CORA Physical Therapy Remote jobs

If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs. As part of the Mars Petcare family of businesses, Mars Veterinary Health is a global network of veterinary practices made possible by 75,000 Associates who care for millions of pets across nearly 3,000 clinics in more than 20 countries each year. We are committed to leveraging our reach to make a long-term positive impact on people, pets, and the planet and know our Purpose - A BETTER WORLD FOR PETS - starts with the people who care for them. We strive to offer unparalleled veterinary care for pets by first and foremost enabling and empowering our Associates to do what they love, whether in primary, specialty, and emergency care or management and leadership. Why This Role Matters: The primary purpose and function of the Construction Program Coordinator is to help manage/support design and construction functions for all construction department projects. This includes, but is not limited to: design support, construction admin support, equipment ordering, vendor coordination, and hospital opening, turn-over activities. You Will: Live and exemplify the Five Principles of Mars, Inc. within self and team. May occasionally assist in selection, mentoring, and evaluation of associates. May assist with hospital design/planning activities, including but not limited to: material specifications and finishes, standard development/management, supplier coordination, etc. Monitor expenses to budget for individual hospital openings. Develop, document, and maintain processes involved with hospital turn over, hospital setup, and operations move-in. Develop and maintain positive working relationships with vendors, hospital staff and CTS. Submit all Purchase Orders per assigned vendor to fulfill installation and inventory needs, as well as facility repair and construction work orders. Track closely to ensure proper delivery schedules and dates while establishing correct lead times for vendor orders through the PO log. May be involved in aspects of the ordering process for new hospitals, relocations, and hospital closings. Support and/or manage all relocation projects from announcement to completion, including partnering with hospital staff and vendors to complete tasks, moving inventory and ensuring minimal disturbance to the operation of the hospital. May work with Commercial to maintain proper equipment and part numbers in software systems Manage select vendors to confirm correct installation of equipment and items (i.e. radiation equipment, medical equipment, cages/runs, etc.). Develop and implement set-up protocols based on general guidelines, limitations and priorities in order to account for various floor plan or facility variations. Daily liaison between the installation team and hospital Operations. Update Opening's schedule with correct hospital addresses, phone numbers and points of contact. Work closely with construction and design team on all facility issues and punch items are completed in a timely manner before and during hospital set ups. Communicate any remaining issues to practice manager and work to ensure timely resolution. Manage open issues relating to the installation and inventory process (i.e. facilities, equipment/supplies, IT, phones, marketing, banking, etc.). Assist with developing work schedules to maximize cost savings. Develop and document procedures and systems to improve the hospital installation and inventory process. Help maintain the repair databases for hospital openings. Other job duties as assigned. Your Experience Should Include: Preferred: Bachelor's degree in Facilities Management, Construction, or related field or the equivalent combination of education, training and experience that provides the required knowledge, skills, and abilities. Required: Previous high-level administrative support and project coordination experience. Required: Experience managing multiple priorities. Required: Demonstrated ability to establish and maintain cooperative working relationships with diverse groups of individuals (i.e. MVH Associates, PetSmart, vendors, contractors, etc.). Required: Microsoft Office Suite experience. Preferred: Smartsheet experience. Preferred: Healthcare background (veterinary or human healthcare, pharmaceutical, etc.). Does this sound like you? Apply today to be considered and join us to advance our mission to create A BETTER WORLD FOR PETS. Salary: $64,960 - $101,500 Compensation is determined based on education, experience, and other relevant credentials. Our salary ranges are determined by role, level, location, and market competitiveness. What We Offer You: Competitive salary with paid time off & holidays so you can spend time with the people you love. Medical, dental, and vision insurance for you and your loved ones. Fertility and family-building assistance. Paid Parental leave. Practice Paid Basic Life Insurance. Practice Paid Short- and Long-Term Disability. Automatic enrollment 401(k) Savings Plan after 60 days of employment with generous company match. Commuter Benefits. Legal Plan. Health Savings Account & Flexible Spending Account. Mental health support and resources. Student Debt Relief (for full-time DVMs). A Variety of discounts including Mars, PetSmart, Royal Canin, fitness, cellular and so much more. Special Working Considerations: Ability to work at a computer for long periods of time. Project timelines and work volume/deadlines may often require more than 40 hours per week to complete essential duties of this job. Must have mental processes for reasoning, remembering, mathematics and language ability (reading, writing, and speaking the English language) to perform the duties proficiently. Ability to carry out instructions furnished in written, oral, or diagram form and to solve problems involving several variables. Ability to stand, walk, stoop, kneel, crouch, and climb as well as manipulate (lift, carry, move) up to 50 pounds. Requires good hand-eye coordination, arm-hand-finger dexterity with the ability to grasp, and visual acuity to use a keyboard and operate necessary equipment. The noise level in the work environment is normally moderate. Environment where pets are present. WE ARE A DRUG-FREE, SMOKE-FREE, EQUAL OPPORTUNITY EMPLOYER. Mars Veterinary Health (MVH) strongly supports and values the uniqueness of all individuals and promotes a work environment where diversity is embraced. MVH is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, genetic information, status as a protected veteran, or status as a qualified individual with disability. MVH complies with all applicable federal, state and local laws governing nondiscrimination in employment in every MVH location.

The Medical Record Coordinator is responsible for performing quality checks on automated reports, received scans, and guaranteeing electronic filing for assigned products and the corresponding members. The Medical Record Coordinator collaborates with multiple departments to obtain and confirm necessary documents are in place and properly set-up in the Electronic Medical System (EMS) database. Performs quality checks to maintain the integrity of events and criteria for reporting purposes. Processes members' electronic documents, proof of data for inaccuracies, and any other missing information. Resolves discrepancies identified using standard procedures and/or returning incomplete documents to their respective departments for correction and resolution. Responds and coordinates field assignments for Interpreters by checking availability and assigning staff as appropriate taking location into consideration. Facilitates manual mailings for other departments. Move existing members, auto-enrollees and dis-enrollments to and from the appropriate line of business lists in the centralized NY State Uniform Assessment System (UAS) for Integrated Products. Additional duties as assigned. Minimum Qualifications: HS diploma/GED Preferred Qualifications: Ability to prioritize and follow through on assigned tasks. Proficiency in navigating the Internet. Ability to work with multiple electronic documentation systems simultaneously. Ability to troubleshoot or explain basic hardware and software errors and work with a Technician remotely to perform step-by-step repairs. Work experience with an electronic patient health information (PHI) database (medical records database). Microsoft Excel skills including edit, search, sort/filter, format using already created pivot tables to locate information. Data entry/database management experience with Microsoft Excel and other systems/ applications. Attention to detail performing quality checks and proofreading. Work experience in a healthcare environment. Knowledge of Medicare, Medicaid, or managed care and medical terminology. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $39,208 - $52,000 All Other Locations (within approved locations): $34,091 - $49,920 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

is 100% Remote.** **Scope of Responsibilities:** + **Conduct moderately complex to complex quality audits of provider claims, pre-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products.** + **Audit the work of more junior auditors and identify opportunities for coaching and//or training.** + **Identify and communicate issues identified through audits and recommended solutions relevant to business operations.** + **Assist management in preparing departmental reports policies and procedures.** + **Mentor and coach Financial and//or Operations QA auditors.** + **Participate as a Subject Matter Expert on various process improvement projects designed to meet departmental and operational needs.** + **Assist with performing User Acceptance Testing (UAT) on system enhancements or corporate projects in partnership with Business Operations** + **Analyze errors and determine root causes for appropriate classification.** + **Record//track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure the quality of the network.** + **Review and investigate claims and encounters for medical, facility, pharmacy, dental and vision services including contractual provisions, authorizations and Healthfirst policy and procedure.** + **Prepare written reports concerning investigation activities and present results of investigations to senior staff.** + **Complete subsequent auditing and handling of specific claims and appeal requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations.** + **Review the accuracy and efficiency of existing training materials.** **Minimum Qualifications:** + **Audit experience with the investigation, determination and reporting of financial processes** + **Work experience in Microsoft Office suite of applications including advanced Excel (formatting formulas, managing data, filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations)** + **Experience conducting root cause analysis in an auditing capacity** + **Experience conducting analytical work and providing creative ideas for problem solving** + **Work experience requires written and verbal communication that is clear, concise, grammatically correct, and professional** + **Experience handling confidential information** + **Associate degree from an accredited institution** **Preferred Qualifications:** + **Bachelors degree from an accredited institution** + **Audit experience with the investigation, determination and reporting of financial processes** **_specifically around Healthcare Claims Adjudication and Claims Processing_** + **_Ability and willingness to handle increasing workload and responsibility_** + **_Willingness and ability to learn and evaluate new information, both technical and procedural_** + **_ICD10 certification_** + **_Basic foundation of SQL, Tableau, and SharePoint_** + **_Knowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family Health Plus, Child Health Plus_** WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

The Performance Support Specialist will be responsible for providing assistance in resolving complaint issues escalated by the representatives. This role is required to pull non-urgent complaint reporting through various systems on a daily basis, review each matter and reach out to the member in order to provide determinations while maintain a tracking system for any and all incoming complaint issues. Duties & Responsibilities: Assist in resolving customer complaints escalated by internal and external business partners as needed. Assist in reviewing and modifying Physician capitation reports. Assist in resolving member issues who called in multiple times with the same issues. Assist in responding and resolving escalated inquiries from other departments and external contacts. Make recommendations on process improvements. Build sustainable relationships of trust through open and interactive communication with internal and external customers. Able to properly follow procedures based on issues and documents received Make recommendations to management concerning staff performance. Make recommendations on process improvement. Maintain open exchange of information with external and internal customers. Required to multi-task, prioritize and manage time effectively. Timely filing of complaints. Conduct outreaches as required. Attend meetings as business requires. Additional duties as assigned. Minimum Qualifications: High School Diploma or GED from an accredited institution Healthcare industry experience Experience working in customer service Excellent telephone & customer service skills Experience working in clerical or administrative capacity Experience meeting strict deadlines Proficient in Microsoft suite of applications including Word, Power point, Outlook and Excel. Preferred Qualifications: Associate degree from an accredited school Conflict Resolution Experience Experience handling complex situations and/or projects Experience in developing and coaching of staff Compliance & Regulatory Responsibilities: NA License/Certification: NA WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400 All Other Locations (within approved locations): $41,101 - $60,320 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. Duties and Responsibilities: Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and opportunities for intervention. Develops care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes. Liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed. Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes. Assists in identifying opportunities for alternative care options based on member needs and assessments. Evaluates service authorizations to ensure alignment and execution of the member's care and physician treatment plan. Contributes to corporate goals through ongoing execution of member care plans and member goal achievement. Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. Occasional overtime as necessary. Additional duties as assigned. Minimum Qualifications: For Medical Care Management: NYS RN or LCSW or LMSW (any state) For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations For Behavioral Health (BH) Care Management: NYS RN or LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state) 3 years of work experience in a mental/behavioral health or addictions setting For BH PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations Preferred Qualifications: Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing situations. Fluency in Fujianese Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors. Experience managing member information in a shared network environment using paperless database modules and archival systems. Experience and knowledge of the relevant product line Relevant work experience preferably as a Care Manager Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480 All Other Locations (within approved locations): $71,594 - $106,080 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

Pay: $17-19/hr Candidate MUST be in one of these States: NV, ID, AZ, NM, TX, MT, OK, WY, SD, ND, MN, MO, KY, TN About the Role: If you LOVE working in a Revenue Cycle or Medical Billing in a fast-paced environment, but from the comfort of your own home, then this might be an exciting opportunity for you. We are rapidly growing and leading physical therapy (PT) clinic platform in the U.S. We own and operate 200+ PT clinics that provide a variety of outpatient rehabilitation services, including physical therapy, occupational therapy, hand therapy and other ancillary services. Voted Glassdoor's “Best Places to Work 2021”, we are seeking an independent and extremely detail oriented Follow Up Representative. The position is responsible for the full range of Payor follow up with different types of Payors. This position is full time (40 hours/week, Monday-Friday). Job Duties: Manage primary and secondary claims Respond promptly to billing inquiries from patients, insurance companies and departments Work with clinics to identify and resolve issues regarding outstanding account balances Resolve denials and submit appeals Utilizes the most efficient resources to secure timely payment of open claims Research assigned correspondence and takes necessary action to resolve requests Ensures daily accomplishments contribute toward company goals for A/R Resolve accounts in follow-up queues Job Requirements: High School/G.E.D requirement or equivalent combination of education and experience required 1-year prior medical receivable collections experience preferred Understanding of medical claims processing Experience with insurance systems Knowledge of insurance including State and Federal rules and regulations as they relate to billing and collections Ability to understand claim denials/rejections Ability to read an Explanation of Benefits Knowledge of medical terminology About Our Company: Founded in 1991, Physical Rehabilitation Network (PRN) is a physical therapy organization headquartered in Carlsbad, California. We currently support over 200 independently owned and operated physical rehabilitation clinics across sixteen states with more than 1,800 employees. As the leading, therapist-friendly physical rehabilitation organization in the west, our purpose is to provide our therapist partners full operational and administrative support so they can focus on what they do best deliver the highest levels of quality care and experiences for patients. Title: Follow Up Representative

Sign on Bonus Available!! ***This is NOT a remote position, but candidates can be based anywhere in the US and will require availability to travel Nationwide to any location within our practice. As an internal traveler, you'll enjoy the flexibility of travel therapy while also having access to the resources of a private practice, including the mentorship and professional development that sets PT Solutions apart. Internal travelers can work in a variety of settings and patient populations across more than 25 states that PT Solutions serves. As an internal traveler, you are part of a team who works together to maximize outcomes for patients through creative, hospitable, evidence-based care. UNBEATABLE BENEFITS & PERKS Do you have interest in travel therapy, but are worried that you may miss out on mentorship, benefits, and career building opportunities? You can have it all as a PTS traveler! Be Well: Competitive pay, insurance benefits, fitness incentive, 401k, and PTO package Earn: Tax-exempt monthly living expenses stipend and travel expense reimbursement Learn: Variety of accredited courses offered inhouse, minimum 40 credits per year Connect: Local and national organization dues and license renewal fees are on us Grow: Opportunities for professional growth through our structured Mentorship Program, Clinic Manager Training, Leadership Development Program, and more SUCCESS LOOKS LIKE A-Game Attitude: Each day in the clinic you showcase a desire to connect and collaborate with current staff and patients to create a positive, cohesive and engaging clinical experience Coachability: Be able to take constructive feedback and turn it into actionable items Patient Satisfaction & Outcomes: Ensure that each patient leaves feeling happy and healthy with the ability to exceed their functional goals and become unstoppable MUST HAVES Graduate of an APTA or CAPTE approved physical therapist assistant program State Licensure (Additional Reimbursement for initial licensing and renewal fees) Basic Life Support Certification via the American Heart Association Exceptional Communication and Coachability preferred PERKS Salary range for this position is $30 - $40 / hour Up to $10k sign-on bonus Up to $30k tax-exempt living stipend Incentive plan (Any posted pay range considers multiple compensations factors including background, experience, and work location while also allowing for salary growth within the position. This does not include bonuses). Expanding Access to Quality Care At PT Solutions, we're more than colleagues; we're a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training. As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact. Let's go further together and transform care. Join the #PTSLife today! To see what #PTSLife is like, visit Instagram, Facebook, and LinkedIn.

The DSE Operations Specialist is a resource with in-depth account knowledge and is responsible for strengthening provider engagement and enhancing quality. This role will develop effective provider relationships that enhance Health first's reputation as a “trusted partner” and supports administrative ease. Duties/Responsibilities: • Will be the primary point of contact for all delegated entities with regards to onboarding/credentialing providers. Responsible for the resolution of all issues, including those identified by the provider, and those identified internally that impact the physician. • Schedules regular meetings with assigned delegated entities to identify and trouble shoot issues. Trains/educates entities regarding the onboarding delegated process. • Responsible for investigations to ensure online Provider directory is updated and accurate. Makes all changes necessary to ensure the directory is at all times accurate. • Configures new Provider loads, updates and terminations. Provides assistance and guidance with large ad-hoc data entry projects in MHS. • Performs quarterly roster reconciliations to ensure that the health plan directory is current, accurate and adheres to department guidelines, regulations, and government laws. Tasked with making required changes to ensure directory is compliant. • Designated to receive and review provider credentialing applications. Coordinates with hospital/clinic, medical staff, and practitioners to ensure privileging process is timely completed. Determines whether additional documentation, verifications, references, and/or applications are needed. • Receives, reviews and submits provider contracts • Coordinates with Network Management staff to finalize provider applications and contracts. Responsible for all follow-up so that timely approval occurs. • Reports to Team Lead • Additional duties as assigned Minimum Qualifications: • Associate's Degree or above. • Familiarity with Credentialing and Provider rosters • Understanding Network Management • Must have experience working as a liaison with providers and internal support groups • Must have experience meeting deadlines under time sensitive constraints • Must have experience adapting to last minute project requests • Must have experience working independently with minimal supervision • Must have ability to communicate effectively with providers and internal staff members • Demonstrated willingness to be flexible and adaptable to changing priorities • Time management skills with ability to manage multiple tasks • Computer proficient (i.e. excel, V lookup, pivot, formulas, reporting) • Oral and written communication skills • Critical thinking skills Preferred Qualifications: • Bachelor's Degree or above • Experience with MHS, DocuSign and CRM software • Compliance & Regulatory Responsibilities: N/A • License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070 All Other Locations (within approved locations): $51,000 - $75,905 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

About City of Hope, City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the U.S., and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked top 5 in the nation for cancer care by U.S. News & World Report at its core, City of Hope's uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas. The successful candidate: Under the supervision and leadership of the Executive Director of Pharmacy, the Program Director of Clinical Pharmacy Programs is responsible for programmatic and strategic oversight and coordination of all aspects of the Pharmacy Clinical Programs across CAP pharmacy, in conjunction with the counterpart incumbent, to enhance patient outcomes and safety in the most efficient and optimal fashion. The Program Director of Clinical Pharmacy Programs collaborates closely with the Executive Director and other pharmacy leaders to establish the vision for the clinical services provided at City of Hope CAP. Responsibilities include but are not limited to planning and executing new clinical programs, partnering to standardize and optimize medication utilization across the System, leading the regional Formulary/Pharmacy and Therapeutics/other related committees, and developing and implementing policies, guidelines and best practices related to medication therapy. Position is also responsible for management of the CAP pharmacoeconomic program to ensure cost effectiveness of treatments provided. Additionally, the Program Director is responsible for developing strategies to mitigate drug shortage impact to patients treated at all CAP sites. Collaboration is imperative to the success of this position, so routine communication with providers, nurses, pharmacists, and other clinical leaders is essential. This resource will work very closely with clinical pharmacists and pharmacy leadership at each CAP site, helping to guide and lead the development of consistent clinical programs across the System. Essential Functions: Clinical Program Oversight and Compliance: Strategically plan and provide leadership for all aspects of Enterprise Clinical Pharmacy Program across all CAP sites. Developing new programs based on patient needs and optimizing existing programs and practices. Standardizing clinical practices, medication management policies/guidelines, and treatment plans across all CAP sites. Leading the Formulary, Pharmacy and Therapeutics (P&T), and other related committees. Providing drug formulary oversight. Developing and coordinating implementation plans for the use of new products in compliance with institutional policies and regulatory guidelines (e.g. FDA, The Joint Commission) Developing metrics to measure staff productivity and program effectiveness. Liaising between internal affiliated departments and external stakeholders to ensure program integrity. Pharmacoeconomics Program: Leading pharmacoeconomic initiatives to enhance patient care and optimize cost effectiveness of treatments provided. Monitoring the pharmaceutical marketplace for cost saving opportunities. Implementing and tracking therapeutic conversions. Other Responsibilities: Clinical development of pharmacy staff to promote practice at top of their license. Supporting research, publication, and presentation opportunities for the staff at local and national level. Collaborating with schools of pharmacy to oversee pharmacy student training during City of Hope rotations. Representing City of Hope-CAP Pharmacy Department at professional and community organizations at the local, state, and national level. Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality. Performs other related duties as assigned or requested. The following Pillars in Action are the behaviors that accelerate our impact as we deliver on our Vision and Strategic Priorities: Position Qualifications: Minimum Education: Doctor of Pharmacy Degree (Pharm.D.) Minimum Experience: 6 years of experience planning and executing pharmacy programs with 10 years of experience in a hospital setting Req. Certification/Licensure: Current Pharmacy license Board Certified Oncology Pharmacist (BCOP) Preferred Education: ASHP accredited PGY-1 or PGY-1 and PGY-2 Residencies Preferred Experience: 5 years of experience in Oncology Skills/Abilities: Personal computer approximately 75% of time Working/Environmental Conditions: Work is primarily performed within an office setting. Frequent meetings & walking to meeting sites as required City of Hope is an equal opportunity employer. To learn more about our comprehensive benefits, click here: Benefits Information City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location. This position is eligible for an annual incentive bonus.

The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner. The A&G Specialist is the subject matter expert responsible for non-clinical case development and case resolution while ensuring compliance with Federal and/or State regulations. The A&G Specialist will manage his/her own caseload and is accountable for investigating and resolving member or provider initiated cases. Manages all Department of Health (DOH) and executive complaints as needed. The incumbent may also handle non-clinical claim appeals that come from Healthfirst participating and non-participating providers. This is full-time on-site position located at either the 100 Church Street location in New York City or the 1101 Greenwood Avenue location, Lake Mary, Florida. This position may require attendance at A&G/ Operations divisional meetings and Town Halls, some of which may require travel to one of the locations (T&E will be covered according to policy). **This position is Remote Duties and Responsibilities Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and member and provider appeals. The end-to-end process requires the Specialist to independently: Research issues Reference and understand HF's internal health plans' policies and procedures to frame decisions Interpret regulations Resolve cases and make critical decisions Edit and finalize resolution letters Manage all duties within regulatory timeframes Communicate effectively to hand-off or pick-up work from colleagues Work within a framework that measures productivity and quality for each Specialist against expectations Additional duties as assigned Minimum Qualifications Bachelor's degree from an accredited institution or relevant work experience Preferred Qualifications Minimum of two (2) years of work experience in Managed Care or Health Insurance Work experience in claims, customer service, home health, hospital or doctor's office preferred Experience working in care management systems, such as CCMS, TruCare or Hyland Demonstrated critical thinking and decision-making competencies Highly effective communication, organizational, and customer service skills Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960 All Other Locations (within approved locations): $49,795 - $72,800 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960 All Other Locations (within approved locations): $49,795 - $72,800 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations. Duties/Responsibilities: Credentials providers, facilities, and vendors in accordance to regulations and Healtfirst policy. Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings. Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements. Prepares hard-copy directories and works with third party vendors for posting online directories. Reviews relevant data to ensure accuracy. Effectively communicates to internal departments and external partners. Identifies and assesses opportunities to improve processes to better ensure regulatory compliance and adherence to state and federal regulations. Raises issues to management and assists in resolution. Additional duties as assigned. Minimum Qualifications: HS diploma/GED Preferred Qualifications: Bachelor's degree Prior relevant experience Time and project management, critical/creative thinking, communication, and problem-solving skills. Intermediate Microsoft software skills include Adobe, Access, Excel, Word, PowerPoint, and Office WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

The Talent Acquisition Sourcer is responsible for large scale development and deliverance of brand awareness by connecting with allied health professionals (PT, OT, SLP, AT) throughout their assigned region. The Talent Acquisition Sourcer works with the Clinical Engagement Team to source university students and experienced clinical professionals via national/state event data, university event attendance, regional competitor mapping and internet-based sourcing via Linkedin, Indeed and other resources. Sourced candidates will be delivered to the Talent Acquisition Partner for appropriate region. Successful Talent Acquisition Sourcer will be measured based on number of net new contacts generated, seasoned leads generated from market mapping, national and state event lead maintenance, student Rotation Roundups completed, pipeline maintenance, leads generated to TAP and clinical starts. Student pipeline owned by Sourcer will be those students who are greater than 6 months to graduation. Essential Functions National and State events lead interaction and maintenance with conversion of quality leads to candidates for employment. Utilization of multiple platforms to generate clinical leads/candidates, including but not limited to LinkedIn, indeed, CRM, Text Recruit and Market Mapping. Align multiple events leads and draft boards into pipelines, while managing direction of candidate to appropriate leaders in practice. Collaborate with Clinical engagement, Clinical operations and Talent Acquisition to maximize generation of quality student and seasoned clinical candidates. Drive consistency in PTS branding and marketing to student and seasoned clinical leads. Provide quarterly regional content to pipelined student - e-mail, texts, newsletters, etc. Design and implement practice-wide initiatives to drive clinical engagement with seasoned clinicians external to the practice. Partner with CES to identify appropriate department members to assist with both on campus and virtual events and engagements. Provide recommendations on how to enhance communication and maintain interest of leads greater than 6 months to graduation. Contribute to overall clinical hiring output across the practice by leveraging the Student Internship Program, corporate university partnerships, student engagement programs, and student internship conversions. Support team as needed on campus for presentations, event support, career fairs and student/faculty relationship development Other duties and special projects as assigned. Required Skills & Abilities Strong leadership skills and ability to manage multiple projects. Strong interpersonal, written & verbal communication skills. The ability to work independently and in a group setting, with high integrity, reasoned and thoughtful judgment, a sense of urgency and analytical and intuitive skills. Demonstrates proactivity and follow-through in all initiatives. Ownership of results tracking and ability to achieve measurable targets. Superior organizational skills and ability to deliver tasks to meet deadlines. Strong customer service skills, customer service driven, positive attitude, and ability to provide specific and timely feedback. Excellent presentation and time management skills. Expanding Access to Quality Care At PT Solutions, we're more than colleagues; we're a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training. As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact. Let's go further together and transform care. Join the #PTSLife today! To see what #PTSLife is like, visit Instagram, Facebook, and LinkedIn.

If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs. As part of the Mars Petcare family of businesses, Mars Veterinary Health is a global network of veterinary practices made possible by 75,000 Associates who care for millions of pets across nearly 3,000 clinics in more than 20 countries each year. We are committed to leveraging our reach to make a long-term positive impact on people, pets, and the planet and know our Purpose - A BETTER WORLD FOR PETS - starts with the people who care for them. We strive to offer unparalleled veterinary care for pets by first and foremost enabling and empowering our Associates to do what they love, whether in primary, specialty, and emergency care or management and leadership. This is a field-based role that requires associate to travel on a monthly basis to our hospitals in the field or one of the four North American HQ hubs (Vancouver, WA | Santa Monica, CA | Tampa, FL | New York City, NY). Why This Role Matters: The Mental Health and Wellness Manager is responsible for the strategic development, implementation, and oversight of comprehensive wellness programs that foster healthy behaviors, enhance Associate wellbeing, and contribute to organizational success. This role oversees day-to-day operations of health and wellness initiatives, provides health education to associates and clients we serve, and partners with leaders to embed wellness into the culture of the organization. You Will: Design, implement, and manage wellness programs that promote healthy lifestyles and improve overall associate wellbeing. Oversee daily operations of health and wellness initiatives, ensuring seamless delivery and continuous improvement. Provide health education and resources to associates and clients, covering topics such as nutrition, exercise, stress management, and preventive care. Partner with leadership teams, P&O, and cross-functional stakeholders to integrate wellness into organizational strategies. Develop metrics to evaluate program effectiveness and make data-driven recommendations for enhancement. Monitor trends in health, wellness, and associate engagement to identify innovative practices that drive participation and outcomes. Serve as a wellness advocate, encouraging healthy behaviors and building a supportive environment for wellbeing across the organization. Manage vendor relationships, wellness partnerships, and internal communications to promote engagement. Ensure compliance with relevant health regulations, guidelines, and organizational policies. Live and exemplify the Five Principles of Mars, Inc. within self and team. Other job duties as assigned. Your Experience Should Include: Bachelor's degree in Health Promotion, Public Health, Nursing, Healthcare Administration, Veterinary Medicine, or a related field; Master's degree preferred. Must be a Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC. Certified Health Education Specialist (CHES), Certified Wellness Practitioner (CWP), or equivalent certification is a plus. 5+ years of experience in mental health wellness program development, health education, or a related healthcare/veterinary health role. Strong understanding of healthcare or veterinary medicine and their impact on wellbeing initiatives. Proven ability to design, implement, and evaluate wellness initiatives that drive measurable outcomes. Excellent communication, facilitation, and interpersonal skills, with the ability to engage and inspire associates. Ability to manage senior stakeholders, including presentation of business cases to Senior Leadership Team and other high visibility stakeholders. Strong analytical and problem-solving skills with a data-driven approach. Experience managing vendors, budgets, and cross-functional projects. Salary Range: $90,300 - $169,312 Compensation is determined based on education, experience, and other relevant credentials. Our salary ranges are determined by role, level, location, and market competitiveness. What We Offer You: Competitive salary with paid time off & holidays so you can spend time with the people you love. Medical, dental, and vision insurance for you and your loved ones. Fertility and family-building assistance. Paid Parental leave. Practice Paid Basic Life Insurance. Practice Paid Short- and Long-Term Disability. Automatic enrollment 401(k) Savings Plan after 60 days of employment with generous company match. Commuter Benefits. Legal Plan. Health Savings Account & Flexible Spending Account. Mental health support and resources. Paid Volunteering. Optimum Wellness Plans for up to three pets. Continuing Education allowance & MED hours for eligible positions. Student Debt Relief (for full-time DVMs). A Variety of discounts including Mars, PetSmart, Royal Canin, fitness, cellular and so much more. Special Working Considerations: Ability to work at a computer for long periods of time. Project timelines and work volume/deadlines may often require more than 40 hours per week to complete essential duties of this job. Must have mental processes for reasoning, remembering, mathematics and language ability (reading, writing, and speaking the English language) to perform the duties proficiently. Ability to carry out instructions furnished in written, oral, or diagram form and to solve problems involving several variables. Ability to stand, walk, stoop, kneel, crouch, and climb as well as manipulate (lift, carry, move) up to 50 pounds. Requires good hand-eye coordination, arm-hand-finger dexterity with the ability to grasp, and visual acuity to use a keyboard and operate necessary equipment. The noise level in the work environment is normally moderate. Environment where pets are present. WE ARE A DRUG-FREE, SMOKE-FREE, EQUAL OPPORTUNITY EMPLOYER. Mars Veterinary Health (MVH) strongly supports and values the uniqueness of all individuals and promotes a work environment where diversity is embraced. MVH is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, genetic information, status as a protected veteran, or status as a qualified individual with disability. MVH complies with all applicable federal, state and local laws governing nondiscrimination in employment in every MVH location.

The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices and leverages strong communication and customer service skills when providing updates and delivering decision notifications to members and providers, The UM Pharmacy Technician position is part of multidisciplinary team and works closely with Providers, Pharmacists, and Medical Directors. Duties & Responsibilities: Reviews prior authorization requests and units for medications requested under the medical benefit Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria Sends notification to members and providers of authorization decisions via telephone, fax, or mail Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH Establishes great rapport with Provider offices via telephonic communication Sends request for information sheets to Providers Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations Additional duties as necessary Minimum Qualifications: High School Diploma or GED from an accredited institution Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing Experience conducting prior authorization reviews Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional Preferred Qualifications: Strong written and verbal communication skills in Chinese, Spanish, or Russian Demonstrated critical thinking and problem-solving skills Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities Knowledge of specialty pharmaceuticals and billing practices in the medical benefit Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables). Experience with TruCare Care Management Platform Compliance & Regulatory Responsibilities: Noted above License/Certification: Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $47,403 - $64,338 All Other Locations (within approved locations): $41,101 - $60,320 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations. Duties/Responsibilities: The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations. The Medical Peer Reviewer will render determinations in the format and within timeframes to follow Regulatory and Operational policies. The Medical Peer Reviewer will: Maintain productivity standards. Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases/caseload from multiple lines of businesses Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members/internal medical departments as needed Complete mandatory Company compliance training and training in new systems and software. Enter each day's hours worked in Workday, on the same day. Perform other duties as assigned Responsibilities may be adjusted based on changing needs of the organization. Weekday Requirements: The Medical reviewer requires 25 hours a week of coverage/5 days per week. Each Medical Reviewer will cover one legal holiday /year and will be compensated Holiday pay and straight hours worked The Medical Reviewer is eligible for Paid Time Off (PTO) and is required to plan and schedule time off with their direct supervisor following the Company policy. Weekend Requirements: Each Medical Reviewer is required to be primary coverage one weekend a month Each Medical Reviewer is required to be available as back up, if needed, one weekend a month . Minimum Qualifications: Licensed M.D. or D.O. or D.M.D. or D.D.S. Board Certified in a specialty recognized by the American Board of Medical Specialties Preferred Qualifications: New York State Board Certified in Internal Medicine or Family Practice Previous, relevant experience in utilization management and clinical practice Knowledge of Medicare, Medicaid, and MLTC plans Time management, critical thinking, communication, and problem-solving skills Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies Knowledge of member satisfaction/incident management and regulations Knowledge of quality improvement methodologies Compliance & Regulatory Responsibilities: Ensures compliance to internal Healthfirst and external regulations. Licensed M.D. or D.O. or D.M.D. or D.D.S. Annual Compliance and other training as assigned, may include but not limited to hardware, software, and system training upgrades Annual Inter-Rater Reliability (IRR) Testing Complies with the Healthfirst Conflict of Interest Policy for Professionals WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $122,907 - $188,020 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Clinical Auditor performs audit functions for Healthfirst clinical teams (e.g. Care Management, Reassessment/Clinical Eligibility, Utilization Management, etc.) and delegated vendors and partners [within internal timeframes and deadlines] to determine operational efficiency, adherence to regulatory requirements, and achievement of quality standards. The audits may include but are not limited to listening to Care Manager phone calls; review of Uniform Assessment System (UAS) assessments, care plans, medical authorizations, and supporting documentation ensure compliance with regulatory requirements and internal policy; etc. Duties and Responsibilities: Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of improvement are needed for discussion with management and/or at departmental team meetings Assists with evaluating and analyzing aggregate quality performance data Develops strategies for business performance improvement initiatives. This includes: identifying opportunities for improvement, problem prioritization, and creating performance improvement plans for non-compliant audits and/or reports Assists with creating and revising audit tools to ensure audits and reports are value-added Applies clinical and critical thinking skills to evaluate the quality and effectiveness of case management and/or utilization review decision-making Additional duties as assigned Minimum Qualifications: NYS LPN or RN license. In order to access the Uniform Assessment System (UAS), an unexpired NYS driver's license or NYS ID is required. If residing outside of NYS, the candidate must be able to obtain a NYS ID before commencement of employment. Preferred Qualifications: Relevant previous work experience such as medical records review; claims processing; utilization/case management in a clinical practice or managed care organization; managed care plan products (e.g. Medicaid, Medicare, Commercial) and knowledge of Department of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS) regulations pertaining to managed care; nursing experience in an acute, sub-acute or long-term care (LTC) setting or managed long-term care plan (MLTCP, FIDA); Geriatrics, Medical Surgical Nursing, Case Management or Discharge Planning; etc. Experience working with any of the following systems: CareEnhance Clinical Management Software (CCMS), TrueCare, PEGA, Citrix, RightFax, VoIP, Virtual work platforms (VPN), Electronic medical record (EMR) database containing patient health information (PHI), and/or MACESS archival system. Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese. Intermediate Microsoft Word, Excel, and Outlook skills Ability to build and maintain positive relationships with cross-functional teams and interact with all levels of management. Time management, critical/creative thinking, project management, communication, and problem-solving skills License or Certification: NYS LPN or RN license. Regulatory or Compliance activities: n/a WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is ********************, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480 All Other Locations (within approved locations): $71,594 - $106,080 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Job Summary:MaineGeneral Health is a leading health care system proud of the culture of excellence, compassion, and collaboration that extends to our patients and their families. We are committed to attracting talented, ambitious people who share our values and strive to provide excellent customer service. We are actively seeking a finance professional to join our experienced team as the Director of Reimbursement and Managed Care who will oversee all aspects of reimbursement, managed care contracts, and payer enrollment. The successful candidate will have a deep understanding of healthcare finance, regulatory requirements, and a proven track record in a similar role. Additionally, they will have a strong work ethic, intuitive problem-solving skills, and the drive to meet evolving organizational needs.Job Description: The Work: Manage and oversee the Charge Description Master (CDM) rate setting Lead contract negotiations and manage payer relationships Utilize Soarian and StrataJazz contracting modules Perform contract modeling and troubleshoot payer issues Oversee contract management and reporting Ensure compliance with price transparency regulations Support the revenue budget process, including revenue/statistical variance analysis Prepare monthly and ad-hoc net revenue reporting Assist in service line analysis with FP&A Oversee cost reporting for most companies and conduct regulatory research Analyze government reimbursement and assist with provider and payer enrollment Manage professional enrollment, facility credentialing and re-credentialing, including CAQH processes Lead PHO contract negotiations and planning You have: Bachelor's degree in Finance, Accounting, Business Administration, or related field (Master's preferred) Minimum of 7 years of experience in healthcare reimbursement and managed care - some leadership experience is preferred Extensive knowledge of healthcare finance, reimbursement methodologies, and regulatory requirements Experience with Soarian, StrataJazz, and other relevant software systems preferred Strong analytical, problem-solving, and decision-making skills Excellent communication and negotiation abilities Demonstrated ability to lead and manage a team effectively Ready to join our team? Apply today! This position is available immediately and we're excited to welcome passionate individuals who share our commitment to providing exceptional healthcare services. Scheduled Weekly Hours: 40 Travel Requirement: To stay connected with our teams and operations, this role includes up to 10% travel to on-site locations. Travel is planned in advance whenever possible to support work-life balance. Scheduled Weekly Hours:40Scheduled Work Shift:Job Exempt: YesBenefits: Supporting all aspects of our employees' wellness - physical, emotional and financial - is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future. Physical Wellness: We offer quality health, dental, and vision benefits and wellness programs and resources to provide employees access to resources for a healthy lifestyle and help manage health care costs. Employees have access to industry-leading leave for new parents. A generous earned time plan is offered to all employees - We believe employees need and deserve time away from work to observe holidays, be with family, go on vacation, or simply take care of themselves. Emotional Wellness: When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household. Financial Wellness: An employee discount program is available to all employees for services provided by MaineGeneral Medical Center. Tuition Reimbursement is available to all employees to further develop skills and career. We offer eligible employees up to 2% of eligible pay in 403(b) company-matching contributions plus another 2% in the 401(a) retirement income plan. Three insurance plans are available to protect your family from the sudden loss of income in the event of your death, terminal illness or serious injury from accident. We offer both short-term and long-term disability insurance to replace a portion of your income if you become disabled and cannot work for a period of time. Career Mobility: Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development. We know that our employees are our most valuable resource - they're how we grow our business and care for our community. Equal Opportunity Employer M/F/Vet/Disability Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at ************** .

***Note: This is NOT a remote position, but candidates can be based anywhere in the US and will require availability to travel Nationwide to multiple locations within our practice ( ). Why Join PT Solutions? At PT Solutions, we're clinician-founded and mission-driven-expanding access to transformative care. Join a team of intentional and collaborative clinicians advancing evidence-based therapy through connection, learning, and real career growth. Recognized as a USA Today Top Workplace four years running, including 2025, working with PT Solutions is more than just a job. Unbeatable Benefits & Perks Whether you're just starting out or bringing years of experience, this unique opportunity combines the adventure of travel therapy with the stability and benefits of a full-time role. Be Well: Competitive salary, insurance benefits, fitness incentive, 401k, and PTO package. Earn: Tax-exempt monthly living expenses stipend and travel expense reimbursement. Learn: Variety of accredited courses offered in-house, minimum 40 credits per year. Connect: All national organization dues and license renewal fees are on us, regardless of where you travel. Grow: Opportunities for professional growth through our structured Mentorship Program, Clinic Manager Training, Leadership Development Program, and more. What Does Success Look Like An All-In Attitude: Each day in the clinic you showcase a desire to connect and collaborate with staff and patients to create a positive, engaging and transformative clinical experience. Coachability: Be able to take constructive feedback and turn it into actionable results. Patient Satisfaction & Outcomes: Ensure that each patient leaves feeling happy and healthy with the ability to exceed their functional goals to become unstoppable. Flexibility: Comfortable navigating change and delivering high-quality care across diverse settings, and a strong commitment to flexibility, as work locations, schedules, and clinical environments may vary based on patient needs, staffing, and practice priorities. Qualifications Graduate of a CAPTE approved physical therapy program. Current or pending state licensure (additional reimbursement for initial licensing and renewal fees). Basic Life Support certification. Reliable transportation and willingness to travel locally, regionally, or nationally. Compensation Salary range: $87,000-$100,000 annually (a ny posted pay range considers multiple compensations factors including background, experience, and work location while also allowing for salary growth within the position ) Sign-On Bonus: Up to $10,000 Tax-Exempt Living Stipend: Up to $30,000 per year Monthly Incentive Plan: You will also be eligible for our internal incentive plan A Mission That Moves Us At PT Solutions, we are a team united by a shared purpose: expanding access to transformative care. No matter where you are in your career, we're committed to your professional growth and empowering you to shape the future of rehabilitation therapy. Join us and transform care. Let's go further together. Learn more about careers with PT Solutions at Physical Therapy Careers | PT Solutions Follow #PTSLife on Instagram, Facebook, and LinkedIn to see our community in action. We are an equal opportunity employer and welcome all qualified candidates to apply.