Clinical care manager jobs near me - 938 jobs

Career Opportunities with Summit Therapeutics Sub, Inc. A great place to work. Careers At Summit Therapeutics Sub, Inc. Current job opportunities are posted here as they become available. Senior Director, Clinical Operations (TMF & CTMS) Location: On-site 4 days per week at our Menlo Park, CA, Princeton, NJ or Miami, FL office. About Summit: Ivonescimab, also known as SMT112, is a novel, potential first-in-class investigational bispecific antibody combining the effects of immunotherapy via a blockade of PD-1 with the anti-angiogenesis effects associated with blocking VEGF into a single molecule. Ivonescimab displays unique cooperative binding to each of its intended targets with multifold higher affinity when in the presence of both PD-1 and VEGF. Summit has begun its clinical development of ivonescimab in non-small cell lung cancer (NSCLC), with three active Phase III trials: HARMONi is a Phase III clinical trial which intends to evaluate ivonescimab combined with chemotherapy compared to placebo plus chemotherapy in patients with EGFR-mutated, locally advanced or metastatic non-squamous NSCLC who have progressed after treatment with a 3rd generation EGFR TKI (e.g., osimertinib). HARMONi-3 is a Phase III clinical trial which is designed to evaluate ivonescimab combined with chemotherapy compared to pembrolizumab combined with chemotherapy in patients with first-line metastatic NSCLC. HARMONi-7 is a Phase III clinical trial which is intended to evaluate ivonescimab monotherapy compared to pembrolizumab monotherapy in patients with first-line metastatic NSCLC whose tumors have high PD-L1 expression. Ivonescimab is an investigational therapy that is not approved by any regulatory authority in Summit's license territories, including the United States and Europe. Ivonescimab was approved for marketing authorization in China in May 2024. Ivonescimab was granted Fast Track designation by the US Food & Drug Administration (FDA) for the HARMONi clinical trial setting. Overview of Role: The Senior Director, Clinical Operations (TMF) is a clinical research drug development expert accountable for leading and optimizing the delivery of our next generation, integrated platform for clinical trial operations and document management systems including the people, process, technology that support these functions. The individual leads transformative initiatives that create effective and efficient processes that meet high compliance standards; collaborating across Development (focus on Clinical Operations); serving as a change manager to implement new systems and practices that support the organization as we continue to grow. The Senior Director, Clinical Operations (TMF) is an effective clinical operations team leader accountable for talent acquisition, development, management, and evaluation of team members in his/her/their group. This includes responsibility for the ‘What' (delivery to performance goals) and the ‘How' (deliver consistent with Summit Therapeutics core values). The individual is also a member of the Clinical Operations extended leadership team and as such supports and influences the direction of the Clinical Operations extended team. The individual collaborates with team members to reinforce and operationalize strategic direction and solutions that support the ability to deliver on commitments to the organization and to patients. Role and Responsibilities: Develop, implement, and oversee the CTMS and TMF systems and related processes Lead the oversite of TMF and CTMS vendors, contractors, and cross-functional teams provide leadership and development to existing TMF employees and lead by example by demonstrating our core values Define, eexecute, and communicate the strategic vision for TMF and CTMS to maximize end user focus and engagement Partner with key internal and external stakeholders to remediate risks and manage emerging issues. Develop proactive approaches to process improvements and enhancements of TMF and CTMS capabilities and standards Provide business level leadership, foster best practices, and mentor and consult on TMF and CTMS across the Development and Operations organizations Lead a team of TMF and CTMs colleagues and ensure their continuous development Develop and maintain effective working relationships with stakeholder functions to achieve Clinical Operations goals Keep current on changes in industry and regulatory standards for GCP requirements and advises on business impact for TMF and CTMS Provide strategic leadership, insight, and guidance as an active member of the Clinical Operations Extended Leadership Team (XLT) Ensure inspection ready TMF and CTMS and provide expert support for audits and inspections Instill a culture of continuous improvement; acts as a change champion and effectively leads change Other key assignments including ad hoc and stretch assignments in support of Clinical Operations and clinical trial execution Travel on assignment (~25%) All other duties as assigned Experience, Education and Specialized Knowledge and Skills: Bachelor's degree (e.g. BA, BS or equivalent) required; preferably in life science; a clinical or advanced degree in a science, health related, or industry related discipline is preferred Minimum of 12+ years of strong experience with a pharmaceutical company and/or CRO with increasing levels of responsibility in Clinical Operations in a global environment (including directing platform support teams and key clinical systems such as TMF, CTMS) preferred A minimum of 5+ years of experience in people management/leadership required Proven line and functional manager experience, able to effectively lead teams including regional (multi-country) and remote-based staff Experience in Phase III execution of clinical trials; Oncology trials preferred Previous regulatory inspection experience preferred Strong comprehensive and current regulatory knowledge, including ICH Good Clinical Practice, regulations and guidelines Significant vendor oversight experience including contracts and budget management preferred The pay range for this role is $230,000-$250,000 annually. Actual compensation packages are based on several factors that are unique to each candidate, including but not limited to skill set, depth of experience, certifications, and specific work location. This may be different in other locations due to differences in the cost of labor. The total compensation package for this position may also include bonus, stock, benefits and/or other applicable variable compensation. Summit does not accept referrals from employment businesses and/or employment agencies in respect of the vacancies posted on this site. All employment businesses/agencies are required to contact Summit's Talent Acquisition team at ********************* to obtain prior written authorization before referring any candidates to Summit. #J-18808-Ljbffr

Permanent Associate Medical Director Board Certified in Family Medicine / Internal Medicine FQHC Setting What we Offer: Schedule: M- F 8am to 5pm, No Weekends Competitive Pay: $250k to $270k. depends on experience Sign On Bonus: $30,000 Full Benefits Package - Medical, dental, vision, disability & life insurance. 401(k). What the Associate Medical Director will Do: 80% Clinical / 20% Administration Supervise and coach fellow providers in how to provide excellent primary care / urgent care and community care This is a FQHC setting must be comfortable with Community Medicine Partake in leadership meeting and also act as an ambassador to community based organizations, hospitals, and payers Requirements of the Associate Medical Director: 5+ Years clinical experience / Administrative leadership experience needed Must have 2 -3 recent years experience in primary care medicine Active and unrestricted medical or nursing license in the state required Background in working for a clinic or community based inpatient setting a plus Must be ok prescribing opioids

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

*Care Manager (Remote)* *Start Date : 2/17* *Work Environment:* * Fully remote; must have a quiet workspace and provide a photo of designated area. * Shift: 8:00 AM - 8:00 PM EST (8-hour shift) * Training: 8:30 AM - 5:00 PM EST for 2 weeks Care Managers make high-volume outbound calls to payors/pharmacy benefit managers (PBMs) to verify copay support eligibility for commercially insured patients. This is a phone-intensive role (up to 95% of shift on calls) requiring strict adherence to scripts, accurate documentation, and professional customer service. *Key Responsibilities:* * Make outbound calls to PBMs/payors for copay eligibility; maintain 95% phone engagement. * Follow approved call guides and compliant scripts. * Identify and record plan types (e.g., Traditional, Accumulator, Maximizer). * Use PBM-specific workflows to gather benefit details. * Document all interactions accurately in CRM/telephony tools in real time. * Manage follow-up tasks promptly. * Maintain proper telephony status and campaign selection. * Adhere to compliance, privacy, and quality standards. * Collaborate professionally with PBM contacts and internal teams. *Requirements:* * *Experience:* 1+ year in a call center or high-volume phone environment preferred. * *Skills:* Strong attention to detail, excellent verbal communication, ability to follow scripts and document accurately. * *Technical:* Reliable high-speed internet, computer with webcam, and ability to work in a quiet space (photo required). * *Availability:* Must commit to training schedule and assigned shift. *Job Type & Location* This is a Contract position based out of Houston, TX. *Pay and Benefits*The pay range for this position is $21.00 - $21.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) *Workplace Type*This is a fully remote position. *Application Deadline*This position is anticipated to close on Jan 16, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people in more than 160 countries. Working at Abbott At Abbott, you can do work that matters, grow, and learn, care for yourself and your family, be your true self, and live a full life. You'll also have access to: Career development with an international company where you can grow the career you dream of. Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year. An excellent retirement savings plan with high employer contribution Tuition reimbursement, the Freedom 2 Save student debt program and FreeU education benefit - an affordable and convenient path to getting a bachelor's degree A company recognized as a great place to work in dozens of countries around the world and named one of the most admired companies in the world by Fortune. A company that is recognized as one of the best big companies to work for as well as a best place to work for diversity, working mothers, female executives, and scientists. The Opportunity Abbott Heart Failure (HF) delivers devices for patients living with heart failure in the areas of hemodynamic monitoring and mechanical circulatory support. Medical affairs of Abbott HF is seeking to hire a director who will join a team of medical specialist dedicated to all medical aspects of safe and effective device heart failure treatment. The director will report to the Chief Medical Officer. The Director of Medical Affairs will provide daily business operations support related to product development and clinical research, product quality, compliance, commercial/marketing activities and customer interactions. The director assists the Chief Medical Officer in being medical representative of Abbott HF to external regulatory agencies and professional societies. What You'll Work On The Medical Director Develops medical opinions, medical platform documents and Health Hazard Assessments. Provides medical input for promotional and commercial activities as requested. Serves as medical representative on Risk Evaluation teams. Assists investigation teams by providing medical input as needed. Responsible for updating medical affairs procedural documents and submitting change requests when needed. Provides medical support for MDR reporting when needed. Provides initial medical input for quality/regulatory customer communications, technical bulletins and quality directives. Engages with direct customer interactions with medical content as needed. Regionally responsible for Investigator Initiated Study and Research Grant programs. Provides input or content to professional education activities. Responsible for engaging in and documenting off-label discussions. Assists the Chief Medical Officer in KOL and professional society engagement. Provides medical input to new product development An MD is strongly preferred for this role, but a PhD in a relevant area would be considered. A minimum of 5 years of clinical experience including in CV medicine would be clinical research, including interpretation and presentation would be expected. Strong presentation skills required. The role is remote (US-based) Up to 70 % travel should be expected. APPLY NOW Enjoy a competitive base salary plus exciting bonus opportunities and long-term incentives designed to recognize your success. Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives: ********************** Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity. Connect with us at *************** on Facebook at *********************** and on Twitter @AbbottNews and @AbbottGlobal #J-18808-Ljbffr

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Telephonic clinical case management with Medicare population.Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. Completes a Comprehensive Assessment and Plan of care.Will document in clinical systems to support legacy Aetna and Coventry membership.Provides BH consultation and collaboration with Aetna partners.Active participation in clinical treatment rounds.Active participation in team activities focused on program development. Innovative thinking expected.The majority of time is spent at a desk on telephonic member outreaches and computer documentation.Assist members with locating community based behavioral health resources.Required Qualifications3+ years of direct clinical practice experience An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC, LISW, LSW) Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service Bilingual Spanish and English Preferred QualificationsCrisis intervention skills preferred Managed care/utilization review experience preferred Case management and discharge planning experience preferred Discharge planning experience Utilization review, prior authorization, concurrent review, appeals experience CCM preferred DSNP experience a plus Knowledge of Substance Abuse DisordersEducationMasters Degree in Social Work or Counseling required Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095.00 - $116,760.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/30/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Contract Duration: 03 Months Location: Miami-Dade County (Hialeah: 33010, 33012, 33013, 33014, 33015, 33016, 33018, 33142, 33147). We are seeking a Bilingual Case Management Coordinator (Spanish/English) to support Medicaid Long Term Care/Comprehensive Program members in Miami-Dade County, FL. This is a work-from-home position that requires significant field travel (50-75%) for face-to-face member visits in homes, Assisted Living Facilities, and Skilled Nursing Facilities. The Case Management Coordinator is responsible for assessing, planning, implementing, and coordinating care management activities for members with supportive and medically complex needs. The role focuses on improving short- and long-term health outcomes through care coordination, education, and integration of community resources. Key Job Duties Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program members Conduct telephonic and face-to-face comprehensive member assessments Develop, implement, and monitor individualized care plans Coordinate care with Primary Care Providers, skilled providers, and interdisciplinary teams Facilitate services including prior authorizations, condition management support, medication reviews, and community resources Conduct multidisciplinary reviews to achieve optimal healthcare outcomes Utilize motivational interviewing and influencing skills to promote member engagement and behavior change Educate and empower members to make informed healthcare and lifestyle decisions Experience & Qualifications Required Qualifications Bilingual (Spanish/English) - fluent in speaking, reading, and writing 1+ year of experience in behavioral health, long-term care, or case management Preferred Qualifications Managed care experience Case management and discharge planning experience Long-term care experience Education Bachelor's degree required, preferably in Social Work or a related field About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ************************ US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Recruter Details: Name: Umar Farooq Email: ********************************** Internal Id #26-00632

Symetra has an exciting opportunity to join our team as aShort-Term Disability (STD) Case Manager! About the role In this role, you'll be responsible for making timely, accurate, and customer-focused decisions on STD, Statutory Disability Insurance (SDI), and Absence Management (AM) claims. You'll collaborate with internal and external partners to gather and analyze information, ensuring each claim is handled with care, efficiency, and empathy. What You Will Do Evaluate and manage new and ongoing STD, SDI, and AM claims with accuracy and timeliness. Gather and assess clinical, vocational, employer, and financial information to support claim decisions. Apply contract terms and procedural guidelines to determine claim outcomes. Maintain detailed and accurate documentation in claim systems. Communicate clearly and professionally with claimants, employers, and internal teams. Develop and follow claim management plans to achieve optimal outcomes. Deliver compassionate, customer-first service that builds trust and confidence. Foster a collaborative, respectful, and high-performing team environment. Why Work at Symetra Here's what some of our employees have to say about why they work at Symetra: "I chose Symetra because I heard it was a pro-employee company-and it's absolutely true. The work environment is supportive, the people are great, and the benefits are generous. Symetra truly cares about its employees. The relaxed atmosphere and opportunities to learn and grow-both within your role and beyond-make it a great place to build your career." - Alicia L., Claims Examiner "What I was searching for was a company that genuinely valued my voice-and I found that at Symetra. I truly enjoy working one-on-one with our customers, especially when they're going through life's toughest moments. Being able to offer support and hear their relief and gratitude when we help-it's deeply meaningful. That's what makes me proud to be part of the Symetra team." - Lilly H., Claims Team Lead What we offer you Benefits and Perks We don't take a "one-size-fits-all" approach when it comes to our employees. Our programs are designed to make your life better both at work and at home. Flexible full-time or hybrid telecommuting arrangements Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6% Paid time away including vacation and sick time, flex days and ten paid holidays Give back to your community and double your impact through our company matching Want more details? Check out our Symetra Benefits Overview Compensation Hourly Range: $22.00 - $36.23 plus eligibility for annual bonus program Who You Are High school diploma required. 3+ years of STD claims experience preferred. Knowledge of STD, SDI, and Absence management products and relevant regulations preferred. Understanding of medical terminology, anatomy, and pathology preferred. Excellent communication, decision-making, and organizational skills. Strong customer service and problem-solving skills. Able to manage multiple priorities concurrently with attention to detail. Proficiency with the Microsoft Office Suite required. Claim Vantage and/or Fineos experience a plus. NY Independent Adjuster license or industry certifications (e.g., FMLA Specialist) are a plus. We empower inclusion At Symetra, we aspire to be the most inclusive insurance company in the country. We're building a place where every employee feels valued, respected, and has opportunities to contribute. Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here. Creating a world where more people have access to financial freedom Symetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we're guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they're buying, and we design products--and operate our company--to stand the test of time. We're committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom. For more information about our careers visit: careers Work Authorization Employer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company. Please review Symetra's Remote Network Minimum Requirements: As a remote-first organization committed to providing a positive experience for both employees and customers, Symetra has the following standards for employees' internet connection: Minimum Internet Speed:100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband." Internet Type:Fiber, Cable (e.g., Comcast, Spectrum), or DSL. Not Permissible:Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up. When applying to jobs at Symetra you'll be asked to test your internet speed and confirm that your internet connection meets or exceeds Symetra's standard as outlined above. Identity Verification Symetra is committed to fair and secure hiring practices. For all roles, candidates will be required (after the initial phone screen) to be on video for all interviews. Symetra will take affirmative steps at key points in the process to verify that a candidate is not seeking employment fraudulently, e.g. through use of a false identity. Failure to comply with verification procedures may result in: Disqualification from the recruitment process Withdrawal of a job offer Termination of employment and other criminal and/or civil remedies, if fraud is discovered

A leading biopharmaceutical company is seeking a Senior Director for Medical Affairs to lead initiatives focused on liver diseases. The ideal candidate should have substantial clinical experience in hepatology and a commitment to scientific excellence. This remote position requires strategic collaboration and contributions to research efforts to improve liver care outcomes. Strong leadership and communication skills are essential for engaging diverse healthcare professionals in clinical discussions. #J-18808-Ljbffr

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. This is a home-office based position with field responsibilities. You will spend approximately 50% to 75% of the time in the field within an assigned coverage area. Candidates must be in Franklin County, OH and willing to commute to surrounding counties. If you reside in Franklin County, OH or surrounding counties, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted independent licensure as a Registered Nurse in Ohio 2+ years of clinical experience as an RN 1+ years of experience with MS Office, including Word, Excel, and Outlook Reliable transportation and the ability to travel up to 75% within Franklin County, OH and surrounding counties in OH to meet with members and providers Reside in Franklin County, OH and surrounding counties Preferred Qualifications: BSN, Master's Degree or Higher in Clinical Field CCM certification 1+ years of community case management experience coordinating care for individuals with complex needs Experience working in team-based care Background in Managed Care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

JAG Healthcare Marion is now scheduling RN/DON interviews as we are searching for our next long-term Director of Nursing (DON). JAG Healthcare Marion is seeking a strong, energetic Director of Nursing (DON) to work alongside their long-time Administrator to help maintain the excellent care culture that is established there. The Director of Nursing (DON) should be a compassionate RN who has at least five years of experience as a Director of Nursing or in a comparable position. Recognizing that there is much opportunity in our healthcare employment market for potential applicants, we are seeking candidates interested in employment stability, flexible scheduling, and the desire to secure a long-term employment opportunity. Being a smaller facility, there is a balance in the workload and exceptional patient care ratios. Leadership staff are expected to lead by example and be team-oriented to ensure the highest level of quality care and service can be delivered to our residents. JAG Healthcare Marion has only 45 beds, giving it a homelike feel for our residents. This quaint environment also provides our nurses the opportunity to spend meaningful time with their residents without rushing from one room to the next. This is one of the most common positive comments that we hear from nurses coming from larger healthcare facilities. If you are looking for a rewarding job as a Director of Nursing (DON) that allows you to build meaningful connections with residents while improving their quality of life, this job could be for you!. Skills & Responsibilities (include but not limited to): Direct, oversee, coordinate & evaluate nursing care services provided to the residents. Emphasis on education and staff development to grow and develop the nursing team Ensuring compliance with all State & Federal guidelines. Ensuring all confidentiality and privacy rights of residents are observed & enforced. Overseeing State Survey complaints, investigations, and resolutions. Develop and enforce policies aiming for legal compliance and high-quality standards. Develop objectives and long-term goals for the department. Guide staffing procedures. Excellent ability to lead and develop personnel. Willingness for continual education to keep up with changing standards in nursing administration. Exceptional communication and problem-solving skills, with a focus on customer service. Strong focus on Quality Assurance and Performance Improvement Team-oriented with the ability to work in a collaborative interdisciplinary setting Requirements for the position include: Licensed as a Registered Nurse (RN) in the State of Ohio and in good standing with the Board of Nursing. Must be familiar with and be able to follow all established Federal, State and Local rules, regulations, and guidelines. Must understand and be able to implement and follow the facility policy/procedure. Proven ability to lead a clinical team to successful clinical outcomes. Minimum of 5 years DON experience, or comparable position (required) Minimum of 5 years of acute care, long-term care, or geriatric supervisor and management experience in a Medicaid/Medicare certified facility (required). Experience working with cognitive deficits and behavioral health care (plus). Successful completion of the Infection Preventionist Training (preferred, but willing to assist with certification) Strong focus on inventory and supply chain management At JAG Healthcare, we offer a homelike family family-oriented atmosphere, striving to create a lifetime of balance for our residents, employees, and the communities in which we serve .

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Manager, Utilization Management (UM) Coordination, oversees non-clinical inpatient and pre-service operations under the direction of the Director of Utilization Management. This role provides leadership to UM Supervisors and their coordinator teams to ensure timely, accurate, and compliant processing of authorizations and referrals in accordance with CMS and organizational standards. The Manager drives operational efficiency, staff development, and process improvement while collaborating with internal departments to support continuity of care and overall service quality. Job Responsibilities: Provide operational leadership and direction to two Utilization Management Supervisors overseeing non-clinical coordinator teams supporting both Inpatient and Pre-Service workflows. Lead the teams meet established turnaround times (TATs), quality, and productivity standards for authorization processing, referral routing, and related UM functions. Oversee staffing allocation, scheduling, and workload balancing between inpatient and pre-service units to maintain consistent service levels. Conduct regular one-on-one meetings with supervisors to review performance metrics, workflow barriers, and staff development needs. Own the daily operations to ensure timely and accurate completion of authorizations, correspondence, and documentation in compliance with CMS, NCQA, and organizational standards. Identify process inefficiencies and implement corrective actions to improve turnaround, accuracy, and staff productivity. Lead root-cause analyses for escalated operational issues and coordinate corrective action plans. Responsible for all the accuracy of all UM workflows, systems, and reporting dashboards to support data-driven decision making. Oversee the development and delivery of training materials, competency assessments, and reference guides to promote consistent and compliant practices. Mentor Supervisors to build leadership capacity, coaching them on staff management, delegation, and performance improvement techniques. Drive onboarding, cross-training, and refresher sessions are regularly conducted to support staff versatility across inpatient and pre-service functions. Manage all team activities adhere to CMS and organizational policies related to Utilization Management, confidentiality, and member communication standards. Oversee internal audit reviews and collaborate with the Quality and Compliance teams to address findings and implement improvement plans. Direct that all letters and communications use approved templates and standardized language for UM determinations and continuity-of-care requirements. Participate in internal and external audits, Medical Services Committee meetings, and other regulatory reviews as required. Review and analyze key performance indicators (KPIs), including volume, turnaround time, accuracy, and productivity reports; present trends and improvement strategies to leadership. Support the preparation and submission of monthly UM reports, dashboard summaries, and Medical Services Committee deliverables. Leverage data to identify training needs, process gaps, and operational trends impacting service delivery or compliance. Serve as a liaison between UM, Case Management, Provider Relations, and Claims departments to streamline interdepartmental communication and issue resolution. Collaborate with network providers and internal teams to clarify authorization processes and ensure alignment with benefit and policy criteria. Participate in internal workgroups or initiatives to improve system functionality, workflow automation, and reporting enhancements. Assist with the development, implementation, and monitoring of UM-related initiatives and special projects (e.g., claims review process, continuity-of-care tracking, or performance optimization programs). Evaluate and revise UM policies and procedures to align with evolving regulatory standards and organizational goals. Support readiness activities for CMS audits and other accreditation requirements. Perform other related functions and special assignments as directed by senior leadership. Core Competencies: Leadership & Talent Development - Demonstrates the ability to lead through others by developing and empowering supervisors and staff. Fosters a culture of accountability, engagement, and continuous improvement within the UM department. Operational Management - Applies strong organizational and analytical skills to oversee workflow execution, resource allocation, and performance metrics across inpatient and pre-service teams. Regulatory & Compliance Expertise - Maintains in-depth knowledge of CMS regulatory standards, confidentiality requirements, and UM protocols to ensure full compliance and audit readiness. Analytical Thinking & Decision-Making - Uses data to identify trends, evaluate outcomes, and implement process improvements that enhance accuracy, turnaround times, and service quality. Communication & Collaboration - Communicates clearly across all organizational levels; partners effectively with Clinical Operations, Provider Relations, Case Management, and Claims to resolve issues and align priorities. Process Improvement & Innovation - Continuously evaluates operational workflows and implements efficiency strategies that support organizational goals and member satisfaction. Member & Service Orientation - Demonstrates commitment to delivering high-quality service, ensuring that UM processes support positive member experiences and continuity of care. Change Management - Adapts to evolving regulatory, system, and organizational needs while leading teams through process transitions and new initiatives effectively. Supervisory Responsibilities: Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management. Job Requirements: Experience Required: Minimum (4) years of related experience in a managed care setting and a minimum (3) years of recent and related supervisory experience Education Required: Highschool Diploma or GED Required Preferred: Bachelor's Degree or higher Other: Strong knowledge of Medicare Managed Care Plans Proficient in Microsoft Word, Excel, and Outlook; advanced Excel skills preferred (pivot tables, formulas, data visualization, and reporting functions for performance tracking and analysis). Experience leading and sustaining process improvement initiatives within healthcare operations to enhance efficiency, compliance, and service quality. Communication and Interpersonal Skills - Excellent written and verbal communication skills; able to build and maintain collaborative relationships with diverse teams, including leadership, staff, and external partners. Analytical and Reasoning Skills - Strong analytical thinking with the ability to define problems, collect and interpret data, establish facts, draw valid conclusions, and develop actionable solutions. Problem-Solving and Organizational Skills - Demonstrated ability to prioritize multiple tasks, manage time effectively, and maintain accuracy in a fast-paced, dynamic environment. Data and Report Analysis - Ability to interpret, analyze, and present statistical and operational reports to support decision-making and performance monitoring. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $70,823.00 - $106,234.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.

ABOUT THE COMPANY Tembo Health is a virtual medical practice that helps patients in nursing homes receive care in hard to access specialties like psychiatry and cardiology. Our mission is to improve healthcare outcomes. The status quo is unacceptable, as our seniors have difficulty receiving specialty care leading to worse healthcare outcomes including re-hospitalizations. By partnering with nursing homes, Tembo Health drives quality improvement with our network of world-class clinicians. Our technology allows our clinicians to provide both complex and quality care with a seamless user experience integrating medical data from various sources. Our leadership team has deep expertise in clinical medicine, clinical transformation, operations, and technology with experience at top institutions including BCG, GE, Harvard Hospitals, Mount Sinai, Northwell Health, and Oscar. We're backed by prominent investors including Bloomberg Beta, B Capital Group, and Resolute Ventures. We've proven product market fit over the past two years, have customer traction in NY, TX, and MI, and are scaling upon our success. In other words, it's a great time to get in on the ground floor! ABOUT THE ROLE We're looking for a Practice Manager to assist us with our growing clinical team. Responsibilities. Manage day-to-day clinical operations. You'll be asked to coordinate and execute all non-clinical aspects of patient care, starting with patient registration through appointment note sharing through claim followup/ Implement and refine billing and credentialing You'll contract with the major payor and enroll new providers. You'll submit claims, research superior billing methods, and more. Develop tools that improve the work of all team members. You'll leverage Athena, Google Suite and other tools to directly build tools that will help the team with things like tracking project progress. You'll also lend your insight to the Engineering team to build tools for clinicians and others within our EMR. Sample Work Plan With in the first week, you'll own and manage day-to-day clinical operations with activities like patient registration preauthorizations claim submission claim followup Within the first month, you'll have used your experience to get us working more efficiently than most offices with activities like cleaning up our billing processes instituting a plan for credentialing Within first three months, you'll use your management skills make sure our operations can serve our quickly scaling company through activities like owning contracting and onboarding processes for providers owning onboarding processes for facilities Within 6 months, you'll use you problem solving skills and innovation develop best in class procedures across the company implement high levels of automation within the EMR serve as subject matter expert with Engineering team to build tools for the clinical and account management teams ABOUT YOU Qualifications. You'll be successful in this role if You know the Athena EMR You strive to make things efficient You love the challenge of figuring out something new You're not afraid to pick up the phone You keep great notes You've worked in or managed a medical practice or similar Suggested Requirements. The following experiences are suggested but not required: You've worked on large or growing teams Experience with national provider contracts

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Location: Remote (U.S.) Schedule: Monday-Friday, 8:00 AM-4:30 PM ET Employment Type: Full-Time Position Overview We are seeking an experienced Program Manager to oversee daily operations for the CMS Review and Validation Contractor (RVC) Program. This role serves as the primary point of contact to the CMS RVC COR and is responsible for ensuring all contract, operational, and medical review requirements are executed in accordance with CMS guidelines. The ideal candidate brings a strong clinical background (RN), extensive Medicare program knowledge, and proven leadership experience managing large, complex healthcare projects. Key Responsibilities Serve as the contractor's authorized representative on all daily operational matters. Maintain ongoing communication with the CMS RVC COR regarding contract performance, staffing, and deliverables. Oversee medical review activities and ensure compliance with CMS guidelines and FFS RAC Program requirements. Lead cross-functional teams and manage staff required to support RVC operations. Ensure accurate interpretation of Medicare coverage, documentation, and regulatory standards. Monitor project progress, performance measures, and quality assurance outputs. Prepare operational updates, reports, and data summaries for CMS and internal leadership. Ensure effective workflows, staffing coverage, and adherence to deadlines and contract terms. Provide clinical oversight and guidance across medical review tasks and methodologies. Required Qualifications 5+ years of Program Management experience overseeing large or complex healthcare projects. Experience in medical review, healthcare auditing, or clinical review operations. Extensive knowledge of the Medicare program, including CMS regulatory and operational requirements. Working knowledge of the CMS FFS RAC Program. Strong leadership abilities with experience managing multidisciplinary teams. Education & Licensure Master's degree in Business, Healthcare Administration, Nursing, Management, or a related healthcare field from an accredited institution. Current, active U.S. Nursing License (RN); must be maintained throughout employment. Preferred Skills Excellent written and verbal communication skills. Strong analytical, organizational, and problem-solving abilities. Experience working with government contracts or federal healthcare programs. Ability to manage multiple projects and deadlines in a fast-paced environment. Why Join Us Opportunity to lead mission-critical work that supports the integrity of the Medicare program. Collaborative team environment with impactful clinical and operational responsibilities. Competitive compensation and benefits package. How to Apply Submit your resume detailing your program management experience, clinical background, and Medicare/CMS expertise. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Leads the alignment, standardization and ongoing improvement of ministry length of stay for designated patient populations. Serves as designated ministry liaison with providers and ministry Care Coordination teams, to move patients towards safe and effective discharge plans or transitions to the most appropriate next level of care. Providence caregivers are not simply valued - they're invaluable. Join our team at St. Joseph Hospital Of Orange and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we Providence know that to inspire and retain the best people, we must empower them. Required qualifications: + Associate's Degree in Nursing + Bachelor's Degree in Nursing. Or + Upon hire: California Registered Nurse License. + 3 years Experience in Utilization Management. + Experience working with InterQual and MCG guidelines. Preferred qualifications: + Master's Degree in Nursing. + 5 years Experience as a utilization/case manager in an acute care setting. + Experience in a multi-hospital and/or integrated healthcare system. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 410644 Company: Providence Jobs Job Category: Clinical Administration Job Function: Clinical Support Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 7540 SJO CASE MGMT Address: CA Orange 1100 W Stewart Dr Work Location: St Joseph Hospital-Orange Workplace Type: Remote Pay Range: $67.93 - $107.26 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Job Address: 10270 Blacklick - Eastern Road NW Pickerington, OH 43147 Role: Director of Clinical Services Job Post Title: Director of Clinical Services Solero Behavioral Transitions We provide a safe and supportive environment for individuals struggling with severe mental illness. Our program offers comprehensive care, including individual and group therapy sessions, case management services and life skills training. A mental health residential facility is a place where people receive intensive, specialized care for mental health and or substance abuse issues in a non-hospital setting. Residents receive 24-hour supervision, treatment, and support from mental health experts. The environment is homelike and supportive, and residents participate in therapeutic activities. Shift: M-F, with a weekend rotation Hours: 8-4:30 Perks at Work Healthcare: Medical Packages with Rx - 3 Choices Flexible Spending Accounts (FSA) Dependent Day Care Spending Accounts Health Spending Accounts (HSA) with a company match Dental Care Program - 2 choices Vision Plan Life Insurance Options Accidental Insurances Paid Time Off + Paid Holidays Employee Assistance Programs 401k with a Company Match Education + Leadership Development Up to $15,000 in Tuition Reimbursements Student Loan Forgiveness Programs Approved HRSA Site Approved STAR-LRP Site The Role Itself License/Education/Certification: Formal education program or training in Quality Improvement/Risk Management/Compliance for inpatient or behavioral health settings. Familiarity with healthcare laws, regulations, accreditation standards, state licensure or certification and Best Practices in healthcare compliance program implementation Knowledge of the principals of The Joint Commission and must be well versed in CMS guidelines Knowledge and understanding of the Regulatory Compliance Ohio Department of Mental Health and Addictions Serves as resource for faculty regarding medical record content and regulatory requirements Ability to adapt to change and work under stressful situation Education: Masters degree in social work with LSW and documented experience in group therapy setting. Counselor Degree Must be 21 yrs or older Top of Form License: LSW, LISW, LPC, LPCC, MFT, LMFT Current unencumbered clinical license per state of practice guidelines. Levels of Care Residential Mental Health Services A service activity which uses clinical and medical interventions, including the administration of physician prescribed medications and clinical monitoring, to help stabilize mental health symptoms to for individuals requiring a more structured and supervised environment. Partial Hospitalization Program Comprehensive Mental Health program with intensive treatment services to help individuals prepare for re-entry into all aspects of their lives including home, work, school and relationships. Program Purpose: We are committed to producing the highest level of clinical outcomes for clients and their families. Solero Behavioral Transitions is a trauma-informed, non-coercive treatment program designed to treat individuals struggling with Mental Health symptoms. The Solero's focused mental health rehabilitation includes; Building Resiliency Optimistic outlook Locus of control Sense of self Ability to bounce back Change management Practical Life Skills Problem-solving Money management Time management Personal change Self-awareness Communication Skills Active listening Nonverbal communication Communication skills Social Radar Negotiation skills These are the core concepts that extend into many areas of a client's life and help develop the foundations for recovery and recovery sustainability.

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

The purpose of this position is to assist the College in fulfilling its mission by facilitating student acquisition of the required knowledge, attitudes, and skills necessary for success in the student's chosen career in health sciences. ESSENTIAL FUNCTIONS: * Provides teaching, supervision and evaluation of student learning experiences in didactic, lab, and/or clinical environments. * Correlates clinical education with didactic education. * Provides individual advisement and guidance for intellectual and professional development of students. * Coordinates clinical education and evaluates effectiveness. Provides recommendations for improvement to Program Chair. * Ensures student outcomes are met by participating and assisting with assessment activities. * Serves as an academic advisor for students. * Collaborates with other faculty, preceptors, field faculty, and clinical agencies to provide optimum learning opportunities for students. * Develops, implements and revises course content in a limited subject area. * Serves as a mentor to new or inexperienced faculty as appropriate. * Participates in scholarly activities (e.g., grant writing, research, college projects, publications, creative teaching strategies). * Participates in and seeks out quality improvement opportunities. * Holds office hours for students. * Performs miscellaneous duties as assigned. MINIMUM KNOWLEDGE/SKILLS AND ABILITIES REQUIRED: * Bachelor's degree in Radiology Technology or related field. * Two years' clinical experience in radiology technology. * Current and valid certification in American Registry of Radiology Technology. * Current Ohio General Permit to Practice. * Current and valid certification in Cardio-pulmonary Resuscitation. * Demonstrated experience providing guidance or training to others. * Minimum one year experience as an instructor or as a preceptor in a JRCERT accredited program. * Proficient in curriculum design and/or course development, instruction, evaluation and academic counseling * Master's degree preferred. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

The Clinic Manager II assumes primary responsibility for overseeing clinical and administrative functions of capital and operating budgets, patient registration, billing, clinical information systems, management of clinical and administrative staff and clinic marketing and planning. This position is responsible for managing performance for Caregiver Engagement, Service Excellence, Quality & Safety and Stewardship. Responsible for multiple small practices or a large complex practice with a score between 7 and 12 on the Manger Trigger Tool (see below). This position ensures compliance with all regulatory and accreditation standards, financial performance and clinic policies. Decisions are made independently or in collaboration with others. This position has patient contact, has access to confidential information and functions under the direct supervision of a Director. Minimum Qualifications: Required Educational Degree: Bachelor's Degree Major/Area of Concentration: Any Effective 01/01/2021 for all current Managers and New Hires Bachelor's degree required within 5 yrs (3 yrs if you already posses an Associate's degree) Preferred Education: Bachelor's Degree in Business Administration or related field preferred Required Certifications, Credentials and Licenses: De-escalation training within 6 months. Required Experience: 2 - 4 years of practice management experience with progressive responsibility Job Specific Essential Functions: Provide operational leadership and oversight of one or more high-volume or multi-specialty clinics. Participate in recruitment, hiring, onboarding, training, and professional development of staff. Direct, supervise, and evaluate performance of clinical and administrative staff. Partners with hospital leaders to oversee outpatient ancillary operations, when applicable. Engage physicians and staff through communication of priorities, delegation of clinic tasks, and accountability to the achievement of goals. Utilize huddles and rounding to facilitate problem solving, communication from AHS system meetings, and identification of clinic concerns/issues. Manage processes in the clinic through implementation of SOP's, auditing, correction and suggestions for continuous quality improvement. Develop plans for improved provider productivity by working with providers on waste elimination, template redesign, optimization of outrotations, improving fill rate, and marketing / sales interfaces where appropriate. Responsible for metric tracking, root cause analysis, and improvement to meet or exceed budgeted quality, service, volumes and expenses. Ensure all provider encounters are captured, documented, locked in a timely manner and coded for comprehensive revenue cycle process. Responsible for completion of cash posting, financial deposits, A/R tracking and improvement toward MGMA service specific days in A/R and reporting of variances Act as liaison for providers to answer questions, communicate concerns to system, and solve day to day issues. Holds clinic team accountable for adherence to leadership and provider compact expectations of communication / behavior in delivery of care for optimal service to patients. Adhere to AHS, local, state and national legal and regulatory compliance requirements through ongoing clinic audit reviews and corrective action Benefits for Eligible Caregivers: Paid Time Off Retirement Plan Medical Insurance Tuition Reimbursement Work-Life Balance About Adena Heart and Vascular: The Adena Heart and Vascular Institute provides advanced, comprehensive care for heart, vascular, and thoracic conditions through cutting-edge technology and a skilled team of specialists. The institute emphasizes personalized treatment plans, collaboration among experts, and a focus on both immediate and long-term health. A key feature is our new hybrid operating room, which integrates advanced imaging and surgical capabilities to perform complex, minimally invasive cardiovascular procedures-such as TEVAR and EVAR-with a multidisciplinary team. This approach reduces complications and recovery times, allowing patients to receive high-quality, innovative care close to home. About Adena Health: Adena Health is an independent, not-for-profit and locally governed health organization that has been “called to serve our communities” for more than 125 years. With hospitals in Chillicothe, Greenfield, Washington Court House, and Waverly, Adena serves more than 400,000 residents in south central and southern Ohio through its network of more than 40 locations, composed of 4,500 employees - including more than 200 physician partners and 150 advanced practice provider partners - regional health centers, emergency and urgent care, and primary and specialty care practices. A regional economic catalyst, Adena's specialty services include orthopedics and sports medicine, heart and vascular care, pediatric and women's health, oncology services, and various other specialties. Adena Health is made up of 341 beds, including 266-bed Adena Regional Medical Center in Chillicothe and three 25-bed critical access hospitals-Adena Fayette Medical Center in Washington Court House; Adena Greenfield Medical Center in Greenfield; and Adena Pike Medical Center in Waverly.