Clinical manager work from home jobs - 663 jobs

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: Upon the direction of the Sr. Manager of Clinical Operations, the Manager of Clinical Training is responsible for oversight, strategy, measurement of impact, and maintenance of scalable learning solutions for training programs supporting teams across Clinical Services. This role drives the development of complex training programs and materials, including processes for tracking and deploying competency in line with departmental and regulatory requirements. The Manager of Clinical Training oversees and advises the Clinical Trainers to standardize and develop training tools and resources that are scalable and aligned with strategic initiatives and goals. Chairs the Continuing Education Committee that fosters integration and education across the health system in support of staff and provider learning and development. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions/Responsibilities: · Lead a team of clinical trainers and coordinators to achieve departmental learning and development initiatives. · Responsible for the Clinical Services training program addressing new hire orientation and ongoing learning, standardization of training materials, and collaboration across multiple departments within Clinical Services to expand scope of knowledge to enhance job performance, and development and promotion of continuing education and professional development for staff. · Facilitate cross-functional internal stakeholders (customer service, marketing, product, finance, care management, utilization management, pharmacy, behavioral health) to ensure operational requirements are developed to support Clinical Services objectives · Strategize with department leadership in developing department training plans · Actively lead projects focused on aligning learning and development solutions for various functional areas and key strategic initiatives. · Manage training programs and projects using industry best practices such as ADDIE or SAM models to design training curricula and define program/project life cycle with an eye on sustainability. · Prioritize program roadmaps to manage multiple programs concurrently · Advise clinical leaders, subject matter experts and other training staff to identify objectives, measures of success, content, audience, length and delivery vehicles. · Collaborate with Human Resources as appropriate in the standardization of company-wide orientation materials. · Execute the development, implementation and revisions of Clinical Service training and education initiatives including working with the department management to identify gaps in workflows, and policies and procedures. · Analyze training program feedback to effectively create / modify training to meet individual / departmental needs and goal · Engage with stakeholders, evaluate business problems, and conduct needs analysis exercises to identify training opportunities. · Create mechanisms for systematically measuring the impact and continuously improving training programs to maximize the training effectiveness and translate results in ROI. · Other duties as assigned. Supervision Exercised: · Directly or indirectly oversees management of up to 15 clinical and non-clinical staff Supervision Received: · Indirect supervision is received weekly Qualifications: Education Required: · Bachelor's degree or equivalent combination of education and relevant experience in health plan setting required Education Preferred: · Master's degree in related field (e.g. Adult Education, Learning Design, Instructional Design), etc) Experience Required: · 5+ years of experience in a learning and development environment · 2+ years of prior management/supervisory experience · 5+ years of related managed health or insurance operations experience Experience Preferred/Desirable: · 10+ years of experience in a learning and development environment · 10+ years of related managed healthcare clinical program experience · Project management experience · Experience in leader development programming · Active and unrestricted RN or SW license Certification or Conditions of Employment: · Pre-employment background check Competencies, Skills, and Attributes: · Exceptional written and oral communication skills. · Excellent organizational skills and attention to detail · Ability to interact with all levels of the organization, as well as external stakeholders. · Superior meeting facilitation skills and experience in leading cross-functional teams · Demonstrated ability to work independently and manage multiple complex projects simultaneously. · Proactive, motivated, and a collaborative team player. · Demonstrated ability to adapt quickly to changing priorities. · Ability to analyze, compile, format, and present data to a variety of stakeholders. · Strong critical thinking, analytical, and problem-solving skills. · Proficiency with MS tools including Word, Excel, PowerPoint, Visio and MS Project · Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives. · Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project. · Comprehensive knowledge of training program design and delivery required to include materials development is required including e-learning tools. · Outstanding interpersonal, communication and team building skills required. · Ability to work effectively in a fast-paced environment. Organized, able to prioritize and work independently. · Able to negotiate enterprise solutions with other departments that work interdepartmentally. Working Conditions and Physical Effort: · Regular and reliable attendance is an essential function of the position. · Fast paced office environment. · Work is normally performed in a typical remote work environment. · No or very limited physical effort required. No or very limited exposure to physical risk. Compensation Range $96,000 - $139,500 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This range is based on Boston-area data, and is subject to modification based on geographic location. About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi , the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Location: Remote (For Non-Local) or Hybrid (Local to NYC area) Position Responsibilities: Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process. Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance. Actively participate in the prior authorization technician metric and quality goal setting process. Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders. Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees. Investigate/resolve escalated issues or problems from team members, clients, and other internal teams. Key stakeholder in ensuring the prior authorization review platform is optimized for technician functions. Maintain relationships with external Independent Review Organizations and clinical resource vendors. Support the training and growth of both new and existing staff members in adherence to proper procedures. Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties. Assists with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department. Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines. Maintain compliance with local, state, and federal laws, in addition to established organizational standards. Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies Required Qualifications: Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required Bachelor's or Associate's degree is preferred 4+ years of PBM or Managed Care pharmacy experience required Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint Strong clinical background required Excellent communication, writing, and organizational skills Ability to multi-task and collaborate in a team with shifting priorities Preferred Qualifications: 2+ years of regulated market prior authorization operations experience or knowledge of how to operationalize regulated market requirements Previous prior authorization operations leadership experience Salary Range$80,000-$90,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at *********************************************

How will you make an impact? Manages identified Clinical Sites to educate prospective study subjects and health care professionals about clinical trial participation. Takes on added responsibility as requested from VP of Clinical Relations to assist the team in achieving Glaukos clinical enrollment goals. The specific tasks could be: new employee training, planning and leading Glaukos study investigators meetings, planning and implementing scheduled Investigator conference calls, overseeing the creation and delivery of monthly clinical study newsletters, Updating iPad with CRM study tools, performing the functions of CRM while also executing the Surgical Specialist tasks on identified trained Investigators, leading the team with updates with tracking subject software (iMednet), development of tools for scheduling clinical surgery, development of patient out-reach programs, development of surveys to track performance from our customers, attendance as needed to major local, regional, national, international industry meetings, development of surgical forms as needed as technique is developed for new Glaukos products. Being prepared as a back-up to the CRA to deliver the "Excellence in Research" program, Take the lead as directed on developing the system for Glaukos in-office surgery. What will you do? Leads clinical recruitment efforts on key US IDE and post-approval trials. Acts as an integral member of the core project team working directly with the Clinical Affairs team (Directors or Managers of Clinical Affairs, and Clinical Research Associates) and the Surgical Specialists (Regional Business Managers), and any other relevant team members. Develops strong personal relationships with study investigators, clinical coordinators, and glaucoma/cataract key opinion leaders. Establishes and builds rapport with clinical sites and assess their recruitment challenges and opportunities. Based on a thorough assessment, develops a detailed and specific subject recruitment plan for clinical sites participating in Glaukos-sponsored studies. Implements and facilitates subject recruitment and retention activities. Analyzes metrics to identify trends, issues, areas of success and for improvement. Identifies and proposes strategies, procedures, systems, technology etc. to improve productivity and efficiencies in clinical trial subject recruitment. Develops detailed site specific study pre-screening plans based on protocol inclusion/exclusion criteria. Performs and oversees patient chart reviews to identify potential study subjects. Complies with HIPAA, pertinent federal and state laws and regulations, and relevant Glaukos internal procedures. Identifies outreach opportunities to educate patients, health care professionals, advocacy groups, and potential referring physicians about study participation. Monitors referral sources to ensure adequate study information is provided to potential participants. Identifies, coordinates, and staffs appropriate events and meetings, as needed. Proactively and effectively communicates updates on site status to clinical management, Clinical Affairs, and RBMs. Communicates trends in the industry and, whenever possible, status of competitive clinical trials. Determines best practices for working with sites on increasing subject enrollment. Works with other respective Clinical Relations Managers to elevate team success. Attends major ophthalmic meetings, as needed. Provide training to ophthalmology practices on how to properly and efficiently identify patients within their practice who are potential candidates for commercial iStent implantation. Employ effective tools and programs to properly communicate the potential benefits of iStent implantation to appropriately identified patients. How You'll Get there: Minimum 9+ years relevant work experience in the medical device or pharmaceutical industry, preferably with experience in ophthalmology and medical devices. Required Knowledge of medical terminology required, with knowledge of ophthalmology terminology strongly preferred Required Prior experience in business development or as a study coordinator or clinical research assistant desirable Required Prior experience developing and executing training plans Required Knowledge of the medical, scientific, design, and clinical research aspect of medical device and/or pharmaceutical trials Required Strong communication, interpersonal, and analytical skills Required Excellent time management and organizational skills Required Experience in MS Office (Outlook, Word, Excel); familiarity with databases helpful Required Self-motivated and able to work independently, as well as within a team in a multidisciplinary environment Required Must be willing and able to travel a significant amount of time (> 50%) Required Flexibility, as assignments vary in location, time intensity Required Exhibits personal integrity, credibility, and responsibility Required Bachelor's Degree with major in biological science, nursing, or other health-related discipline preferred COA - Certified Ophthalmic Assistant Preferred COT - Certified Ophthalmic Medical Tech Preferred #GKOSUS

Artech is the 10th Largest IT Staffing Company in the US, according to Staffing Industry Analysts' 2012 annual report. Artech provides technical expertise to fill gaps in clients' immediate skill-sets availability, deliver emerging technology skill-sets, refresh existing skill base, allow for flexibility in project planning and execution phases, and provide budgeting/financial flexibility by offering contingent labor as a variable cost. Job Description • The Study Specialist will augment activities performed by existing study team members whether from client or client's preferred CROs by providing support to CRA activities to ensure adherence to study timelines and deliverables. • This position will provide site level problem solving expertise for complex rare disease clinical studies in early and late phase development. • Position will support all site management activities, which may include operational activities related to site evaluation, initiation, monitoring and close out for assigned clinical study sites to ensure compliance with ICH/Good Clinical Practices (GCP), client SOPs, protocol and patient safety. Organizational Relationships: • Oversight by client Clinical Operations Study Team Lead • Role will lease with client Compliance Oversight Lead for monitoring related activities if they occur • Interfaces with cross-functional study team members in a matrix environment (e.g., CRO Project Lead) Primary Duties: • Removing site obstacles to site start-up, maintenance and close-out while maintaining awareness of site dynamics with ability to motivate and educate site staff • Exhibits ability to independently and proactively identify and interpret problems, recommend creative solutions, drive resolution, and influence appropriate changes • Liaise with site, sponsor and CRO to provide site issue identification and resolution bringing sites to initiation, readiness to enroll and recruitment for assigned clinical research sites • Point of escalation for clinically identified site related issues • Problem solves identified issues (monitoring and/or regulatory) with appropriate escalation to Project Manager and/or designee • Supports the management of multiple academic sites (e.g., clinical research naive requiring in depth coordination and support) • Assures protection of the rights, safety, and wellbeing of subjects, study integrity and data quality • Supports inspection readiness including for example the facilitation of the collection and maintenance of regulatory and site documentation for the Trial Master File and site file • Supports local IRB workflow, submission through approval and reporting of safety information and may prepare answers, as required, to the IRB in conjunction with study team/Client • Completes assigned training as necessary, including general training requirements, SOPs, system and process related training, and protocol specific training. • Complies with all departmental objectives and metrics related to study execution • Attend/lead/facilitate meetings as requested (i.e. investigator, project) to gain and/or share project/site knowledge Secondary Duties • As needed, performs site development and training (supporting and coaching site personnel), site monitoring, and site close-out activities for assigned clinical research sites with designated project SOPs, Client expectations, study specific protocol and GCPs • As needed, supports activities such as but not limited to source data verification, case report form review, AE/SAE review and reconciliation, IP accountability, questionnaire reconciliation, equipment maintenance, supplies tracking and query resolution • Complies with the Clinical Monitoring Plan (CMP) and becomes knowledgeable of the protocol to guide assigned sites in the proper conduct of the study • Potential to complete monitoring reports in compliance with requirements in the Clinical Monitoring Plan Training and Education Preferred: • Bachelor's Degree in Life Science, RN preferred • Minimum 5 years of study management experience with preferred focus in Rare Diseases (for example Sickle Cell Disease and/or other genetic hematological diseases) and experience in on-site monitoring • Expertise in study start up and site management (experience in complex hospital-based Phase 3 clinical trials highly desirable) • Demonstrated ability to problem solve and to prioritize site related activities • Demonstrates solid understanding of drug development and clinical practices • Understands and is able to comprehend study protocols • Has knowledge of FDA regulations • Possesses working knowledge of GCPs and other regulations governing clinical research • Demonstrates technical expertise in computer skills • Demonstrates diligent and self-motivated approach to working in an independent environment • Demonstrates effective oral and written communication skills • Travel anticipated at 25% but could up to 50% at times. Qualifications BS/MS Additional Information For more information, please contact Akriti Gupta ************** Morristown, NJ 07960

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

The Clinical Specialist (CS) is responsible for positively impacting regulatory standards and clinical outcomes of clinics in an assigned geographic region. The CS is also responsible for the training of new employees and current clinical staff. The CS will also be responsible for conducting in-services and review classes, ensuring that the clinics have properly trained staff that meet regulatory standards and provide quality patient care. The CS reports directly to the next level of clinical management which may be the Director of Clinical Operations or Vice President of Clinical Operations/Services, depending on the region/demographics or responsibilities. Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned. GROWTH · Responsible for overseeing overall clinical operation of assigned clinics from regulatory and growth perspective in accordance with Company goals. · Assist in clinical operational development and transition of new or acquired clinic(s) as needed or requested. · Assess and integrate clinical policy and regulatory requirements in acquired clinic(s). · Demonstrate effective use of company resources, i.e. supplies, safety and risk reduction, and best support methodologies. · Work with Administrators and regional management toward the achievement of monthly, quarterly and annual projections based on clinical outcomes and management objectives. · Perform duties as assigned to meet the patient care or operational needs of assigned clinics. OUTCOMES · Assist with developing, implementing and monitoring of quality of care processes for program regulatory compliance in accordance with Company goals. · Ensure clinical processes in assigned USRC facilities are maintained in accordance to company policy and federal, state and local regulations. · Assist with developing, implementing, and improving quality and productivity goals and measures. · Work with Administrators and regional management to ensure optimal patient care and regulatory compliance. · Remain current with dialysis industry and technology. · Assist with program target goals for patient outcomes in accordance with quality patient care and Company goals at assigned clinics. OPERATIONAL READINESS OPERATIONAL READINESS (cont.) · Knowledge of and remain current with federal, state, local laws and regulations. · Assure that assigned clinics are in compliance with all applicable federal, state, and local laws and regulations and receive continuing certification from all statutory and regulatory agencies by conducting internal clinical reviews. · Perform duties at all times within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations. · Assist Administrators and regional management with necessary Corrective Action Plan development, implementation and follow through as required for internal and external surveys. · Provide follow up on any/all deficiencies for all audits done internally (corporate) or externally (CMS & state specific). · Assure compliance with required Governing Body meetings, monthly CQI meetings and care plan conferences and assures documentation of such through recorded minutes. · Evaluate patient care data to ensure that care is provided in accordance with clinical guidelines and organizational performance standards. · Assist with developing, implementing and monitoring of clinical, education and QAPI policies. · May assist with policy/procedure revisions and dissemination of new and revised policies. · Know and understand the function and safe operation of water treatment equipment and related mechanical and electrical systems. · Be familiar with all emergency equipment and emergency operational procedures. · Use appropriate safety measures including personal protective equipment as necessary. · Be familiar with OSHA regulations. PARTNERSHIPS · Understand, lead and promote the Company's mission and philosophy relating to ethics, integrity, safety, corporate responsibility and objectives. · Communicate with clinical operations management and regional management on a consistent basis regarding the status of each clinic in the region. · Communicate completion status of Plans of Correction for internal and external surveys to Administrators, regional management and clinical operations management. · Maintain collaborative working relationship with Administrator(s) and regional management. Partner with Administrator(s) and regional management to ensure clinic needs are met. · Maintain a positive/collaborative relationship with physicians, state agencies and the community. · Actively promote GUEST customer service standards; develop effective relationships at all levels of the organization. · Respond effectively to inquiries or concerns. STAFF DEVELOPMENT/ RETENTION · Ensure all clinical staff meet required qualifications for position held and perform duties within limitations established by and in accordance with company policy/procedures, health care professionals practice acts, applicable state and federal laws and regulations. · Orient and mentor Administrators in the QAPI process, outcomes, education programs and operational readiness in accordance with USRC practices. · Review IntraLearn assignments and compliance reports; communicate results to facility management as needed. · Coordinate and conduct PCT certification review programs, CPR certification training (if required), and ongoing mandatory continuing education. · Perform clinical education of new hires as needed or requested. · Provide clinic based in-service programs as needed or requested. · Coordinate and conduct charge nurse training and preceptor training programs as directed. · Uphold management goals of corporation by leading staff in team concepts and promoting a team effort. · Effectively communicates expectations; accepts accountability and holds others accountable for performance.

Ready to Elevate Addiction Recovery? If you're looking to redefine the way care is delivered and be at the forefront of addiction recovery, we have the career for you! Your expertise and compassion can change lives-one virtual session at a time Gateway Rehab Center (GRC) is seeking a passionate and skilled Clinical Manager to revolutionize the way we deliver care. This management position allows you to bring compassion, innovation, and expertise to individuals on their journey to recovery-all from the comfort of your home with occasional travel to a GRC location. If you're driven by the mission of making high-quality, accessible care a reality for all, we want to hear from you! Please Note: This is a remote position with occasional travel to a GRC facility in Robinson, PA. Ideal candidate should live in the Pittsburgh area or surrounding counties. Why Choose Gateway Rehab? Make an impact through Gateway's mission “to help all affected by addictive disease to be healthy in body, mind, and spirit.” Be a part of an organization that has been leading the way in addiction treatment for over 50 years. Leverage cutting-edge telehealth technology to bridge gaps in care and transform lives. Enjoy the flexibility of a remote role while maintaining meaningful client. Why This Role is the Future of Addiction Treatment? GRC's Telehealth Services team is changing lives, and as a Clinical Manager, you'll be at the forefront of this movement. Your work will expand access to critical services, empower clients, and shape the future of addiction recovery. This is more than just a job-it's a mission-driven career where you can make a lasting impact every single day. Your Role in Transforming Recovery Conduct authorization audits to ensure timely completion, avoiding any disruption in payments. Develops a training curriculum for Aura/m.care, tailored for new hires in all Telehealth positions. Performs chart audits for compliance of all new admissions, ensuring deadlines are met and sending reminders to staff with outstanding documentation. Maintains staff training records and identify training opportunities based on areas of need, as recommended by the Director or Executive Director. Oversees patient program attendance, ensuring compliance with policies and licensure requirements, particularly for psych services and IOP. Conducts documentation audits across different levels of care to ensure timely completion of all required items. Attends mandatory GRC trainings and in-services. Requirements What We're Looking For Master's degree in field that meets Pennsylvania Department of Health staffing qualification regulations required. License or certification from the Pennsylvania Certification Board eligible. Two years' clinical experience in a health or human service agency, including one year working directly with chemically dependent persons. Supervisory experience preferred. Knowledge of Substance Use Disorders and Evidence-based treatment methods. Strong leadership skills. Ability to manage crisis, make decisions, and make sound clinical judgements. Excellent written and verbal communication skills. Additional Requirements Pass PA Criminal Background Check. Obtain PA Child Abuse and FBI Fingerprinting Clearances. Pass Drug Screen. TB Test. Work Conditions Remote with travel into a GRC facility. Favorable working conditions. Minimal physical demands. GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.

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.

Syneos Health is a leading fully integrated biopharmaceutical solutions organization built to accelerate customer success. We translate unique clinical, medical affairs and commercial insights into outcomes to address modern market realities. Our Clinical Development model brings the customer and the patient to the center of everything that we do. We are continuously looking for ways to simplify and streamline our work to not only make Syneos Health easier to work with, but to make us easier to work for. Whether you join us in a Functional Service Provider partnership or a Full-Service environment, you'll collaborate with passionate problem solvers, innovating as a team to help our customers achieve their goals. We are agile and driven to accelerate the delivery of therapies, because we are passionate to change lives. Discover what our 29,000 employees, across 110 countries already know: WORK HERE MATTERS EVERYWHERE Why Syneos Health We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program. We are committed to our Total Self culture - where you can authentically be yourself. Our Total Self culture is what unites us globally, and we are dedicated to taking care of our people. We are continuously building the company we all want to work for and our customers want to work with. Why? Because when we bring together diversity of thoughts, backgrounds, cultures, and perspectives - we're able to create a place where everyone feels like they belong. Job Responsibilities Core Responsibilities Line management of Clinical Operations staff, responsibilities including interviewing and selection, termination, professional development, performance appraisals, and employee counselling May be involved in assignment of project work and will review workloads for all direct reports. Manages staff by establishing goals that will increase knowledge and skill levels, and by delegating tasks commensurate with skill level. Review workload for all staff in reporting chain, participate in managing the resource availability for the assigned staff, providing support that projects are suitably resourced and staffing needs are identified in a timely fashion. Provide expert operational oversight and guidance to support prioritization of activities, review and monitor the work performed, metric compliance, and development of contingency plans, among others. Assist in recruiting new staff, including participation in interview process and new hire on boarding. Proactively work to ensure staff retention and turnover rates remain within expected levels. Ensure quality and adherence to Standard Operating Procedures/Work Instructions (SOP/WIs) and compliance with federal and local guidelines and ICH GCP. Ensure all staff follow required training and complete required documentation. Provide regular updates to management accordingly. Work closely within appropriate business unit/region to ensure staff performance on studies and correct deficiencies as identified by staff, customers, and auditors. Able to contribute to BU level process improvements. May provide business development support. May conduct several types of sign off and assessment visits to ensure Clinical Operations on-site performance. Develop and oversee training plans to address performance deficiencies. Ensure staff adhere to training guidelines, training records maintenance, and individual and corporate training needs are identified and addressed. Organize and chair clinical staff meetings at regular intervals. Manage issues and provide follow up for action items requiring resolution. Facilitate and support project and team/country reviews with Clinical Operations staff, focusing on budget, schedule, and risk analysis. Use department systems, reports, and dashboards to identify performance issues, process gaps and monitor overall performance progress in line with departmental goals and metric targets. Oversee all quality control efforts of assigned teams. Qualifications Bachelor's degree in life sciences, nursing degree, or equivalent related experience, plus extensive clinical research experience in a contract research organization, pharmaceutical or Biotechnology Company, including some time in a leadership capacity or equivalent combination of education, training and experience is required. Extensive knowledge of GCP/ICH guidelines and other applicable regulatory requirements Excellent communication, presentation, interpersonal, and change management skills, both written and spoken, with an ability to inform, influence, convince, and persuade. Strong time management, technical and organizational skills. Ability to work independently and within a team environment. Knowledge of basic financial concepts as related to forecasting and budgeting. Understands project budgets. Must demonstrate good computer skills and be able to embrace modern technologies. Ability to travel as necessary (up to 25%) At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position may include a company car or car allowance, Health benefits to include Medical, Dental and Vision, Company match 401k, eligibility to participate in Employee Stock Purchase Plan, Eligibility to earn commissions/bonus based on company and individual performance, and flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos complies with all applicable federal, state, and municipal paid sick time requirements. Salary Range: The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. Get to know Syneos Health Over the past 5 years, we have worked with 94% of all Novel FDA Approved Drugs, 95% of EMA Authorized Products and over 200 Studies across 73,000 Sites and 675,000+ Trial patients. No matter what your role is, you'll take the initiative and challenge the status quo with us in a highly competitive and ever-changing environment. Learn more about Syneos Health. *************************** Additional Information Tasks, duties, and responsibilities as listed in this are not exhaustive. The Company, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills, and/or education will also be considered so qualifications of incumbents may differ from those listed in the Job Description. The Company, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms. Any language contained herein is intended to fully comply with all obligations imposed by the legislation of each country in which it operates, including the implementation of the EU Equality Directive, in relation to the recruitment and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the provision of reasonable accommodations, when appropriate, to assist employees or applicants to perform the essential functions of the job.

Join one of the nation's leading and most impactful health care performance improvement companies. Over the years, Health Catalyst has achieved and documented clinical, operational, and financial improvements for many of the nation's leading healthcare organizations. We are also increasingly serving international markets. Our mission is to be the catalyst for massive, measurable, data-informed healthcare improvement through: Data: integrate data in a flexible, open & scalable platform to power healthcare's digital transformation Analytics: deliver analytic applications & services that generate insight on how to measurably improve Expertise: provide clinical, financial & operational experts who enable & accelerate improvement Engagement: attract, develop and retain world-class team members by being a best place to work Job Title: Clinical Abstraction Specialist Team: TEMS (Tech-Enabled Managed Services) Location: US Remote Travel: 0% **This position is currently not eligible for visa sponsorship** Job Summary The Clinical Abstraction Specialist is a skilled professional abstractor responsible for collecting, screening and analyzing data that profiles the appropriateness, utilization management, quality and outcome of patient care provided by the healthcare team. This individual must maintain professional confidentiality and is responsible for the understanding and knowledge of specific regulatory data requirements for the National Surgical Quality Improvement Program (NSQIP). Data abstraction and process improvement will occur concurrently and retrospectively to evaluate the quality of patient care. This individual will be responsible for utilizing clinical expertise to analyze and evaluate medical records and collaborate with physicians and coding staff as appropriate. This individual will possess excellent clinical judgment in the area of related care and outcomes management. What you'll own in this role: The following functions describe the essential duties of this role including but not limited to: Aligns all work and resource management with Health Catalyst's mission, cultural attributes, and operating principles. Obtain certification and maintain American College of Surgeons Certification. Works directly with customers to understand and help achieve goals and expectations. Interacts with the medical staff and other key stakeholders to: educate, obtain and/or provide pertinent information specific to what is required to meet metrics and to provide excellent patient care. May act as a subject matter expert (SME) to assist with escalations and educate external and internal stakeholders. Review, abstract, and evaluate clinical data on a case by case basis in a timely manner. Reviews, validate, and communicate data specific to outliers, failures, opportunities for improvement, and refers cases to appropriate parties for additional review if needed. Maintains knowledge of current regulatory guidelines, definitions of data variables and compliance with data outcomes. May monitor and appropriately query physicians or members of the multi-disciplinary team for documentation to support accuracy or clarity in the medical record. Able to review and abstract medical records within predefined standards as measured by internal and external audits. Provide back up support to other registries as business need arises. Additional duties as required. What you bring to this role: Exceptional organizational skills with attention to detail and ability to prioritize. Must work well independently and remotely. Must work well under constantly changing and stressful situations. Ability to understand and operationalize quality improvement philosophy, principles, and technology. Demonstrated ability in communication, creativity, flexibility, and problem-solving aligned with Health Catalyst operating principles and cultural attributes. Ability to establish partnerships with customers to accomplish the goals of the work. Knowledge of or ability to learn Microsoft Office products including but not limited to Outlook, Excel, Word, etc. Knowledge of or ability to learn how to navigate various databases including but not limited to Epic and ACS NSQIP/IQVIA platforms. Education, Certification/Licenses, & Relevant Experience: Clinical Data Abstraction experience for the National Surgical Quality Improvement Program (NSQIP) Registry is required. Current NSQIP SCR Certification. Current Registered Nurse (RN) license Minimum of three (3) to five (5) years' experience in a clinical setting to include deep clinical knowledge. Information Security and Compliance Responsibilities Maintain compliance with training directives required by the organization pertaining to Information Security, Acceptable Use Policy and HIPAA Privacy and Security. Adhere to and comply with the organizations Acceptable Use Policy. Safeguard information system assets by identifying and reporting potential and actual security events to the organizations Security and Compliance Officers. The above statements describe the general nature and level of work being performed in this job function. They are not intended to be an exhaustive list of all duties, and indeed additional responsibilities may be assigned by Health Catalyst. Studies show that candidates from underrepresented groups are less likely to apply for roles if they don't have 100% of the qualifications shown in the job posting. While each of our roles have core requirements, please thoughtfully consider your skills and experience and decide if you are interested in the position. If you feel you may be a good fit for the role, even if you don't meet all of the qualifications, we hope you will apply. If you feel you are lacking the core requirements for this position, we encourage you to continue exploring our careers page for other roles for which you may be a better fit. At Health Catalyst, we appreciate the opportunity to benefit from the diverse backgrounds and experiences of others. Because of our deep commitment to respect every individual, Health Catalyst is an equal opportunity employer.

Syneos Health is a leading fully integrated biopharmaceutical solutions organization built to accelerate customer success. We translate unique clinical, medical affairs and commercial insights into outcomes to address modern market realities. Our Clinical Development model brings the customer and the patient to the center of everything that we do. We are continuously looking for ways to simplify and streamline our work to not only make Syneos Health easier to work with, but to make us easier to work for. Whether you join us in a Functional Service Provider partnership or a Full-Service environment, you'll collaborate with passionate problem solvers, innovating as a team to help our customers achieve their goals. We are agile and driven to accelerate the delivery of therapies, because we are passionate to change lives. Discover what our 29,000 employees, across 110 countries already know: WORK HERE MATTERS EVERYWHERE Why Syneos Health * We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program. * We are committed to our Total Self culture - where you can authentically be yourself. Our Total Self culture is what unites us globally, and we are dedicated to taking care of our people. * We are continuously building the company we all want to work for and our customers want to work with. Why? Because when we bring together diversity of thoughts, backgrounds, cultures, and perspectives - we're able to create a place where everyone feels like they belong. Job Responsibilities Core Responsibilities * Line management of Clinical Operations staff, responsibilities including interviewing and selection, termination, professional development, performance appraisals, and employee counselling May be involved in assignment of project work and will review workloads for all direct reports. Manages staff by establishing goals that will increase knowledge and skill levels, and by delegating tasks commensurate with skill level. * Review workload for all staff in reporting chain, participate in managing the resource availability for the assigned staff, providing support that projects are suitably resourced and staffing needs are identified in a timely fashion. * Provide expert operational oversight and guidance to support prioritization of activities, review and monitor the work performed, metric compliance, and development of contingency plans, among others. * Assist in recruiting new staff, including participation in interview process and new hire on boarding. Proactively work to ensure staff retention and turnover rates remain within expected levels. * Ensure quality and adherence to Standard Operating Procedures/Work Instructions (SOP/WIs) and compliance with federal and local guidelines and ICH GCP. Ensure all staff follow required training and complete required documentation. Provide regular updates to management accordingly. * Work closely within appropriate business unit/region to ensure staff performance on studies and correct deficiencies as identified by staff, customers, and auditors. Able to contribute to BU level process improvements. May provide business development support. * May conduct several types of sign off and assessment visits to ensure Clinical Operations on-site performance. Develop and oversee training plans to address performance deficiencies. Ensure staff adhere to training guidelines, training records maintenance, and individual and corporate training needs are identified and addressed. * Organize and chair clinical staff meetings at regular intervals. Manage issues and provide follow up for action items requiring resolution. * Facilitate and support project and team/country reviews with Clinical Operations staff, focusing on budget, schedule, and risk analysis. Use department systems, reports, and dashboards to identify performance issues, process gaps and monitor overall performance progress in line with departmental goals and metric targets. Oversee all quality control efforts of assigned teams. Qualifications * Bachelor's degree in life sciences, nursing degree, or equivalent related experience, plus extensive clinical research experience in a contract research organization, pharmaceutical or Biotechnology Company, including some time in a leadership capacity or equivalent combination of education, training and experience is required. * Extensive knowledge of GCP/ICH guidelines and other applicable regulatory requirements * Excellent communication, presentation, interpersonal, and change management skills, both written and spoken, with an ability to inform, influence, convince, and persuade. * Strong time management, technical and organizational skills. Ability to work independently and within a team environment. * Knowledge of basic financial concepts as related to forecasting and budgeting. Understands project budgets. * Must demonstrate good computer skills and be able to embrace modern technologies. * Ability to travel as necessary (up to 25%) At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position may include a company car or car allowance, Health benefits to include Medical, Dental and Vision, Company match 401k, eligibility to participate in Employee Stock Purchase Plan, Eligibility to earn commissions/bonus based on company and individual performance, and flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos complies with all applicable federal, state, and municipal paid sick time requirements. Salary Range: The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. Get to know Syneos Health Over the past 5 years, we have worked with 94% of all Novel FDA Approved Drugs, 95% of EMA Authorized Products and over 200 Studies across 73,000 Sites and 675,000+ Trial patients. No matter what your role is, you'll take the initiative and challenge the status quo with us in a highly competitive and ever-changing environment. Learn more about Syneos Health. *************************** Additional Information Tasks, duties, and responsibilities as listed in this are not exhaustive. The Company, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills, and/or education will also be considered so qualifications of incumbents may differ from those listed in the Job Description. The Company, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms. Any language contained herein is intended to fully comply with all obligations imposed by the legislation of each country in which it operates, including the implementation of the EU Equality Directive, in relation to the recruitment and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the provision of reasonable accommodations, when appropriate, to assist employees or applicants to perform the essential functions of the job. Summary Accountable for and provides management support and direct supervision to Clinical Operations staff in the assigned areas including Site Selection support, site contracts support, regulatory/ethics submissions, site activities including site activation as well as On-Site Monitoring and/or Central Monitoring through Study Close Out. Provides training, consultation and oversees metric compliance and quality related to operating activities of assigned staff to ensure project deliverables are met. Collaborates and oversees Clinical Operations Team to ensure fulfillment of customer requirements and compliance with related regulations. Supports senior management in operational level planning. May participate in business development presentations as a subject matter expert in Clinical Operations functions within the Company.

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

This opportunity will be on-site in Washington. Cornerstone, part of The Pennant Group family, is currently seeking entrepreneurial-minded leaders with proven results in building and leading exceptional clinical teams - and has a passion for the home health, hospice and home care industry. Join us in making an impact and shaping the future of home healthcare! About the Opportunity: The CCO-in-Training (CCIT) Program is a 12-week, full time paid executive training program designed to prepare outstanding leaders for an opportunity to lead and manage clinical services and teams in a home health, hospice, or home care setting. CCITs learn how to drive results, cultivate a strong team culture, and develop a deep understanding of the unique business model that powers Pennant's success. Successful CCIT graduates may advance to lead one of our thriving agencies or future agencies, with continued mentorship and operational support from experienced clinical partners. As a CCIT, you will gain hands-on practical experience in high quality clinical care services, agency operations, administrative support, and people leadership skills to equip you to take on a more strategic and elevated Director of Clinical Services position (or equivalent). The CCIT program offers mentorship, cross-functional training, and real responsibility in a dynamic environment. Key Responsibilities: Engage in immersive, on-the-job training across clinical, operational and administrative management functions. Shadow department heads and front-line staff to understand the day-to-day rhythm of agency operations, processes, and clinical controls. Take the lead on real-time projects and contribute to meaningful improvements within your host agency. Prepare for a Director-level role by mastering staffing, team engagement, and community growth initiatives. Study relevant state regulations and best practices in home healthcare operations. Align leadership and interpersonal skills with our CAPLICO core values and mission. Qualifications: Current, unencumbered, active license to practice as a Registered Nurse, Speech-Language Pathologist, Occupational Therapist, or Social Worker in the state where services are rendered; must maintain applicable state licensure requirements at hire, and for the entire duration of employment. Minimum of one (1) year of experience required, preferably in a home health or hospice treatment setting. Current and nationally accredited CPR certification. Enthusiasm, passion for working with people, and an internal drive to improve the lives of individuals in our care. Must understand and adhere to the ethical standards of the respective licensure governing board. Must have a valid driver's license, current automobile insurance, and a safe driving record. Open to relocation based on available opportunities About Us: Cornerstone, an affiliate of The Pennant Group (NASDAQ: PNTG), is committed to delivering compassionate, personalized care to patients and families in the comfort of their own homes. As part of the Pennant family-a growing national network with over 180 affiliated locations across 14 states spanning home health, hospice, and senior living-we operate with the independence and flexibility that allow our local leaders to truly make a difference. Pennant Services provides robust clinical, legal, accounting, IT and HR support, enabling our teams to focus on delivering exceptional service and care. We are guided by the core values that shape Pennant's unique culture: Customer Second Accountability Passion for Learning Love One Another Intelligent Risk Taking Celebrate Ownership We believe in empowering our people, fostering excellence, and creating an environment where personal and professional growth thrives. Our culture makes Pennant a truly unique place to work. The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at **************************** #onsite The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at ****************************

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary General Summary: Under the general direction of the Director of Risk Capture, the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and appropriate identification of patient medical conditions through comprehensive chart review combined with review of coding output data sources (internal and external claims) that results in improvement in the overall quality, completeness and accuracy of problem lists, visit documentation and disease registry assignments. The CRS utilizes both clinical and coding knowledge of Hierarchical Condition Categories (HCCs) to inform accurate and appropriate diagnosis considerations for suspect condition identification and recapture opportunities. This role serves to educate providers and the clinical care team on all aspects of risk capture and linkages with quality. Qualifications Principle Duties: Drive Clinical Delivery * Performs accurate and timely pre-visit review of selected ambulatory encounters to identify opportunities to recapture medical conditions that meet criteria as HCC diagnoses and to capture new, suspected HCC conditions. * Accurately interprets clinical information in the medical record, evaluating clinical indicators to identify potential diagnoses * Presents clear HCC Consideration Communication to provider and educates providers to obtain greatest possible diagnostic specificity to accurately reflect the patient's condition(s) Identify Education Opportunities * Identifies themes through chart review that might present education opportunities for individual or groups of providers * Gathers feedback from periodic post-visit chart reviews and incorporates these learnings into educational opportunities with providers * Identifies opportunities for Process Improvement and Quality Improvement, as needed Foster collaborative relationships across the enterprise * Communicates appropriately and compliantly with physician or care team through Epic resources to improve medical record documentation * Participates in ambulatory unit/organizational programs and meetings as needed * Maintains professional competency by keeping abreast of new coding issues and guidelines. Attends classes and meetings as assigned. Reviews professional CDI and coding literature regularly * Maintains clinical licensure and/or medical coding credentials (e.g. RN, PA, NP, CRC, CDEO, CCS, CPC) and completes all required Organizational Competencies and trainings (if applicable) * Meets with providers on an as-needed basis to address concerns or areas of opportunity, and performs chart reviews as needed * Maintains good rapport and professional relationships, as outlined in MGB Code of Conduct - * Approaches conflict in a constructive manner, helps identify problems, offers solutions and participates in resolution * Responsible to perform any other assigned duties as requested Qualifications: * Minimum three (3) - five (5) years' experience required in either, case management, outpatient coding, utilization review, CDI or other disciplines with either coding experience however, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements. * 2 years' experience in Primary Care, medical coding, risk adjustment or CDI preferred * Current certification in Clinical Documentation Improvement (CDIP, CCDS, CCDS-O or CDEO) preferred * Certification in medical coding and or risk adjustment (i.e., CRC, CPC, CCS, CDEO, or CCS-P or other pertinent to outpatient) preferred (CRC Required training within 1 year of employment) * Medical licensure (RN, PA, NP) preferred * Bachelor's degree healthcare related preferred * Strong PC skills / Microsoft applications, including Outlook, Teams, Excel, PowerPoint Additional Job Details (if applicable) Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $62,400.00 - $90,750.40/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Are you passionate about making a meaningful impact on the lives of individuals facing mental health challenges, while working behind the scenes? If so, Utilization Management might be the perfect fit for you! In this role, you'll play a critical part in shaping care decisions and improving outcomes, all without direct, face-to-face interaction. What You'll Do Apply your knowledge of Behavioral Health and Withdrawal Management diagnoses. Navigate the continuum of care and levels of care for Behavioral Health and Withdrawal Management. Present cases confidently and effectively during clinical rounds. Work independently with minimal supervision. Excel in a fast-paced, dynamic environment. Our Ideal Candidates will have an RN or Social Work license and: 3 years - Clinical behavioral health / substance use disorder experience required 1 year - Must be knowledgeable about community care resources and levels of behavioral health care available. Along with: 3+ years of experience in Psychiatric and/or Substance Use treatment. Background in Behavioral Health settings (both inpatient and outpatient). Prior experience in Utilization Management or Managed Care. Strong communication and presentation skills. Ability to work autonomously and manage time effectively. Adaptability and resilience in a rapidly changing work environment. Why Choose Us? This is more than a job; it's an opportunity to make a lasting difference in people's lives while leveraging your expertise in a collaborative, supportive setting. Job Responsibilities Assists non-clinical staff in performance of administrative reviews Initiate referrals to ensure appropriate coordination of care. Seek the advice of the Medical Director when appropriate, according to policy. Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility. Various immunizations and/or associated medical tests may be required for this position. Job Qualifications License Current, active unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) (Ph.D., LCSW/LMSW, LLP, MHC, LPC, etc.) required. RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical behavioral health / substance use disorder experience required Skills\Certifications Must be knowledgeable about community care resources and levels of behavioral health care available. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Independent, Sound decision-making and problem-solving skills Excellent oral and written communication skills Strong interpersonal and organizational skills Strong analytical skills Positive relationship building skills and ability to engage with diverse populations Ability to quickly identify and prioritize member needs and provide structured and focused support and interventions Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

**Voted Raleigh's Best Nonprofit Organization and Raleigh's Best Mental Health Services two years in a row!** Are you a clinician with a passion for making a real difference in the lives of youth living with mental health challenges and intellectual / developmental disabilities? At Easterseals PORT Health (ESPH), our mission is rooted in empowering individuals and strengthening communities. We're seeking a compassionate and creative full-time Clinical Specialist to join our VA REACH team working onsite at our Youth Crisis Therapeutic Home in Culpeper, VA. $7,500 Sign-on & Retention Bonus Your Role in Our Mission The Clinical Specialist provides clinical and administrative support to the REACH Youth Crisis Therapeutic Home (YCTH) and assists the mobile team as needed. In this role you will conduct assessments and reassessments, deliver crisis prevention and intervention services, and support Behavior Technicians on the floor while maintaining a safe, therapeutic environment for up to six youth. The Clinical Specialist assists the YCTH Supervisor in developing and maintaining clinical and therapeutic integrity to the daily programming such as modifying therapeutic groups and developing therapeutic activities. This is a great opportunity to utilize your creativity! The Clinical Specialist also provides support to leadership through virtual oversight of assessments as needed, provides QMHP-T supervision to Behavior Techs, and participates in the residential on-call rotation. Why Join Us? As a part of our mission, we help our team members embrace their potential, build resilience, and thrive! You will benefit from ongoing professional growth and development as you work alongside leaders of clinical excellence in mental health and substance use services that care about your success. Consistent Monday-Friday schedule with your choice of 7:00am-3:00pm, 8:00am-4:00pm, or 9:00am-5:00pm. After training, this role offers the option to work remotely one day per week. Some on-call flexibility is required, with additional stipends provided for on-call coverage. We also offer a full benefits package for benefits-eligible positions. Compensation & Benefits Competitive salary: $60,000 - $70,000 for this full-time, exempt position Generous paid time off and paid holidays Full benefits package including Medical, Dental, and Vision benefits Life and Disability Insurance(company paid) 403(b) Retirement Plan Employee Assistance Program and legal services support Public Service Loan Forgiveness (PSLF) qualifying employer Supervision for licensure Sign-on & Retention Bonus is paid out at successful completion of 90 days, 6 months, and 1 year for full-time, new hire staff What We're Looking For Education: Master's in health, psychology or social work from USDOE or CHEA accredited institution Licensed or License-eligible as a LPC, LCSW, LMFT 3 years of experience with developmental disabilities and mental health populations preferred Experience with crisis prevention and intervention services a plus Valid driver's license, good driving record and current auto insurance Proficiency with EHR systems and Microsoft Suite Ready to Apply? Join a team where work isn't just something you do - it's a purpose. Bring your expertise to a mission that matters. Apply now at *************** PORT.com or send your resume to recruiter@easterseals PORT.com. About Easterseals PORT Health Easterseals PORT Health is a trustworthy and compassionate partner, providing exceptional services in disability, mental health, and substance use to help our neighbors live their best lives. Purpose, dedication, and empathy drive our in-person and telehealth service delivery. Our diverse and inclusive 2,600-member team provides more than 10.2 million hours of meaningful support to 40,200 kids, adults, and families in 11,000 home, facility, and community locations across North Carolina and Virginia. Easterseals PORT Health is an Inclusive Culture, Diverse Voices, Embracing Potential, Authentic Self, and Learning and Growing (IDEAL) organization. Applicants of all abilities are encouraged to apply!

Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. What You'll Do: As Clinical Educator with Imagine Pediatrics, you will play a critical role in supporting the clinical development and education of all clinical health professionals. This position involves developing, implementing, and evaluating training programs to ensure the delivery of high-quality, family-centered care. The Clinical Educator will collaborate with interdisciplinary teams to enhance the competencies of clinicians, improve patient outcomes, and ensure adherence to value-based care principles. You will support various learning programs through in-person and remote training. You will: Develop and maintain new hire standards for onboarding and clinical orientation. Collaborate with program and regional leaders to design and deliver robust clinical onboarding experience that focuses on care delivery models, process improvement, tailored services, value-based care, and SDOH. Create, coordinate, and deliver training programs, workshops, and continuing education sessions for team members focusing on evidence-based practices, child/adolescent health, and our integrated care models. Oversee preceptor training by collaborating with clinical staff on current practices, interpersonal skills and EMR training. Create and present educational content with a focus on areas that support business objectives to include but not limited to transitions of care, disease management, and case management. Provide clinical coaching and mentorship to clinical health staff, focusing on skill development, case consultation, and clinical supervision. Foster a culture of continuous learning and improvement. Utilize clinical data, outcome measures, and performance metrics to assess the effectiveness of educational programs and make data-driven recommendations for program enhancements. Assist in the development and revision of clinical policies, procedures, and protocols to ensure compliance with regulatory requirements and alignment with Imagine Pediatrics care model. Create educational materials, guides, and resources for clinicians and families to support understanding of pediatric behavioral health conditions, treatments, and the value-based care model. Provide training for various electronic medical records and software. Design compelling training for wide audiences and skill levels for both online and instructor-led material. Travel to Imagine Pediatrics' offices to train on various content or reinforce adherence to process. This position will require up to 20% travel. What You Bring & How You Qualify First and foremost, you're passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support, they deserve. You want an active role in building a diverse and value-driven culture. Things change quickly in a startup environment; you accept that and are willing to pivot quickly to priorities. In this role, you will need: You hold an unrestricted RN and/or NP state license, including board certification, or the ability to become board certified within 2 years. You have strong comprehension of clinical standards of care and are focused on quality of life for your patients. You have proficiency in Microsoft products and general technological savviness. Experience with curriculum design platforms. Experience leading training efforts or as a Clinical Educator. Experience working with a pediatric population strongly preferred, virtual care experience a plus. Willingness to travel up to 20%. What We Offer (Benefits + Perks) The role offers a base salary range of $80,000 - $110,000 In addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We're guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward - together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Job SummaryThe Senior Clinical Implementation Educator is responsible for leading the successful adoption and integration of Fresenius Kabi's IV Therapy solutions at healthcare facilities. This role drives clinical excellence through comprehensive education, hands-on implementation support, and ongoing partnership with internal teams and external stakeholders. The Senior Clinical Implementation Educator ensures optimal product utilization, customer satisfaction, and contributes to the continuous improvement of clinical workflows and patient outcomes. The ideal candidate will live near a major airport. Travel will be up to 75%. Salary Range: $90,000 - $100,000 per year Position is eligible to participate in a bonus plan with a target of 6% of the base salary. Final pay determinations will depend on various factors, including, but not limited to experience level, education, knowledge, skills, and abilities. Our benefits and programs are comprehensive and thoughtfully crafted to ensure our colleagues live healthy lives and have support when it matters most.Responsibilities Develops and maintains relationships with internal multi-disciplinary team members from sales, pharmacy, technical, and project management teams. Develops professional relationships with customer contacts while onsite providing education and go live/post go live clinical support. Provides classroom setup and training for Fresenius Kabi's customer clinicians (users, super users, and peer-based training) on the appropriate use of our IV Therapy products. Communicates and escalates risks, concerns and customer issues to the project manager, and Clinical Implementation Specialist. Supports education for Ivenix device integration with customer EMR (Electronic Medical Records) Applies understanding of clinical workflows, voice of customer, and healthcare expertise to provide troubleshooting tips related to Ivenix clinical workflows and infusions. Ensures client satisfaction through follow-up, client responsiveness and thorough communication. Provides clinical support for sales team during device demonstrations/pump fairs as directed by implementation leaders. While not providing education/onsite go live support, other activities include (but not limited to): Supports Clinical Implementation Specialist with onsite Infusion System Assessment activities, as well as remote follow up from Infusion System Assessment tasks. Supports Clinical Implementation Specialist with formatting tubing cross references. Supports Clinical Implementation Specialist with formatting customer education schedules. Completes all training requirements, including all department-specific, compliance training, etc. All employees are responsible for ensuring the compliance to company documents, programs and activities related to the Health, Safety, Environment, Energy, and Quality Management Systems, as per your roles and responsibilities. Requirements Bachelor of Science in Nursing (BSN) degree or related degree with a current RN license. 5+ years related experience Experience providing education and/or training in a clinical environment preferred. RN license must be maintained throughout the course of employment. Direct patient care experience highly preferred. Experience implementing medical device products highly preferred. Excellent communication and collaboration skills. Experience providing professional services to clinical environments. EMR/EHR integration (Epic, Cerner, Meditech) experience a plus Ability to work well in a collaborative environment and willingness to multitask and be hands-on. Demonstrated ability to develop strong working relationships with internal departments and external customers. Strong presentation skills accompanied with exceptional interpersonal and communication skills (verbal and written). Intermediate skillset with Microsoft Office (Excel, Word, PowerPoint, Outlook), and other database/ERP concepts (i.e., Salesforce.com). Travel is required to attend meeting/trainings/programs at client locations (up to 75%) and is based on business need (via public transportation: air/auto); may require overnight travel. Must have a valid driver's license. Must maintain all requirements for access to customer sites, including active and current compliance with all credentialing requirements (may include COVID-19 and annual influenza vaccinations), in order to perform the essential functions of the role at customer locations. Demonstrated ability to prioritize and execute tasks in a dynamic environment. Ability to work effectively with all employees and external business contacts while conveying a positive, service-oriented attitude. Highest level of integrity and good judgment, with the ability to effectively deal with highly sensitive, confidential information. Ability to maintain complete confidentiality and discretion in business relationships and exercise sound business judgment. Ability to work flexible hours and weekends as needed to meet business/customer needs. Additional Information We offer an excellent salary and benefits package including medical, dental and vision coverage, as well as life insurance, disability, 401K with company contribution, and wellness program. Fresenius Kabi is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, citizenship, immigration status, disabilities, or protected veteran status.

--------------------------------------------------------------- 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.