit candidates for consideration.
$85k-110k yearly 5d ago
Family Law Attorney
Dudley and Smith, P.A 3.0
Mendota Heights, MN jobs
Dudley and Smith, P.A. is seeking an experienced and passionate Family Law Attorney to join our team. This is a full-time position available at our well-respected, well-known, Mendota Heights law firm practicing in litigation, family law, personal injury, business, bankruptcy, criminal law, estate planning and real estate. Applicant must have significant experience in representing clients in family law matters, including: dissolution of marriage, orders for protection, custody and parenting time, child support, prenuptial agreements, and appeals. Applicants should also have strong verbal and written communication skills and be prepared to handle a caseload of files upon starting. This is a unique opportunity to work with an enthusiastic and dedicated team of legal professionals, and to truly make a difference. If you have a strong background in family law, and a desire to help others, we encourage you to apply. Must be duly licensed in the State of Minnesota.
Family Lawyer Responsibilities & Duties
* Represent clients in legal proceedings, including negotiations, mediations, and court conferences, hearings, trials and appeals
* Conduct research and analysis of legal issues, and provide legal advice to clients
* Draft legal documents, including motions, affidavits, memorandums of law, judgment and decrees, pleadings, proposed orders, petitions, stipulations and appellate briefs
* Manage a high volume of cases, and prioritize tasks effectively to meet deadlines
* Communicate regularly with clients, and keep them informed of their rights and options
* Work collaboratively with other members of the legal team, and support the overall goals of the firm
* Maintain confidentiality and professionalism
Dudley and Smith offers the following:
* Salary based upon experience $140,000.00 to $160,000.00, plus production Bonus that is paid twice a year
* Full or Part time work from home is an option and can be discussed at the time of hiring
* IRA matching
* Free Parking
* Free gym in building
* Paid Time Off
Job Type: Full-time
Pay: $140,000.00 - $160,000.00 per year
Benefits:
* Dental insurance
* Flexible schedule
* Health insurance
* Paid time off
* Retirement plan
* Vision insurance
License/Certification:
* Bar (Preferred)
Ability to Commute:
* Mendota Heights, MN 55120 (Required)
Ability to Relocate:
* Mendota Heights, MN 55120: Relocate before starting work (Required)
Work Location: In person
$140k-160k yearly 12d ago
Field Service technician Remote
Step Up Recruiting 4.0
Atlanta, GA jobs
100% Travel Very Technical person
We are seeking a skilled and motivated Service Technician to join a growing team in the sheet metal machinery industry. This role is ideal for individuals who enjoy hands-on work, problem-solving, and providing exceptional technical support. You will work with advanced equipment used for bending, rolling, cutting, and forming metal, ensuring optimal performance and customer satisfaction. Candidates must have experience with Installing, troubleshooting, repairing, maintaining electrical, mechanical, hydraulic, and pneumatic systems as it applies to sheet metal fabrication equipment incompliance with all plant policies and procedures.
Responsibilities:
Install, troubleshoot, repair, and maintain electrical, mechanical, hydraulic, and pneumatic systems on sheet metal fabrication equipment.
Provide effective technical assistance and warranty support for in-field equipment.
Deliver phone-based technical support to customers via Help Desk.
Perform preventive and predictive maintenance tasks.
Read and interpret diagrams, schematics, operation manuals, and manufacturer specifications.
Operate hand tools, power tools, precision-measuring devices, and electronic/electrical test instruments.
Train customers during installation and ensure proper machine operation.
Collaborate with team members to support organizational growth.
Uphold core values of professionalism, adaptability, and teamwork.
Requirements:
Ability to travel frequently (domestic and occasional international).
Must be able to lift 50 lbs and work in varied environments.
Valid U.S. work authorization and driver's license.
Ability to obtain a U.S. passport within 60 days.
Strong troubleshooting skills across electrical, mechanical, hydraulic, and pneumatic systems.
Comfortable reading schematics and technical documentation.
Experience with machine installation and commissioning preferred.
Excellent communication and customer service skills.
Preferred Location:
Candidates should live within approximately one hour of a major airport such as:
Atlanta (ATL)
Dallas/Fort Worth (DFW) or Houston (IAH)
Chicago (ORD)
Miami (MIA), Orlando (MCO), or Fort Lauderdale (FLL)
Seattle (SEA)
Salt Lake City (SLC)
Detroit (DTW)
Why Join Us?
Work with cutting-edge technology in a dynamic industry.
Opportunities for growth and professional development.
Collaborative team environment that values innovation and sustainability.
$51k-74k yearly est. 16d ago
Registered Nurse - Hybrid Float PACU / Same Day Surgery - Meyer Orthopedic Rehab Hospital
L.E. Cox Medical Centers 4.4
Springfield, MO jobs
:The Registered Nurse is responsible for managing the care of the patients experiencing medical conditions or surgical procedures. The nurse must be able to assess patient condition, administer medications, change dressings, monitor vital signs, keep records and provide patients and families with support and education. The Registered Nurse maintains a wide array of medical care knowledge in order to care for a diverse group of patients.
Additional Information About the Position for Qualified Candidates
• $10,000 Sign-On Bonus
• 80 hours of front-loaded Paid Time Off
• Up to $3,000 Relocation bonus
• $1.00 Certification pay
• $1.00 BSN pay
• Career Ladder Bonus eligible up to $5,000
Work Requirements:
The PACU/SDS Hybrid nurse will be required to work a minimum of:
One 10 hour shift at Cox South per pay period
Take eight hours of call every six weeks at Cox South
Work one holiday per year at Cox South
Education
â–ª Required: Graduate of an accredited nursing program
â–ª Preferred: Bachelor's Degree in Nursing
Experience
â–ª Preferred: 1 year of SDS/PACU or critical care experience
Skills
â–ª Excellent verbal and written communication skills
â–ª Demonstrate effective leadership abilities
â–ª Exhibits valuable time management skills
â–ª Strong critical thinking/problem solving skills
â–ª Flexibility and ability to work in a multi-tasking environment
Licensure/Certification/Registration
â–ª Required: RN license active in the state of Missouri
$60k-120k yearly est. 20d ago
Admissions Specialist- Specialty
Acadia Healthcare Inc. 4.0
Franklin, TN jobs
100% Remote "Work from Home" Opportunity
Schedule:Sat - Weds scheduled (Thurs and Fri off) 11a - 7:30p CST
PURPOSE STATEMENT:
As one of the nation's leaders in treating individuals with co-occurring mood, addiction, eating disorders and trauma, Acadia Healthcare places a strong emphasis on our admissions and inside sales functions to allow us to help every possible person in need. To this end, Acadia Healthcare is currently interested in hearing from dynamic candidates with proven track record of hitting sales goals, closing skills, prospecting skills who may be a fit for the Admissions Specialist position. The Admissions Specialist will be primarily responsible for converting inquiries into scheduled admissions at our Acadia facilities, and maintaining communications between the organization, referral source, patient and family.
ESSENTIAL FUNCTIONS:
Support multiple facilities' admissions functions within a given region in an effort to promptly assist clients and their family's seeking treatment.
Review prospective admissions against approved admission criteria, policies, and procedures.
Initiate contact to gather required clinical and demographic data from patient and other sources.
Respond promptly to inquiry calls.
Schedule assessments.
Assist prospective patients and significant others in seeking treatment.
Refer inquiries to other agencies and community resources when not appropriate for facility assistance or admission.
Coordinate with referral sources.
Responsible for maintaining all the documentation involved with the admissions process.
OTHER FUNCTIONS:
* Perform other functions and task as assigned
STANDARD EXPECTATIONS:
Complies with organizational policies, procedures, performance improvement initiatives and maintains organizational and industry policies regarding confidentiality.
Communicate clearly and effectively to person(s) receiving services and their family members, guests, and other members of the health care team.
Develops constructive and cooperative working relationships with others and maintains them over time. Encourages and builds mutual trust, respect, and cooperation among team members.
Maintains regular and predictable attendance.
Conscientious, highly organized and able to prioritize multiple tasks when busy.
Ability to work well under pressure and in crisis situations.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
* College degree preferred
* Two years' experience in healthcare admissions, preferably in the mental health or substance use field, or related experience preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
* Registered, Certified or Licensed Addictions Counselor a plus
Employee Perks
Ability to work 100% remotely
Competitive wage
Strong incentive bonus plan
Tuition reimbursement program
Full benefits package including Health/Dental/Eye/Life Insurance; FSA & Dependent Care FSA; 401K and EAP services
Opportunity to work with a team of enthusiastic individuals who collaborate well together.
Acadia is a leading provider of behavioral healthcare services in the United States and Puerto Rico, operating 253 treatment facilities across 38 states.
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
AHCORP
#LI-TB1
$27k-33k yearly est. 4d ago
Behavioral Health Group Home Worker
Center for Mental Health 3.6
Great Falls, MT jobs
On-Call, Non-exempt, Group Home, Great Falls A paraprofessional person working on a therapeutic team involved in the operation of a transitional 24-hour group home facility.
Assisting residents with problems related to daily living activities, assisting in team evaluation.
Treatment planning for clients, cooking, meal preparation, and teaching living skills.
Will work as a team with other group home employees.
Maintains required paperwork for assigned clients.
Assists with care and maintenance of group home and grounds.
Bargaining Unit position.
Must participate in Union Pension Fund.
Minimum Qualifications:
MT Driver's License, valid vehicle insurance, and vehicle required.
Excellent computer skills.
Must be able to transport clients.
Completion of high school is required or equivalency or job-related vocational training.
One-year job related experience serving persons with severe disabilities or CNA experience is preferred.
Benefits:
401K Matching Contributions
Health Insurance
Dental Insurance
Flexible Spending Account
Health Savings Account
Flexible Work Schedule
Paid Holidays
Paid Birthday
Pet Insurance
All Positions at Many Rivers Whole Health must pass Background Checks and Motor Vehicle Record Checks.
About Us:
Since 1976, we have been dedicated to 13 counties in Montana and seek to serve a variety of both individuals and groups in all settings. We define resilience as the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress - such as family and relationship problems, serious health problems, or workplace, school place and financial stressors - alongside those of chronic, severe disabling behavioral health conditions. with an integrated team of specialists and a personal approach to wellness. Today, we are focused on becoming Montana's healthcare provider of choice.
We are committed to recruiting qualified employees, continually striving for advancement, and above all, working as a team to meet the health needs of clients living in our 13 counties. Our vision is to be the healthcare provider of choice for clients and employer of choice for employees and providers. We will achieve this vision by committing to a culture of integrity, safety, evidence based exceptional care, compassionate customer service, and great work environment.
Our Mission:
Many Rivers Whole Health partners with people and communities to serve the whole person - body, mind, and spirit - by providing expertise in wellness, mental health, and substance use disorders, addressing prevention and treatment with a recovery-based approach.
Our Values:
Ambassador of Many Rivers, own it, Individuals Matter, Create Joy, Embrace Change, Show Up. Step In.
About Great Falls:
Great Falls lies about halfway between Yellowstone and Glacier National Parks. With close access to world class fishing and floating, not only on the Missouri River, but also several other lakes and rivers. Great Falls is an active community within 1 hour of two local ski resorts. We encourage a fun, collaborative work environment as well as a good work/home life balance. If you are interested in being a part of a dynamic, impactful team, in a family friendly community, Great Falls and the Center for Mental Health is an excellent choice for you. We would love to hear from you and discuss this opportunity.
EQUAL OPPORTUNITY EMPLOYER:
Many Rivers Whole Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability, or any other basis protected by applicable law.
$39k-48k yearly est. 5d ago
PACT Intensive Home Based Treatment (IHBT) Intern
Bellefaire JCB 3.2
Shaker Heights, OH jobs
Bellefaire JCB is among the nation's largest, most experienced child service agencies providing a variety of behavioral health, substance abuse, education and prevention services. Through more than 25 programs, we help more than 30,000 youth and their families each year achieve resiliency, dignity and self-sufficiency.
Program Summary: Bellefaire JCB's Parents and Children Together (PACT) Family Therapy Program provides intensive home based treatment (IHBT) and Integrated Co-occurring Treatment (ICT) to families who are experiencing stress due to factors such as social or emotional problems, issues related to housing or childcare, and more. Our program provides services to children and adolescents who are suffering with mental health symptoms and/ or substance use disorders. We also help parents to better understand and support their children's emotional and behavioral health needs.
Intern Position Summary: The Parents and Children Together (PACT) IHBT Intern is a paid position that places qualified graduate students under the administrative and clinical supervision of an experienced clinician who serves as both supervisor and field Instructor. The Parents and Children Together (PACT) IHBT Intern provides therapeutic services to children and their families. This unique role affords advanced graduate students the opportunity to work within a strong clinical team and receive invaluable opportunities for hands-on learning, advanced clinical training, and 24/7 supervisor support. The schedule is flexible and affords The Parents and Children Together (PACT) IHBT Intern the ability to work around classes, job, or other responsibilities.
Intern Experience Details: As the PACT IHBT Intern, you will provide the following services, including, but not limited to:
Assist in providing model-driven assessments, individual and family counseling/psychotherapy, and case management services to youth and their families.
Collaborate with community organizations, schools, health and social service professionals, the justice system, and other agencies involved with the client
Participate in weekly individual supervision, group supervision and quarterly department trainings
Other services necessary to the enrichment of the internship experience
Location: Services are provided in the community. Travel is to be expected.
Hours: Field hours are flexible. Evening work should be expected.
Qualifications: This internship is open to second year Master's level students. Therefore, a Bachelor's Degree is required and you must be currently enrolled in a Masters level Social Work, Counseling, or Marriage and Family Therapy program. A SWT, CT or MFTT is also required.
Bellefaire JCB is an equal opportunity employer, and hires its employees without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability or any other status protected by federal, state or local law.
Bellefaire JCB is a partner agency of the Wingspan Care Group, a non-profit administrative service organization providing a united, community-based network of services so member agencies can focus on mission-related goals and operate in a more cost-effective and efficient manner.
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$29k-36k yearly est. 5d ago
Remote Process Improvement Analyst II - Healthcare Ops
Humana Inc. 4.8
Washington, DC jobs
A leading health services organization is seeking a Process Improvement Professional 2 to analyze business processes and improve operational efficiency. This remote role requires a Bachelor's degree and less than 5 years of technical experience. Candidates should be passionate about enhancing consumer experiences. Responsibilities include data analysis, case preparation, and compliance. A competitive salary range of $65,000 - $88,600 and comprehensive benefits package are offered, including potential bonus eligibility and flexible working arrangements.
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$65k-88.6k yearly 3d ago
National Account Director, Payer (United/Optum/Emisar)
Revolution Medicines 4.6
Redwood City, CA jobs
Revolution Medicines is a clinical-stage precision oncology company focused on developing novel targeted therapies to inhibit frontier targets in RAS-addicted cancers. The company's R&D pipeline comprises RAS(ON) Inhibitors designed to suppress diverse oncogenic variants of RAS proteins, and RAS Companion Inhibitors for use in combination treatment strategies. As a new member of the Revolution Medicines team, you will join other outstanding Revolutionaries in a tireless commitment to patients with cancers harboring mutations in the RAS signaling pathway.
The Opportunity:
Reporting directly to the Senior Director, Payer Account Team & Access Marketing, the National Account Director (NAD) is responsible for establishing and maintaining strategic relationships to secure optimal market access for our innovative oncology medicines with national payers, Pharmacy Benefits Managers (PBMs), and payer-driven clinical pathways. This person will lead engagement with the NAD will develop and execute account plans and strategies that drive rapid formulary placement, reimbursement, and support patient access while representing the company's interests with key decision-makers. In addition to securing positive policy decisions, the NAD will help to coordinate cross-functional workstreams to ensure products are included when appropriate in payer-driven clinical pathways, this is a field-based remote position, and the candidate can live anywhere in the United States.
Key Responsibilities:
Translates national, brand-level payer strategy to key accounts across National Payers/PBMs, Regional Payers/PBMs/IDNs, VA/DoD, and state Medicaid plans, and work with Market Access leadership to refine value story and messaging as needed.
Leads and oversees account activities such as driving rapid payer coverage and payer clinical pathways inclusion post launch in close collaboration with Medical Affairs.
Leads cross-functional team across Commercial Field to pro-actively identify and resolve payer policy and pathway issues.
Negotiates with customers to enable favorable formulary positioning and net revenue profitability.
Creates medium to long term strategic payer/PBM/pathway engagement plan spanning multiple product and indication launches, and focuses on engaging beyond traditional rebates with tactics such as facilitating executive exchanges.
Champions voice of customer to internal stakeholders and Commercial leadership.
Required Skills, Experience and Education:
Bachelor's degree.
Strong existing relationships with the UHC/Optum/Emisar organization and 10+ years in account management.
Deep understanding of pharmacy benefit management, economic flows, and oral oncolytic trends within Medicare Part D, Commercial, Medicaid FFS and Managed Medicaid plans.
Strong communication skills to educate and influence other Commercial stakeholders, including the executive leadership team, Access Marketing, and Strategic Pricing.
Ability to clearly and efficiently communicate the value proposition of novel oncology therapies to customers.
Excellent negotiation skills and pride in P&L and enterprise stewardship.
Prior experience with pipeline products and product launches.
Ability to partner effectively with Medical Affairs, Sales, and FRM teams.
~30-50% travel required to customer meetings, industry conferences, and RevMed's home office in Redwood City, CA.
Preferred Skills:
Advanced degree (MBA, Master's, PharmD, PhD).
Existing relationships with key regional plans that are OptumRx clients.
Comprehensive understanding of federal accounts and VA/DoD processes and procedures.
Experience in GI oncology, PDAC and/or NSCLC, including oral targeted therapies.
Successful coordination of leadership exchanges and strategic partnerships beyond traditional contracting and rebate agreements.
Desire to continuously learn, develop, and stay abreast of the evolving healthcare landscape.
Passion for establishing high-functioning, collaborative relationships with new and rapidly growing teams.
Prior experience or demonstrated development interest in payer marketing.
Prior people leadership experience and ability to build team as company grows.
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$112k-156k yearly est. 2d ago
Licensed Clinical Social Worker (LCSW) - Remote - Spanish Speaking
Brave Health 3.7
Florida City, FL jobs
Why We're Here: At Brave Health, we are driven by a deep commitment to transform lives by expanding access to compassionate, high-quality mental health care. By harnessing the power of technology, we break down barriers and bring mental health treatment directly to those who need it most-wherever they are. As a community health-centered organization, we are dedicated to ensuring that no one is left behind. Nearly 1 in 4 people in the U.S. receive healthcare through Medicaid, yet two-thirds of providers don't accept it. Brave Health is stepping up to close this gap by making mental health care accessible, affordable, and life-changing for all.
Job description
We are looking for full-time Licensed Therapists to join our team and provide outpatient services through our telehealth program!
Benefits: Our team works 100% remotely from their own homes!
W2, Full-time
Compensation package includes base salary plus bonus!
Monday - Friday schedule; No weekends! Shift options include 9am-6pm, 10am-7pm, 11am-8pm Eastern
Comprehensive benefits package including PTO, medical, dental, vision benefits along with liability insurance covered and annual stipend for growth & education opportunities
Additional compensation offered to bilingual candidates (Spanish)!
We not only partner with commercial health plans, but are also a licensed Medicaid and Medicare provider and see patients across the lifespan
Requirements:
Master's level degree and licensure
Candidates must have unrestricted authorization to work in the United States that does not require employer sponsorship now or in the future. At this time, we are unable to support employment authorization tied to temporary or employer-dependent visa statuses.
Work from home space must have privacy for patient safety and HIPAA purposes
Fluency in English, Spanish preferred; proficiency in other languages a plus
Meets background/regulatory requirements
Skills:
Knowledge of mental health and/or substance abuse diagnosis
Treatment planning
Comfortable with utilizing technology at all points of the day, including telehealth software, video communication, and internal communication tools
Experience working in partnership with clients to achieve goals
Ability to utilize comprehensive assessments
Ready to apply? Here's what to expect next:
It's important to our team that we review your application and get back to you with next steps, fast! To help with that, and be most considerate of your time (which we value and know is limited), you may receive a call from Phoenix - our AI Talent Scout. She'll ask for just 5 minutes of your time to gather some information about you and your job search to get the basics out of the way. If there is a mutual fit we'll match you to the right senior recruiter on our team.
Brave Health is very proud of our diverse team who cares for a diverse population of patients. We are an equal opportunity employer and encourage all applicants from every background and life experience to apply.
$56k-66k yearly est. 2d ago
Remote radiologist needed
All Star Healthcare Solutions 3.8
Dallas, TX jobs
All Star Healthcare Solutions is seeking a remote radiologist for Locum coverage in Texas. Some details include:
Modalities needed include: MR, CT, US, and plain films
5p-1a cst
Can use weekdays and weekends
Would consider Locum-Perm
When can you start and what availability can you offer?
All Star Healthcare Solutions benefits
Competitive pay;
Malpractice coverage;
Paid and coordinated travel services;
Full-service agency;
24/7 professional and reliable service;
Dedicated, specialty-specific consultants;
Member of NALTO
$178k-324k yearly est. 3d ago
Patient Access Liaison (PAL)- Great Lakes
Catalyst Pharmaceuticals, Inc. 4.3
Chicago, IL jobs
The Patient Access Liaison (PAL) is a regional, field-based position that provides clinical disease state education and product education to patients and their families for our rare disease portfolio of products, oftentimes in the patient's home. This patient facing individual will work closely with patients, families, physicians and other office staff to prevent and address barriers to access and help insure optimal understanding for Catalyst's medicines. The Patient Access Liaison (PAL) will also be responsible for supporting advocacy for patients and providing educational resources and opportunities for patients. The PAL will also interact with our HUB partners at Catalyst Pathways to ensure seamless communication with and to the patients and their families.
This is a remote position covering the Great Lakes Geography. Potential candidates should reside in the Great Lakes region and have access to major airports in the preferred states of: Michigan or Illinois.
Requirements
Responsibilities (included but not limited to):
Educate patients and or their families on their disease and Catalyst's FDA approved medication for their disease
Provide education to patients and or their families on reimbursement and insurance protocols that affect their ability to access therapy
Coordinate communication among key stakeholders to ensure patients have the clinical support required to transition successfully to therapy
Advise patients and their families about access and affordability programs that may be available to them
Work cross functionally with other commercial personnel to resolve access issues for patients
Provide expertise to HCPs on health plan policies and procedures, including guidelines and timelines for Prior Approvals (when appropriate) and Appeals
Work cross functionally with Care Coordinators and Reimbursement Specialists at Catalyst Pathways to address any outstanding issues the patient and or family might have and escalate issues when appropriate
Conduct Connect Calls to discuss open cases (de-identified) in Catalyst Pathways with sales and market access to address any issues that are actionable and delegate as appropriate
Respect and Protect the PHI that is available to the PAL in their work with patients
Attend regional and national meetings and come prepared to contribute and participate
Document appropriately and accurately all interactions with patients and other stakeholder in the Patient Portal
Become an expert on recognizing and reporting AE and product complaints, along with documenting those interactions
Maintain ongoing contact with patients and their families to address unmet needs and offer compliant solutions so that patients may adhere to therapy when appropriate
Understand and participate in Patient Services Programs developed by agency partners
Ability to regularly work extended hours including attendance at business events on evenings and weekends
Education/Experience/Skills:
Bachelor's degree and 5+ years in the Pharma/Biotech industry in required
Prior experience as a Field Reimbursement Manager
Experience in the Patient Services Department strongly preferred
Be able to work in a team environment that ultimately benefits the patients
Ability to work independently with patients for educational purposes and support
High comfort level working directly with patients and their families as their main point of contact for access and education
Can lead external customers including physicians, nurses and others to assist in achieving access for patients
Ability to independently identify access solutions and determine the appropriate plan for resolution
Work cross functionally with an external HUB to solve patient issues
Ethics above reproach and a strong compliance mindset
Must have a high degree of emotional intelligence coupled with empathy and listening skills
Technical Experience in at least two of the following areas
Rare Disease access or reimbursement
Managed Care or public payer reimbursement
Nursing
Specialty Pharmacy
Billing and coding
Patient Advocacy
Highly recommended Bilingual-fluent in English and Spanish
Willingness to travel up to 70% of the time depending on the territory
Prefer applicants to live near a commercial airline HUB
Catalyst is committed to providing competitive wages and comprehensive benefits including health, dental, and vision insurance, generous paid time off, a retirement savings plan with Company Match, and more. Further details about our benefits package can be found here: **************************************************************************** AsMember=true
The base salary for this position will range from $181,000 to $200,000. Candidate experience, professional licensing, and geographic location will be taken into consideration.
Employment is contingent upon successful completion of all required screening and verification processes, including for authority to work in the United States.
EEO Statement
Catalyst Pharmaceuticals is an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status.
Recruitment & Staffing Agencies: Catalyst Pharmaceuticals does not accept unsolicited agency resumes. Agency resumes will only be accepted if the agency is formally engaged by Catalyst Human Resources.
$37k-45k yearly est. 5d ago
Emergency Radiologists - Clinical Associates
AMN Healthcare 4.5
Chicago, IL jobs
Job Description & Requirements Emergency Radiologists - Clinical Associates
Emergency Radiologists - Clinical Associates
Salary Range: $430,000 - $480,000 per year as well as an anticipated annual incentive payment between $30,000 to $75,000 based on work schedule
The University of Chicago s Department of Radiology seeks Clinical Associates at 100% effort for renewable terms of up to three years. Appointees will have responsibilities that include interpretation of all aspects of emergency radiology diagnostic examinations and will be joining our team of six emergency radiologists, extending an existing evening shift. Work shifts will be primarily nights and weekends; arrangements are flexible and may be fully remote. The anticipated clinical schedule is 7 days on clinical service and 14 days off clinical service. These positions do not require teaching or scholarly activity. Compensation (including a generous package of fringe benefits) depends on qualifications. For information on benefits, please consult the University of Chicago Benefits Guide: .
Prior to the start of employment, qualified applicants must: 1) have a medical doctorate or equivalent, 2) hold or be eligible for medical licensure in the State of Illinois and the State of Indiana, and 3) be American Board of Radiology certified or eligible.
We especially welcome applicants with emergency radiology fellowship training or equivalent experience. Basic pediatric ER radiology skills are also sought.
The University of Chicago has retained AMN Healthcare to support this recruitment. CJ Stanford, Senior Search Consultant and Nicole Sturznickel, Senior Search Consultant with AMN Healthcare is leading the search. Inquiries, applications, and nominations must be sent by email to CJ Stanford and Nicole Sturznickel at and . Please note all job seekers wishing to be considered for the position must also submit their materials through The University of Chicago s Academic Recruitment job board, which uses Interfolio to accept applications: . Applicants must upload a CV including bibliography and cover letter. Review of applications ends when the positions are filled.
For instructions on the Interfolio application process, please visit .
Equal Employment Opportunity Statement
The University of Chicago is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender, gender identity or expression, national or ethnic origin, shared ancestry, age, status as an individual with a disability, military or veteran status, genetic information, or other protected classes under the law. For additional information please see the University's Notice of Nondiscrimination .
Job seekers in need of a reasonable accommodation to complete the application process should call or email with their request.
Facility Location
Situated on the banks of Lake Michigan, this Midwestern metropolis combines global high-style with a friendly, down-home soul. Along with its superb medical facilities, visitors to Chicago relish the city s 29-mile long lakefront park, fabulous shopping districts, multicultural neighborhoods and world-class arts and entertainment.
Job Benefits
About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.
Radiology Physician, Radiologist, Radiology Doctor, Radiology Specialist, Imaging Radiologist, Diagnostic Radiologist, radiology radiology, radiologist
AMN Healthcare is a digitally enabled workforce solutions partner focused on solving the biggest challenges affecting healthcare organizations today. We offer a single-partner approach to optimize labor sources, increase operating margins, and provide technologies to expand the reach of care.
$36k-44k yearly est. 19d ago
Intensive Home-Based Therapist
Integrated Services for Behavioral Health 3.2
Zanesville, OH jobs
We are seeking an Intensive Home-Based Therapist! Muskingum County, OH
Intensive Home-based Treatment
is eligible for a sign-on bonus of $5,000!
Join our team!
Do you have a passion for working with children and families? Integrated Services for Behavioral Health is looking for compassionate, dedicated people in Franklin County who want to empower youth and families by creating strength-based behavior change that will be sustained long after treatment ends.
You will receive ongoing training in the Intensive Family and System Treatment (I-FAST) as you work with families, youth, their communities, and other key members of their ecology to implement I-FAST as designed.
The salary range for this position is based on experience, education, and/or licensure:
Dependently Licensed: $70,000-$74,295.45/year
Independently Licensed: $80,000-84,909.08/year
Essential Functions:
Provide direct clinical treatment using the I-FAST model and principles, including but not limited to leveraging strengths and focusing on the positive, understanding frames, patterns, and increasing mature behavior.
Conduct a thorough assessment of the client and family that gathers information on behaviors of concern and strengths in the family and their ecology to inform conceptualization of the problem behaviors and interactions within the family's ecological context.
Works with families to define cultural factors that influence strengths, functioning, and family behaviors to ensure ongoing engagement and success in care.
Provide individual and family psychotherapy services that support the identified needs.
Develop collaborative and creative partnerships with community resources to meet the needs of each family.
Continuously work to engage the primary caregiver, family members, supports, and community agency staff (school, probation, child welfare) in change-oriented treatment.
Dedicate time to weekly case planning and evaluation of case progress, with ongoing support from your supervisor and team members.
Receive regular training, professional development, supervision, and consultation activities designed to help you acquire extensive clinical skills within the I-FAST model.
Work collaboratively with the team to ensure that clients have access to support 24 hours/day, 7 days/week as needed.
Maintains necessary documentation, participates in program evaluation, attends team and program planning meetings, cross-systems training, and acquires knowledge of community resources.
Meets billing productivity requirements established by Integrated Services for Behavioral Health.
Other duties as assigned.
Minimum Requirements:
Must meet requirements for licensure as defined by the Ohio Counselor, Social Worker, and Marriage & Family Therapist Board.
Experience and passion for delivering services to youth and families.
Demonstrated a high degree of cultural awareness.
Comfortable working with a diverse community of clients.
Knowledge of or experience engaging with families in the community.
Experience with multi-need individuals and families.
Broad knowledge of community service systems.
Willing to participate in and lead cross-systems team-building activities.
Able to effectively communicate through verbal/written expression.
Must be able to operate in an Internet-based, automated office environment.
Enjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package.
Benefits include:
Medical
Dental
Vision
Short-term Disability
Long-term Disability
401K w/ Employer Match
Employee Assistance Program (EAP) provides support and resources to help you and your family with a range of issues.
To learn more about our organization: *****************
OUR MISSION
Delivering exceptional care through connection
OUR VALUES
Dignity - We meet people where they are on their journey with respect and hope
Collaboration - We listen to understand and ask how we can best support the people and communities we serve
Wellbeing - We celebrate one another's strengths, and we support one another in being well
Excellence - We demand high-quality care for those we serve, and are a leader in how we care for one another as a team
Innovation - We deeply value a range of perspectives and experiences, knowing it is what inspires us to stretch past where we are and reach towards what we know is possible
We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
$80k-84.9k yearly 3d ago
Claims Auditor- Remote
American Health Partners 4.0
Franklin, TN jobs
American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com.
If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!
Benefits and Perks include:
* Affordable Medical/Dental/Vision insurance options
* Generous paid time-off program and paid holidays for full time staff
* TeleMedicine 24/7/365 access to doctors
* Optional short- and long-term disability plans
* Employee Assistance Plan (EAP)
* 401K retirement accounts
* Employee Referral Bonus Program
ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
* Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
* Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
* Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
* Work assigned claim projects to completion
* Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
* Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
* Maintain production and quality standards as established by management
* Participate in and support ad-hoc audits as needed
* Other duties as assigned
JOB REQUIREMENTS:
* Proficient in processing/auditing claims for Medicare and Medicaid plans
* Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
* Current experience with both Institutional and Professional claim payments
* Knowledge of automated claims processing systems
* Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.
REQUIRED QUALIFICATIONS:
* Experience:
* Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
* Two (2) years' experience in managed healthcare environment related to claims processing/audit
* Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
* Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
* Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans
* License/Certification(s):
* Coding certification preferred
EQUAL OPPORTUNITY EMPLOYER
Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.
This employer participates in E-Verify.