Managed Care Coordinator jobs at Centene - 242 jobs

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants must reside in Baton Rouge or surrounding areas and need to be a Licensed Clinical Behavioral health professional with one of the following licensures: LCSW, LMSW, LMFT, LMHC, LPC and at least 5 years BH experience. Predominately work from home but may require some face to face member visits in Baton Rouge and surrounding areas. Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder. Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 - 4 years of related experience. Applicants must reside in Baton Rouge or surrounding areas and need to be a Licensed Clinical Behavioral health professional with one of the following licensures: LCSW, LMSW, LMFT, LMHC, LPC and at least 5 years BH experience. Predominately work from home but may require some face to face member visits in Baton Rouge and surrounding areas. License/Certification: Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required Pay Range: $56,200.00 - $101,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

This role works closely with Care Team Operations, Clinical Operations, Behavioral Health clinicians (LMFT/LCSW/LPCC), Community Health Workers (CHWs), Compliance, Finance (for authorizations), Care Operations Associates, and external partners including hospitals, primary care providers, behavioral health agencies, housing providers, and community-based organizations. Responsibilities Serve as the primary point of contact for assigned members with behavioral health and psychosocial complexity, building trust through consistent, trauma-informed engagement. Conduct comprehensive, holistic assessments addressing behavioral health, substance use, functional status, social determinants of health, safety risks, and care gaps. Develop, implement, and maintain person-centered care plans that integrate behavioral, medical, and social goals; update plans following transitions of care or changes in condition. Coordinate services across the continuum of care, including behavioral health providers, primary care, hospitals, housing supports, transportation, social services, and community-based organizations. Conduct required in-person home or community visits based on acuity, risk stratification, and payer requirements. Support Transitions of Care (TOCs) by completing timely follow-up, coordinating post-discharge services, and reinforcing discharge instructions and medication understanding. Utilize motivational interviewing, behavioral coaching, and health education to promote engagement, adherence, self-management, and long-term member stability. Identify, escalate, and address behavioral health risks, safety concerns, service delays, benefit lapses, and environmental barriers using HHN escalation protocols. Coordinate and track referrals, appointments, transportation, and follow-ups to ensure continuity and timeliness of care. Maintain accurate, timely, and audit-ready documentation of all assessments, encounters, and interventions in eClinicalWorks (ECW) and other HHN systems. Meet or exceed HHN and health plan productivity standards, including outreach cadence, encounter requirements, documentation timeliness, TOC completion, and quality measures. Actively participate in multidisciplinary case reviews, care conferences, team huddles, and escalations with nurses, behavioral health clinicians, CHWs, care operations, and compliance. Assist members with plan navigation, eligibility redeterminations, social service applications, housing resources, and crisis intervention support. Communicate professionally with members and care partners using HHN-approved channels, including phone, RingCentral, secure messaging, and SMS workflows. Contribute to continuous quality improvement efforts by identifying workflow gaps, documenting barriers, and sharing insights to improve care delivery. Uphold confidentiality and comply with all HIPAA, Medi-Cal, ECM, and payer regulatory requirements. Remain flexible and responsive to member needs, including field-based work and engagement in community settings. Skills Required Bilingual (English/Spanish) proficiency required to support member engagement and care coordination. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field. Licensure: Licensed LMFT, LCSW, LPCC.; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

The Bilingual Lead Care Manager partners with Care Team Operations, Clinical Operations, Compliance, Community Health Workers, Behavioral Health staff, and external providers (medical, housing, and social services) to ensure seamless, culturally responsive, member-centered care coordination. The bilingual LCM additionally supports members with limited English proficiency by facilitating communication, translation, and cultural interpretation as needed. Responsibilities Serve as the primary point of contact for assigned members, building trust and maintaining active engagement through consistent outreach, relationship-based strategies, and a trauma-informed approach. Provide all communication in the member's preferred language. Conduct comprehensive assessments (physical, behavioral, functional, social) and develop person-centered care plans that reflect the member's goals, risks, preferences, cultural needs, and social determinants of health. Implement, monitor, and update care plans following transitions of care, significant changes in condition, or required reassessments; ensure timely and compliant submission of all care plans. Coordinate services across the continuum-including medical, behavioral health, housing, transportation, social services, and community programs-to reduce fragmentation and remove barriers to care. Conduct required in-person home or community visits based on member need and risk stratification and maintain a compliant monthly visit structure. Utilize motivational interviewing, coaching, and health education to promote behavioral change, self-management, and long-term member stability. Identify gaps in care, service delays, lapses in benefits, unmet needs, and environmental risks; collaborate with internal and external partners to resolve issues quickly and effectively. Maintain accurate, timely, audit-ready documentation of all interactions, assessments, and interventions using required HHN platforms, including eClinicalWorks (ECW), Google Suite, RingCentral, PowerBI dashboards, and payer portals. Meet or exceed HHN and payer productivity standards, including encounter metrics, outreach requirements, documentation timelines, and quality measures. Actively participate in multidisciplinary case reviews, team huddles, care conferences, and escalations with nurses, behavioral health staff, CHWs, care operations, and compliance. Coordinate and schedule appointments with primary care, specialists, behavioral health providers, and community partners; manage referrals, transportation, and follow-ups to ensure continuity of care. Support hospital discharge (TOC) planning through follow-up scheduling, care transitions, medication reconciliation support, and education on discharge instructions. Assist members in navigating plan eligibility, redeterminations, documentation, social service applications, housing resources, and crisis interventions. Maintain active and professional communication with members and care partners through HHN-approved channels, including RingCentral, secure messaging, SMS workflows, and phone. Participate in HHN's continuous quality improvement efforts, identifying workflow gaps, documenting barriers, sharing insights, and contributing to best-practice development. Uphold confidentiality and adhere to all HIPAA and payer regulatory requirements across all areas of care delivery. Open to seeing patients in their home or their location of preference. Provide real-time interpretation and translation support (verbal and written) for members and families with limited English proficiency. Help bridge cultural gaps that may impact communication, trust, adherence, or engagement. Skills Required Fluency in English and another language (Spanish preferred); ability to read, write, and speak at a professional level. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Bilingual Communication (interpretation + translation) Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field preferred; equivalent experience considered. Licensure: Not required; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

The Bilingual Lead Care Manager partners with Care Team Operations, Clinical Operations, Compliance, Community Health Workers, Behavioral Health staff, and external providers (medical, housing, and social services) to ensure seamless, culturally responsive, member-centered care coordination. The bilingual LCM additionally supports members with limited English proficiency by facilitating communication, translation, and cultural interpretation as needed. Responsibilities Serve as the primary point of contact for assigned members, building trust and maintaining active engagement through consistent outreach, relationship-based strategies, and a trauma-informed approach. Provide all communication in the member's preferred language. Conduct comprehensive assessments (physical, behavioral, functional, social) and develop person-centered care plans that reflect the member's goals, risks, preferences, cultural needs, and social determinants of health. Implement, monitor, and update care plans following transitions of care, significant changes in condition, or required reassessments; ensure timely and compliant submission of all care plans. Coordinate services across the continuum-including medical, behavioral health, housing, transportation, social services, and community programs-to reduce fragmentation and remove barriers to care. Conduct required in-person home or community visits based on member need and risk stratification and maintain a compliant monthly visit structure. Utilize motivational interviewing, coaching, and health education to promote behavioral change, self-management, and long-term member stability. Identify gaps in care, service delays, lapses in benefits, unmet needs, and environmental risks; collaborate with internal and external partners to resolve issues quickly and effectively. Maintain accurate, timely, audit-ready documentation of all interactions, assessments, and interventions using required HHN platforms, including eClinicalWorks (ECW), Google Suite, RingCentral, PowerBI dashboards, and payer portals. Meet or exceed HHN and payer productivity standards, including encounter metrics, outreach requirements, documentation timelines, and quality measures. Actively participate in multidisciplinary case reviews, team huddles, care conferences, and escalations with nurses, behavioral health staff, CHWs, care operations, and compliance. Coordinate and schedule appointments with primary care, specialists, behavioral health providers, and community partners; manage referrals, transportation, and follow-ups to ensure continuity of care. Support hospital discharge (TOC) planning through follow-up scheduling, care transitions, medication reconciliation support, and education on discharge instructions. Assist members in navigating plan eligibility, redeterminations, documentation, social service applications, housing resources, and crisis interventions. Maintain active and professional communication with members and care partners through HHN-approved channels, including RingCentral, secure messaging, SMS workflows, and phone. Participate in HHN's continuous quality improvement efforts, identifying workflow gaps, documenting barriers, sharing insights, and contributing to best-practice development. Uphold confidentiality and adhere to all HIPAA and payer regulatory requirements across all areas of care delivery. Open to seeing patients in their home or their location of preference. Provide real-time interpretation and translation support (verbal and written) for members and families with limited English proficiency. Help bridge cultural gaps that may impact communication, trust, adherence, or engagement. Skills Required Fluency in English and another language (Spanish preferred); ability to read, write, and speak at a professional level. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Bilingual Communication (interpretation + translation) Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field preferred; equivalent experience considered. Licensure: Not required; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

Job Description Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Hours: 8am - 5pm in your local time zone Call rotation - 1 weekend every 16 weeks You will report into the Associate Medical Director, Utilization Management. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $211,200 - $ 277,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses. Responsibilities: Provide timely medical reviews that meet Oscar's stringent quality parameters. Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen. Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level). Use correct templates for documenting decisions during case review. Meet the appropriate turn-around times for clinical reviews. Receive and review escalated reviews. Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research. Compliance with all applicable laws and regulations Other duties as assigned Requirements: Board certification as an MD or DO Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC. 6+ years of clinical practice 1+ years of utilization review experience in a managed care plan (health care industry) Bonus points: Licensure in multiple Oscar states BC in Cardiology, Radiation/Oncology, or Neurology Experience with care management within the health insurance industry. Willing and able to obtain additional state licensure as needed, with Oscar's support This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. The Care Coordinator will coordinate the with the Care Team Lead and Care Team Member Services Manager to ensure the team has the resources required to satisfy member enrollment and maintenance in the IPC Copay Assistance Program. The Care Coordinator will respond accordingly to incoming and make external calls to client members to ensure appropriate processing of copay assistance. Essential Duties and Functions: Provide client support where needed Coordinate member implementation calls with Care Team Lead Provide adhoc claims review as required Identify utilizing patients, review history, determine next coverage date Assist patient with enrollment in the manufacturer's program Maintain patient database for follow-up, tracking and reporting Receive notification of new patient's prior authorization/or review daily rejected and paid claims This position will include job duties that require risk designations for access to Electronic Protected Health Information (PHI) in the course of their job responsibilities Other duties may be assigned Competencies: Planning/organizing-the individual prioritizes and plans work activities and uses time efficiently. Makes good and timely decisions that propels our company forward Interpersonal skills-the individual maintains confidentiality, remains open to others' ideas and exhibits willingness to try new things. Creates an environment where teammates feel connected and energized. Written and Oral communication-Communicate a concise message that resonates every time. The individual speaks clearly and persuasively in positive or negative situations and demonstrates group presentation skills. Problem solving-Create innovative ways for our customers and our company to be successful. The individual identifies and resolves problems in a timely manner, gathers and analyzes information skillfully and maintains confidentiality. Quality control-the individual demonstrates accuracy and thoroughness and monitors own work to ensure quality. Adaptability-the individual adapts to changes in the work environment, manages competing demands and is able to deal with frequent change, delays or unexpected vents. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Required Certified Pharmacy Technician (CPhT.) License or 2-5 years of experience in a retail pharmacy or pharmacy benefit management environment Excellent communication skills Proficient with MS Office Suite Professional telephone demeanor Ability to maintain a high level of confidentiality Pay Range 18.00 - 20.00 Hourly The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

Provide support to members for disease prevention and healthy promotion. Empower members to achieve optimal health and wellness by providing personalized guidance, education, and support. This role collaborates with individuals to set and reach health goals, navigate the healthcare system, and make informed decisions about their well-being within the context of their health plan benefits. Description Location This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm and will be fully remote. The candidate will be required to report on-site for their first day. What You'll Do: Assess for needs related to a member's chronic condition, clinical risk and readiness for change via company needs questionnaire. Based on the needs assessment, complete and coordinate action plans in cooperation with members, then implement plans to include member goals. Provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to elicit behavior change and increase member program engagement. Participates in patient education with members and providers regarding the member's condition and available benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in health and chronic condition management programs. Provides appropriate communications (written, telephone) regarding member conditions to both health care providers and members. Participates in data collection/input into system for clinical information flow. 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 network status of all service providers to educate members on care they may receive related to their chronic condition(s). Assists members with referrals to appropriate internal support areas to ensure proper processing of authorized or unauthorized services, as needed. To Qualify for This Position, You'll Need the Following: Required Education: Associate's in job related field Degree Equivalency: Graduate of Accredited School of Nursing OR graduate of a health-related degree OR 2 years job related work experience Required work experience: 3 years of professional health and wellness experience 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. Software and other tools: Microsoft Office Licenses and Certifications: Within 4 years of hire, must get certification in health coaching (ex: National Board Certified Health and Wellness Coach). We Prefer That You Have the Following: Preferred Education: Bachelor's degree in health-related field (e.g. Nursing, Social Work, Health Ed, Wellness, Health Promotion, Behavioral Health) Preferred Work experience: 5 years - healthcare management Preferred Specialized Training: Health Coaching Certification Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. 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. 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. 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We are currently hiring for a Managed Care Coordinator I to join BlueCross BlueShield of South Carolina. In this role as a Managed Care Coordinator I, you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Description Location This position is full time (40 hours/week) Monday-Friday from 8:30am - 5:00pm EST and will be fully remote. What You'll Do: Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. 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). Provides patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. 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. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. 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 of job-related work experience. Required Work Experience: 2 years' clinical experience. Required Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in typing, 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 Licenses and Certificates: Active, unrestricted RN licensure 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 LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire. We Prefer That You Have the Following: Preferred Education: Bachelor's degree- Nursing. Preferred Work Experience: work experience in healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits 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. 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. 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FLSA Status: Non-Exempt Department: Health Services Reports To: Supervisor, Utilization Management The Medical Management Care Coordinator I performs non-clinical supportive duties related to utilization management (UM) and care coordination for Santa Clara Family Health Plan (SCFHP) members. Routine supportive duties include but are not limited to data entry into system software applications, managing department telephone queues, and assisting with quality monitoring projects for both SCFHP lines of business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, Care Coordinator Guidelines and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Follow established Health Services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent manner * Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction. * Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing. * Assist in gathering and processing data for internal required reports and analysis. * Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions. * Follow UM policies and processes to the management of incoming authorization requests received through fax, mail or telephone. * Identify authorization requests for line-of-business, urgency level, type of service, and assess for complete/incomplete record submission. * Perform complete, accurate, and consistent data entry into system software applications in accordance with policies, procedures and instruction from UM management. * Answer inbound UM phone queue calls timely to assist members and/or providers regarding inquiries involving authorizations, SCFHP program services, and/or benefits. * Process written and verbal notifications of authorization determinations to members and/or providers within regulatory processing timeframes. * Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * High school diploma or GED. (R) * Minimum two years of experience in a health care setting in positions requiring interaction with members and/or providers. (R) * Knowledge of health plan benefits, process and operations related to commercial, Medi-Cal and/or Medicare programs. (D) * Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support department operations as dictated by business needs. (R) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) * Demonstrated ability to consistently meet Key Performance Indicators by participating in and achieving the standards put forth to achieve the standard requirements of the Utilization Management Department (R) * Ability to work within an interdisciplinary team structure. (R) * Work weekends and company holidays as needed based on business and regulatory requirements. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific UM programs. (R) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

Are you a compassionate individual who enjoys helping others achieve their personal health and wellness goals? If so, a career as a CHOICES Care Coordinator might be perfect for you. As a Care Coordinator, you will make a lasting impact on members' lives by ensuring their safety at home or within a community setting. In this role, you'll travel to member's homes for visits, while managing various demands and requests from both internal and external stakeholders. We're seeking individuals who excel in problem-solving through critical thinking, and who are adept at time management and prioritizing daily tasks. You should be self-motivated, flexible, and thrive in a fast-paced environment. Most importantly, you should have a passion for improving the quality of life for diverse members in their communities. You will be a great match for this role if you have: • 3 years of experience in a clinical setting • Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). • Exceptional customer service skills • Must live within the following counties: Memphis/Shelby County • Available for an 8:00am - 5:00pm EST(no on call) schedule, with the option (upon management approval) to work a compressed work week after 1 year. Job Responsibilities Partnering with members and families to identify needed supports and direct services to meet personal goals for good health, employment and independent or community living. Collaborates with a team of clinical and social support colleagues to meet the physical, behavioral health and long term service needs of each member. Conduct thorough and objective face-to-face visits with and assess each members situation to determine current status and needs, including physical, behavioral, functional, psycho-social, financial, and employment and independent living expectations. Utilizing criteria for authorizing appropriate home and community based services and confirm those services are being provided and that members needs are being met. Valid Driver's License. TB Skin Test (applies to coordinators that work in the field). Position requires 24 months in role before eligible to post for other internal positions. Various immunizations and/or associated medical tests may be required for this position. Job Qualifications Experience 2 years - Clinical experience required Skills\Certifications PC Skills required (Basic Microsoft Office and E-Mail) Effective time management skills Excellent oral and written communication skills Strong interpersonal and organizational skills License Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Are you a compassionate individual who enjoys helping others achieve their personal health and wellness goals? If so, a career as a CHOICES Care Coordinator might be perfect for you. As a Care Coordinator, you will make a lasting impact on members' lives by ensuring their safety at home or within a community setting. In this role, you'll travel to member's homes for visits, while managing various demands and requests from both internal and external stakeholders. We're seeking individuals who excel in problem-solving through critical thinking, and who are adept at time management and prioritizing daily tasks. You should be self-motivated, flexible, and thrive in a fast-paced environment. Most importantly, you should have a passion for improving the quality of life for diverse members in their communities. You will be a great match for this role if you have: • 3 years of experience in a clinical setting • Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). • Exceptional customer service skills • Must live within the following counties: Hickman, Lewis, and Perry Counties • Available for an 8:00am - 5:00pm EST(no on call) schedule, with the option (upon management approval) to work a compressed work week after 1 year. Job Responsibilities Partnering with members and families to identify needed supports and direct services to meet personal goals for good health, employment and independent or community living. Collaborates with a team of clinical and social support colleagues to meet the physical, behavioral health and long term service needs of each member. Conduct thorough and objective face-to-face visits with and assess each members situation to determine current status and needs, including physical, behavioral, functional, psycho-social, financial, and employment and independent living expectations. Utilizing criteria for authorizing appropriate home and community based services and confirm those services are being provided and that members needs are being met. Valid Driver's License. TB Skin Test (applies to coordinators that work in the field). Position requires 24 months in role before eligible to post for other internal positions. Various immunizations and/or associated medical tests may be required for this position. Job Qualifications Experience 2 years - Clinical experience required Skills\Certifications PC Skills required (Basic Microsoft Office and E-Mail) Effective time management skills Excellent oral and written communication skills Strong interpersonal and organizational skills License Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs. This role requires reviewing provider requests, gathering necessary medical documentation, and making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies care coordination opportunities, and ensures compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the patient's needs in the least restrictive and most effective manner. **Work Arrangement** + Remote role + Monday through Friday from 8:00 AM to 5:30 PM EST + 4 out of 10 recognized company holidays to include Thanksgiving and Christmas (rotating) + Weekends based on business need **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of care, and adherence to clinical guidelines + Collaborate with healthcare providers to facilitate timely authorizations and optimize patient care + Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines + Communicate determinations effectively, providing clear, evidence-based rationales for approval or denial decisions + Identify and escalate complex cases requiring physician review or additional intervention + Ensure compliance with industry standards, including Medicare, Medicaid, and private payer requirements + Maintain productivity and efficiency by meeting established performance metrics, turnaround times, and quality standards in a high-volume environment **Education & Experience** + Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred + Minimum of 3 years of diverse independent clinical practice experience to include Intensive Care Unit (ICU), Emergency Department (ED), Medical-Surgical (Med-Surg), Skilled Nursing Facility (SNF), Rehabilitation, or Long-Term Acute Care (LTAC) settings + Minimum of 2 years of experience applying evidence-based criteria (e.g. InterQual) to complete prior authorization and concurrent reviews for inpatient and/or outpatient services + Experience conducting utilization management reviews for an insurance company (e.g. Medicaid, Medicare or commercial plan) is preferred **Licensure** + An active and unencumbered Registered Nurse (RN) license under the Nursing Licensure Compact (NLC) + Ability to obtain additional licensure across the enterprise to include the District of Columbia + Valid Driver's License **Skills and Abilities** + Competency in electronic medical record (EMR) documentation and charting + Proficiency using MS Office to include Word, Excel, Outlook and Teams + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and regulatory compliance + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment + Maintains a strong working knowledge of federal, state, and organizational regulations to ensure consistent application in the review process + Accurate typing skills Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. We want to connect with you if you want to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at *************************** **Our Comprehensive Benefits Package** Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

In an environment of continuous quality improvement, the Denials Management Coordinator is responsible for reviewing all denials to determine patterns in errors, payors, and internal processes to improve our denial rate. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times. Job Functions: Analyzes all denials for patterns. Works with front line staff and educate on proper processes. Ability to verbalize to insurance carriers and write appeal details to support additional payment on denied claims. Accurately and consistently documents the results of all denial reviews in the hospital information system. Prepares reports as required by management regarding audit results, process improvement recommendations and systemic payment errors. Makes monthly observations and recommendations to prevent future denials. Assumes all other duties and responsibilities as necessary. Qualifications Minimum Education/Experience Required: High School Diploma or GED required. Minimum of two years of previous experience in a healthcare-related position required. Experience in coding, medical necessity, registration, insurances, and precertification processes and/or denials preferred. Minimum of 2 years of experience or formal education in basic ICD10 coding, medical terminology, Anatomy/pathophysiology, and disease process preferred. Depending on healthcare-related experience, may require coding certification within 2 years of date of hire. Experience reviewing ambulatory claim denials preferred. Special Knowledge, Skills, Training: Computer skills (word processing, spreadsheet, graphics, and database software applications). Strong quantitative, analytical and organization skills. Strong negotiation skills. Proficient in payment review systems, hospital information systems and coding methodologies. Ability to understand medical records, hospital bills, and the charge master. Ability to understand all ancillary department functions for the facility. Ability to understand complex insurance terms and payment methodologies. Ability to effectively negotiate with insurance carriers and customers. Ability to utilize and understand computer technology. Ability to communicate orally and in written form. Team-orientated with strong interpersonal skills. Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended. Benefits: Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer, please visit our website at ************************** Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer. Memorial Health System is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at ******************************************* or at any USDA office, or call ************** to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax ************** or email at ***********************. * Memorial Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees.

Job Address: 4770 Larimer Pkwy Johnstown, CO 80534 New Vista Health and Wellness is currently recruiting a Utilization Review Coordinator! WHO WE ARE The New Vista mission: Inspiring Hope, Restoring Peace of Mind, Healing Lives. At New Vista, our passionate and highly trained team of professionals inspires hope and delivers holistic care to those in need of behavioral health services in a contemporary and healing environment - one that is conducive to providing the life skills needed to regain stability and independence. With a blend of group therapy, clinical treatment, and unique surroundings, our beautiful healthcare centers provide a safe, serene, healing environment for adults and seniors with a variety of complex needs. Our compassionate team members work in a challenging yet rewarding environment where each person is a part of making direct impact on our patient's lives. COME JOIN OUR TEAM AS UTILIZATION REVIEW COORDINATOR AT SIERRA VISTA! Salary: Up to $46K PERKS AT WORK Team Members enjoy a variety of perks in working with the NewVista brand company. We offer competitive market wages along with a full, robust package: Healthcare + Life Balance Medical Packages with Rx - 3 Choices Flexible Spending Accounts (FSA) Dependent Day Care Spending Accounts Health Spending Accounts (HSA) with a company match Dental Care Program - 2 choices Vision Plan Life Insurance Options Accidental Insurances Paid Time Off + Paid Holidays Employee Assistance Programs 401k with a Company Match Education + Leadership Development Up to $15,000 in Tuition Reimbursements OR Student Loan forgiveness Handle with Care Trainer - Certifications Recognition + Rewards On the spot recognition Prizes Team Member of the Quarter Team Member of the Year Monthly Celebrations Team Member Recognition Cards Education High school diploma or GED (Required) Bachelor's Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field preferred. Previous Utilization Review experience in a behavioral healthcare facility preferred. JOB RESPONSIBILITIES As Utilization Review Coordinator, you will : Obtain initial authorizations and provide discharge notifications for inpatient and outpatient behavioral health treatment. Coordinate authorization information with third party payors in a timely manner. Complete thorough and accurate documentation in all required systems. Maintain communication system based on documentation and verbal exchange regarding treatment with other UM staff and staff at the facilities as needed. Reports appropriate denial and authorization information to designated resource. Assist UM Specialists in scheduling and following up on results of Peer to Peer requests for physicians and CNP. Provide support to the UM Specialists. Skills: Ability to multi-task Strong organization skills Strong problem-solving skills Ability to work well independently and as a part of a team Qualified candidates, apply now for a chance to join our outstanding team as we Inspire Hope, Restore Peace of Mind, and Heal Lives.

New York Psychotherapy and Counseling Center (NYPCC) is a leading non-profit organization in New York that has been caring for the community for over 40 years. We are founded on the belief that everyone, no matter age, race or socioeconomic status, is entitled to the best possible mental health treatment. With seven treatment facilities within Brooklyn, Queens, and the Bronx, we assist children, families, and individuals with behavioral and emotional challenges in becoming more productive, independent members of society. Why Work at NYPCC? Medical, Dental, and Vision Insurance is Paid for by NYPCC 100% Paid Time Off and Company Paid Holidays Annual Rate Increases We pay down your student loans! Loan Forgiveness 403B Retirement Plan Professional Development through NYPCC Academy Are You a Good Fit? We are currently seeking an energetic, bright, and self-motivated Care Coordinatorto join our team. This is a full-time position that will be based out of our state-of-the-art Child and Family Health Center located at 579 Courtlandt Ave, Bronx, NY. Gateway to Wellnessis a Health Home Care Management initiative being implemented by New York Psychotherapy & Counseling Center (NYPCC) to supplement and enhance the current behavioral health services we offer and provide throughout the NYC area. Job Responsibilities: Manage a 85+ caseload of Health Home Care clients Assist in developing a Comprehensive Care Plan Address various service needs (e.g. Housing, Benefits, medical care, transportation, education, employment, Crisis Intervention and other supportive services to enhance client's quality of life) Work as a member of Care Team including; Supervisor, Clinicians, verbal Psychotherapists, and Psychiatrists Successfully execute advocacy, assessment, service planning, creating linkages/referrals and ongoing documentation and monitoring of Electronic Health Records Contact individuals diagnosed with mental illness, substance abuse disorders and chronic medical conditions that significantly impact functioning on a monthly basis in person and by phone Job Qualifications: MUSTbe bilingual (English/Spanish) Bachelor's Degree required Experience with GSI Health Home Software required Experience with HARP clients preferred Possess knowledge of various resources and services within a community to assist with overall service delivery and linking members to the services they need or want based on a client-centered service plan Possess excellent verbal and written communication skills to be able to provide linguistically appropriate services to their assigned caseload Communicate with other professionals, a network of providers and managed care organizations regarding client statuses, level of functioning and needs for additional services NYPCC is a fast-paced, energetic, dynamic environment that employs people with a passion for our mission. We offer a very competitive salary with full benefits including; Medical, Dental, Vision, Paid Time Off, Salary Increases, Bonuses, 403b Retirement Plan and more. Perkins and other loan forgiveness may also be available, in addition to our Student Loan Pay Down incentive. NYPCC is an Equal Opportunity Employer

--------------------------------------------------------------- The Intensive Care Coordinator (ICC) is responsible for developing and implementing member-centric, individualized care plans and providing telephonic and community-based care coordination for members with high health care needs, including members with complex behavioral concerns, severe and persistent mental illness, substance use disorders, and/or receiving facility based, in-home or community-based psychiatric services. The ICC utilizes clinical expertise in behavioral health conditions and knowledge regarding the adult and children's system of care to provide coordination that is member driven, strengths based, and culturally and linguistically appropriate. The ICC acts as the primary care coordination liaison for providers working with members involved in, on waitlists for, or who may qualify for, Wraparound or Choice Model Services. NOTE: This hybrid role averages 2-3 partial days per week in the community, with the remainder of work done remotely from home. Estimated Hiring Range: $81,000.00 - $99,000.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Assessment and Care Planning * Assess for and identify care coordination needs. * Identify risk factors and service needs that may impact member outcomes and address appropriately. * Utilize a trauma-informed approach to provide member-centric care and support. * Assist in helping members move through the continuum of care based on clinical/medical need. * Coordinate with providers to ensure consideration is given to unique needs in integrated planning and that care plans are timely and effective. * Identify suspected abuse and neglect issues and appropriately report to mandated authorities. * Implement care coordination plan in collaboration with member, providers, case workers and other relevant parties. * Work closely and collaborate with behavioral health treatment providers, crisis services, Developmental Disability, APD, DHS, etc. Intensive Care Coordination * Provide telephonic and community-based care coordination to eligible members and families. * Provide support and coordination for members receiving treatment in the higher levels of behavioral health care such as psychiatric residential treatment, intensive community based or psychiatric day treatment. * Ensure treatment recommendations are understood by the member and provider and assist members through transitions to the next level of care or treatment provider. * Facilitate communication between members, their support systems other community-based partners and clinical care providers and ensure care plans are shared, as appropriate. * Forward relevant information of members requiring special consideration of benefits to Medical Management Review RNs or to affiliated CareOregon programs. * Serve as a resource to the organization on mental health and substance use topics and issues. * Accept assignment of and maintain a caseload of members. * Effectively coordinate an interdisciplinary team for integrated care plan support of complex members. * May participate in monthly state hospital IDT meetings as well as discharge planning meetings. * Participate in CCO/APD IDT meetings to coordinate care services for OHP members in long term care services. * Collaborate with community providers, state and county case workers, community partners, vendors, agencies, Choice contractors, wraparound teams, and other relevant parties * Provide direction as appropriate to non-clinical Care Coordination staff involved with the member Transition Assistance * Assist in transition/discharge planning for members discharging from acute care settings or those who are transitioning from long term care, the Oregon State Hospital or other residential facilities to ensure a smooth transition back to community-based supports. * Ensure discharge/transition plans are evaluated holistically from physical and behavioral health perspectives. * Ensure members on the state hospital Ready to Transition (RTT) list are prioritized for referral into appropriate transition setting through collaboration with and community partners including the CHOICE ENCC. * May compile and distribute referral packets to residential and foster care facilities as needed. * Coordinate care for members residing outside of service area as required in contract. Compliance * Maintain unit compliance with Coordinated Care Organization requirements. * Maintain tracking data for program evaluation and reporting purposes. * Maintain timely and accurate documentation about each member per program policies and procedures. * Maintain working knowledge of COA and OHP benefits, including Addictions and Mental health benefits. * Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. * Participate in quality and organizational process improvement activities and teams when requested. * Assist Quality Assurance (QA) staff in identifying behavioral health providers with practice patterns which are not in conformity to best practice standards. * Maintain unit compliance with the Model of Care requirements if applicable. Organizational Responsibilities * Perform work in alignment with the organization's mission, vision and values. * Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. * Strive to meet annual business goals in support of the organization's strategic goals. * Adhere to the organization's policies, procedures and other relevant compliance needs. * Perform other duties as needed. Experience and/or Education Required * Master's degree in social work, counseling or other behavioral health field * Minimum 2 years' experience in mental health and/or drug and alcohol treatment for the population being served * Valid driver's license, acceptable driving record, and automobile liability coverage or access to an insured vehicle Preferred * Experience with a similar population in health plan case management/care coordination or behavioral health integration in a person-centered primary care home, experience administering the Oregon Health Plan (OHP) (Medicaid) and the Centers for Medicare and Medicaid Services (CMS) (Medicare) benefits * Related experience in the use of Motivational Interviewing (MI) * Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), or equivalent * Certification as CCM (Certified Case Manager) and/or Certified Alcohol Drug Counselor II or III (CADC II or III) Knowledge, Skills and Abilities Required Knowledge * Knowledge of current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for mental health and substance dependence/abuse diagnoses, ASAM (American Society of Addiction Medicine) criteria for alcohol and/or drug dependence treatment and Mental health * Knowledge of best practices and treatment modalities * Knowledge of co-morbidities that indicate potential for psychiatric de-compensation and/or relapse * Knowledge of side effects of psychotropic medications that may impact health status and adherence with treatment recommendations and behavioral health integration in primary care settings * Knowledge of the Oregon Health Plan benefit package, eligibility categories, and Oregon Medical Assistance Program (MAP) rules and regulations * Knowledge of Medicare parts A and B benefit packages and the Centers for Medicare and Medicaid Services (CMS) rules and regulations and community resources * Knowledge of community resources Skills and Abilities * Ability to exercise sound clinical judgment, independent analysis, critical thinking skills, and knowledge of behavioral health conditions to link members with appropriate providers * Ability to meet department standards for competency in the use of motivational interviewing within 12 months of hire, collaborate with members, providers, and community partners to develop plans to address complex care needs and monitor and evaluate a plan of care for optimal outcomes * Ability to work in an environment with diverse individuals and groups * Ability to establish collaborative relationships and effectively lead a multidisciplinary team * Ability to manage multiple tasks and to remain flexible in a dynamic work environment and work autonomously and effectively set priorities * Ability to participate in work-related continuing education when offered or directed * Ability to provide excellent customer service and verbal and written communication * Basic word processing skills * Ability to learn, focus, understand, and evaluate information and determine appropriate actions * Ability to accept direction and feedback, as well as tolerate and manage stress * Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day * Ability to operate a motor vehicle Working Conditions Work Environment(s): ☒ Indoor/Office ☒ Community ☐ Facilities/Security ☒ Outdoor Exposure Member/Patient Facing: ☐ No ☒ Telephonic ☒ In Person Hazards: May include, but not limited to, physical, ergonomic, and biological hazards. Equipment: General office equipment and/or mobile technology Travel: Requires travel outside of the workplace at least weekly; the employee's personal vehicle may be used. Driving infractions will be monitored in accordance with organizational policy. If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws. If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws. We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

FLSA Status: Non-Exempt Department: Health Services Reports To: Director, Behavioral Health The Behavioral Health Services Personal Care Coordinator is responsible for supporting and coordinating internal and external resources for members referred to case management programs for all lines of business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. * Work with case managers to assist members navigating the healthcare delivery system and home and community-based service to facilitate access related to medical, psychosocial and behavioral health benefits and services. * Monitor and respond to inbound case management inquiries and referrals and escalate to clinical staff, as appropriate. * Provide outreach to members to facilitate timely completion of Health Risk Assessments (HRA's) by telephone, mail or in person, as needed. * Support the coordination of member care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers and other stakeholders to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community. * Assist with coordinating the involvement of the interdisciplinary care team (ICT) members including the member and/or their family/responsible party to implement the individualized care plan (ICP). Oversee correspondence related to care plans. Document ICT meetings following SCFHP policies and procedures. * Support successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review. Assist to ensure follow up for psychiatric hospitalizations for members to obtain psychiatric/behavioral health care. * Follow UM policies and procedures for new authorization requests. May conduct data entry into the authorization software application system and determination notification to member and/or provider in accordance with regulatory timeframes. * Produce and distribute internal reports that may include QI reports, member admission and discharge reports and external stakeholder reports, as appropriate. * Follow established Health Services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent manner. * Maintain knowledge of current resources in communities served by our members to support case management goals. * Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing. * May support and conduct non-clinical training in accordance with training guidelines and protocols; provide input and develop training and reference materials. May develop Behavioral Health department orientation binder and assist with onboarding of new employees. * Identify issues and trends (data, systems, member, provider, other) as well as general departmental questions/concerns; report relevant information to management; and make recommendations to improve operations. * Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction. * Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training, coaching sessions and external stakeholder meetings. * Understanding of Behavioral Health and 1115 Waiver programs, including Alcohol and Drug Services and assess members for appropriate referrals into these programs. May be required to facilitate Behavioral Health Treatment (BHT) services, including identification of providers, timely access to assessment and treatment. * Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. * Bachelor's Degree in a health related field or equivalent experience, training or coursework. (R) * Minimum three years of relevant experience in a healthcare or community setting providing care coordination of health and/or social services. (R) * Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) * Knowledge of Medicare and/or Medi-Cal benefits, community resources and principals of case management. (D) Knowledge of medical terminology. (D) * Knowledge of Santa Clara County Health and Social Services. (D) * Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support department operations as dictated by business needs. (R) * Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) * Ability to work within an interdisciplinary team structure. (R) * Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R ) * Ability to use a keyboard with moderate speed and a high level of accuracy. (R) * Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R) * Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) * Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) * Ability to maintain confidentiality. (R) * Ability to comply with all SCFHP policies and procedures. (R) * Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: * Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) * Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) * Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) * Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) * Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) * Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels

At Collective Health, we're transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. At Collective Health, Care Navigation plays a crucial role in helping people get the right support, at the right time, across a wide range of complex health needs. Care Navigation is a comprehensive care management program made up of our team of pharmacists, social workers, nurses, dietitians, and care coordinators that support people dealing with chronic or serious illnesses by guiding them on their journey to help them understand and navigate the disjointed U.S. healthcare system. In joining our Care Navigation team, you'll have the important role of helping our members achieve better health at a lower cost. You will report to the Care Coordinator Team Lead of Care Navigation. What you'll do: Provide telephonic support for our Care Navigation program, care managers and members we serve Take ownership of tasks as assigned for cases requiring additional non-clinical follow up and case coordination, including, but not limited to: researching and answering plan benefits and claims questions, provider research, obtaining medical records with a focus on cost-savings Work directly with members, vendors and providers to ensure superior coordination of care Co-manage cases with care managers, ensuring all assigned tasks are completed on time Act as liaison between Care Navigation and other Customer Service teams within Collective Health, ensuring member needs are met in an accurate and timely manner Utilize multiple systems to respond to, troubleshoot and document customer inquiries including Google Suite Other duties and projects as assigned by Manager To be successful in this role, you'll need: 1+ years experience in customer-facing role, healthcare experience is preferred. Bilingual Preferred: (English/Spanish) Bachelor's or Associate's degree is a plus Medical Assistant or Pharmacy technician experience is a plus Effectively handle multiple priorities, organize workload, and meet deadlines Establish and maintain positive, cooperative, working relationships with ability to work in a team-based environment and achieve common goals Have outstanding oral and written interpersonal communication skills to navigate sophisticated member inquiries Self-driven and maintain composure and compassion when balancing a high volume of tasks You are comfortable navigating multiple computer applications with dexterity Want to simplify healthcare because you believe people deserve better Pay Transparency Statement This is a hybrid position based out of our Lehi office, with the expectation of being in office at least two weekdays per week depending on location. #LI-hybrid The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the hourly rate, you will be eligible for 5000 stock options and benefits like health insurance, 401k, and paid time off . Learn more about our benefits at ******************************************** Lehi, UT Pay Range$21.55-$26.95 USD Why Join Us? Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare Impactful projects that shape the future of our organization Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests Flexible work arrangements and a supportive work-life balance We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact recruiting-accommodations@collectivehealth.com. Privacy Notice For more information about why we need your data and how we use it, please see our privacy policy: *********************************************

ComForCare Home Care is a franchise of premier in-home care providers. We take time to understand the needs of our clients and work diligently to keep them safe at home. With ComForCare, clients can live independently and continue to do the things they love. As a Scheduler at ComForCare, you will oversee the scheduling and coordination of client services, manage staffing assignments, ensure compliance with agency policies and regulations, and maintain confidentiality of client and employee information Learn more about how we show we value our team and why they love working at ComForCare. Why Join ComForCare: Competitive salary based on experience Mileage reimbursement Tuition Assistance Discounted Prescription medications Paid Time Off (PTO) Paid Training Work with a team committed to excellence in home care Company support for educational and learning opportunities Bonus opportunities /performance bonus On-Call Pay We know the industry better than anyone. Make a meaningful difference by ensuring that clients receive timely and effective care while fostering a supportive, positive environment for employees. KEY RESPONSIBILITIES: Scheduling & Coordination Create and maintain weekly caregiver schedules, ensuring client needs are met. Quickly respond to call-offs and arrange coverage. Communicate schedule updates to caregivers, clients, and families. Maintain accurate records in scheduling software. Caregiving (Primary Backup Support) Provide in-home care when primary caregivers are unavailable. Assist clients with activities of daily living (ADLs) such as personal care, meal preparation, light housekeeping, and companionship. Follow care plans and company standards to ensure quality service. This position requires the person to be in-office during normal business hours and provide one-call support as needed or required by the supervisor/manager. QUALIFICATIONS: Previous scheduling or office coordination experience (preferred). Experience in caregiving, home care, or healthcare (required). Strong communication and problem-solving skills. Ability to multitask and adapt to changing priorities. Reliable transportation and valid driver's license. Must pass background check and meet state caregiving requirements. PERSONAL CHARACTERISTICS: A positive, can-do attitude, with the resilience to thrive in a fast-paced environment. Strong communication and interpersonal skills to build relationships with clients, families, and team members. A problem-solver, with the ability to navigate challenges and find effective solutions. Empathy, humility, and a genuine desire to support both clients and team members. Willingness to go the extra mile when needed-be available after hours, weekends, and on-call as necessary. Job Type: Full-time PAY: $41,700 per year + Bonus + On-Call Pay Compensation: $41,700.00 per year Live your best life possible while helping others live theirs. Our Caregivers are the heart and soul of what we do. For that reason, we put our CaregiversFirst each and every day. At ComForCare, it is our CaregiverFirst promise, that our caregivers will be: Treated with respect and dignity. Provided exceptional training on a regular and ongoing basis. Are never alone in the field - support is always available. Thoughtfully matched with clients that they are compatible with. Join our team and be a part of a certified Great Place To Work ! Thousands of ComForCare employees were surveyed and the response was overwhelmingly positive, with 90% agreeing that ComForCare is in fact a Great Place To Work . By selecting the positions below, you acknowledge that you are applying for employment with an independently owned and operated ComForCare franchisee, a separate company and employer from ComForCare and any of its affiliates or subsidiaries. You understand that each independent franchisee is solely responsible for all decisions relating to employment including (and without limitation to) hiring and termination, and ComForCare does not accept, review or store my application. Any questions about your application or the hiring process must be directed to the locally owned and operated ComForCare franchisee. Equal Opportunity Employer: Disability/Veteran.