Change Healthcare jobs - 154 jobs

Commonwealth Care Alliance (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care, which yields improved quality outcomes and lower costs of care. Job Summary: inst ED provides patient-centered, high-quality acute care in place to adults with complex medical needs. Reporting to the Manager, Network Delivery, the inst ED Mobile Health Coordinator (MHC) is the first point of contact for patients who are seeking an inst ED visit. The Mobile Health Coordinator warmly greets all callers and completes a thorough and accurate intake for callers requesting a referral for an inst ED visit. The MHC assigns the visit to one of inst ED's paramedic partners based on geography and availability and monitors the physician assignment algorithm. In addition, the MHC monitors visit progression to ensure timely service delivery. Finally, the MHC assists the nursing team with non-clinical administrative support and serves as the main point of contact for paramedic partner dispatchers, paramedics, and the inst ED Virtual Medical Control (VMC) team for all non-clinical issues. Essential Functions: Answer incoming phone calls in a timely manner using a cloud-based platform. Collect accurate patient information and document in the inst ED NOW platform and Athena medical record to process an inst ED referral. Collect, review, and accept written consent from patients, upload consents from paramedics. Verify patient eligibility using inst ED NOW, Athena, or external payor portals. Collect payment(s) from patients (e.g., copay, co-insurance). Assign visits to one of inst ED's ambulance partners based on geography and availability; collaborate with nursing staff to prioritize high acuity patients. Communicate with the dispatchers from the ambulance partners to facilitate throughput of inst ED visits; convey clinical concerns/questions to the nursing team. Maintain awareness of all ambulance partner vehicle's status and location. Call patients if mobile health providers are unable to reach patients with an updated ETA; escalate to the nursing team when patients cannot be reached via phone. Make recommendations to improve the inst ED NOW platform. Monitor that VMC providers are checked in and out of inst ED NOW in a timely manner and outreach to them if this does not occur. Monitor VMC auto-assignments and manually re-assign if needed when a VMC provider is nearing the end of shift and cannot complete a visit. Complete an end of shift report before logging off at the end of a shift. Ensure that mobile health providers have completed all documentation by the end of their shift and outreach to the paramedic partner when there is outstanding documentation. Perform any other job related duties as requested. Education and Experience: High School or GED required Associates degree preferred Five (5) years professional work experience in a healthcare setting with at least one (1) year of remote work experience required Customer service experience via phone communications, preferably in a health care call center setting interacting with patients required Process improvement experience required Experience working closely with colleagues at all levels of a company including front-line staff to senior leaders required Medical assistant, or other related experience in an urgent care, emergency or home care setting preferred Administrative support to clinicians in healthcare setting preferred 911 Telecommunicator or Emergency Medical Dispatcher Certification preferred Mobile integrated health experience preferred Competencies, Knowledge and Skills: Ability to communicate effectively without judgment to a diverse patient population while demonstrating empathy Highly adaptable to frequent workflow changes in a fast-paced environment Willing to learn and utilize several different software applications (e.g., proprietary inst ED NOW platform, Teams, etc.) Proficient with Microsoft Outlook Superb verbal communication skills and strong written communication skills Computer and phone system proficiency (e.g., Ring Central or other cloud communications platform) Power BI or other business intelligence software knowledge preferred Proficient in Excel preferred Process improvement training (e.g., lean, six sigma, etc.) preferred Medical terminology preferred Athena (electronic medical record) knowledge preferred Bilingual (Spanish), bicultural preferred Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Must be willing to work weekends, evenings, and holidays Travel is not typically required Compensation Range: $41,200.00 - $66,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Hourly Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

The Community Based Waiver Service Coordinator, Duals Integrated Care is responsible for managing and coordinating services for individuals who require long-term care support and are eligible for community-based waiver programs, ensuring that members receive the necessary services and supports to live independently in their communities while also coordinating care across various healthcare and social service systems. Essential Functions: Engage with member in a variety of community-based settings to establish an effective, care coordination relationship, while considering the cultural and linguistic needs of each member. Conduct comprehensive assessments to determine the needs of members eligible for community-based waiver services. Develop individualized service plans that outline the necessary supports and services, ensuring they align with the individual's preferences and goals. Serve as the primary point of contact for members and their families, coordinating care across multiple providers and services, including healthcare, social services, and community resources. Facilitate access to necessary services such as home health care, personal care assistance, transportation, and other community-based supports. Regularly monitor the implementation of service plans to ensure that services are being delivered effectively and that individual needs are being met. Conduct follow-up assessments to evaluate the effectiveness of services and make adjustments to person-centered care plans as needed. Advocate for the rights and needs of members receiving waiver services, ensuring they have access to the full range of benefits and supports available to them. Empower members and their families/caregivers to make informed decisions about their care and support options. Build and maintain relationships with healthcare providers, community organizations, and other stakeholders to facilitate integrated care. Lead and collaborate with interdisciplinary care team (ICT) to discuss individual cases, coordinate care strategies, and create holistic care plans that address medical and non-medical needs. Provide education and resources to members and their families/caregivers about available services, benefits, and community resources. Offer guidance on navigating the healthcare system and accessing necessary supports. Maintain accurate and up-to-date records of member interactions, care/service plans, and progress notes. Assist in preparation of reports and documentation required for compliance with state and federal regulatory requirements. Respond to crises or emergencies involving members receiving waiver services, coordinating immediate interventions and support as needed. Evaluate member satisfaction through open communication and monitoring of concerns or issues. Regular travel to conduct member, provider and community-based visits as needed and per the regulatory requirements of the program. Report abuse, neglect, or exploitation of older adults as a mandated reporter as required by State law. Regularly verify and collaborate with Job and Family Service to establish and/or maintain Medicaid eligibility. On-call responsibilities as assigned. Perform any other job duties as requested. Education and Experience: Nursing degree from an accredited nursing program or Bachelor's degree in health care field or equivalent years of relevant work experience is required. Minimum of 1 year paid clinical experience in home and community-based services is required. Medicaid and/or Medicare managed care experience is preferred Competencies, Knowledge and Skills: Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel Prior experience in care coordination, case management, or working with dual-eligible populations is highly beneficial. Understanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiaries. Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers. Awareness of and sensitivity to the diverse backgrounds and needs of the populations served. Ability to manage multiple cases and priorities while maintaining attention to detail. Adhere to code of ethics that aligns with professional practice, including maintaining confidentiality. Decision making and problem-solving skills. Knowledge of local resources for older adults and persons with disabilities. Licensure and Certification: Current and unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) in the State assigned is required. Case Management Certification is highly preferred. Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check and verified insurance. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated. Employment in this position is conditional pending successful clearance of a criminal background check. Results of the criminal background check may necessitate an offer of employment being withdrawn or, if employee has started in position, termination of employment. To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process. Working Conditions: This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need. May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer. Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members. Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-ST1

Key Responsibilities: Serves as the point of contact for customer queries and resolution. Provides customer services relating to sales, sales promotions, installations and communications. Ensures that good customer relations and seamless turnaround in problem resolution are maintained and customer claims, product orders and complaints are resolved fairly, effectively and in accordance with the consumer laws. May answer questions and provide prompt information related to potential concerns. Develops organization-wide initiatives to proactively inform and educate customers. ***Shift Details - 11:30pm - 8:00pm Minimum Requirements: High School Diploma or GED Required Skills: Ability to complete multiple activities while utilizing excellent customer service skills Demonstrate ability to communicate clearly in both written and oral communication Maintains all patient confidentiality Other duties and responsibilities as assigned by supervisor. Career Level - IC-Business Support - B1 Additional Information ALL ANSWERS MUST BE "YES" Do you have a High School Diploma or GED? Are you able/comfortable working from home?

The Quality Analyst II is responsible for analyzing and interpreting complex healthcare data. This role will collaborate with cross-functional teams, providing analytical insight to inform strategy and interventions to drive improved quality performance. Essential Functions: Generate graphics that effectively describe, explore and summarize analyses for communication to appropriate parties Responsible for completing the analysis process to determine best course of action for each inquiry/problem Review reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques and provide management level summaries that explain key findings Collaborate with team members on technical specifications and coding tactics Assist in quality dashboard development and reporting using Power BI and other visual data tools Gathers and understands requirements for analytic requests Perform any other job duties as assigned Education and Experience: Bachelor of Science/Arts degree in Management Information Systems (MIS), computer science or related field or equivalent work experience is required Minimum of two (2) year experience of HEDIS or similar quality healthcare performance metrics experience is required. 2 years Prior programming experience (i.e. SQL, SAS, Python or DAX) is required Health care delivery and/or payer experience is preferred Clinical experience is preferred Competencies, Knowledge and Skills: Proficient with Microsoft Office Suite Proficient in minimum one of the programming skills (i.e., SAS, SQL, or DAX) required Analytic skills for solving multi-dimensional business questions Graphic development & presentation skills Exposure to statistical concepts preferred Critical listening & thinking skills Effective verbal and written communication skills Problem Solving skills Knowledge of managed care and health care data coding Ability to work with IT teams, familiarity with MDS and data architecture Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-GB1

This position is responsible for selling and renewing accounts, conservation account management for specified consultants and large agencies, as well as, defined strategic accounts. This Position is accountable for establishing and maintaining relationships with key and essential face-to-face business partners. Essential Functions: Work within a team environment Lead the consultants/agents through the BCBSF sales process to achieve renewal goals, collateral material, proposal and rating, closing/acquisition, objection handling, enrollment/implementation, account management/retention, renewal, channel knowledge and integration Develop and manage a strategic alliance to accounts Manage and lead consultants/agents to obtain renewal goals Create consultant/agents commitment to BCBSF Favorably position BCBSF by demonstrating BCBSF's value to the consultant/agency: reliability, innovation, product portfolio, negotiated discounts, service, flexibility, expansive networks/provider accessibility, and customer satisfaction Participate in or conduct information forums, as needed Develop and implement focused tactics and programs that recognize the consultant/agency as an integral part of the customer relationship that maximizes the value of the account/business partner Establish and maintain a good relationship with consultant/agency/ key community influencers by focusing on four critical elements: trust, flexibility, service and value Readily identify with the environment in which the consultant/agency operates Determine "mode of thinking" of consultant/agency Determine consultants'/agencies' "hot buttons" Recognize and support consultant/agency programs Educate consultants on BCBSF renewal process, products, pricing, policies and procedures Focus on account's/consultants' needs and our ability to positively respond Act as liaison or key point of contact between account/consultant and BCBSF Manage relationship with consultant/agency to strengthen partnership with customer Build strong partnerships with individuals within and outside the sales organization who support servicing and selling of our products Manage own personal and professional development Establish contacts and enhance relationships with consultant/agency by exhibiting knowledge, technical competency, reliability and professionalism Identify opportunities to mentor and coach others to achieve results and is open to cultural and geographic considerations Manage time, territory, costs and administrative requirements by effectively planning and carrying out plans to ensure that support activities are achieved at reasonable cost Comply with state and regulatory requirements and corporate policies and procedures Required Experience: 8+ years related work experience. Related Bachelor's degree or additional related equivalent work experience Proven dynamic problem solver, accustomed to drawing upon varied disciplines and resources to tailor solutions for a complex, multifaceted and specific scenario Public speaking and presentation proficiency (i.e. "Board Ready") Must be a self-started, comfortable in an environment in which there is no one right answer, and where flexibility, creativity, and nimbleness of thought is paramount. Must be customer-oriented, and calm in the face of adversity Health and Life Insurance License or ability achieve professional certification within 3 months Proven relationship management skills Preferred Qualifications: Multiple years of experience working with Fortune 500 companies. Demonstrated experience working and capitalizing in an industry with an evolving regulatory framework (state and federal). Proven community, industry and civic leader accustomed to balancing competing interests of shareholders, employees, members, and/or outside vendors. Masters Degree General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. What We Offer: As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to: Medical, dental, vision, life and global travel health insurance; Income protection benefits: life insurance, short- and long-term disability programs; Leave programs to support personal circumstances; Retirement Savings Plan including employer match; Paid time off, volunteer time off, 10 holidays and 2 well-being days; Additional voluntary benefits available; and A comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Typical Annualized Hiring Range: $201,600 - $252,000 Annualized Salary Range: $201,600 - $327,600 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

The Media Relations Specialist III is responsible for maximizing earned media opportunities in both traditional news and across a variety of platforms, tracking the benefits of these efforts to drive awareness and business goals. Essential Functions: Responsible for identifying new story opportunities to position CareSource with media outlets and build brand awareness with target audiences Develop and manage content for media and external audiences, including news stories, news releases and other communications Manage agencies in markets to support company initiatives Respond to media inquiries in a timely and appropriate manner Provide support during crisis situations with strategic communications Monitor daily local, regional and national news coverage about CareSource, health care and related issues Manage ongoing earned media intelligence platforms and develops quarterly reports Support social media strategy Responsible for promoting CareSource locally in all markets and nationally including developing award entries, coordinating media events and providing support to company spokespeople/ presenters Develop and maintain relationships with key internal stakeholders, including executives, to ensure successful collaboration Responsible for ensuring all external materials are consistent with brand positioning, established guidelines Serve as a liaison with key departments to provide effective communication strategy Maintain a leadership role on project teams Perform any other job duties as requested Education and Experience: Bachelor's degree or equivalent in Communications, Public Relations, Journalism, or related field or equivalent work experience is required Minimum of five (5) years of experience in media relations is required; healthcare communications experience is preferred Previous professional writing experience is preferred as demonstrated by portfolio Competencies, Knowledge and Skills: Intermediate proficiency level with Microsoft Office Intermediate proficiency level with visual software programs, such as PowerPoint or other related software program is required Ability to communicate effectively through oral and written communications Ability to articulate thoughts with all levels of management and in pressure intense situations Ability to handle sensitive and confidential matters with discretion. Effective decision making and problem resolution skills Strong critical listening and thinking skills Advanced writing and editing skills Experienced technical writing skills preferred Ability to work on and meet tight deadlines Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time May require minimal travel Compensation Range: $61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-RW1

Talent Acquisition Sourcing for Personal Financial Counseling Positions. Seeking someone with experience sourcing for CFP's, AFC's and CHFC's. Contract position up to 6 months. Fully Remote. What is Talent Acquisition at Magellan? It may not be what you think. We operate with one goal in mind, to share our unique brand far and wide. We are thought leaders in health care and masters of networking. This position is ideal for recruitment partners with exceptional ability to find and engage passive candidates, utilize market intelligence and influence key business leaders. In this position, you are a. . . . Digital Citizen You use digital technology purposefully and confidently to communicate, find information and come up with effective solutions. You are a Super User of our Candidate Relationship Management (CRM) technology and use it to automate the candidate communication process, encourage engagement and improve the candidate experience. You fully leverage our CRM methodology and technology to effectively manage talent pipelines, work efficiently and engage in new ways of finding candidates. You understand that technology will improve results and appreciate the way cutting edge systems can differentiate Magellan. Marketer You understand Magellan's vision, hiring goals and business needs. You live and give life to our brand and share it throughout our networks. You speak, write and listen combining empathy with business savvy. Career Coach You create authentic relationships with hiring managers, candidates and colleagues. You understand and balance the hiring need with the candidate's career goals. You manage conflicting situations, such as salary level vs. skill set, with professionalism and objectivity. Design Thinker You construct talent acquisition strategies infused with market, industry and labor intelligence in order to understand how best to personalize candidate engagement and attract the talent needed. Data-Based Decision Maker You use data to ask questions, seek answers and gain accurate insights. You use data to help candidates, managers and business leaders make better decisions. Why join Magellan? Working at Magellan is more than a job. It's a calling to make a difference for our most vulnerable populations - we're leading humanity to healthy, vibrant lives. You're a key part of our purpose, you're not just filling vacancies. Through best in class processes and technology solutions, and a commitment to what makes us uniquely Magellan, you'll find the talent we need to lead our organization into the future. Come join us! The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities To be successful in this role, you should have the following skills and experience: At a minimum, 3 years or more of recruitment/recruitment coordinator/HR experience and a bachelor's degree OR 5 years or more of recruitment/recruitment coordinator/HR experience and an associate's degree Demonstrated ability using CRM technology or sophisticated ATS technology. Understand and drive the full life cycle recruitment process. Strong understanding of marketing and branding principles and how to effectively use them to hire talent. Ability to manage high volume recruitment and meet deadlines for hiring. Ability to attend career fairs and other hiring events. Ability to establish relationships and partner effectively with candidates, HR business partners, managers and peers. Ability to be flexible and work in a sometimes ambiguous and changing environment and able to juggle shifting priorities and manage time effectively. General Job Information Title Financial Talent Acquisition Sourcer - Contract Position/Remote Grade 25 Work Experience - Required Talent Acquisition/Recruiting Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's Education - Preferred Master's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $64,285 Salary Maximum: $102,855 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience. CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC. Strategic Solutions Management Consultants (SSMC) is a full-service medical billing and practice management firm offering a comprehensive, sophisticated approach to private practice physicians, and physician and hospital networks. Strategic Solutions expertise goes beyond traditional transactional billing. Their team of consultants, coders, and billers provide critical insights for their providers. The Medical Biller with SSMC will be responsible for providing direct billing services to their assigned clients, which may include provider offices, hospitals, and other facilities. They will act as a primary resource for billing support, submission of claims, statement management, reporting and other duties as assigned or requested. Billers are required to meet work quality and productivity standards, to ensure outstanding client service. QUALIFICATIONS: * High school diploma or GED required * Minimum one (1) year of customer service experience required. * Experience in a medical office setting strongly preferred. * Knowledge of medical billing and/or collections preferred. * Experience with Medent preferred. * Experience with Microsoft Office, including Outlook, Word and Excel required. * Must be detail-oriented with strong organizational skills. * Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions. * Demonstrated ability to provide excellent customer service and develop relationships both internally and externally. * Demonstrated ability to work with and maintain confidential information. * Excellent verbal and written communication skills. * Flexibility to adapt to a changing and fast-paced environment. Please note, the option to work from home is contingent on the below: * A dedicated private workspace. * Agreement to our telecommuting policy. * Wired internet connection and minimum internet speeds. Salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. Some roles may also be eligible for overtime pay. Our compensation packages go beyond just salary. In addition to cash compensation, employees have access to award-winning health care coverage, health and flexible spending accounts, and a 401(k) plan with company match. The company also provides a generous paid time off allowance, life insurance, and employee assistance programs. As an Equal Opportunity / Affirmative Action Employer, CDPHP does not discriminate in employment practices on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. Strategic Client Executives help providers overcome one of the biggest headaches in healthcare. You will develop and oversee relationships with our Provider clients, which include some of the nation's most prestigious medical centers and eHR organizations. This position is responsible for having an in-depth knowledge of ePA and will develop targeted strategies to both grow our network and meet clients' needs. What You'll Do You will retain and develop some of our fastest-growing accounts, with a focus on creating tailored solutions for individual clients. You will ensure full adoption of our provider solutions, with an eye towards long-term account retention. Leverage relationships with assigned accounts to deliver on utilization initiatives Manage complex problems and requests by coordinating the development of solutions through collaboration with internal partners. Lead business reviews, webinars, and training sessions Develop strategies to find and capitalize on retention and expansion opportunities utilizing a value-based selling approach Foster loyal, long-term relationships with decision-makers Travel to clients as needed (about 20%) About You You love working with people - both colleagues and clients - in a fast-paced, entrepreneurial environment. You have a healthy mix of left-brain (detail-oriented and analytical) and right-brain (charismatic and collaborative). You take a data-driven approach to understanding your clients, and are always up-to-date on trends affecting their accounts. You are results-oriented, self-motivated, and have a high level of initiative. Bachelor's degree required At least 4 years of client-facing experience, with record of results in launching, growing, and retaining client accounts Healthcare experience a plus Great communicator one-on-one, in writing, and in formal presentations, at any level, from hospital staff to executives Top-notch strategic acumen, problem-solving, and analytical ability About Us CoverMyMeds is one of the fastest growing healthcare technology companies in the US. We help prescribers and pharmacies submit Prior Authorization requests for any drug and nearly all health plans - 100% free - to get millions of patients on their medications every single year. Our team of highly-productive healthcare enthusiasts with a passion for helping others is the best thing about working here. On-site chef and paid benefits? Yeah, we have those too. But don't take our word for it. We've been named to Glassdoor's top 50 places to work in the nation, Inc. 500's list three times, were awarded one of the top places to work by Modern Healthcare and three times won best places to work in Columbus, Ohio. These requirements represent the knowledge, skills, and abilities necessary to perform this job successfully. Reasonable accommodation can be made to enable individuals with disabilities to perform essential functions. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $79,400 - $132,300 McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

Internship Program The CareSource Intern is responsible for providing support on special projects, initiatives, and specific activities which will vary by assignment. We offer a 12-week, paid summer internship program for college students who want to separate themselves from the pack. This is an exciting opportunity to obtain real-world experience and prepare yourself for your career after college. The program offers: The opportunity to work on projects that truly impact the company Journey-to-the-Job seminars with CareSource leaders to network and learn about their career paths An assigned mentor and access to former interns who earned full-time positions with CareSource An opportunity to test what you have learned and discover where you want to go The satisfaction of working with smart and motivated people while building new skills Essential Functions: Project Development & Implementation - Lead the design and execution of a listening session with an underrepresented Medicaid membership population to gain insight and ensure effective outreach and engagement strategies are in place. Data Analysis - Conduct thorough analyses of membership data to evaluate retention strategies, assess marketing campaign effectiveness and identify health equity gaps including actionable insights. Round Table Facilitation - Organize and facilitate a monthly roundtable meeting with call center staff to discuss trends, gather insight, and suggest improvements for the overall member experience based on this real time feedback. Education and Experience: High School Diploma or equivalent is required Current Rising Junior or Senior in an accredited degree program or graduated within the last 6 months is required Competencies, Knowledge and Skills: Proficient with Microsoft Office Suite to include Outlook, Word, Excel and PowerPoint Good written and verbal communication skills Ability to work in a fast-paced environment Ability to work independently and within a team environment Effective listening and critical thinking skills Dependable, flexible and ability to maintain confidential information Effective problem-solving skills with attention to detail Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Personalized orientation and mentoring programs Company and job-specific training Feedback opportunities throughout your first 90 days Inclusive culture with employee resource groups Flexible work environment with remote opportunities and paid volunteer hours Performance and personal growth goals with defined success metrics Ongoing feedback process with your manager to discuss your progress and identify actions for continued growth Potential for internal and external training and development programs, stretch assignments, expanded responsibilities and more Compensation Range: $35,200.00 - $56,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JH1

The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Essential Functions: Responsible for pricing, forecasting, reserving or other actuarial processes including development of key assumptions, as well as evaluation of financial experience and trend drivers Develop and communicate actionable and strategic recommendations to leadership in support of company goals Manage the development and maintenance of actuarial models to support key business goals and initiatives, such as actual to expected experience reporting, actuarial reserves and accruals, bid pricing/rate filings, forecasting, and contracting models Own the actuarial processes being managed (i.e., rate/bid filings, pricing, forecasting, reserving) within the company and with external vendors for assigned lines of business Specific function may require performing baseline analysis on expectations of rate changes for future years and work with federal and state agencies to support rate filings and other relevant activities Specific function may require overseeing development and review of Incurred But Not Reported (IBNR) reserve estimates for all CareSource lines of business on a monthly basis Perform any other job related instructions as requested Education and Experience: Bachelor's degree in actuarial science, mathematics, economics or a related field or equivalent years of relevant work experience is required Two to three (2 to 3) years or more of management experience is preferred Two to three (2 to 3) years or more of actuarial experience is preferred Strong database (SQL, SAS or Access) experience is preferred Managed care or healthcare experience is preferred Preferred: Experience leading Medicaid rate advocacy in at least one state Preferred: Understanding of accounting concepts such as accruals Competencies, Knowledge and Skills: Excellent written and verbal communication skills Excellent listening and critical thinking skills Strong interpersonal skills and high level of professionalism Ability to manage, develop, and motivate staff Ability to develop, prioritize and accomplish goals Ability to interact with all levels of management as well as external stakeholders Excellent problem-solving skills with attention to detail Excellent auditing and peer reviewing skills Ability to work independently and within a team Ability to effectively analyze data, develop/maintain appropriate models, draw and report findings and/or conclusions tailored for respective audiences Demonstrate sound business judgment when drawing conclusions and making recommendations Communicate status and results of processes, projects, goals and tasks with leader as needed or requested Expert proficiency level with Microsoft Excel Advanced proficiency with Microsoft Suite to include Word and Power Point Knowledge of SQL, SAS, R, Python or other data manipulation software Licensure and Certification: Associate of the Society of Actuaries (ASA) is required Fellow of the Society of Actuaries (FSA) is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to travel less than 10% of the time Compensation Range: $94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-RW1

The Community Health Worker participates as a member of the inter-disciplinary care team (ICT) to coordinate care for members. Essential Functions: Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to; hospital, provider office, community agency, member's home, telephonic or electronic communication Accompany members to appointments and other social service encounters when necessary Coordinate logistics to support members' care plan goals and interventions - reminders, transportation, and childcare arrangements Verify eligibility, previous enrollment history, demographics and current health status of each member Contribute to assessments by gathering information from the member, family, providers and other stakeholders Contribute to the development and implementation of the individualized care plan based on member's needs and preferences, reporting information to the Case Manager Assist with identifying and managing barriers to achievement of care plan goals Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination Assist with the provision of health education and wellness materials as directed by the Case Manager(s) or Team Lead Evaluate member satisfaction through open communication and monitoring of concerns or issues Maintain appropriate documentation within protocols and guidelines of the Care Management program Looks for ways to improve the process to make the members' experience with CareSource easier and shares with leadership to make it a standard, repeatable process Regular travel to conduct member, provider and community based visits as needed to ensure effective administration of the program Perform any other job duties as requested Education and Experience: High School Diploma or General Education Diploma (GED), is required Minimum of two (2) years of experience in either volunteer or paid position working in community settings with at risk populations providing coordination of services is preferred Competencies, Knowledge and Skills: Proficient with Microsoft Office, including Outlook, Word and Excel Sensitivity to and experience working within different cultures Good interpersonal skills Ability to work independently and within a team environment Ability to identify problems and opportunities and communicate to management Developing knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices Demonstrate compassion, support and collaboration with members and families Self-motivated and inquisitive Comfort with asking pertinent questions Ability to work in a fast-paced environment Ability to demonstrate and promote ethical conduct Ability to develop positive relationships with all stakeholders Awareness of community & state support resources Organized , detail-oriented and conflict resolution skills Ability to keep composure and professionalism during times of high emotional stress Ability to maintain confidentiality and act in the company's best interest Proven track record of demonstrating empathy and compassion for individuals Proven track record for improving processes to make things easier for those you have served Licensure and Certification: Community Health Worker Certification, or equivalent approved training program, is preferred Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check and verified insurance. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated. To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process. Working Conditions: This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members Compensation Range: $35,900.00 - $57,300.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Hourly Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JS1

The Clinical Policy Specialist I provides clinical policy support to both new and established lines of business (LOB) through managing state submissions, submitting Communication Request Forms, tracking processes, and ensuring clinical policy compliance. Essential Functions: Assist Clinical Policy Project Specialist to execute, monitor and support new lines of business throughout the entire clinical policy project lifecycle. Audit, monitor and prepare clinical policies for NQCA, state, and internal audits Develop, implement, configure, and maintain decision trees, workflows, documentation and monitoring protocols to operationalize clinical policies and criteria in a timely manner Participate in department initiatives and projects including implementation of new document management systems Support the development and maintenance of enterprise Clinical Policy programs (i.e., policy assessments, department newsletter, network notification communications) Collaborate with interdisciplinary team members to achieve team goals Participate in risk assessment and continuous improvement activities, as needed Follow Workfront procedures to coordinate and implement changes ensuring regulatory, compliance, and business goals are met Ensure timely submission, accurate documentation, and tracking of all Communication Request Forms and network notifications for clinical policies to be published on external websites Monitor the CareSource public website to ensure policies are accurately published and accessible Document and track state submissions and approvals, keeping consistent communication with Clinical Policy team, leadership, and regulatory as necessary. Track and trend clinical policy metrics (i.e., CRF, archives, revisions) reported monthly, quarterly, end of year, and as needed Assist with Policy Tech functions to streamline policies through the entire end-to-end process Support the operational processes of the Clinical Policy Governance Committee (CPGC) Create agendas, document, and store minutes and pertinent records for all assigned team meetings as necessary Maintain and update job related internal policies and procedures applicable to Clinical Policy process and workflows Provide coverage for both Policy Coordinator and Policy Project Specialist when needed Perform any other job duties as requested Education and Experience: Bachelor's degree or equivalent years of relevant work experience is required Health plan experience is preferred SharePoint management experience preferred Minimum of two (2) years of healthcare policy experience is preferred Documentation Management system experience is preferred Competencies, Knowledge and Skills: Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software Detail-oriented and critical thinker Proficient in documentation management systems Proficient in SharePoint Proficient in creating and delivering effective PowerPoint presentations Knowledge of medical terminology, pharmacy claims processing, and healthcare administration Ability to interpret clinical information Excellent verbal and written communications skills Presentation and decision-making skills Excellent organization and tracking skills Strong problem-solving skills Ability to communicate effectively with employees at all levels of the organization. Ability to work autonomously and in a team environment Ability to handle multiple priorities/projects simultaneously Licensure and Certification: Basic Six Sigma or Lean certification preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Occasional travel may be required to fulfill job duties Compensation Range: $54,500.00 - $87,300.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1

The Internal Auditor II works in a self-directed team environment to execute internal audits as defined by management and the Audit Committee with progressive latitude for team goal setting, initiative and independent judgement on collective work products. The auditor works to identify and evaluate organizational risk, recommends and monitors mitigation action and supports the development of the annual audit plan. Essential Functions: Conduct operational, performance, financial and/or compliance audit project work including, business process survey, project planning, risk determination, test work, recommendation development and monitoring and validation of remediation Work within a self-directed team environment with limited direct supervision, employing significant creativity in determining efficient and effective ways to achieve audit objectives Actively participate in the development and implementation of a flexible risk-based, flexible annual audit plan considering control concerns identified by senior management Coordinate and collaborate on internal audit projects including assessing the adequacy of the control environment to achieve defined objectives in accordance with the approved audit program and professional standards Facilitate communication of organizational risks and audit results to business owners through written reports and oral presentations and provide support and guidance to organizational leadership on effective internal control design and risk mitigation Coordinate, monitor, and complete team tasks within agreed upon timeframes and meet individual and team project timelines, which may be aggressive at times. Influences team prioritization and scheduling of work, problem solving, assignment of tasks, and takes initiative when problems arise. Provides cross-training of team members Support management in onboarding new team members through mentorship, shadowing, and training of all required functions and processes and influence standards for expected team behaviors Assist in the coordination of external audits of CareSource by government agencies, accounting firms, etc. Develop and maintain productive professional relationships with CareSource staff and management by developing trust and credibility Significant interaction with others in the Department of differing skillsets (clinical, IT, etc.), organizational management and staff throughout CareSource, including interaction with the senior most levels Coordinate audit projects as necessary with other CareSource functions, including CareSource Assurance teams Generally conform to IIA standards and maintain all organizational and professional ethical standards, even in difficult or challenging situations Willing to accept feedback, coaching and criticism from others, including peers and management both in Internal Audit or outside of Internal Audit, reflect on the information, and adapt when appropriate Perform any other job duties as requested Education and Experience: Bachelor's degree in finance, business management, healthcare administration, accounting or related field or equivalent years of relevant work experience is required Master of Business Administration (MBA), or other graduate degree is preferred A minimum of three (3) years of finance, business management, healthcare administration, accounting or related field is required; experience in internal auditing or public accounting is preferred Knowledge of audit principles and IIA Standards and Code of Ethics required Experience in risk and control assessments is preferred Experience in thoroughly documenting process flows and controls in financial, and/or business operations cycles preferred Experience with Sarbanes Oxley 404 or Model Audit Rule preferred Experience in health care or insurance fields is preferred Competencies, Knowledge and Skills: Strong communication skills, including proper writing skills adaptable for the audience and purpose, presentation skills for internal or external audiences and senior management, and interpersonal skills sufficient to develop strong professional relationships with CareSource management and staff Solid critical thinking skills including professional skepticism and problem resolution Data analysis and trending skills and ability to compose and present reports using audit data Ability to work in a matrix environment with responsibility for multiple deliverables for multiple functional areas within CareSource Team and customer service oriented Collaborative mindset and ability to operate in a self-directed team environment with collective accountability Strong ability to adapt to changing environment Strong self-leadership, organizational and time management skills Driven to proactively seek relevant development, education and training opportunities Strong sense of integrity and ethics in performance of all duties Takes initiative to identify and influence innovative process improvement Self-driven to work independently within a team environment Success in working in a self-directed matrixed environment Advanced level experience in Microsoft products Licensure and Certification: CIA, CISA, CPA, CMA, CRMA or other appropriate finance, IT or internal audit licensure or certification is preferred Working Conditions: Most work will be performed in an office or virtual setting; however, performing onsite audits may also be necessary depending on assignments May be required to sit or stand for extended periods Compensation Range: $61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-RW1

This position provides non-clinical, evidence-based peer support services and serves as a member and family advocate. The FSN brings their life experiences and skills to deliver assistance to the family as they explore the goals they would like to achieve and offers interventions to the family to increase engagement and empowerment within a variety of service delivery systems. Provides peer support to family/caregivers of children with mental health and substance use conditions identified as requiring intensive wellness support and recovery-oriented interventions. Guides families in creating Wellness Recovery Action Plans (WRAP ) for themselves and their family to recognize strengths and identify wellness self-management and crisis prevention strategies. Utilizes the 8 dimensions of wellness to help parents/caregivers identify their social determinants of health needs, determine their whole health goals and objectives in order to address their own challenges and those of their child. Guides and empowers family members to understand and participate in all decisions related to the treatment process, the support plan, service choices, and transitions in care. Coaches and role-models regarding a parent's perspective and lessons learned from life experience. Facilitates support and education to families who have questions, concerns or specific needs related to mental health or substance use and their relationship to Magellan and child serving agencies. Strategically shares their lived experience to inspire hope, empowerment, and positive action. Performs ongoing interventions to engage families and members in traditional and nontraditional health services and supports, as well as community and social support networks including community-based peer, parent, and family support services. Facilitates a team approach to member care including with the Magellan care coordination team. Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Acts as an advocate for family and member`s needs by identifying and addressing gaps in services and supports. Educates providers, supporting staff, members, and families on resiliency and recovery-oriented principles, practices, strategies, and tools. Documents all interactions according to company standards. Maintains professional responsibility to maximize supervision, respond appropriately to personal stressors that impact ability to perform job duties, and recognize crisis situations or risks to the member's safety and respond appropriately. Travels to meet families within the community. Other duties as assigned. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities 2+ years' experience working as a family peer specialist. Peer Specialist certification as required by the state. CFPS/National Peer Support Credential required within one year of hire. Must be or have been a parent or caregiver of a child who is or who has in the past received services from a child-serving agency for mental health related issues. Applicants must be able to draw from their own personal experience of parenting or caregiving for a child or youth with significant mental health or substance use challenges; negotiating services and supports for their child and family; be familiar with key resources for children, youth and families in the community; be able to transcend personal events to provide unconditional support and assistance to families. Positive attitude that communicates hope and a recovery and resiliency orientation; approachable and empathetic; strong people skills. Must have a vehicle in good, working condition with the ability to travel within the community regularly. Working knowledge of Microsoft Office Product Suite. Ability to make decisions that require significant analysis of solutions, and quick, original, and independent thinking. Ability to determine appropriate courses of action in complex situations that may not be addressed by existing policies or protocols. Knowledge of local mental health, substance use, and community systems; wellness strategies, resiliency and recovery principles, practices, and tools, such as system of care, Wellness Recovery Action Plans (WRAP), wraparound process, and community-based peer, family and parent support organizations and services. Strong interpersonal and organizational skills and effective verbal and written communication skills. Ability to represent strengths and needs of families and members in clinical settings. Ability to summarize and document findings and maintain complete and accurate records. Must be able to work effectively, independently and in a team, and prioritize in a fast-paced environment to meet the demands of the organization. General Job Information Title Family Support Navigator Grade 19 Work Experience - Required Lived experience as parent/caregiver of a child with mental health challenges, Peer Specialist Work Experience - Preferred Education - Required Education - Preferred Associate License and Certifications - Required CPRS/CPS/CPSS/CRPS/PRSS, Peer Specialist, State Requirements - Care MgmtCare Mgmt, DL - Driver License, Valid In State - OtherOther License and Certifications - Preferred NCPS - National Certified Peer Specialist - Care MgmtCare Mgmt Salary Range Salary Minimum: $37,725 Salary Maximum: $56,595 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Independently coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties performed are either during face-to-face home visits or facility based depending on the assignment. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. May act as a team lead for non-licensed care coordinators. Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately (e.g., during transition to home care, back up plans, community based services). Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for members' care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan. Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary. Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases. Provides assistance to members with questions and concerns regarding care, providers or delivery system. Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources. Generates reports in accordance with care coordination goals. Other Job Requirements Responsibilities Associate's Degree in Nursing required for RNs, or Master's Degree in Social Work or Healthcare-related field, with an independent license, for Social Workers. Licensed in State that Services are performed and meets Magellan Credentialing criteria. 2+ years' post-licensure clinical experience. Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required. Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment. Knowledge of referral coordination to community and private/public resources. Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data. Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking. Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols. Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures. Ability to establish strong working relationships with clinicians, hospital officials and service agency contacts. Computer literacy desired. Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills. General Job Information Title CISC Care Coordinator, Licensed Grade 24 Work Experience - Required Clinical Work Experience - Preferred Education - Required Associate - Nursing, Master's - Social Work Education - Preferred License and Certifications - Required DL - Driver License, Valid In State - Other, LISW - Licensed Independent Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $58,440 Salary Maximum: $93,500 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

The Assignment Ready Counselor (ARC) will provide coverage in short-term, surge and on demand situations resulting from the Military needs such as a post-deployment event or to cover an existing assignment for counselors who are absent. The Summer ARC counselor position covers assignments during the May 15th through September 15th time period, coinciding with the school summer break. With minimal guidance and oversight, provides the full breadth of Adult or Child and Youth Behavioral (CYB) counseling services to military service members and their families at military installations. These services may include non- medical counseling, training/health and wellness presentations, consultation with parents, personnel at child daycare centers and schools, and consultation to installation command regarding behavioral health issues affecting military personnel and their family members. ARC CYB counselors may be assigned to DoDEA schools and community schools and will need to have experience working in a school setting to qualify for ARC role in backing up a school position. CYB counselors may also be assigned to youth programs, summer camps, and on demand assignments. ARC adult counselors may be assigned to support MFLC services in a variety of military community and readiness centers, as well as on-demand and surge assignments. The counselors work closely with the installation and military branch Points of Contact (POC) to assure that the program is provided within scope and meets the needs of the installation. Provides non-medical, short term, solution focused, counseling directly to adults, children, and youth of service members. Services include assessment, brief counseling and consultation, action planning, referral to resources (assuring linkage as appropriate), and follow-up as indicated. CYB counselors will also have a focus on supporting the staff and personnel of CDCs, DoDEA and community schools, youth programs and summer camps as well as providing parent training and guidance. Provides training and health and wellness presentations, participate in health fairs and other base/installation activities. Enters counselor activity data daily through smart phone or web application assure that reporting is accurate from assigned installation while maintaining confidentiality and anonymity of service / family member. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities Master's Degree from an accredited graduate program in a mental health related field, or social work. With short notice, willing to accept assignments of undefined periods to include weekends. Can cover, on a full-time basis, assignments of varying length from a weekend to two weeks. Quickly builds rapport with service personnel clients, family members, students, parents and co-workers. Adaptable to new working conditions, varying location rules, etc.; adjusts working style to align with each work environment. Able to work effectively with minimal instruction and guidance. Listens carefully to instructions provided. With minimal notice, participates in regular in-services/training, Quality Improvement committees or other contract activities as assigned. Requires ability to quickly engage and communicate with military members, spouses or children as assigned, in order to accomplish job functions, and to respond quickly to emergent situations in any physical location on a military installation and/or within a school setting, which includes the need to traverse short and/or long distances within the base to both indoor and outdoor locations, to maneuver through rugged, outdoor or uneven locations (e.g., steep inclines, stairs, grass), and work in outdoor weather and other military base conditions. Due to the nature of working on military installations or related worksites, counselors may need to comply with various site-specific requirements to work at designated locations. For example, for some assignments, counselors will need to have certain current immunizations or vaccinations and provide record of receipt. Ability to prove US Citizenship and must be fluent in English. Advanced knowledge of brief therapy and solution-focused counseling methods. Prior military service/military family member and/or strong familiarity with military culture desired. For CYB positions must meet the Magellan MFLC CYB criteria for experience with children and youth and specialty in child and adolescent development/psychology. Creates a presence on the installation in which the service and family members feel comfortable approaching the counselor and recognize the program to be confidential; for CYB counselors -- creates a presence in child and youth settings, is available to children, youth, and staff. When working with children, counselor must abide by line of site protocol. Establishes and maintains working relationships with community resources and provides appropriate linkages. Partners with POC to provide Adult and CYB services in a manner that addresses the needs of the installation/facility. Develops an excellent working relationship with the installation/facility POC. Manages duty to warn and restricted reporting situations according to DoD protocol and staffs the cases with Regional Supervisor/Regional Director. Communicates with Regional Supervisors and participate in regular individual and group supervision, sharing information regarding trends and issues on the installations and in facilities to which they are assigned for substitute or on call services. Responds to critical incidents and special requests as directed by the POC and approved by the OSD program manager. General Job Information Title Military and Family Life Counselor - Short Term Assignments or On Demand for On Site Grade MFLC ARC Work Experience - Required Clinical Work Experience - Preferred Education - Required Master's - Behavioral Health, Master's - Social Work Education - Preferred License and Certifications - Required Current licensure required for this position that meets State, Commonwealth or customer-specific requirements - Care MgmtCare Mgmt, DL - Driver License, Valid In State - OtherOther, LPC - Licensed Professional Counselor - Care MgmtCare Mgmt, Must be an independently licensed behavioral health clinician - Care MgmtCare Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $59,922 Salary Maximum: $100,280 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Responsible for the development, strategy, and implementation of community outreach programs in conjunction with the Clinical and Administrative departments. Leads the development of strategic plans for engagement, within assigned territories, regions or communities, that nurture and retain positive relationships between the health plan, members and caregivers, the community, and provider organizations. Leads resource assessments within assigned region to identify potential partnerships to serve our members through enhanced access, improved community awareness of programs, and participation with established community advisory boards. Provides information about health care services, preventative care, as well as information related to health, welfare, and social services or social assistance programs offered by the state or local communities. Organizes and attends community events and health fairs. Serves as the liaison to community organizations. Conducts member, community, and organizational trainings. Completes face-to-face outreach. Ensures compliance with all state and federal marketing requirements. Drives engagement in care by facilitating a robust engagement strategy, which may include leveraging community relationships and developing opportunities to present and educate in front of members, caregivers, and other interested parties. Develops and implements promotional plans for new outreach opportunities. Distributes educational materials to community and provider organizations. Presents the program and offerings in group settings. Consistently achieves member engagement strategies while meeting quality performance standards. Attends provider and community meetings and participates in special projects. Conducts consumer and community surveys as needed. Provides training on programs to staff and agencies as necessary. Collaborates with multiple departments, including peers, business development, marketing, network contracting, and provider liaison teams. Participates as a member of the Clinical team in developing and implementing strategies to engage stakeholders. Develops and implements promotional plan for new outreach opportunities. Maintains thorough knowledge of healthcare programs and community resources. May act as a subject expert on Medicaid programs and benefits for internal and external stakeholders. Develops a resource guide for assigned territory (such as community-based organizations, service agencies, housing, food pantries, churches etc.), and cultivates relationships and identifies potential collaboration opportunities. Plans and implements territory monthly action plan and consistently meets and/or exceeds outreach targets. Produces summary reports on outreach activities. Participates in cross functional teams and quality improvement initiatives. Responsible for identifying, developing and maintaining strategic relationships with community contacts and organizations to pursue outreach engagements for multiple regions. Distributes written material to community and provider organizations. May schedule and facilitate marketing events, both formal and informal, with stakeholders that meets contract requirements. Identifies and attends community and health events. Identifies and coordinates outreach activities and necessary materials at community and health events. Organizes staff and other resources in the participation and the support of select community events and activities. Responsible for post-event follow up and maintenance of relationships for future and recurring events. Other Job Requirements Responsibilities 5+ years of community outreach and engagement experience with 1 year working with government-sponsored population, particularly Medicare and Medicaid. Self-starter with the ability to work with limited supervision. Excellent verbal and written communication skills. Must exhibit sensitivity towards the target population. 2+ years of experience working with individuals with adverse childhood experiences. General Job Information Title CISC Member, Caregiver and Stakeholder Engagement Manager Grade 23 Work Experience - Required Community Relations/Outreach Work Experience - Preferred Education - Required Associate Education - Preferred Bachelor's, Master's License and Certifications - Required DL - Driver License, Valid In State - Other License and Certifications - Preferred CPRS/CPS/CPSS/CRPS/PRSS, Peer Specialist, State Requirements - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt Salary Range Salary Minimum: $53,125 Salary Maximum: $84,995 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

The Network Contract Specialist will be responsible for creating and maintaining behavioral health provider contracts across the New Mexico territory for Presbyterian Health Plan with Medicaid, Medicare, and Commercial lines of business. This role includes managing provider contracting activities in coordination with the Network team and processing all necessary contract-related updates. Key responsibilities include handling contract changes, Statements of Work, amendments, rate updates, Letters of Direction, and other required modifications. The specialist will also ensure all contract updates are compliant with internal policies and New Mexico-specific regulatory requirements. Strong collaboration with internal departments is essential to maintain network accuracy, provider data integrity, and overall operational efficiency. Detailed tracking and documentation of all contract activities and provider communications are critical components of this role. Support and maintain behavioral health provider contracts for Medicaid, Medicare, and Commercial lines of business across the New Mexico territory Perform provider contracting functions in collaboration with the Network team Process contract-related updates including: Exhibits Contract changes SOS Amendments Rate updates Letters of Direction (LODs) NCQA/CAQH Ensure compliance with internal standards and state-specific requirements Collaborate with internal departments to support network accuracy, provider data integrity, and operational efficiency Maintain thorough documentation and tracking of all contract activity and communications This position is responsible for the support of all activities related to developing and maintaining the physician, practitioner, group, and/or facility, MPPS and organization services delivery system in small to mid-size market defined by membership, number of providers in delivery system, number of business operating units and lines of business. Interacts with all areas of organization to coordinate network management and network administration responsibilities. Assesses network needs, analyzes network composition, and using organization databases, application of regulatory requirements, accreditation entities and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality network. Conducts and coordinates contracting and amendment initiatives. Provides issue resolution and complex trouble shooting for providers. Conducts provider education and provider relation activities, providing necessary written materials. Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests. Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers. Conducts and manages ongoing audits of provider compliance with Magellan policies and procedures as well as contractual obligations for multiple customers. Develops work plans to address audit requirements. Works with management to draft, clarify and recommend changes to policies which impact network management. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities Knowledge of National Committee for Quality Assurance (NCQA) requirements. Ability to work independently and prioritize activities. Intermediate knowledge of Microsoft Office Suite, specifically Excel. Strong presentations skills using PowerPoint. Minimum of 1 year experience in related position/field. General Job Information Title Network Management Specialist (Contract Specialist) Grade 21 Work Experience - Required Network Work Experience - Preferred Education - Required Education - Preferred Bachelor's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $45,655 Salary Maximum: $68,485 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.