Commercial Counsel
Remote job
About Lyra Health
Lyra Health is the leading provider of mental health solutions for employers supporting more than 20 million people globally. The company has delivered 13 million sessions of mental health care, published more than 20 peer‑reviewed studies, and achieved unmatched outcomes in access, clinical effectiveness, and cost efficiency. Extensive peer‑reviewed research confirms Lyra's transformative care model helps people recover twice as fast and results in a 26 % annual reduction in overall healthcare claims costs. Lyra is transforming access to life‑changing mental health care through Lyra Empower, the only fully integrated, AI‑powered platform combining the highest‑quality care and technology solutions.
About the Role
You will be a critical member of Lyra's legal team, helping to drive vendor contracting and support internal stakeholders to fulfill Lyra's mission to bring mental and emotional health solutions to large employers across the country. As a vital member of our commercial contracts team, you will review and negotiate contracts with vendors as the main focus, work with internal stakeholders to resolve questions, and contribute to team projects as needed to support Lyra's growth.
The ideal candidate will be an experienced contracts negotiator who enjoys being part of a tight‑knit collegial team with enthusiasm for building better internal processes through technology and process improvements. The legal team plays an essential role at the company, responding and managing all legal questions; candidates with all‑around experience are welcome to help support the various needs of the company.
This role can be carried out from our Burlingame, CA headquarters, hybrid, or fully remote/virtually. Remote candidates must be physically located within the United States.
Responsibilities
Negotiate, draft, and redline vendor agreements, customer agreements, license agreements, partnership agreements, confidentiality agreements, statements of work, data‑security agreements, and other documents; when appropriate, collaborate with leadership and internal stakeholders to define and drive discussions with clients and prospects.
Independently support critical commercial matters for the company, including complex and strategic transactions (partnerships, technology integrations, among others).
Collaborate with internal and external experts to ensure that commercial agreements comply with policies, laws, rules, and regulations.
Provide practical and creative legal advice and support on business matters in a fast‑paced environment.
Work cross‑functionally and provide legal guidance to various internal functions in the business, including new opportunities and product lines.
Collaborate with internal and external experts to ensure that commercial agreements appropriately manage risk and comply with policies, laws, rules, and regulations.
Qualifications
Law degree from an accredited law school and membership in a state bar with good standing.
5+ years legal experience, in‑house, at a law firm, or a combination of both.
Experience negotiating, drafting, and reviewing a wide range of complex commercial agreements, including technology transactions, health‑care agreements, data‑sharing agreements, and sales contracts.
Strong understanding of how to balance legal risks and business needs to both protect the company and drive growth, with an enthusiasm for plain English and business‑friendly contract drafting.
Excellent problem‑solving capabilities, judgment, communication (written and verbal), and interpersonal skills. Eager and willing to take on new areas of law and function independently in a demanding, fast‑paced environment.
Enjoy building relationships with fun & friendly coworkers!
Preferred Qualifications
Experience working in-house with a technology company and/or healthcare organization strongly preferred.
Additional contracting experience with the following a plus:
Health‑care privacy laws, CCPA, GDPR, etc.
State and/or Federal health‑care programs/regulations.
ERISA.
Provider contracts and partnerships.
Technology transactions.
Compensation & Benefits
Salary Range: $134,000 - $205,000 per year. As a full‑time Commercial Counsel, you will be employed by Lyra Health, Inc. The anticipated annual base salary range for this full‑time position is $134,000 to $205,000. The base range is determined by role and level, and placement within the range will depend on a number of job‑related factors, including but not limited to your skills, qualifications, experience and location. This role may also be eligible for discretionary bonuses.
Benefits include:
Comprehensive health‑care coverage (medical, dental, vision, FSA/HSA, life, and disability insurance).
Lyra for Lyrians: coaching and therapy services.
Equity in the company through discretionary restricted stock units.
Competitive time off with pay (vacation, sick days, and company holidays).
Paid parental leave.
401(k) retirement benefits.
Monthly tech allowance.
Well‑being perks and activities, surprise swag, free food, community celebrations, and more.
Equal Opportunity & Privacy Notice
We are an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, or any other category protected by law.
By applying for this position, you acknowledge that your personal information will be processed as per the Lyra Health Workforce Privacy Notice. Through this application, to the extent permitted by law, we will collect personal information from you, including but not limited to your name, email address, gender identity, employment information, and phone number for the purposes of recruiting and assessing suitability, aptitude, skills, qualifications, and interests for employment with Lyra. We may also collect information about your race, ethnicity, and sexual orientation, which is considered sensitive personal information under the California Privacy Rights Act (CPRA) and special category data under the UK and EU GDPR. Providing this information is optional and entirely voluntary. If you provide it you consent to Lyra processing it for the purposes described at the point of collection, for example for diversity and inclusion initiatives. If you are a California resident and wish to limit how we use this information, please use the “Limit the Use of My Sensitive Personal Information” form. This information will only be retained for as long as needed to fulfill the purposes for which it was collected. Please note that Lyra does not “sell” or “share” personal information as defined by the CPRA. Outside of the United States, for example in the EU, Switzerland, and the UK, you may have the right to request access to, or a copy of, your personal information, including in a portable format; request that we delete your information from our systems; object to or restrict processing of your information; or correct inaccurate or outdated personal information in our systems. These rights may be subject to legal limitations. To exercise your data privacy rights outside of the United States, please contact ************************. For more information about how we use and retain your information, please see the Workforce Privacy Notice.
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IP Licensing & Transactions Counsel [Hybrid - Cupertino]
Remote job
Legal.io is working with a top tech company who is looking to hire an IP Licensing and Transactions Counsel. This is a 12 month contract, and is hybrid in Cupertino, CA.
Scope of Work
Title: IP Licensing and Transactions Counsel (Secondment)
Experience: 7+ Years
Location: Hybrid (Cupertino, CA)
Hours: 40 Hours / Week
Duration: 12 Months (From April 2025 until April 2026)
Pay Rate: $100 - $110 / hour ($200,000 - $220,000 annualized)
Benefits: Vision, medical, dental (all 99% covered), 401k
Responsibilities:
Handle cutting-edge, novel intellectual property issues, including transactions covering all forms of intellectual property, technology licenses, and development agreements.
Engage in IP dispute resolution and portfolio cross-licensing.
Ensure a complete package of IP licenses, ownership, warranties, and indemnities covering all business activities.
Provide strategic IP advice and counsel to support the company's business objectives
General IP counsel role, so some familiarity in software and silicon is best, although the organization touches materials science, manufacturing, wireless communications, and even satellite technologies. Don't need to be an expert in any of these, but need someone who can at least communicate with experts and understand the implications for IP and tech transactions.
Qualifications:
At least 5-10 years of experience in technology and IP transactions.
Undergraduate degree in electrical engineering, computer science, physics, mathematics, or a related field.
Deep expertise in patent law, copyright law, trademark law, trade secret law, and other forms of intellectual property.
Intuitive understanding of the key intellectual property strategies of Fortune 50 Silicon Valley companies.
Exceptional attention to detail and accuracy in parsing complex legal documents.
Familiarity with the differences between Japanese, Korean, European, and US copyright and patent laws.
A lifelong passion for technology.
Past experience as an in-house group or chief IP counsel is a plus.
Patent prosecution or intellectual property litigation experience is a plus.
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Legal.io is committed to the principle of equal opportunity. All employment decisions are made without regard to race, color, gender, gender identity, gender expression, sexual orientation, religion (including religious dress and grooming practices), creed, sex (including pregnancy, childbirth, breastfeeding and related medical conditions), marital status, age, national origin, ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), genetic information, military and veteran status or any other basis protected by the laws or regulations in the locations where we operate.
Licensed Professional Clinical Counselor (LPCC) - Hybrid Role - Encinitas, CA
Remote job
We are actively looking to hire talented therapists in the San Diego area, who are passionate about patient care and committed to clinical excellence.Is this you?
Wanting to deliver high quality behavioral healthcare.
Seeking work life balance.
Interested in growing professionally.
What we offer Therapists:
Sign on bonus
Competitive Compensation: $117,000 - $134,000
Flexible work schedules.
Telemedicine and in-person flexibility.
Generous ‘above market' compensation with unlimited/uncapped earnings.
Full benefits package: health, dental, vision, life, 401k (with match), paid parental leave, EAP and more.
Collegial work environment.
Newly designed and modern offices.
Full administrative support.
Latest in digital technology.
Strong work/life balance.
Licensed Therapists are a critical part of our clinical team. We're seeking Licensed Therapists that are:
Fully licensed LMFT or LCSW.
CA state license.
Experienced in working with adult, and/or child and adolescent populations.
Please reach out directly to arrange a time to speak by phone and include your CV, thank you.
Michael Pitts Director, Practice Development...@lifestance.com(W) 619-###-####(C) 623-###-####
Product & Commercial Counsel - Hybrid & High-Impact
Remote job
A dynamic mobility company based in San Francisco is seeking an experienced attorney to join the Product & Commercial Legal team. The successful candidate will provide legal guidance on product counseling and employment law, drafting contracts, and advising on regulatory matters. This is a hybrid role, requiring in-office presence three days a week, with a competitive salary range of $178,000 - $220,000.
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Remote Child, Family and School Social Workers - AI Trainer ($60-$75 per hour)
Remote job
## **About the Role**
Mercor is seeking experienced **Child, Family and School Social Workers** to support a leading AI lab in advancing research and infrastructure for next-generation machine learning systems. This engagement focuses on diagnosing and solving real issues in your domain. It's an opportunity to contribute your expertise to cutting-edge AI research while working independently and remotely on your own schedule. ## **Key Responsibilities** - You'll be asked to create deliverables regarding common requests within your professional domain - You'll be asked to review peer developed deliverables to improve AI research ## **Ideal Qualifications** - 4+ years professional experience in your respective field - Excellent written communication with strong grammar and spelling skills ## **More About the Opportunity** - Fully remote and asynchronous - complete work on your own schedule - Expected workload: ~30 hours per week, with flexibility to scale up to 40 hours - Project start date: immediately, lasting for around 3-4 weeks ## **Compensation & Contract Terms** - Independent contractor engagement through Mercor - Hourly compensation, paid weekly via Stripe Connect - Payments based on services rendered; contractors maintain full control over their work schedule and methods **About Mercor** - Mercor is a talent marketplace that connects top experts with leading AI labs and research organizations - Our investors include Benchmark, General Catalyst, Adam D'Angelo, Larry Summers, and Jack Dorsey - Thousands of professionals across domains like engineering, research, law, and creative services have partnered with Mercor on frontier AI projects We consider all qualified applicants without regard to legally protected characteristics and provide reasonable accommodations upon request. ## **Earn $100 by referring** Share the referral link below, and earn $200 for each successful referral through this unique link. There's no limit on how many people you can refer. Restrictions may apply. [Learn consider all qualified applicants without regard to legally protected characteristics and provide reasonable accommodations upon request.
VA Intake Specialist
Remote job
Job Details Advocacy Fort Lauderdale Office - Plantation, FL Fully Remote Full Time $18.00 - $18.00 Hourly Customer ServiceDescription
Do you want to have a fulfilling career with purpose helping military veterans? The VA Intake Specialist will be a direct point of contact for potential new clients. They provide great customer service and have a clear phone presence. They should be proficient in using computers, be able to verify that there are no discrepancies within documents, and excel at both verbal and written communication. The ideal candidate for this position is detail-oriented, professional, and has a genuine desire to meet the needs of others.
Work hours are Monday - Friday from 10:00 am to 7:00 pm EST. This is a remote work from home position
Our benefits package includes health, dental, and vision insurance, company paid life insurance and disability insurance, a 401(k) plan with an employer match, paid time off after 90 days of employment, and ten company paid holidays.
Essential Functions:
· Receive all inbound and outbound calls for potential disability clients
· Perform general office clerk duties
· Ask a series of questions verbatim for the purpose of compiling data about the client to confirm eligibility
· Record information as needed
· Respect client confidentiality
· Performs other related duties as assigned.
Qualifications
Required Skills/Abilities:
· Must have experience using an auto-dialer system and reading a script verbatim
· Experience using computers and performing data-entry functions
· Legal experience is a plus
· Minimum typing speed of 35 WPM
· Ability to type and talk while using a hands free headset
· Solid reading, writing, and verbal communication skills
· Professional communication skills over the phone and with co-workers and supervisors
· Previous telecommuting/remote work experience is a plus
· Must be able to multitask and be proficient in the use of today's technology
· Must have a desk, chair and basic essentials to work from home
· Must have a quiet work area without noise or distractions
· Must have your own/personal high speed internet ** you cannot use Wi-Fi **
· Reliable and dependable attendance.
Education and Experience:
· This job requires a minimum of a high school diploma or G.E.D and two years of telephone customer service or previous call center experience. Associate degree is preferred.
· Telephone experience is required.
· Experience using computers and performing data-entry functions.
Physical Requirements:
· Prolonged periods of sitting at a desk, talking on a telephone and working on a computer.
Remote Work from Home Requirements:
· Not all positions are remote; some require that the employee work in the office.
· Must have a desk, chair and basic essentials to work from home.
· Must have a quiet work area without noise or distractions.
· Must have personal high speed internet service (Wi-Fi is not acceptable). Our minimum internet speed requirement is 100 download & 20 upload MBPS speed.
· Must be logged onto your work computer and able to answer calls during your normal work hours.
· Remote workers must be based in the United States and must reside in one of the following states: FL, GA, IL, IN, MI, NC, NJ, NV, NY, PA, SC, TX or WV. Must be able to work EST hours provided above.
CASE CARE SPECIALIST - 8B - HYBRID
Remote job
Job Description
The candidate must reside within the following county(s) within Region 8: Bexar, Kerr, Bandera, Gillespie, Kendall, Comal, Guadalupe, Frio, La Salle, Atascosa, Wilson, Karnes, Victoria, De Witt, Lavaca, Calhoun, Jackson, Val Verde, Edwards, Real, Kinney, Uvalde, Medina, Maverick, Zavala and Dimmit County.
PRIMARY FUNCTION/RESPONSIBILTY
The Case Care Specialist is responsible for coordination of services within the SJRC Texas/Belong Network of providers as required by the contract and licensing regulations. The Case Care Specialist will provide support and coordination of services in order to facilitate safety, permanency, and well-being of placements. This includes collaboration with Network Providers to ensure all children receive recommended and/or required services.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Responsible for carrying out case coordination services as required by the contract and licensing regulations.
Coordinates admissions, case planning, extensions, and discharges of child/youth with appropriate parties in the provider network.
Works closely with professional and childcare staff of SJRC Texas/Belong network providers and community partners to ensure the delivery of services outlined in the child/youth service plan.
Makes frequent contact after placement of child/youth to ensure appropriate services are provided with appropriate parties within the provider network and community partners.
Documents child/youth records and services provided by Network Providers in accordance with the provisions of licensing standards, COA, and SJRC Texas/Belong policy.
Attends child/youth case meetings as required with appropriate parties.
Document all contact with clients and collaterals; complete case activity logs each month and keep record of all related documentation; maintain client files.
Maintains strong business relationships with DFPS, the provider network and children and youth to facilitate collaboration and cooperation.
Provide support to intake and placement to include transportation.
Able to assess the strengths and needs of children/youth referred to SJRC Texas/Belong.
Able to engage and communicate effectively with persons from diverse cultures and communities, including children/youth, their parents, network provider's staff, supervisors, administrators, and the legal and judicial system.
Works efficiently in a hybrid setting
Performs other related duties as assigned.
GENERAL EXPECTATIONS
Contributes to building a child welfare system that is safe, secure, and stable; family centered; connected to the community; which relies on evidence-based practice necessary to support contract services in rural counties.
Adheres to all policies and procedures of the agency and its accrediting and standard setting bodies, such as Council on Accreditation (COA) and state licensing.
Maintains client confidentiality per SJRC Texas/Belong standards and all applicable codes of ethics
Learns, understands, and supports the SJRC Texas/Belong mission, purpose, and function.
Carries out the Trauma Informed Care principles and practices for both internal and external stakeholders.
Responsible for the environmental, cultural, safety, diversity issues and needs of the clients and others that enter the work area.
Attends mandatory trainings as defined in positions training matrix.
Attends continuing education necessary to expand knowledge and maintain certifications or licenses.
Uses outside professional collaboration and intra-agency teamwork appropriate to the agency.
Skills in organizing work in a responsible way in an environment with multiple challenges and priorities.
Avoid all conflicts of interest, real or perceived.
QUALIFICATIONS
Required:
Associate's degree from an accredited college or university in Child Welfare or related field plus two (2) years of relevant work experience OR 60 accredited college credit hours plus two (2) years relevant work experience OR 90 accredited college credit hours plus one (1) year of relevant work experience.
Preferred:
Bachelor's degree from an accredited college or university in Child Welfare or related field OR Master's degree from an accredited college or university in Child Welfare or related field.
Certifications/Licenses/Registrations:
Valid Texas Driver's License, good driving record, ability to provide own transportation and proof of current automobile insurance.
PHYSICAL/MENTAL REQUIREMENTS
Physical Demands
Body mobility to stoop, kneel, bend, reach, walk and walk briskly in order to interact with and monitor children.
Stamina to work long days and drive long distances.
Moderate to heavy lifting up to 60 pounds.
Visual and Cognitive Demands
Must have the ability to communicate both verbally and in writing.
Must have the ability to give and receive verbal and written instructions (with or without hearing aids).
Must have the ability to read fine print, have sustained vision, and peripheral vision (with or without glasses).
Environmental Demands
Environment requires dexterity to remain calm and adapt to fast paced and emotional environments consisting of children with moderate to severe emotional and psychological needs.
Minimum of 40 hours per week but may necessitate additional time in order to complete assigned work, which would include evenings and weekends.
May serve as back up to transport clients.
Work Environment
Home-like settings with varying moderate to high degrees of background noise.
Light and ventilation are found in a typical home setting.
Campuses are smoke-free, except on permitted campuses in designated areas.
Possible Hazards
Possible injury when lifting or moving if employee fails to use proper body mechanics, or if proper techniques are not used.
DESCRIPTION OF ORGANIZATIONAL RELATIONSHIP/REPORTING RELATIONSHIPS
Supervised by: Case Care Supervisor
Supervises: N/A
Intake Specialist
Remote job
Purpose
The Intake Financial Clearance Specialist role belongs to the Revenue Cycle team and is responsible for coordinating all financial clearance activities by navigating all pre-registration (to include acquiring or validating patient demographic, insurance, and other required elements along with insurance verification activities), obtaining referral authorization, or precertification number(s). The role ensures timely access to care while maximizing reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. This position reports to the Intake Financial Clearance Manager and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, and practice staff.
**This is a fully remote role**
Responsibilities
Monitors accounts routed to registration, referral and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines.
Maintains knowledge of and complies with insurance companies' requirements for obtaining prior authorizations/referrals and completes other activities to facilitate all aspects of financial clearance.
Acts as subject matter experts in navigating payer policies to get the appropriate approvals (authorizations, pre-certs, referrals, for example) for the ordered services to proceed. The Intake Financial Clearance Specialist is an important part of the larger patient care team and helps clinicians understand what payer requirements are necessary for the widest possible patient access to services.
Supports staff at all levels for hands-on help understanding and navigating financial clearance issues.
Uses appropriate strategies to underscore the most efficient process to obtaining insurance verification, authorizations, and referrals, including online databases, electronic correspondence, faxes, and phone calls.
Obtains and clearly documents all referral/prior authorizations for scheduled services
Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients, and any other parties to ensure that required managed care referrals and prior authorizations are obtained and appropriately recorded in the relevant systems.
When it is determined that a valid referral does not exist, utilize computer-based tools, or contact the appropriate party to obtain/generate referral/authorization and related information. Record the referral/authorization in the practice management system.
Contact physicians to obtain referral/authorization numbers.
Perform follow-up activities indicated by relevant management reports.
Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients' scheduled services.
Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required referral/prior authorizations.
Work collaboratively with the practices to resolve registration, insurance verification, referral, or authorization issue to the extent that these unresolved issues impact the ability to obtain a referral/authorization.
Escalates accounts that have been denied or will not be financially cleared as outlined by department policy
Accept registration updates from various intake points, including but not limited to those received via paper forms, internet registration forms, telephones located in practices and direct calls from patients.
Ensure that all updated demographic and insurance information is accurately recorded in the appropriate registration systems for primary, secondary, and tertiary insurances.
Review all registration and insurance information in systems and reconcile with information available from insurance carriers. For any insurance updates, utilize any available resources to validate the updated insurance information, insurance plan eligibility, primary care physician, subscriber information, employer information and appointment/visit information. Contact patients as necessary if clarifications or other follow-up is required, and at all times maintain sensitivity and a clear customer friendly approach.
For self-pay patients or patients with unresolved insurance, and for financial counseling, refer patients Patient Financial Counseling.
Maintains confidentiality of patient's financial and medical records; adheres to the State and Federal laws regulating collection in healthcare; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately.
Demonstrates knowledge & skills necessary to provide level of customer experience as aligned with BMC management expectations.
Demonstrates the ability to recognize situations that require escalation to the Supervisor.
Establishes relationships and effectively collaborates with revenue cycle staff to support continuous improvement aligned with management expectations as outlined.
Takes opportunity to know and learn other roles and processes and works together to assist with process improvement initiatives as directed.
Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities.
Handle telephone calls in a timely fashion, following applicable scripting and customer service standards. Appropriately manage all calls by either working with the customer or referring the call to the appropriate party.
Communicate with all internal and external customers effectively and courteously.
Maintain patient confidentiality, including but not limited to, compliance with HIPAA.
Perform other related duties as assigned or required.
Requirements
Qualifications
High School Diploma or GED required, Associates degree or higher preferred.
1-3 years patient registration and/or Insurance experience desirable. At least one year of experience must be in a customer service role
General knowledge of healthcare terminology and CPT-ICD10 codes.
Complete understanding of insurance is required.
Demonstrated customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues.
Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management, staff, and other customers.
Able to communicate effectively in writing.
Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view.
Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.
Must be able to maintain strict confidentiality of all personal/health sensitive information.
Ability to effectively handle challenging situations and to balance multiple priorities.
Basic computer proficiency inclusive of ability to access, enter and interpret computerized data/information including proficiency in Microsoft Suite applications, specifically Excel, Word, Outlook and Zoom.
Displays a thorough knowledge of various sections within the work unit to provide assistance and back-up coverage as directed.
Displays a deep understanding of Revenue Cycle processes and applies knowledge to meet and maintain productivity standards as outlined by Management
Salary & Benefits
The estimated hiring salary range for this position is $22/hr - $24/hr. * The actual salary will be based on a variety of job-related factors, including geography, skills, education and experience. The range is a good faith estimate and may be modified in the future. This role is also eligible for a range of benefits including medical, dental and 401K retirement plan.
Appeals Intake Specialist
Remote job
Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. We tailor our services to each client's needs, providing everything from individual specialty claims repricing, to full plan replacement as a high-performance, open-access network alternative.
As an Appeals Intake Specialist, you will play a critical role in resolving post-payment disputes related to Workers' Compensation bills. This includes conducting provider outreach, negotiating disputed charges, and ensuring compliance with state-specific regulations. Your work will directly support our cost containment efforts and ensure appropriate bill reimbursement for our clients.
Primary Responsibilities
Responsible for screening/returning all voicemails and answering questions
Offer guidance to providers including sharing details on documents needed to process their appeal/reconsideration request
If the situation appears to have issues escalating to the senior appeal specialist for direction
Responsible for monitoring/managing the shared appeals inbox
Locating the bill in question and assigning to the appropriate team member for handling
Creation of appeal case in Salesforce or Claimsave
Update the attorney referred cases spreadsheet based on received emails
Bimonthly report updates shared with clients on cases referred to attorneys
Responsible for updating claim platform with new status received from attorneys
Work with senior appeal specialist on updates needed to the process SOP's
Insures accurate and thorough documentation in claims platform for every email and voicemail.
Demonstrates knowledge about workers' comp and Reliant processes
Adheres to our department TAT, either individual claim based or organization wide
Understands the support function of the job and assumes responsibility for assignments.
Establishes and prioritizes job tasks, desired solutions to problems and develops a realistic plan for their accomplishment.
Qualifications
1 -2 years of relevant experience in Workers' Compensation bills or appeals.
Strong understanding of Workers' Compensation reimbursement methodologies, state regulations, and provider billing practices.
Experienced communicator with providers and clients
Ability to collaborate with a variety of individuals both internally and externally.
Familiarity with claims processing systems and provider communications.
Excellent communication and organizational skills.
Requires organizational skills, communication proficiency, discretion, ethical conduct, decision making, technical skills
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
Pay Transparency$50,000-$55,000 USDBenefits:
Comprehensive medical, dental, vision, and life insurance coverage
401(k) retirement plan with employer match
Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
Paid time off (PTO) and disability leave
Employee Assistance Program (EAP)
Equal Employment Opportunity: At Reliant, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business-and our society-stronger. Reliant Health Partners is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
Auto-ApplyUtilization Review Intake Specialist
Remote job
Who We Are
Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future.
Responsibilities Ready to Connect Members to Care Through Expert Pre-Certification Support?
We're seeking a customer-focused professional who can perform critical clerical and administrative duties in the utilization management division while managing high volumes of member interactions with precision and care. As our Utilization Review Intake Specialist, you'll provide accurate information about pre-certification processes while gathering essential demographic and provider data that supports clinical decision-making. This flexible position is ideal for candidates seeking reduced hours while making meaningful impact, with weekend availability required.
What makes this role different:
✓ Flexible schedule: Reduced hours with required weekend availability to support healthcare operations and member needs
✓ First impression impact: Serve as initial point of contact for pre-certification inquiries, setting tone for positive member experience
✓ Process expertise: Master pre-certification processes while providing accurate information to internal and external customers
✓ Data integrity: Ensure complete documentation and data accuracy that supports downstream utilization review decision-making
What You'll Actually Do
Manage customer interactions: Answer and route all incoming phone calls while providing accurate information to internal and external customers regarding pre-certification process.
Gather critical information: Collect demographic, non-clinical, and provider data for pre-certification using phone, fax, inter/intranet, and various computer software programs.
Review and route requests: Analyze service requests and manage them efficiently, involving appropriate departments as needed for optimal resolution and timely processing.
Maintain comprehensive documentation: Perform accurate data entry and maintain complete case information documentation while assisting in document maintenance, revisions, and monthly report compilation.
Meet performance standards: Achieve productivity, quality, and turnaround time requirements on daily, weekly, and monthly basis while supporting team excellence.
Manage high-volume operations: Handle multiple customer service calls while maintaining logs, files, and organized documentation systems in fast-paced environment.
Schedule Requirements
Candidates will be assigned one of the below shifts.
Tuesday - Saturday, 12:30 - 5pm PST
Sunday - Thursday, 12:30 - 5pm PST
Qualifications
What You Bring to Our Mission
The foundational experience:
Associate degree preferred in business, management, or related field
Prior experience in customer service and/or medical background
Prior insurance and/or claims background preferred
Experience in medical front office, hospital patient intake, medical claims processing, or equivalent combination of education and experience
The technical competencies:
Proficiency in Microsoft Excel, Word, and Outlook
Accurate data entry skills (40wpm minimum)
Knowledge of medical terminology; ICD-10, CPT & HCPCS coding desirable
Ability to navigate various computer software programs for data collection and documentation
The professional qualities:
Strong written and verbal communication skills for diverse customer interactions
Ability to manage high volumes of customer service calls while maintaining quality and accuracy
Capability to organize, prioritize, and multitask in fast-paced, deadline-driven environment
Demonstrate ability to work independently with excellent judgment and decision-making
Strong customer orientation with commitment to providing accurate, helpful information
Flexibility to work weekends as required to support operational needs
Adaptability to changing priorities and ability to involve appropriate departments for complex requests
Why You'll Love It Here
We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work.
Your wellbeing comes first:
Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life, not the other way around
Financial security that makes sense:
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Growth without limits:
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
A culture that energizes:
People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable
The practical stuff:
Competitive base salary that rewards your success
Unlimited PTO policy because rest and recharge time is non-negotiable
Benefits effective day one-because you shouldn't have to wait to be taken care of
Ready to create a healthier world? We're ready for you.
No candidate will meet every single desired qualification. If your experience looks a little different from what we've identified and you think you can bring value to the role, we'd love to learn more about you!
Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.
In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $15 to $18 per hour. Note that compensation may vary based on location, skills, and experience. This position is part time and therefore not eligible for benefits.
We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.
#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded
Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site.
Auto-ApplyCASE CARE SPECIALIST - 8B - HYBRID
Remote job
The candidate must reside within the following county(s) within Region 8: Bexar, Kerr, Bandera, Gillespie, Kendall, Comal, Guadalupe, Frio, La Salle, Atascosa, Wilson, Karnes, Victoria, De Witt, Lavaca, Calhoun, Jackson, Val Verde, Edwards, Real, Kinney, Uvalde, Medina, Maverick, Zavala and Dimmit County.
PRIMARY FUNCTION/RESPONSIBILTY
The Case Care Specialist is responsible for coordination of services within the SJRC Texas/Belong Network of providers as required by the contract and licensing regulations. The Case Care Specialist will provide support and coordination of services in order to facilitate safety, permanency, and well-being of placements. This includes collaboration with Network Providers to ensure all children receive recommended and/or required services.
ESSENTIAL DUTIES AND RESPONSIBILITIES
* Responsible for carrying out case coordination services as required by the contract and licensing regulations.
* Coordinates admissions, case planning, extensions, and discharges of child/youth with appropriate parties in the provider network.
* Works closely with professional and childcare staff of SJRC Texas/Belong network providers and community partners to ensure the delivery of services outlined in the child/youth service plan.
* Makes frequent contact after placement of child/youth to ensure appropriate services are provided with appropriate parties within the provider network and community partners.
* Documents child/youth records and services provided by Network Providers in accordance with the provisions of licensing standards, COA, and SJRC Texas/Belong policy.
* Attends child/youth case meetings as required with appropriate parties.
* Document all contact with clients and collaterals; complete case activity logs each month and keep record of all related documentation; maintain client files.
* Maintains strong business relationships with DFPS, the provider network and children and youth to facilitate collaboration and cooperation.
* Provide support to intake and placement to include transportation.
* Able to assess the strengths and needs of children/youth referred to SJRC Texas/Belong.
* Able to engage and communicate effectively with persons from diverse cultures and communities, including children/youth, their parents, network provider's staff, supervisors, administrators, and the legal and judicial system.
* Works efficiently in a hybrid setting
* Performs other related duties as assigned.
GENERAL EXPECTATIONS
* Contributes to building a child welfare system that is safe, secure, and stable; family centered; connected to the community; which relies on evidence-based practice necessary to support contract services in rural counties.
* Adheres to all policies and procedures of the agency and its accrediting and standard setting bodies, such as Council on Accreditation (COA) and state licensing.
* Maintains client confidentiality per SJRC Texas/Belong standards and all applicable codes of ethics
* Learns, understands, and supports the SJRC Texas/Belong mission, purpose, and function.
* Carries out the Trauma Informed Care principles and practices for both internal and external stakeholders.
* Responsible for the environmental, cultural, safety, diversity issues and needs of the clients and others that enter the work area.
* Attends mandatory trainings as defined in positions training matrix.
* Attends continuing education necessary to expand knowledge and maintain certifications or licenses.
* Uses outside professional collaboration and intra-agency teamwork appropriate to the agency.
* Skills in organizing work in a responsible way in an environment with multiple challenges and priorities.
* Avoid all conflicts of interest, real or perceived.
QUALIFICATIONS
Required:
* Associate's degree from an accredited college or university in Child Welfare or related field plus two (2) years of relevant work experience OR 60 accredited college credit hours plus two (2) years relevant work experience OR 90 accredited college credit hours plus one (1) year of relevant work experience.
Preferred:
* Bachelor's degree from an accredited college or university in Child Welfare or related field OR Master's degree from an accredited college or university in Child Welfare or related field.
Certifications/Licenses/Registrations:
* Valid Texas Driver's License, good driving record, ability to provide own transportation and proof of current automobile insurance.
PHYSICAL/MENTAL REQUIREMENTS
Physical Demands
* Body mobility to stoop, kneel, bend, reach, walk and walk briskly in order to interact with and monitor children.
* Stamina to work long days and drive long distances.
* Moderate to heavy lifting up to 60 pounds.
Visual and Cognitive Demands
* Must have the ability to communicate both verbally and in writing.
* Must have the ability to give and receive verbal and written instructions (with or without hearing aids).
* Must have the ability to read fine print, have sustained vision, and peripheral vision (with or without glasses).
Environmental Demands
* Environment requires dexterity to remain calm and adapt to fast paced and emotional environments consisting of children with moderate to severe emotional and psychological needs.
* Minimum of 40 hours per week but may necessitate additional time in order to complete assigned work, which would include evenings and weekends.
* May serve as back up to transport clients.
Work Environment
* Home-like settings with varying moderate to high degrees of background noise.
* Light and ventilation are found in a typical home setting.
* Campuses are smoke-free, except on permitted campuses in designated areas.
Possible Hazards
* Possible injury when lifting or moving if employee fails to use proper body mechanics, or if proper techniques are not used.
DESCRIPTION OF ORGANIZATIONAL RELATIONSHIP/REPORTING RELATIONSHIPS
Supervised by: Case Care Supervisor
Supervises: N/A
Claimant Outreach & Intake Specialist
Remote job
OverviewAt Advocate, our mission is to empower Americans to obtain the government support they've earned. Advocate aims to reduce long wait times and bureaucratic obstacles of the current government benefits application process by developing a unified intake system for the Social Security Administration, utilizing cutting-edge technologies such as artificial intelligence and machine learning, crossed with the knowledge and experience of our small team of EDPNA's and case managers.
We are seeking a dynamic and persistent Outreach & Intake Specialist to be the crucial first point of contact for potential claimants. In this role, you will engage new leads, guide them through the initial information gathering and contract signing process via our Onboarding Flow, and effectively convert interested individuals into Advocate claimants. You'll focus on initiating the claimant journey, ensuring potential claimants feel supported and informed from the very beginning. If you are results-oriented, possess excellent communication skills, and are passionate about helping people navigate complex processes, this role offers the opportunity to make a significant impact without managing ongoing case submissions.Job Responsibilities
Act as the first point of contact for potential claimants, managing inbound leads via phone, text, and potentially other channels.
Conduct prompt and persistent outreach to new leads (within 5 minutes) using tools like Salesforce and Aircall Power Dialer, following established contact sequences (calls, texts, voicemails).
Clearly articulate Advocate's value proposition and answer frequently asked questions to build trust and encourage engagement.
Guide potential claimants through Advocate's online Onboarding Flow, assisting them in providing necessary initial information and signing the representation contract.
Maintain accurate and timely records of all outreach activities, claimant interactions, and lead statuses within Salesforce.
Identify and appropriately handle leads who may not be eligible for services based on initial criteria.
Collaborate with the team to meet and exceed lead conversion goals.
Monitor Advocate's Intake communication lines for new client calls and texts, responding appropriately.
Qualifications
Proven experience in a high-volume outreach, sales, or customer engagement role (e.g., call center, intake specialist, sales development).
Excellent verbal and written communication skills, with an ability to explain processes clearly and empathetically.
Strong interpersonal and persuasion skills with a persistent approach to achieving goals.
Experience using CRM software (Salesforce preferred) and communication tools (Dialers like Aircall preferred).
Highly organized with strong attention to detail for tracking lead progress and documenting interactions.
Ability to work independently and manage time effectively in a remote setting.
Passionate about helping others and contributing to a mission-driven company.
Familiarity with the Social Security disability process is a plus, but not required.
This is a remote position and Advocate is currently a fully remote team. Advocate is an equal opportunity employer and values diversity in the workplace. We are assembling a well-rounded team of people passionate about helping others and building a great company for the long term.
Auto-ApplyV104- Intake Case Coordinator II
Remote job
For ambitious, culturally diverse, curious minds seeking booming careers, Job Duck unlocks and nurtures your potential. We connect you with rewarding, remote job opportunities with US-based employers who recognize and appreciate your skills, allowing you to not just survive but thrive.
As a lifestyle company, we ensure that everybody working here has a fantastic time, which is why we've earned the Great Place to Work Certification every year since 2022!
:
Join Job Duck as an Intake Case Coordinator and become an essential part of a dynamic team dedicated to delivering exceptional client support. In this role, you will manage critical communications with providers, verify balances, and ensure accurate documentation to keep cases moving efficiently. Your ability to stay organized and maintain professionalism will directly impact client satisfaction and operational success. This position is ideal for someone who thrives in a fast-paced environment, enjoys problem-solving, and values clear, empathetic communication.
• Salary Range: from $1,150 USD to $1,220 USD
Responsibilities include, but are not limited to:
Contact providers on behalf of clients to request and review outstanding invoices and verify balances
Coordinate timely follow-ups with stakeholders
Negotiate with providers on behalf of clients after training period
Confirm insurance coverage applicability for clients
Accurately document all findings and interactions in the CRM system
Participate in daily, weekly, and monthly team meetings
Maintain professionalism and empathy in all client and provider interactions
Communicate with multiple providers and consolidate inquiries for efficiency
Requirements:
Additional Job Description:
• Location: Virginia (Remote support for U.S.-based office)
• Time Zone: Eastern Standard Time (EST)
• Office Hours: Monday to Friday 8:30 AM - 5:30 PM EST
• Software/Tools:
• CRM: Neos
• VoIP: Intermedia
• Internal Communication: Neos, Zoom
• Email: Neos
• Calendar: Neos
Required Skills:
• Minimum of 1 year of experience in a client-facing role, such as customer service or sales.
• Advanced/native-level English skills (both written and spoken)
• Strong attention to detail and organizational skills
• Excellent verbal and written communication
• Emotional maturity and ability to handle sensitive information
• Empathetic and professional demeanor
• Ability to work independently and as part of a team
• Comfortable with CRM systems and VoIP tools
EQUIPMENT REQUIREMENTS:
• Intel i5 or better CPU (i5/i7/i9) or AMD Ryzen 5 series
• 8GB RAM (16GB recommended)
• Windows 11
• Internet speed of 15 Mbps upload and download
• Headset with microphone (laptop webcam microphones are not acceptable)
• Apple's mac OS is not supported
Work Shift:
8:30 AM - 5:30 PM [EST][EDT] (United States of America)
Languages:
English, Spanish
Ready to dive in? Apply now and make sure to follow all the instructions!
Our application process involves multiple stages, and submitting your application is just the first step. Every candidate must successfully pass each stage to move forward in the process.
Please keep an eye on your email and WhatsApp for the next steps. A recruiter will be assigned to guide you through the application process. Be sure to check your spam folder as well.
Auto-ApplyMedicaid Enrollment & Intake Specialist (Onsite) Lakeland, FL
Remote job
Join a USA Today Top 100 Workplace & Best in KLAS Team!
Enrollment & Intake Specialist
Pay Range: $23-$25 per hour | Schedule: Sunday-Thursday 8:00am-4:30pm or Monday-Friday 8:00am-4:30pm | Location: Lakeland, FL
Work Where Excellence is Recognized At RSi, we've proudly served healthcare providers for over 20 years, earning recognition as a "Best in KLAS" revenue cycle management firm and a USA Today Top 100 Workplace. Our reputation is built on delivering exceptional financial results for healthcare providers-and an unbeatable work culture for our team. We seek high-performing individuals willing to join our sharp, committed, and enthusiastic team. Here, your performance is valued, your growth is prioritized, and your contributions make a meaningful impact every day. Your Role: Essential, Rewarding, Impactful As an Enrollment Specialist, you have the unique opportunity to advocate for patients and their families, while working hand in hand with hospital personnel to determine eligibility for Medicaid, Social Security Disability, and various County programs. We are looking for you to act as liaisons between government entities and patients to secure funding for healthcare services rendered at Lakeland Regional Hospital. What You'll Do:
Determine patient's eligibility for state, federal, or county programs.
Maintain case load, uphold productivity standards.
Develop and maintain processional relationships with hospital staff, patients, and state workers.
Prepare documents, ensure accuracy and completion.
Adhere to and support organizational standards, policies, and procedures.
Perform other duties as assigned.
What We're Looking For:
Bachelor's Degree preferred.
High School Diploma or equivalent required
Exceptional customer services skills
Demonstrates problem solving and case management skills.
Proficient with technology such as phone systems, computers, Microsoft software applications such as Word, Excel, Outlook, etc.
Excellent written and verbal communication skills
Knowledge of Medicaid, Social Security Administration, and County Social Service programs
An understanding of HIPAA and HITECH patient confidentiality laws to protect the patient, client, and company.
Knowledge of major hospital systems and healthcare environment
Bilingual (English & Spanish)
Why You'll Love RSi:
Competitive pay with ample opportunities for professional growth.
Fully remote position with a stable Monday-Friday schedule.
Collaborative, performance-driven environment with expert leadership.
Mission-driven work supporting essential healthcare services.
Recognition as a nationally respected leader in healthcare revenue management.
Physical Requirements:
Requires prolonged sitting, standing, and walking.
Requires eye-hand coordination and manual dexterity enough to operate a keyboard, photocopier, telephone, calculator, and other office equipment.
Requires normal range of hearing and eyesight to record, prepare, and communicate appropriate reports.
Requires lifting papers or boxes up to 15 pounds occasionally.
Work must be performed inside the hospital or facility.
Travel to other offices and/or client facilities may be required.
What to Expect When You Apply: Our hiring process is designed to find exceptional candidates. Once your application is received, you'll receive an invitation to complete an initial skills assessment. This step is essential: completing this assessment promptly positions you for an interview and demonstrates your commitment to excellence. We believe in creating exceptional teams, and this process ensures that every member at RSi has the opportunity to thrive and grow. Ready to be part of something special? Apply now and join our team!
CASE CARE SPECIALIST - 8B - HYBRID
Remote job
The candidate must reside within the following county(s) within Region 8: Bexar, Kerr, Bandera, Gillespie, Kendall, Comal, Guadalupe, Frio, La Salle, Atascosa, Wilson, Karnes, Victoria, De Witt, Lavaca, Calhoun, Jackson, Val Verde, Edwards, Real, Kinney, Uvalde, Medina, Maverick, Zavala and Dimmit County.
PRIMARY FUNCTION/RESPONSIBILTY
The Case Care Specialist is responsible for coordination of services within the SJRC Texas/Belong Network of providers as required by the contract and licensing regulations. The Case Care Specialist will provide support and coordination of services in order to facilitate safety, permanency, and well-being of placements. This includes collaboration with Network Providers to ensure all children receive recommended and/or required services.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Responsible for carrying out case coordination services as required by the contract and licensing regulations.
Coordinates admissions, case planning, extensions, and discharges of child/youth with appropriate parties in the provider network.
Works closely with professional and childcare staff of SJRC Texas/Belong network providers and community partners to ensure the delivery of services outlined in the child/youth service plan.
Makes frequent contact after placement of child/youth to ensure appropriate services are provided with appropriate parties within the provider network and community partners.
Documents child/youth records and services provided by Network Providers in accordance with the provisions of licensing standards, COA, and SJRC Texas/Belong policy.
Attends child/youth case meetings as required with appropriate parties.
Document all contact with clients and collaterals; complete case activity logs each month and keep record of all related documentation; maintain client files.
Maintains strong business relationships with DFPS, the provider network and children and youth to facilitate collaboration and cooperation.
Provide support to intake and placement to include transportation.
Able to assess the strengths and needs of children/youth referred to SJRC Texas/Belong.
Able to engage and communicate effectively with persons from diverse cultures and communities, including children/youth, their parents, network provider's staff, supervisors, administrators, and the legal and judicial system.
Works efficiently in a hybrid setting
Performs other related duties as assigned.
GENERAL EXPECTATIONS
Contributes to building a child welfare system that is safe, secure, and stable; family centered; connected to the community; which relies on evidence-based practice necessary to support contract services in rural counties.
Adheres to all policies and procedures of the agency and its accrediting and standard setting bodies, such as Council on Accreditation (COA) and state licensing.
Maintains client confidentiality per SJRC Texas/Belong standards and all applicable codes of ethics
Learns, understands, and supports the SJRC Texas/Belong mission, purpose, and function.
Carries out the Trauma Informed Care principles and practices for both internal and external stakeholders.
Responsible for the environmental, cultural, safety, diversity issues and needs of the clients and others that enter the work area.
Attends mandatory trainings as defined in positions training matrix.
Attends continuing education necessary to expand knowledge and maintain certifications or licenses.
Uses outside professional collaboration and intra-agency teamwork appropriate to the agency.
Skills in organizing work in a responsible way in an environment with multiple challenges and priorities.
Avoid all conflicts of interest, real or perceived.
QUALIFICATIONS
Required:
Associate's degree from an accredited college or university in Child Welfare or related field plus two (2) years of relevant work experience OR 60 accredited college credit hours plus two (2) years relevant work experience OR 90 accredited college credit hours plus one (1) year of relevant work experience.
Preferred:
Bachelor's degree from an accredited college or university in Child Welfare or related field OR Master's degree from an accredited college or university in Child Welfare or related field.
Certifications/Licenses/Registrations:
Valid Texas Driver's License, good driving record, ability to provide own transportation and proof of current automobile insurance.
PHYSICAL/MENTAL REQUIREMENTS
Physical Demands
Body mobility to stoop, kneel, bend, reach, walk and walk briskly in order to interact with and monitor children.
Stamina to work long days and drive long distances.
Moderate to heavy lifting up to 60 pounds.
Visual and Cognitive Demands
Must have the ability to communicate both verbally and in writing.
Must have the ability to give and receive verbal and written instructions (with or without hearing aids).
Must have the ability to read fine print, have sustained vision, and peripheral vision (with or without glasses).
Environmental Demands
Environment requires dexterity to remain calm and adapt to fast paced and emotional environments consisting of children with moderate to severe emotional and psychological needs.
Minimum of 40 hours per week but may necessitate additional time in order to complete assigned work, which would include evenings and weekends.
May serve as back up to transport clients.
Work Environment
Home-like settings with varying moderate to high degrees of background noise.
Light and ventilation are found in a typical home setting.
Campuses are smoke-free, except on permitted campuses in designated areas.
Possible Hazards
Possible injury when lifting or moving if employee fails to use proper body mechanics, or if proper techniques are not used.
DESCRIPTION OF ORGANIZATIONAL RELATIONSHIP/REPORTING RELATIONSHIPS
Supervised by: Case Care Supervisor
Supervises: N/A
Auto-ApplyRN Case Management Coordinator - Renal
Remote job
We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care.
Description
Job Description
Location
This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm or 8:30am - 5:00pm EST and will be fully remote.
What You'll Do:
Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members' identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs.
Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
To Qualify for This Position, You'll Need the Following:
Required Education: Associates in a job-related field.
Degree Equivalency: Graduate of Accredited School of Nursing or 2 years job related work experience.
Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Required Skills and Abilities: Working knowledge of word processing software.
Knowledge of quality improvement processes and demonstrated ability with these activities.
Knowledge of contract language and application.
Ability to work independently, prioritize effectively, and make sound decisions.
Good judgment skills.
Demonstrated customer service, organizational, and presentation skills.
Demonstrated proficiency in spelling, punctuation, and grammar skills.
Demonstrated oral and written communication skills.
Ability to persuade, negotiate, or influence others.
Analytical or critical thinking skills.
Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.
Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager.
We Prefer That You Have the Following:
Preferred Work Experience: At least 4 years of renal nursing experience.
Prior hemodialysis, peritoneal dialysis, nephrology nursing, and/or access management experience.
7 years-healthcare program management.
Preferred Education: Bachelor's degree- Nursing
Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
Pay Range Information:
Range Minimum
$53,462.00
Range Midpoint
$77,860.00
Range Maximum
$102,258.00
Pay Transparency Statement:
Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
Auto-ApplyOvernight Housing Case Aide (Homebase Phoenix)
Remote job
Join Our Team at Native American Connections! Who We Are: Native American Connections (NAC) is a nonprofit organization dedicated to improving the lives of individuals and families through affordable housing, behavioral health, and community development services. For over 50 years, we have proudly served Native American and underserved communities in the Phoenix area with culturally competent, trauma-informed care
grounded in respect and tradition. Our Mission: Our mission, grounded in traditional Native American culture, is to reduce health disparities by delivering high-quality, comprehensive integrated healthcare and providing stable housing throughout the communities we serve. Why Work With Us?
When you join NAC, you're not just taking a job - you're becoming part of a movement. A movement that values cultural identity, honors resilience, and believes in the power of community. You'll work alongside passionate professionals who are committed to healing generational trauma, strengthening families, and building vibrant futures. What We Do:
Behavioral Health Services: Culturally responsive treatment for mental health and substance use disorders including outpatient therapy, residential programs, and youth services.
Affordable Housing: Safe, stable, and supportive housing options - from transitional housing to permanent low-income housing.
Community Development: Revitalizing neighborhoods and preserving Native heritage through community-based projects and education.
Our Values:
Health & Wellness | Quality | Accountability | Growth | Interconnectedness/Belonging | Community Now Hiring:
We are seeking compassionate, mission-driven individuals to join our growing team across various departments including clinical services, housing support, youth engagement, and administrative leadership. If you're passionate about social change, cultural advocacy, and serving diverse communities with dignity and care - NAC is the place for you. Based in Phoenix, Arizona | ️ 501(c)(3) Nonprofit Organization Apply Today & Make a Difference Tomorrow:
Visit ************************************************* to view open positions and join our circle of care. Overnight Housing Case Aide Schedule: Friday & Saturday 11:00 PM to 7:00 AM Part time schedule - Sunday - Tuesday 3pm-11:30 pm Salary Range: $16.00 - $18.00 POSITION SUMMARY: The Home Base Youth Services Case Aide provides the necessary stability to the residents of the property through enforcement of community and program rules, life skills education, some case management services, and enforcement of all property rules and state and federal laws for residents residing at Native American Connections properties. RESPONSIBILITIES: Case management in these communities relies on the collaboration and communication of this case aide, case manager, property manager, and any other outside support systems.
Initiate contact with hard-to-engage residents.
Maintain the daily shift report and document all resident communications.
Complete job readiness tasks, such as assisting residents with online job applications and resume writing.
Organize and facilitate social activities, including creating flyers and promoting events.
Complete daily shift tasks, such as property safety walks and cleaning duties
Assist Maintenance in removing trash from a vacated unit. Clean/replenish soft goods when a unit is ready for move-in.
Manage inventory of soft goods. Notify the Property Manager when goods need to be ordered.
Collaborate on the monthly community meetings and work to improve the payment history, health and safety issues, and resident conduct through the community through one-on-one education of the residents as needed.
Other duties as assigned.
EDUCATIONAL/WORK EXPERIENCE REQUIREMENT:
High School Diploma or GED required.
WORK EXPERIENCE / SKILLS REQUIREMENT:
One year experience in service delivery or any combination of related education, professional training, or work experience that demonstrates the ability to successfully perform duties.
Knowledge of the economic, educational, and social problems of Native Americans and referral services
Must be able to work well with others in a team approach.
Excellent communication skills - written and oral
Experience in working with the Native American population preferred.
Possess and maintain a valid Arizona driver's license and reliable transportation.
MS Office skills
NATIVE AMERICAN PREFERENCE
Preference is given to qualified Native American applicants in accordance with the Indian Preference Act. If claiming a preference, a copy of valid documentation will be required.
DRUG FREE WORK PLACE
Native American Connections is a drug free workplace with safety-sensitive jobs. Use of alcohol and legal or illegal drugs may impair and alter employee's judgement resulting in increased safety risks, workplace injuries, and faulty decision making. Reporting to work at NAC after use of alcohol, a controlled substance, or abuse of any other substance is absolutely prohibited.
FAIR LABOR STANDARDS ACT
This position is considered to be Exempt for overtime pay provisions as provided by the Federal Fair Labor Standards Act (FLSA) and any applicable state laws. Non-Exempt employees are entitled to overtime pay for hours worked in excess of forty (40) hours per work week.
Case Management Extender (Part Time Casual, As Needed)
Remote job
**We are more than a health system. We are a belief system.** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities.
** Summary:**
The Case Manager extender works collaboratively with all interdisciplinary staff internal to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of patient care. Primary responsibilities include but are not limited to: insurance verification, obtaining pre-authorization and data entry of patient information, triaging phone calls, and directing calls appropriately, status changes, entering initial and correcting inpatient room and bed charges and performing charge reconciliation. The case manager extender is well organized, highly motivated, customer service oriented and expresses good communication skills. May require weekends and holiday rotations.
**Responsibilities And Duties:**
60%
ASSURING APPROPRIATE PAYER AUTHORIZATION AND/OR PAYER REQUIREMENTS ARE IN PLACE FOR HOSPITAL PAYMENT. 1. Responsible for insurance verification. When necessary, obtains pre-authorization from insurance companies. Interacts with physician offices and other third parties to obtain all necessary paperwork. 2. Triage incoming calls within the phone processing benchmarks. Answers multi line phone system, screens calls for office/hospital associates, directing to appropriate office/hospital associate, and ensures appropriate phone coverage. 3. Communicate and document accurate and appropriate information to internal and external customers. Communicates with third party payers and sends appropriate clinical information for authorization of hospital stay. 4. Perform authorization data entry and coordination of services through proactive collaboration and communications with utilization management and care coordination team. 5. Monitor commercial payers accounts, to include but not limited to: attachment of requested dictation to claims, addition of diagnosis allowances and authorization numbers 6. Refer utilization management/clinical decisions beyond level of authority to care coordination/UM team and Manager/Director of UM team for review and decision. 7. Provides general office and clerical support for office as assigned by Office Supervisor and or Manager, to include but not limited to: faxing dictation to referring physician offices, completion of disability forms, FMLA forms, Attorney request letters for reports, patient record releases, Industrial C-9s, C-84s, C-86s, Medco 17s, Industrial appeal paperwork and retroactive C-9s. 8. Researching, obtaining and completing required documents for the team. 9. Coordinating ancillary services according to policies 10. Facilitate communication between community agencies, care coordination and utilization management team. 1 1. Facilitates transfers of patients to alternative facilities 12. Attends staff meetings 13. Attends continuing in-house education seminars for further education as needed
30%
PATIENT STATUS AND CHARGE RECONCILIATION 1. Responsibility for updating/correcting patient status for appropriate claim drop. 2. Perform charge entry to match appropriate patient status. 3. Review the charge reconciliation report daily to ensure that all room and bed charges are entered correctly on a patient. 4. Work in conjunction with the clinical, revenue and observation billers to correct or adjust any claims as directed by payer discussions.
10%
ORGANIZATIONAL/OFFICE RESPONSIBILITIES 1. Sorts, distributes, and mails transcription as assigned 2. Orders and stocks office supplies. 3. Ensure office equipment, are clean and well-maintained. 4. Provides support to appropriate staff members as assigned
**Minimum Qualifications:**
High School or GED (Required)
**Additional Job Description:**
Associates degree, or three to five years related Experience and/or training, or equivalent combination of and Experience . Computer competency in Microsoft Word, Excel, and Outlook, with a strong aptitude to learn other programs as needed. Ability to manage multiple priorities.
**Work Shift:**
Day
**Scheduled Weekly Hours :**
1
**Department**
Transfer Center
Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment
**Remote Work Disclaimer:**
Positions marked as remote are only eligible for work from **Ohio** .
Bilingual Client Intake Specialist - Remote
Remote job
Job DescriptionDescription:
Keches Law Group, P.C. is a well-established, 50 attorney law firm with offices in Milton, Bridgewater, and Worcester, practicing in the areas of workers' compensation, personal injury, medical malpractice, and discrimination.
We are seeking bilingual Client Intake Specialists to join our team. This is a remote position.
Duties:
Receiving incoming client calls and initiates outbound calls to potential clients, as received electronically and by live transfer
Producing information by transcribing, formatting, inputting, editing, retrieving, copying, and transmitting text, data, and graphics
Using the firm software to enter all case and client details, and maintains detailed logs and task history within the database
Conveying accurate information to clients with regard to different case types with confidence and assurance
Setting the tone and pace of all calls, while maintaining a professional attitude and showing empathy and patience when speaking with potential clients
Demonstrating the ability to converse with varying client personalities to collect pertinent details to determine the viability of their claims
Maintaining client confidence by keeping client information confidential
Enhancing the reputation of the department and the organization by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to the position
Requirements:
Skills/Qualifications:
High School diploma or equivalent
1-2 years of customer service/call center experience or law firm experience is preferred
Multi-lingual abilities are required (Haitian Creole, Cape Verdean Creole, Spanish, or Portuguese require)
Ability to accurately translate verbal information into written correspondence
Ability to prioritize and escalate client calls appropriately
Strong phone, typing, and computer skills are a must; experience with Microsoft Office Suite is preferred
Ability to absorb, retain, and apply new information
Strong attention to detail
Ability to interact professionally and appropriately with clients, attorneys, and others
Must be energetic, well organized, and have the ability to multi-task
Must possess and demonstrate exceptional customer service skills, and the ability to handle situations with tact and diplomacy
Ability to work in a high intensity, high stress environment
Ability to work effectively in a fast-paced environment while accomplishing short-term goals without losing sight and commitment to the longer-term needs of the firm
Excellent verbal and written communication skills
Excellent problem-solving, analytical, and evaluative skills
Schedule
Remote
Monday - Friday
8:30am - 5:00pm (EST)
Benefits
Health, Dental, and Vision Insurance
401(k) Plan with Profit Sharing
Flexible Spending Account
Paid Time Off
Paid Holidays
Basic Life Insurance
Long Term Disability
Employee Referral Bonuses
The anticipated salary range for this position, which we in good faith expect to pay at the time of posting, is $38,000.00 - $41,000.00 annually. This range allows us to make an offer that reflects multiple factors, including experience, education, qualifications, and job-related knowledge and skills, as well as internal pay equity. It's not typical for an individual to be hired at or near the top of the range, as we strive to provide room for future and continued salary growth. Base pay is just one component of our Total Rewards package, which may also include discretionary bonuses, commissions, or other incentives depending on the role.
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. This is largely a sedentary role, however the employee may at times be required to sit; stand; walk; use hands to handle or feel; and reach with hands and arms. The employee must occasionally lift or move office products and supplies, up to 20 pounds.
AAP/EEO Statement
Keches Law Group is an equal opportunity employer. Keches Law Group does not discriminate based on race, ancestry, national origin, color, religion, gender, age, marital status, sexual orientation, disability, veteran status, or any other protected classification under the law.
Specialist - Outreach-Fixed Term
Remote job
Michigan State University actively promotes a dynamic research and learning environment in which qualified individuals of differing perspectives, and cultural backgrounds pursue academic goals with mutual respect and shared inquiry.
The Associate Director supports the overall leadership and strategic direction of IPPSR by fostering connections between academic research and public policy, managing compliance and budgeting, and advancing outreach to state and local stakeholders. It also involves developing independent and collaborative projects, strengthening the survey research unit, mentoring staff, and cultivating a research-driven culture among faculty and students that emphasizes communication, policy engagement, and external funding.
The Associate Director will co-lead signature programs with the Director, such as the Legislative Leadership Program, Michigan Political Leadership Program, Policy Forums, and other educational and training programs. They will also support the Institute's survey research unit, manage large-scale data projects like the Correlates of State Policy database and the Michigan Policy Insiders Panel, oversee the Michigan Applied Public Policy Research grant program, and mentor student research teams.
IPPSR operates within the College of Social Science and seeks to apply research to urgent public issues by offering survey services, educational programs, and fostering problem-solving relationships across academic and policymaker communities on society's most pressing needs. This role requires a collaborative spirit, a commitment to public engagement, and the ability to translate academic research into actionable policy insights. The Associate Director will also contribute to fundraising efforts and represent IPPSR and MSU across campus and beyond.
Key Responsibilities:
Provide strategic leadership and operational support for IPPSR
Co-lead educational programs and policy training initiatives
Expand outreach to policymakers, campus units, and peer institutions
Manage and grow large data projects and research dissemination
Support budgeting, compliance, and staff development
Engage in fundraising and development activities
Oversee research teams and stimulate scholarly output
Represent IPPSR in university and public forums
Equal Employment Opportunity Statement
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, age, disability or protected veteran status.
Required Degree
Masters
Minimum Requirements
• Master's degree and at least 6/8 years' experience in fields of government law, policy affairs, or public policy or bachelor's degree and 8/10 years' experience in fields of government, law, policy affairs, or public policy
• At least three years' professional experience leading teams, managing projects in public policy arenas with increasingly responsible roles involving external relations, program development and execution, strategic planning, team building, conference coordination, budget development and administration, or related fields
• Demonstrated ability to communicate effectively and maintain strategic alliances and relationships with a wide cross section of stakeholders
Desired Qualifications
Strong familiarity with Michigan and national policymaking
Strong writing, editing, and public speaking skills
Commitment to civic engagement and public service
Familiarity with strategic planning, organizational operations, and administrative procedures associated with a university setting
Experience with data-driven policy analysis or survey research
Required Application Materials
• A cover letter detailing your interest and qualifications.
• A current resume/CV.
• The names and contact information of three references
Special Instructions
A valid vehicle operator's license may be required where needed to perform the position's duties. Knowledge of basic personal computer terminology and operations is also required, as is the ability to use e-mail and the Internet.
Standard hours are Monday-Friday, 8:00 a.m. to 5:00 p.m., with occasional evening or weekend commitments.
Review of Applications Begins On
11/18/2025
Remote Work Statement
MSU strives to provide a flexible work environment and this position has been designated as remote-friendly. Remote-friendly means some or all of the duties can be performed remotely as mutually agreed upon.
Website
ippsr.msu.edu
Department Statement
MSU strives to provide a flexible work environment, and this position has been designated as remote-friendly. Remote-friendly means some or all of the duties can be performed remotely as mutually agreed upon.
Michigan State University has been advancing the common good with uncommon will for more than 160 years. One of the top research universities in the world, MSU pushes the boundaries of discovery and forges enduring partnerships to solve the most pressing global challenges while providing life-changing opportunities to a diverse and inclusive academic community through more than 200 programs of study in 17 degree-granting colleges.
MSU is located in East Lansing, MI, with easy access to the state capital, its many great lakes, excellent school districts, affordable housing, Whole Foods, Horrocks, Trader Joe's, and two larger metropolitan areas (Grand Rapids, Detroit). The University is pro-active in exploring opportunities for employment for dual career couples, both inside and outside the University. Information about MSU's dual career support can be found at https://worklife.msu.edu/your-career/dual-career/.
MSU Statement
Michigan State University has been advancing the common good with uncommon will for more than 160 years. One of the top research universities in the world, MSU pushes the boundaries of discovery and forges enduring partnerships to solve the most pressing global challenges while providing life-changing opportunities to a diverse and inclusive academic community through more than 200 programs of study in 17 degree-granting colleges.