Benefit Recovery jobs - 23 jobs

Job DescriptionSIHO Internship Overview - Summer 2026Welcome to the SIHO Summer Internship Program! We are thrilled to offer college students the chance to embark on an immersive, 12-week journey into the dynamic health insurance industry. This program is designed to provide hands-on experience, valuable industry insights, community engagement, and meaningful professional growth opportunities. Program Duration: May 18 - August 7, 2026 (12-week program) Program Highlights:Hands-On Departmental Experience:Dive into department-specific tasks, gaining practical experience and exposure to the inner workings of the health insurance industry. Work alongside experienced professionals and contribute to impactful, real-world projects. Weekly Industry Leader Sessions:Participate in weekly discussions with industry experts on topics such as emerging trends, market insights, and career advice.Build connections and expand your professional network. Capstone Project Presentation:Develop and present a comprehensive end-of-summer project to SIHO's executive leadership team.Demonstrate your understanding, creativity, and problem-solving abilities. Community Engagement:Embrace SIHO's commitment to social responsibility through organized volunteer initiatives.Connect with the community and contribute to positive change.Tentative Roles for 2026: We are finalizing the specific roles, but previous positions have included: - Marketing - Compliance - Part D Vendor Oversight - Project Management- Recruiting/HR - Sales - IT Qualifications:- College students completing their junior or senior year in majors such as Business Administration, Healthcare Management, Finance, Marketing, or related fields.- Strong academic performance and a keen interest in the health insurance industry.- Exceptional communication and teamwork skills. Why Join Us?- Gain hands-on experience in a leading health insurance company.- Network with top professionals in the field.- Explore multiple facets of the health insurance sector.- Engage in community-building activities.- Present your work to executive leadership, receiving feedback and recognition. Application Process: Submit your resume and cover letter by May 1, 2026. Shortlisted candidates will be invited for interviews. At SIHO Health Insurance Company, we value diversity and encourage candidates from all backgrounds to apply. Join us for a transformative summer where innovation meets collaboration and your career takes a leap forward. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

--------------------------------------------------------------- The Claims Examiner II is an intermediate level position responsible for the timely review, investigation and adjudication of all types of Medicaid, Medicare, group and individual medical, dental, and mental health claims. Estimated Hiring Range: $22.82 - $27.89 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures. Re-adjudicate, adjust or correct claims, including some complex and difficult claims as needed. Consistently meet or exceed the quality and production standards established by the department and CareOregon. Provide excellent customer service to internal and external customers. Collaborate and share information with Claims teams and other CareOregon departments to achieve excellent customer service and support organizational goals. Determine eligibility, benefit levels and coordination of benefits with other carriers; recognize and escalate complex issues to the Lead or Supervisor as needed. Investigate third party issues as directed. May review, process and post refunds and claim adjustments or re-adjudications as needed. Report any overpayments, underpayments or other possible irregularities to the Lead or Supervisor as appropriate. Generate letters and other documents as needed. Proactively identify ways to improve quality and productivity. Continuously learn and stay up to date with changing processes, procedures and policies. Organizational Responsibilities Perform work in alignment with the organization's mission, vision and values. Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. Strive to meet annual business goals in support of the organization's strategic goals. Adhere to the organization's policies, procedures and other relevant compliance needs. Perform other duties as needed. Experience and/or Education Required § Minimum 2 years' experience as a Medical Claims Examiner or other role that requires knowledge of medical coding and terminology (e.g., medical billing, prior authorizations, appeals and grievances, health insurance customer service, etc.) Preferred Experience using QNXT, Facets, Epic systems Knowledge, Skills and Abilities Required Knowledge Knowledge of CPT, HCPCS, Revenue, CDT and ICD-10 coding Knowledge of medical, dental, mental health and health insurance terminology Skills and Abilities Understanding of or ability to learn state and federal laws and other regulatory agency requirements that relate to medical, dental, mental health and health insurance industry and Medicaid/Medicare industry Ability to perform fast and accurate data entry Strong spoken and written communication skills Basic computer skills (ability to use Microsoft Outlook, Word and Excel) and learn new systems as needed Good customer service skills Ability to participate fully and constructively in meetings Strong analytical and sound problem-solving skills Detail orientation Strong organizational skills and time management skills Ability to work in a fast-paced environment with multiple priorities Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to lift, carry, reach and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home Schedule: Monday - Friday, 8:00 AM to 5:00 PM We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- The Ambulatory Care Clinical Coordinator (pharmacist) is responsible for providing oversight of an assigned area (i.e., Care Coordination or Network Liaison). The pharmacist needs to demonstrate consistent application of knowledge and skills related to pharmacy benefits, quality measures, and other initiatives in order to communicate, partner, and deliver appropriate, safe, efficient, and cost-effective patient care as part of a multidisciplinary team. Responsibilities include supporting the patient-centered medical home, incorporating principles of population-based medicine, expanding and coordinating the expansion of pharmaceutical care services to patients across the health-system through primary care clinics, community pharmacies, or other designated environments. Care Coordination: This position is responsible for coordinating effective use of the pharmacy benefit by delivering clinical and educational interventions designed to improve pharmaceutical care. Network Liaison: This position is responsible for aligning the clinical pharmacist network with CareOregon strategic goals and aiding the advancement of the practice of clinical pharmacy. This is a 9-month temporary position. Estimated Hiring Range: $151,965.00 - $185,735.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Develop and conduct quality improvement programs related to the pharmacy program. Develop and implement clinical educational programs to improve drug utilization and quality. Develop and conduct educational initiatives to improve prescribing patterns for quality and/or cost opportunities to support sustainable cost trends with the highest quality. Develop and critically evaluate pharmacy claim data analysis/reports in support of specific projects or program objectives. Develop and conduct retrospective drug use reviews. Leading the design, development, and implementation of quality improvement initiatives related to the pharmacy program will be an important aspect of this position. Review medication prior authorization requests and appeals as assigned. Review and refine policies and procedures regarding Pharmacy Department functions including medication therapy management, DUR programs, medication prior authorization, and others as applicable. Use an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics Committee and other pharmacy program activities as assigned. Assess, review and respond to federal and state regulatory requirements/audits of the pharmacy benefit. Consult with clinicians and pharmacists to resolve pharmacy benefit issues. Precept pharmacy students and residents. Care Coordination Critically evaluate drug therapy regimens for patients enrolled in the care coordination program and assist with developing treatment plans. Provide medication therapy management (MTM) services. Utilize technology platforms to document and to meet MTM objectives. Monitor MTM objectives and high-risk population outcomes in partnership with the pharmacy benefit coordinator to provide oversight. Perform medication reviews and other tasks as assigned to meet plan quality metrics. Experience and/or Education Required Minimum Graduate of an accredited pharmacy program Current (or eligible) unrestricted licensure as a pharmacist in the state of Oregon Advanced pharmacy training (PharmD, residency, fellowship, board certification or master's degree in related discipline) Practical experience with minimum 2 years as a clinical pharmacist in pharmaceutical care management in an ambulatory care or other clinical setting (which can include residency experience) Preferred Previous experience in managed care and project management PGY1 residency training Knowledge, Skills and Abilities Required Knowledge Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization Must have comprehensive, clinical pharmaceutical knowledge base Skills and Abilities Ability to critically evaluate clinical pharmaceutical and medical literature and apply principles of evidence-based medicine Ability to design and review pharmacy claims analysis/reports according to specific project requirements Must be highly motivated and have the ability to work independently Excellent organizational, project management, and time-management skills Excellent written and verbal communication skills Excellent customer service skills Ability to work with diverse groups Ability to manage multiple tasks Ability to negotiate, problem-solve, and consensus-build Basic word processing, spreadsheet, and database skills Propose and implement process improvements Meet deadlines for completion of workload Maintain agreed upon work schedule Demonstrate cooperation and teamwork Provide cross-training on specific job responsibilities Meet identified business goals that contribute to departmental goals Follow established departmental policies and procedures Perform other duties and projects as assigned Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Ability to lift, carry, push, pull and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- This position is responsible for assisting with the management of the pharmacy benefit and developing and delivering clinical and educational interventions designed to improve pharmaceutical use. Responsibilities include formulary management; assisting with management of specific patients in the multidisciplinary case management/medication therapy management program, P&T, developing and conducting educational initiatives to improve prescribing patterns; develop and conduct quality improvement programs related to the pharmacy program; evaluating medication authorization requests and providing oversight to the medication PA process; and other pharmacy program activities as assigned. NOTE: This is a temporary position expected to last 9 months. Estimated Hiring Range: $151,965.00 - $185,735.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Prepare drug utilization reports and analyses for the Pharmacy & Therapeutics Committee. Use an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics Committee. Critically evaluate drug therapy regimens for patients enrolled in the case management program and assist with developing treatment plans. Provide medication therapy management services. Develop and conduct retrospective drug use reviews. Review medication prior authorization requests and appeals. Develop and implement clinical educational programs to improve drug utilization and quality. Review and refine policies and procedures regarding Pharmacy Department functions including medication therapy management, DUR programs, medication prior authorization, and others. Develop and conduct quality improvement programs related to the pharmacy program. Monitor functions provided by the plans' Pharmacy Benefit Manager including pharmacy benefit coding, customer service guidelines, prior authorization activities, and other delegated services. Develop and critically evaluate pharmacy claim data analysis/reports in support of specific projects or program objectives. Assess, review, and respond to federal and state regulatory requirements/audits of the pharmacy benefit. Consult with clinicians and pharmacists to resolve pharmacy benefit issues. Review and refine pharmaceutical reimbursement and purchasing procedures. Develop materials to communicate pharmacy benefit or other information to members, clinicians, and pharmacists. Experience and/or Education Required Graduate of an accredited pharmacy program Current, unrestricted license as a pharmacist in Oregon Advanced pharmacy training (PharmD, residency, fellowship, or master's degree in related discipline) Practical experience as a clinical pharmacist in formulary management or ambulatory care or other clinical setting Preferred Previous experience in managed care Experience with reviewing Prior Authorization requests against plan criteria and making approval or decline decisions Knowledge, Skills and Abilities Required Knowledge Must have comprehensive, clinical pharmaceutical knowledge base Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization Skills and Abilities Ability to critically evaluate clinical pharmaceutical and medical literature and apply principles of evidence-based medicine Ability to design and review pharmacy claims analysis/reports according to specific project requirements Must be highly motivated and have the ability to work independently Excellent organizational, project management, and time-management skills Excellent written and verbal communication skills Excellent customer service skills Ability to manage multiple tasks Ability to negotiate, problem-solve, and consensus-build Basic word processing, spreadsheet, and database skills Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to lift and carry for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- The IS Database Developer III is responsible for defining the direction of database and ETL development, as well as designing and developing effective solutions in support of business strategies. This role is essential toward maturing CareOregon's database and ETL development model. Responsibilities include standard database development or may include a focus on EDI-specific development. This position spends substantial time partnering with business leaders, architecting, and implementing IS priorities (plan, design, install, and maintain). Estimated Hiring Range: $124,200.00 - $151,800.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Database Development Lead the design and maintenance of custom databases and processes. Note for EDI-focused roles: lead the design and maintenance of custom EDI databases and processes. Provide database design expertise to the organization; lead small projects independently and participate and consult on other projects. Advise other IS teams on best practices of database design and development, including exploration and insights on cloud-based solutions. May serve as a resource to junior developers. ETL Development Develop ETL processes for advanced to complex activities and provide escalation support for tickets. Develop advanced databases to meet application and web needs. Analyze business requirements; partner with leaders across the organization in order to research and recommend solutions which balance business need and risk mitigation. Develop and maintain appropriate technology documentation, including current design and operation. Standards and Policy Administration Author and serve as subject matter expert to define requirements, standards and best practices for database and ETL development (as well as EDI software/development for EDI-focused roles). Monitor and continually review existing systems to ensure they are designed to comply with established standards and to empower business operations. Vendor Coordination and Relations Conduct product and vendor research, and present recommendations to lead developer and/or management. Establish and manage effective relations with vendors and related equipment suppliers, including installation and repair of services. Experience and/or Education Required Minimum 5 years' experience in database and ETL development that includes most or all of the following: Database development and maintenance ETL development and maintenance Systems analysis and design Agile/Scrum methodology For data warehouse-focused roles: Minimum 5 years' experience developing ETL for loading a dimensional model using a combination of T-SQL and SSIS 2012, 2014, or 2016 For EDI-focused roles: experience using Biztalk for Healthcare EDI transactions (e.g., 834/835/837/270/271, etc.) that includes troubleshooting Biztalk issues, performance tuning and best practices for Biztalk Preferred Additional experience in related technology support and/or operational positions Knowledge, Skills and Abilities Required Knowledge Advanced knowledge/skills with the following: Microsoft SQL Server ETL tools, such as SSIS or Informatica Visual Studio Unit and integration testing For data warehouse-focused roles: Strong knowledge/skills of the dimensional model required in lieu of knowledge/skill requirements above For EDI-focused roles: Ability to use Biztalk for Healthcare EDI transactions such as 834/835/837/270/271, etc. and ability to troubleshoot Biztalk issues, performance tuning and best practices for Biztalk For other roles: General knowledge of BizTalk is preferred Skills and Abilities Advanced abilities in troubleshooting system performance issues and root cause Strong communication skills, including listening, verbal, written, customer service, meeting facilitation, and presentations Ability to clearly articulate policies, instructions, goals, and objectives Able to convey appropriate level of detail effectively to all levels of the organization including non-technical staff Ability to author policies, document risks, and propose solutions to information technology management and senior leadership Possess a high degree of initiative and motivation Ability to effectively collaborate with coworkers, staff, leaders, and executives across all departments Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

FCS Facility Services is a nationwide janitorial services company dedicated to providing high-quality cleaning solutions to our clients. We specialize in maintaining cleanliness and hygiene in various facilities, ensuring a safe and comfortable environment for occupants and visitors alike. Our team is committed to excellence and strives to exceed expectations in every cleaning task. Position Overview: As a General Cleaner at FCS Facility Services, you will be an integral part of our cleaning team, responsible for performing a variety of cleaning duties to uphold the cleanliness and sanitation standards of our clients' premises. The ideal candidate will be detail-oriented, dependable, and dedicated to delivering outstanding cleaning results while adhering to safety protocols and company policies. Key Responsibilities: Surface Cleaning: Clean and sanitize various surfaces, including floors, walls, windows, furniture, and fixtures, using appropriate cleaning agents and equipment. Dusting and Polishing: Dust surfaces, furniture, and equipment thoroughly, ensuring the removal of dirt, debris, and allergens. Polish surfaces to maintain a clean and attractive appearance. Vacuuming and Sweeping: Vacuum carpets and rugs to remove dirt, dust, and debris. Sweep and mop hard surface floors to eliminate dirt and stains, paying attention to corners and hard-to-reach areas. Restroom Maintenance: Clean and disinfect restroom fixtures, including toilets, sinks, mirrors, and countertops. Refill soap dispensers, paper towel holders, and toilet paper rolls as needed. Trash Removal: Empty trash receptacles and replace liners as necessary. Dispose of trash and recyclable materials in designated containers, following proper waste disposal procedures. Restocking Supplies: Monitor inventory levels of cleaning supplies and restroom amenities. Replenish supplies as needed to ensure adequate stock for daily cleaning tasks. Floor Care Support: Assist floor technicians in floor care duties, such as buffing, waxing, and stripping floors, as directed by supervisors. Adherence to Safety Protocols: Follow established safety procedures and guidelines to prevent accidents and ensure a safe working environment. Use personal protective equipment (PPE) as required. Qualifications: Previous experience in commercial cleaning or janitorial services preferred but not required. Knowledge of cleaning techniques, equipment, and chemicals. Strong attention to detail and ability to follow instructions. Good communication skills and ability to work effectively in a team. Physical stamina and flexibility to perform cleaning tasks, including bending, kneeling, and lifting. Dependability and punctuality. Willingness to learn and adapt to new cleaning methods and procedures. Willingness to undergo background checks and drug screenings as required. Be able to lift/carry a minimum of 50 pounds. FCS Facility Services is an equal employment opportunity employer dedicated to promoting an inclusive, diverse, and innovative environment for our employees. We provide all qualified applicants with employment consideration without regard to race, color, religion, sex, pregnancy, childbirth, ancestry, national origin, age, protected veteran status, marital status, genetic information, gender identity or expression, sexual orientation, disability, or any other protected status in accordance with applicable federal, state, or local laws. 1st shift Mon to Fri 6:00am to 2:30pm

Nurses and Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a Care Coordinator in Mobile, AL! VIVA HEALTH knows that nursing and social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION REQUIRED: * Licensed BSN/ADN * Licensed BSW PREFERRED: * Licensed MSW and/or Certified Case Manager (CCM) designation * Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.

--------------------------------------------------------------- This position is responsible for working with CareOregon members, their providers, and pharmacies to support the pharmacy benefit and prescription needs under the major medical benefit. Core responsibilities include customer service and claims processing, as well as assistance with prior authorizations, formulary exceptions, appeals, grievances, and projects. Estimated Hiring Range: $20.51 - $25.06 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Customer Service and Claims Processing Communicate in a professional and respectful manner. Maintain confidentiality within HIPAA regulations and function on “need to know” principles. Respond to drug coverage inquires in an accurate and timely manner to members, members' representatives, providers, and CareOregon staff. Educate members, providers, pharmacies, and CareOregon staff about the CareOregon formularies and pharmacy benefit policies. Document all customer service activities according to organization requirements. Follow policies and procedures to answer questions from members, providers and CareOregon staff regarding claims processing as it pertains to the CareOregon pharmacy benefits and coverage of drugs under the major medical benefit. Follow policies and procedures to determine a resolution to pharmacy claims adjudication issues or triage to other CareOregon staff for assistance. Data Entry and Clerical Support Sort incoming faxes and distribute according to assignments. Maintain files according to unit protocols. Perform data entry into the claims processing system, document management systems, databases and spreadsheets as assigned. Clerical Assistance for pharmacy projects, including, but not limited to distribution of education materials to members, providers or pharmacies, letters & mailings, and reports. Prior Authorizations (PA) and Formulary Exceptions Verify member's plan eligibility and applicable benefit for drug coverage. Review member's medication and eligibility history, load authorization in claim adjudication platform(s). Assist members and providers with the PA, formulary exception and coverage determination process. Follow policy & procedures to facilitate a resolution for prior authorization, formulary exception and coverage determinations requests. Notify members, providers or providers staff of prior authorization and formulary exception decisions. Appeals and Grievances Explain pharmacy appeal and grievances provisions and process to members, providers and CareOregon staff. Assist PBS II and PBS Lead with setting up pharmacy benefit appeals and grievances. Project Coordination Minimal project participation. Experience and/or Education Required Minimum 1 year work experience on a pharmacy team (i.e., retail, long-term care, or hospital) or 1 year experience in a health insurance plan Knowledge, Skills and Abilities Required Knowledge General understanding of managed care, Medicare, and Oregon Health Plan concepts Skills and Abilities Proficient with Microsoft Office Products and general computer literacy Familiarity with medical and pharmaceutical terminology Ability to learn and effectively navigate CareOregon and PBM software programs necessary to perform job responsibilities Ability to follow policies and procedures in performing job responsibilities Effective listening, verbal, and written communication skills Ability to exercise professionalism Growing ability to network and utilize internal and external resources Ability to focus on and comprehend information Ability to learn new skills and abilities Ability to assess a situation and use critical thinking skills and company resources to determine a solution Ability to accept managerial direction and feedback Ability to tolerate and manage stress Results and service oriented Ability to be flexible and adaptable Ability to organize, plan, and prioritize daily workflow within time constraints Ability to work in an environment with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☐ No ☒ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- The IS Information Security Manager leads the development, implementation, and ongoing improvement of CareOregon's information security program. This role partners with leaders across the organization to strengthen security governance, reduce risk, and ensure compliance with regulatory and industry standards. The position oversees security operations, incident response, vulnerability management, and third-party risk, while providing strategic guidance on secure architecture and emerging threats. This position manages a high performing security team and fosters strong collaboration with internal stakeholders and external partners to maintain a resilient enterprise security posture. Estimated Hiring Range: $151,965.00 - $185,735.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Program Leadership Implement and oversee a comprehensive Information Security Program aligned with organizational goals and industry best practices. Partner with IS and executive leadership to define security objectives, maintain the Information Security Roadmap, and report on program performance. Advise senior leadership on security risks, emerging threats, and strategic cybersecurity needs. Establish and maintain a security metrics framework and key performance indicators aligned with organizational priorities and standards. Prepare and deliver clear, actionable reports for senior leadership, including key risk indicators, program status, and operational metrics. Governance, Risk, and Compliance Recommend updates to security policies and standards to align with HIPAA, HITRUST, NIST, and other frameworks. Coordinate implementation of security programs, policies, and configuration standards across IS. Lead risk assessments, vulnerability analyses, remediation planning, and the administration of a GRC platform. Manage third‑party risk processes, including vendor assessments and ongoing monitoring. Oversee penetration tests, program maturity assessments, and risk assessments. Ensure ongoing compliance with regulatory, contractual, and audit requirements. Lead the response to audit requests and efforts to remediate adverse results. Security Operations & Incident Management Build and lead operational security capabilities to monitor, detect, analyze, and respond to threats. Utilize threat intelligence, monitoring, incident management, behavioral analysis, and advanced detection technologies. Maintain SOPs, runbooks, and playbooks supporting incident investigation, containment, recovery, and post‑incident review. Lead the Information Security Incident Response Plan, including training, exercises, and cross‑team readiness initiatives. Aggregate and analyze security data using SIEM technologies to identify patterns, evaluate alerts, and prioritize responses. Conduct proactive threat hunting and enhance monitoring to detect emerging threats. Technical Security Oversight Provide guidance on secure architecture and operations for on‑premises and Azure cloud environments. Manage core security domains such as Vulnerability Management, Identity and Access Management, and Privileged Access Management. Collaborate with other IS teams to ensure robust security configuration management for systems, hardware, and firmware. Perform security reviews and risk assessments for software acquisitions and technology initiatives. Lead periodic testing and improvement of the IS Disaster Recovery Plan. Leadership & Collaboration Lead, mentor, and develop a high‑performing cybersecurity team, fostering innovation, learning, and operational excellence. Act as a subject matter expert for IS and business teams, providing guidance on secure architecture, risk mitigation, and best practices. Maintain strong partnerships with key vendors, partners, and external stakeholders. Facilitate security governance meetings and deliver clear, actionable updates to executive leadership. Awareness & Training Develop, maintain, and continuously improve the organization‑wide information security awareness program. Ensure training content is current, engaging, and effective in reducing human‑related risk and supporting compliance. Employee Supervision Manage team and recommend team direction and goals in alignment with the organizational mission, vision, and values. Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens. Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations. Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff. Train, supervise, motivate, and coach employees; provide support toward employee development. Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making. Ensure team adheres to department and organizational standards, policies, and procedures. Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action). Perform supervisory tasks in collaboration with Human Resources as needed. Experience and/or Education Required Minimum 6 years' experience in information security systems, solutions or related services Experience must include most of the following: Leading teams, including developing and mentoring staff and supporting change management Leading complex systems projects Managing vendors and contracts Influencing others Developing policy and strategy roadmaps with business partners and aligning work efforts and solutions accordingly Developing and implementing information or cyber security programs Preferred Minimum 2 years' experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon's Aspiring Leaders Program Knowledge, Skills and Abilities Required Knowledge Strong understanding of information security best practices and secure design principles Knowledge of ITIL frameworks and their application within IS environments Knowledge of cross‑team alignment practices and organizational calibration processes Understanding of governance standards and adherence to established processes Skills and Abilities Ability to apply core managerial disciplines, including project and change management, cross‑functional collaboration, innovation, and organizational effectiveness Experience across multiple information security domains, including governance risk and compliance, attack surface management, identity and access management, network security, data protection, disaster recovery, security operations, incident response, and threat modeling Experience managing Intrusion Detection and Prevention systems such as Rapid7, InsightIDR and Defender ATP Experience with Data Loss Prevention and data classification Ability to promote continuous learning, empowerment, engagement, and development opportunities for employees Strong oral and written communication skills, including meeting facilitation and presentations Ability to clearly convey complex or controversial topics to diverse audiences Ability to form an independent perspective, collaborate in decision‑making, and motivate others-especially during challenging situations Ability to propose solutions and articulate business value Ability to elevate strategic concerns to senior leadership clearly, accurately, and promptly Ability to build strong working relationships with internal leaders and external partners Ability to collaborate effectively with coworkers, staff, leaders, and executives across all departments Ability to maintain a high degree of professionalism and a positive attitude Ability to develop and monitor policies, risks, and solutions Sound judgment with the ability to develop, implement, and reinforce policy and strategy Ability to see the broader context behind requests and apply holistic, systems‑thinking approaches Advanced project management skills Advanced vendor management skills Advanced budget management skills Strong analytical and research skills Ability to identify patterns in data and draw accurate conclusions Ability to work effectively with diverse individuals and groups Ability to learn, focus, interpret information, and determine appropriate actions Ability to accept direction and feedback, and manage stress effectively Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment and mobile technology Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- This position is responsible for performing data management in Workday and other ancillary systems at a senior level. Core areas of responsibility include data configuration, administration, analysis, reporting, stewardship, and project management. Functional areas of focus may include employment functions such as talent acquisition, compensation, benefits, and learning or finance functions such as accounting, budgeting, and procurement. Estimated Hiring Range: $124,200.00 - $151,800.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Data Configuration and Administration Lead functional administrator tasks for multiple areas within Workday with understanding of cross-functional dependencies. Interpret needs and develop and guide functional teams on routine to complex business processes and workflows. Identify and create new calculated fields, rules, validations, alerts, mass operations management (MOM), passive events, custom objects, custom fields, and standard and custom organizations with expert understanding of the impacts across the organization. Lead functional assessment, setup, and testing of Workday system releases. Lead continuous improvement of system processes and procedures, identifying opportunities for automation and efficiency gains while driving alignment with organizational goals and objectives. Stay updated, interpret, and guide others on system releases, enhancements, and best practices to ensure optimal system performance and user experience. Lead and/or participate in user group meetings/conferences. Identify risks, configuration options to improve processes, and recommend best practices and mitigations based on Workday functionality. Data Analysis and Reporting Apply advanced skills in gathering and analyzing data and providing summaries, reports and dashboards to department staff and other audiences; effectively interpret user needs and serve as a key resource for other Workday staff. Review metrics and report on a regular basis; perform advanced analysis and apply seasoned knowledge for explaining trends, unexpected changes and outliers. Administer reporting intake process; meet with all levels of management to discuss, clarify, interpret, and guide in requests for data; effectively translate requests into deliverable projects and provide options to meet end goals where constraints exist. Maintain data integrity in systems by creating new custom reports or automated alerts to identify and mitigate recurring or critical errors; guides others in resolving errors. Identify and troubleshoot complex report sharing issues and security or object errors; develop report tagging framework to automate and simplify for users. Collaboration and Data Stewardship Provide expert level troubleshooting and resolution for complex issues and cross-functional errors and develop solutions to avoid repeat errors. Within scope of assigned security role, partner with IS to ensure data feeds with internal and external systems and vendors perform as expected; where having visibility and included on notifications, monitors and reports errors and plays a lead role with resolution. Serve as the primary representative and liaison between People and Culture, IS, Finance, external vendors, and other stakeholders for ERP system design and implementation projects and upgrades. Provide advanced technical support, troubleshooting, and guidance to system users; identify and develop effective aids for system users and provides user education. Collaborate with and effectively bridge communications between IS, People and Culture, and Finance to address system inquiries and issues. In collaboration with IS, communicate planned and unplanned ERP systems outages. Develop and leverage expert understanding of data, data infrastructure and processes used for reporting department metrics and for measuring operational and/or program performance. Develop and oversee technical documentation, such as data dictionaries, glossaries, and procedures for relevant data and reports; partners with IS as appropriate. Project Management Provide expert level support on help requests and projects. Maintain project request tracking. Lead project prioritization in collaboration with management and functional team; assess scope, effort, resource requirements, and impact along with feasibility and reasonable deadlines. Set up and test changes in appropriate tenant. Document changes and testing in accordance with change approval and prioritization processes; migrate changes between tenants, as authorized. Advise management and stakeholders on options realistically available to meet requests and project requirements within feasible timelines and resource constraints. Use expert knowledge of system capabilities to develop creative solutions and enhancements. Advise management where use of external consultants would be cost-effective or recommended due to impact, resource constraints or other considerations. Experience and/or Education Required Minimum 5 years' experience performing data administration, configuration, and analysis in the functional area where the position resides Minimum 4 years' experience in Workday, directly administering, troubleshooting, and configuring minimum of 3 HCM or Finance modules Preferred Experience leading Workday implementations or upgrades Experience developing EIB and API integrations, and experience supporting, troubleshooting, and testing Connector and Studio integrations Knowledge, Skills and Abilities Required Knowledge Excellent understanding of data management fundamentals and reporting, including data structures, integration, stewardship, and governance Ability to lead in applying and performing qualitative/quantitative measurement and data collection design principles Advanced understanding of functional policies and procedures Skills and Abilities Excellent ability to anticipate, understand, and interpret data requests and provide timely and accurate reports Advanced research, analytical and problem-solving skills Ability to review and recommend the best course of action or solution based on impacts Ability to identify and lead process improvements and streamline manual processes Advanced Excel and ETL (extract, translate, load) skills that comply with specified data requirements Strong verbal and written communication skills, as well as interpersonal skills Ability to collaborate effectively with ERP cross-department stakeholders and vendors Ability to convert systems terminology into understandable content for educating users Ability to effectively document information; ability to synthesize findings and present recommendations to stakeholders Excellent organizational skills and attention to detail Ability to handle confidential information and upmost discretion, sharing data in support of security access controls, and obtaining appropriate approvals for any relevant exceptions Ability to keep information confidential Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

Work Schedule: Hybrid - after a 5-6 month training period that will be completed 100% onsite at our downtown Birmingham office, this position can transition to a hybrid work schedule with a mix of in-office and remote work. The successful candidate must reside within a reasonable travel distance of Birmingham. Why VIVA HEALTH? VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare. Benefits * Comprehensive Health, Vision, and Dental Coverage * 401(k) Savings Plan with company match and immediate vesting * Paid Time Off (PTO) * 9 Paid Holidays annually plus a Floating Holiday to use as you choose * Tuition Assistance * Flexible Spending Accounts * Healthcare Reimbursement Account * Paid Parental Leave * Community Service Time Off * Life Insurance and Disability Coverage * Employee Wellness Program * Training and Development Programs to develop new skills and reach career goals * Employee Assistance Program See more about the benefits of working at Viva Health - ******************************************* Job Description The Credentialing Coordinator is responsible for credentialing and re-credentialing practitioners, ancillary service providers and allied health professionals to ensure their qualification to participate in VIVA HEALTH'S provider network. The Credentialing Coordinator will serve a primary role in receiving and incorporating provider data appropriately into the provider set-up workflow process. This position will act as a resource for provider data integrity, provider file management and network development. Key Responsibilities * Receive, interpret and incorporate Council for Affordable Quality Healthcare (CAQH) provider data into the credentialing, re-credentialing, and provider data auditing process. * Use CAQH data and credentialing software findings to make credentialing decisions regarding providers. * Analyze trends in monthly credentialing data to forecast workload for CAQH. * Communicate with internal departments to ensure quality assurance findings related to providers are reviewed and acted upon accordingly. REQUIRED QUALIFICATIONS: * Bachelor's Degree or equivalent experience in credentialing * 3 years of experience in credentialing * Ability to analyze and solve problems related to credentialing of providers and facilities * Proficient in manipulation of data to report statistical information to several of departments * Ability to work independently, research and resolve processing issues in a timely manner with little to no supervision * Organized, detail oriented, and skilled at multi-tasking * Demonstrate excellent customer service skills through written and verbal communication * Proficient in the Microsoft Office suite of products * Knowledge of credentialing software, CAQH, CMS, NCQA guidelines, and JCAHO regulations

--------------------------------------------------------------- This position provides clinical operations support, working closely with Population Health regional care teams to achieve team and strategic goals. The overall aim is to improve quality of care, coordinate care across the continuum, reduce hospital re-admissions, and increase access to advanced illness care. The position is responsible for identifying and triaging members and assignment of appropriate referrals. Core functions of the position include serving as a bridge between CareOregon and external partners, community-based organizations, and state governments, taking on special projects, supporting the broader Care Management Team's strategic needs, and coordinating systems across a large regional area. NOTE: This is a remote position but you must reside in the Portland metro area. Estimated Hiring Range: $22.82 - $27.89 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Triage Gather and review all available and relevant information in order to help determine the physical, behavioral, social support, and medical needs of the member in order to help determine the individualized plan of care or support clinical staff working with the member. Identify members' barriers to care and potential resources in consideration of cultural factors, social determinants of health, and member autonomy. Review and assess daily emergency department reports, hospital admission reports, and other targeted patient lists, health plan claims, pharmacy records, EHR, and other relevant information to identify members in need of additional support. Respond to internal and external inquiries, referrals, and service requests for assistance. Effectively respond to requests for Intensive Case Management Services for members who: are deemed high risk (complex clinical and/or behavioral or chemical dependency), have had a recent Emergency Department (ED) visit, have been discharged from a facility (hospital, skilled nursing facility [SNF], inpatient rehabilitation), or are identified by an internal or external referral source. Contribute to and implement integrated plans of care as applies in collaboration with telephone, outreach, and embedded staff. Program Coordination Establish effective relationships with community partners and maintain active familiarity with key services and resources commonly requested by members. Develop working partnerships with health care providers regarding member needs and care coordination plans. Support coordinated care organizations (CCO) and Centers for Medicare and Medicaid Services (CMS) regulatory obligations. Collaborate with others within the organization to ensure the integration of assigned program activities with other organizational projects, as directed. Provide guidance and assistance to staff, as directed, with regards to needs for training, tools, technology, and other resources necessary to carry out their work. Provide population support, including work with a variety of vendors, or community partners. Conduct value stream mapping, process development and improvement, and program coordination. Coordinate multiple CareOregon initiatives to be inclusive of all lines of businesses. Data Tracking and Reporting Identify opportunities for increased case finding efficiencies and effectiveness. Collect and/or audit data and information to inform or evaluate departmental, organizational metrics and regulatory requirements. Contribute to continuous process improvement through team huddles, training, departmental and organizational meetings, and reporting. Ensure correct data inputs through consistent reporting and frequent data audits. Run reports and track incoming referrals. Experience and/or Education Required Minimum 3 years' directly related experience working with vulnerable populations in a healthcare setting, social service agency, outpatient primary care clinic, hospital, or health insurance plan; experience should include working with consumers of Medicaid and Medicare healthcare services Preferred Licensed practical nurse (LPN), certified medical assistant (CMA), certified nurse's assistant (CNA), or other health related field Experience working with Metrics, gaps in care, and/or HEDIS measures Knowledge, Skills and Abilities Required Knowledge Understanding of the impacts of trauma on health Basic understanding of medical terminology Familiarity with health plan claims systems and other sources of clinical information in an applied fashion to recognize potentially modifiable patterns of health services Familiarity with electronic health record applications; comfortable learning new systems if needed General understanding of or ability to learn the basics of motivational interviewing, health care teaching, and coaching principles Skills and Abilities Proficient skills in Microsoft Office, including Word, Excel, and Outlook Basic understanding of data analysis and use of analytical tools (Tableau Prep, Tableau Desktop, Excel, Power BI, etc.) Skills in working with electronic medical records Ability to identify medical or social situations in data that pose a risk to member's safety and increase likelihood of rehospitalization Ability to effectively gather relevant information from members, or those calling on their behalf, regarding their health Ability to develop a concise, initial assessment to appropriately triage Willingness to seek support from clinical staff and/or supervisors in the event of complex situations Proficient communication skills, including written, verbal, listening, and presenting Strong interpersonal and customer service skills Strong organizational skills; ability prioritize and manage multiple tasks and timelines Ability to work independently and use sound judgment Ability to work in a fast-paced, multi-faceted environment Ability to apply critical analysis, creative problem-solving skills, and collaboration in multi-disciplinary teams Detail oriented; accurate record keeping Ability to work in an environment with diverse individuals and groups Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

Nurses and Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a Care Coordinator in Dothan, AL! VIVA HEALTH knows that nursing and social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION REQUIRED: Licensed BSN/ADN Licensed BSW PREFERRED: Licensed MSW and/or Certified Case Manager (CCM) designation Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.

--------------------------------------------------------------- The IS Database Developer II is responsible for developing and maintaining database and ETL processes, as well as recommending and partnering in the design and development of effective solutions in support of business strategies. This role is essential toward maturing CareOregon's database and ETL development model. This position spends substantial time evaluating, architecting, and implementing IS priorities (plan, design, install, and maintain). Estimated Hiring Range: $111,690.00 - $136,510.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Database Development Actively participate in the design of custom databases and processes. Provide advanced database design support to the organization; lead small projects with assistance from Supervisor or Lead and participate and consult on other projects. Collaborate with other IS teams on best practices of database design and development. ETL Development Develop ETL processes for moderate to advanced activities. Develop moderate to advanced databases to meet application and web needs. Analyze business requirements; research and recommend solutions which include potential risks and mitigation. Develop and maintain appropriate technology documentation, including current design and operation. Standards and Policy Administration Propose requirements, standards and best practices for database and ETL development. Participate in the ongoing review of existing systems to ensure they are designed to comply with established standards and to empower business operations. Vendor Coordination and Relations Conduct product and vendor research, and present recommendations to more advanced database developers and/or management. Establish and maintain effective working relationships with vendors and related equipment suppliers, including installation and repair of services. Experience and/or Education Required Minimum 3 years of database and ETL development required. Experience should include some or all of the following: Database development and maintenance ETL development and maintenance Systems analysis and design Agile/Scrum methodology Note: For data warehouse focused roles, minimum 3 years' experience developing ETL for loading a dimensional model using a combination of T-SQL and SSIS 2012, 2014, or 2016 Preferred Bachelor's degree in Computer Science, Information Systems, or a related field Additional experience in related technology support and/or operational positions QNXT experience Knowledge, Skills and Abilities Required Knowledge Working knowledge/skills with the following: Microsoft SQL Server ETL tools, such as SSIS or Informatica Visual Studio Unit and integration testing Note: For data warehouse focused roles, advanced knowledge/skills of the dimensional model required in lieu of knowledge/skill requirements above General knowledge of BizTalk (preferred) Skills and Abilities Advanced abilities in troubleshooting system performance issues and root cause Effective communication skills, including listening, verbal, written, and customer service Ability to clearly articulate policies and instructions Demonstrated progress in conveying appropriate level of detail effectively to all levels of the organization including non-technical staff Ability to recommend policies, document risks, and propose solutions to information technology management and senior leadership Possess a high degree of initiative and motivation Ability to effectively collaborate with coworkers, staff, and leaders across all departments Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

Job Description FCS Facility Services is a nationwide janitorial services company dedicated to providing high-quality cleaning solutions to our clients. We specialize in maintaining cleanliness and hygiene in various facilities, ensuring a safe and comfortable environment for occupants and visitors alike. Our team is committed to excellence and strives to exceed expectations in every cleaning task. Position Overview: As a General Cleaner at FCS Facility Services, you will be an integral part of our cleaning team, responsible for performing a variety of cleaning duties to uphold the cleanliness and sanitation standards of our clients' premises. The ideal candidate will be detail-oriented, dependable, and dedicated to delivering outstanding cleaning results while adhering to safety protocols and company policies. Key Responsibilities: Surface Cleaning: Clean and sanitize various surfaces, including floors, walls, windows, furniture, and fixtures, using appropriate cleaning agents and equipment. Dusting and Polishing: Dust surfaces, furniture, and equipment thoroughly, ensuring the removal of dirt, debris, and allergens. Polish surfaces to maintain a clean and attractive appearance. Vacuuming and Sweeping: Vacuum carpets and rugs to remove dirt, dust, and debris. Sweep and mop hard surface floors to eliminate dirt and stains, paying attention to corners and hard-to-reach areas. Restroom Maintenance: Clean and disinfect restroom fixtures, including toilets, sinks, mirrors, and countertops. Refill soap dispensers, paper towel holders, and toilet paper rolls as needed. Trash Removal: Empty trash receptacles and replace liners as necessary. Dispose of trash and recyclable materials in designated containers, following proper waste disposal procedures. Restocking Supplies: Monitor inventory levels of cleaning supplies and restroom amenities. Replenish supplies as needed to ensure adequate stock for daily cleaning tasks. Floor Care Support: Assist floor technicians in floor care duties, such as buffing, waxing, and stripping floors, as directed by supervisors. Adherence to Safety Protocols: Follow established safety procedures and guidelines to prevent accidents and ensure a safe working environment. Use personal protective equipment (PPE) as required. Qualifications: Previous experience in commercial cleaning or janitorial services preferred but not required. Knowledge of cleaning techniques, equipment, and chemicals. Strong attention to detail and ability to follow instructions. Good communication skills and ability to work effectively in a team. Physical stamina and flexibility to perform cleaning tasks, including bending, kneeling, and lifting. Dependability and punctuality. Willingness to learn and adapt to new cleaning methods and procedures. Willingness to undergo background checks and drug screenings as required. Be able to lift/carry a minimum of 50 pounds. FCS Facility Services is an equal employment opportunity employer dedicated to promoting an inclusive, diverse, and innovative environment for our employees. We provide all qualified applicants with employment consideration without regard to race, color, religion, sex, pregnancy, childbirth, ancestry, national origin, age, protected veteran status, marital status, genetic information, gender identity or expression, sexual orientation, disability, or any other protected status in accordance with applicable federal, state, or local laws. 1st shift Mon to Fri 6:00am to 2:30pm

--------------------------------------------------------------- The Ambulatory Care Clinical Coordinator (pharmacist) is responsible for providing oversight of an assigned area (i.e., Care Coordination or Network Liaison). The pharmacist needs to demonstrate consistent application of knowledge and skills related to pharmacy benefits, quality measures, and other initiatives in order to communicate, partner, and deliver appropriate, safe, efficient, and cost-effective patient care as part of a multidisciplinary team. Responsibilities include supporting the patient-centered medical home, incorporating principles of population-based medicine, expanding and coordinating the expansion of pharmaceutical care services to patients across the health-system through primary care clinics, community pharmacies, or other designated environments. Care Coordination: This position is responsible for coordinating effective use of the pharmacy benefit by delivering clinical and educational interventions designed to improve pharmaceutical care. Network Liaison: This position is responsible for aligning the clinical pharmacist network with CareOregon strategic goals and aiding the advancement of the practice of clinical pharmacy. This is a 9-month temporary position. Estimated Hiring Range: $151,965.00 - $185,735.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Develop and conduct quality improvement programs related to the pharmacy program. Develop and implement clinical educational programs to improve drug utilization and quality. Develop and conduct educational initiatives to improve prescribing patterns for quality and/or cost opportunities to support sustainable cost trends with the highest quality. Develop and critically evaluate pharmacy claim data analysis/reports in support of specific projects or program objectives. Develop and conduct retrospective drug use reviews. Leading the design, development, and implementation of quality improvement initiatives related to the pharmacy program will be an important aspect of this position. Review medication prior authorization requests and appeals as assigned. Review and refine policies and procedures regarding Pharmacy Department functions including medication therapy management, DUR programs, medication prior authorization, and others as applicable. Use an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics Committee and other pharmacy program activities as assigned. Assess, review and respond to federal and state regulatory requirements/audits of the pharmacy benefit. Consult with clinicians and pharmacists to resolve pharmacy benefit issues. Precept pharmacy students and residents. Care Coordination Critically evaluate drug therapy regimens for patients enrolled in the care coordination program and assist with developing treatment plans. Provide medication therapy management (MTM) services. Utilize technology platforms to document and to meet MTM objectives. Monitor MTM objectives and high-risk population outcomes in partnership with the pharmacy benefit coordinator to provide oversight. Perform medication reviews and other tasks as assigned to meet plan quality metrics. Experience and/or Education Required Minimum Graduate of an accredited pharmacy program Current (or eligible) unrestricted licensure as a pharmacist in the state of Oregon Advanced pharmacy training (PharmD, residency, fellowship, board certification or master's degree in related discipline) Practical experience with minimum 2 years as a clinical pharmacist in pharmaceutical care management in an ambulatory care or other clinical setting (which can include residency experience) Preferred Previous experience in managed care and project management PGY1 residency training Knowledge, Skills and Abilities Required Knowledge Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization Must have comprehensive, clinical pharmaceutical knowledge base Skills and Abilities Ability to critically evaluate clinical pharmaceutical and medical literature and apply principles of evidence-based medicine Ability to design and review pharmacy claims analysis/reports according to specific project requirements Must be highly motivated and have the ability to work independently Excellent organizational, project management, and time-management skills Excellent written and verbal communication skills Excellent customer service skills Ability to work with diverse groups Ability to manage multiple tasks Ability to negotiate, problem-solve, and consensus-build Basic word processing, spreadsheet, and database skills Propose and implement process improvements Meet deadlines for completion of workload Maintain agreed upon work schedule Demonstrate cooperation and teamwork Provide cross-training on specific job responsibilities Meet identified business goals that contribute to departmental goals Follow established departmental policies and procedures Perform other duties and projects as assigned Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Ability to lift, carry, push, pull and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- This position is responsible for assisting with the management of the pharmacy benefit and developing and delivering clinical and educational interventions designed to improve pharmaceutical use. Responsibilities include formulary management; assisting with management of specific patients in the multidisciplinary case management/medication therapy management program, P&T, developing and conducting educational initiatives to improve prescribing patterns; develop and conduct quality improvement programs related to the pharmacy program; evaluating medication authorization requests and providing oversight to the medication PA process; and other pharmacy program activities as assigned. NOTE: This is a temporary position expected to last 9 months. Estimated Hiring Range: $151,965.00 - $185,735.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Prepare drug utilization reports and analyses for the Pharmacy & Therapeutics Committee. Use an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics Committee. Critically evaluate drug therapy regimens for patients enrolled in the case management program and assist with developing treatment plans. Provide medication therapy management services. Develop and conduct retrospective drug use reviews. Review medication prior authorization requests and appeals. Develop and implement clinical educational programs to improve drug utilization and quality. Review and refine policies and procedures regarding Pharmacy Department functions including medication therapy management, DUR programs, medication prior authorization, and others. Develop and conduct quality improvement programs related to the pharmacy program. Monitor functions provided by the plans' Pharmacy Benefit Manager including pharmacy benefit coding, customer service guidelines, prior authorization activities, and other delegated services. Develop and critically evaluate pharmacy claim data analysis/reports in support of specific projects or program objectives. Assess, review, and respond to federal and state regulatory requirements/audits of the pharmacy benefit. Consult with clinicians and pharmacists to resolve pharmacy benefit issues. Review and refine pharmaceutical reimbursement and purchasing procedures. Develop materials to communicate pharmacy benefit or other information to members, clinicians, and pharmacists. Experience and/or Education Required Graduate of an accredited pharmacy program Current, unrestricted license as a pharmacist in Oregon Advanced pharmacy training (PharmD, residency, fellowship, or master's degree in related discipline) Practical experience as a clinical pharmacist in formulary management or ambulatory care or other clinical setting Preferred Previous experience in managed care Experience with reviewing Prior Authorization requests against plan criteria and making approval or decline decisions Knowledge, Skills and Abilities Required Knowledge Must have comprehensive, clinical pharmaceutical knowledge base Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization Skills and Abilities Ability to critically evaluate clinical pharmaceutical and medical literature and apply principles of evidence-based medicine Ability to design and review pharmacy claims analysis/reports according to specific project requirements Must be highly motivated and have the ability to work independently Excellent organizational, project management, and time-management skills Excellent written and verbal communication skills Excellent customer service skills Ability to manage multiple tasks Ability to negotiate, problem-solve, and consensus-build Basic word processing, spreadsheet, and database skills Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to lift and carry for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- The Claims Examiner II is an intermediate level position responsible for the timely review, investigation and adjudication of all types of Medicaid, Medicare, group and individual medical, dental, and mental health claims. Estimated Hiring Range: $22.82 - $27.89 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures. Re-adjudicate, adjust or correct claims, including some complex and difficult claims as needed. Consistently meet or exceed the quality and production standards established by the department and CareOregon. Provide excellent customer service to internal and external customers. Collaborate and share information with Claims teams and other CareOregon departments to achieve excellent customer service and support organizational goals. Determine eligibility, benefit levels and coordination of benefits with other carriers; recognize and escalate complex issues to the Lead or Supervisor as needed. Investigate third party issues as directed. May review, process and post refunds and claim adjustments or re-adjudications as needed. Report any overpayments, underpayments or other possible irregularities to the Lead or Supervisor as appropriate. Generate letters and other documents as needed. Proactively identify ways to improve quality and productivity. Continuously learn and stay up to date with changing processes, procedures and policies. Experience and/or Education Required Minimum 2 years' experience as a Medical Claims Examiner or other role that requires knowledge of medical coding and terminology (e.g., medical billing, prior authorizations, appeals and grievances, health insurance customer service, etc.) Preferred Experience using QNXT, Facets, Epic systems Knowledge, Skills and Abilities Required Knowledge Knowledge of CPT, HCPCS, Revenue, CDT and ICD-10 coding Knowledge of medical, dental, mental health and health insurance terminology Skills and Abilities Understanding of or ability to learn state and federal laws and other regulatory agency requirements that relate to medical, dental, mental health and health insurance industry and Medicaid/Medicare industry Ability to perform fast and accurate data entry Strong spoken and written communication skills Basic computer skills (ability to use Microsoft Outlook, Word and Excel) and learn new systems as needed Good customer service skills Ability to participate fully and constructively in meetings Strong analytical and sound problem-solving skills Detail orientation Strong organizational skills and time management skills Ability to work in a fast-paced environment with multiple priorities Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to lift, carry, reach, and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home Schedule: Monday - Friday, 8:00 AM to 5:00 PM We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

--------------------------------------------------------------- This position is responsible for working with CareOregon members, their providers, and pharmacies to support the pharmacy benefit and prescription needs under the major medical benefit. Core responsibilities include customer service and claims processing, as well as assistance with prior authorizations, formulary exceptions, appeals, grievances, and projects. Estimated Hiring Range: $20.51 - $25.06 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Customer Service and Claims Processing Communicate in a professional and respectful manner. Maintain confidentiality within HIPAA regulations and function on “need to know” principles. Respond to drug coverage inquires in an accurate and timely manner to members, members' representatives, providers, and CareOregon staff. Educate members, providers, pharmacies, and CareOregon staff about the CareOregon formularies and pharmacy benefit policies. Document all customer service activities according to organization requirements. Follow policies and procedures to answer questions from members, providers and CareOregon staff regarding claims processing as it pertains to the CareOregon pharmacy benefits and coverage of drugs under the major medical benefit. Follow policies and procedures to determine a resolution to pharmacy claims adjudication issues or triage to other CareOregon staff for assistance. Data Entry and Clerical Support Sort incoming faxes and distribute according to assignments. Maintain files according to unit protocols. Perform data entry into the claims processing system, document management systems, databases and spreadsheets as assigned. Clerical Assistance for pharmacy projects, including, but not limited to distribution of education materials to members, providers or pharmacies, letters & mailings, and reports. Prior Authorizations (PA) and Formulary Exceptions Verify member's plan eligibility and applicable benefit for drug coverage. Review member's medication and eligibility history, load authorization in claim adjudication platform(s). Assist members and providers with the PA, formulary exception and coverage determination process. Follow policy & procedures to facilitate a resolution for prior authorization, formulary exception and coverage determinations requests. Notify members, providers or providers staff of prior authorization and formulary exception decisions. Appeals and Grievances Explain pharmacy appeal and grievances provisions and process to members, providers and CareOregon staff. Assist PBS II and PBS Lead with setting up pharmacy benefit appeals and grievances. Project Coordination Minimal project participation. Experience and/or Education Required Minimum 1 year work experience on a pharmacy team (i.e., retail, long-term care, or hospital) or 1 year experience in a health insurance plan Knowledge, Skills and Abilities Required Knowledge General understanding of managed care, Medicare, and Oregon Health Plan concepts Skills and Abilities Proficient with Microsoft Office Products and general computer literacy Familiarity with medical and pharmaceutical terminology Ability to learn and effectively navigate CareOregon and PBM software programs necessary to perform job responsibilities Ability to follow policies and procedures in performing job responsibilities Effective listening, verbal, and written communication skills Ability to exercise professionalism Growing ability to network and utilize internal and external resources Ability to focus on and comprehend information Ability to learn new skills and abilities Ability to assess a situation and use critical thinking skills and company resources to determine a solution Ability to accept managerial direction and feedback Ability to tolerate and manage stress Results and service oriented Ability to be flexible and adaptable Ability to organize, plan, and prioritize daily workflow within time constraints Ability to work in an environment with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☐ No ☒ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.