Geriatric Care Manager remote jobs - 287 jobs

Care Managers conduct highvolume outbound calls to payors/pharmacy benefit managers (PBMs) to determine whether commercially insured patients on supported products are eligible for copay support. This role is phoneintensive (up to 95% of the shift on calls), requires disciplined use of approved call guides, precise documentation in our systems, and professional customer service on recorded lines. There is no patient or caregiver interaction in this role. Essential Duties & Responsibilities * Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions. * Follow approved Call Guides to ask structured, planidentifying questions of PBM agents; use compliant script/verbiage and payorcall steps. * Determine and record the verified plan type: Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc. using program definitions and SOPs. * Use PBMspecific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination. * Document every interaction accurately and in real time: complete callguide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call. * Create and manage followup activities/tasks as needed with timely completion. * Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time. * Adhere to program compliance and quality standards (privacy, script adherence, recordedcall protocols) and participate in QA monitoring. * Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels. Customer Service & Conduct * Demonstrate courtesy, respect, empathy, and a servicefirst mindset on every payor/PBM interaction. * Apply active listening and deescalation techniques with agents as needed. * Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation. Qualifications * Highvolume outbound call center experience (PBM/payor calling preferred); comfort with phonebased work for the majority of the shift. * Familiarity with pharmacy benefit verification and PBM processes; ability to identify and document the plan types listed above using callguide prompts. *Skills* insurance verification, prior authorization, medical insurance, Customer service, Multi tasking, Call center - provides the equipment *Job Type & Location* This is a Contract position based out of Durham, NC. *Pay and Benefits*The pay range for this position is $21.00 - $21.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) *Workplace Type*This is a fully remote position. *Application Deadline*This position is anticipated to close on Jan 17, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. Primary Responsibilities: A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Registered Nurse with an active unrestricted United States license Must be bilingual in Japanese and English, with strong verbal and written communication skills 3+ years of experience in medical-surgical inpatient acute care Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals Proven communication skills at all levels Proven ability to be flexible and display a positive attitude Proven solid problem-solving, organizational and crisis management skills Proven ability to function confidently and efficiently in fast paced work environment Proven ability to foster team cohesion in an international virtual environment Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members Proven advanced software skills with ability to work in multiple platforms with clinical case reviews Proven advanced skills with Microsoft Office - Excel, Word Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs Preferred Qualifications: Bachelor's degree 2+ years of experience in utilization management or case management in a managed care or hospital environment Experience in international healthcare and/or air medical transport Experience in discharge planning and/or chart review International travel experience Demonstrated familiarity with InterQual criteria guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Benefits: Job you will love Fulfilling work Rewarding Career Supportive Environment Make a difference for your clients In Demand The Care Manager is responsible for providing quality professional care management services to all clients and their responsible parties. Our objective is to assist our clients in managing and navigating challenges in aging as well as Adults with physical and mental disabilities and providing the highest quality of life. This includes: Care Coordination Managing home health aides Medical oversight Interfacing with medical personnel Advocacy, information and referrals Qualifications: Professional and positive approach, commitment to customer service Self-motivated and work with own initiative Strong in building relationships, team player and able to communicate at all levels Recognizes industry trends and problem solves Respectful of company and client confidentiality; any violation of company or client confidence is immediate grounds for dismissal. Personalized and compassionate service - focusing on the individual client's wants and needs. Ability to provide non-directive guidance and facilitate constructive relationships. Ability to ensure inappropriate placements, duplication of services, and unnecessary hospitalizations are avoided. Manage time efficiently. Ability to provide coordinated communication between family members, doctors and other professionals, and service providers. This is a remote position. Aging Life Care Professionals offer a holistic, client-centered approach to caring for older adults or others facing ongoing health challenges. Working with families, the expertise of Aging Life Care Professionals provides the answers at a time of uncertainty. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress and time off of work for family caregivers through: Assessment and monitoring Planning and problem-solving Education and advocacy Family caregiver coaching This business is independently owned and operated. Your application will go directly to the business, and all hiring decisions will be made by the management. All inquiries about employment at this business should be made directly and not to Aging Life Care Association.

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth. Be part of a team that makes a real difference. Enjoy the perfect balance of remote work and meaningful field visits in this flexible role. Central Illinois area residency required as you'll travel throughout the region (up to 200 miles/4 hours round trip) to provide personalized care for clients. This position offers professional autonomy while building valuable connections with patients across diverse healthcare settings throughout Central Illinois. Join our compassionate team and help make a positive difference in an injured person's life. As a Field Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning. In this role, you will: * Demonstrate knowledge, skills, and competency in the application of case management standards of practice. * Use advanced knowledge of types of injury, medications, comorbidities, treatment options, treatment alternatives, and knowledge of job duties to advise on a treatment plan. * Interview disabled persons to assess overall recovery, including whether injuries or conditions are occupational or non-occupational. * Collaborate with treating physicians/providers and utilize available resources to help create and implement treatment plans tailored to an individual patient. * Work with employers and physicians to modify job duties where practical to facilitate early return to work. * Evaluate and modify case goals based on injured/disabled person's improvement and treatment effectiveness. * Independently manage workload, including prioritizing cases and deciding how best to manage cases effectively. * Complete other duties, such as attend injured worker's appointments when appropriate, prepare status updates for submittal to customers, and other duties as assigned. Qualifications * Education: Associates Degree or Bachelor's Degree in Nursing or related field. * Experience: 2+ years clinical practice preferred. Workers' compensation-related experience preferred. * Skills: Ability to advocate recommendations effectively with physicians/providers, employers, and customers. Ability to work independently. Knowledge of basic computer skills including Excel, Word, and Outlook Email. Proficient grammar, sentence structure, and written communication skills. * Certifications, Licenses, Registrations: * Active Registered Nurse (RN) license required. Must be in good standing. * URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC). * Travel: Must have reliable transportation and be able to travel to and attend in-person appointments with injured workers in assigned geography. * Internet: Must have reliable internet. Benefits We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $70,000 - $83,000 annually. In addition to the base salary, you will be eligible to participate in our productivity-based bonus program. Your total compensation, including base pay and potential bonus, will be based on a number of factors including skills, experience, education, and performance metrics. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. #LI-MC1 Registered Nurse (RN), Nursing, Home Care Registered Nurse, Emergency Room Registered Nurse, Clinical Nurse, Nurse Case Manager, Field Case Manager, Medical Nurse Case Manager, Workers' Compensation Nurse Case Manager, Critical Care Registered Nurse, Advanced Practice Registered Nurse (APRN), Nurse Practitioner, Case Management, Case Manager, Home Healthcare, Clinical Case Management, Hospital Case Management, Occupational Health, Patient Care, Utilization Management, Acute Care, Orthopedics, Rehabilitation, Rehab, CCM, Certified Case Manager, CDMS, Certified Disability Management Specialist, CRC, Certified Rehab Certificate, CRRN, Certified Rehab Registered Nurse, COHN, Certified Occupational Health Nurse, CMC, Cardiac Medicine Certification, CMAC, Case Management Administrator Certification, ACM, Accredited Case Manager, MSW, Masters in Social Work, URAC, Vocational Case Manager

Address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required by using communication and available resources to promote quality, cost-effective health outcomes. Performing within the Registered Nurse and/or Licensed Clinical Social Work scope of practice, collaborate with the Primary Care Provider, member, guardian, caregivers, family members, other members of the Care Management Team, and the community to coordinate a full continuum of health care services. Holistic needs of the member, inclusive of unique social and cultural dynamics should be considered. The Care Manager may work remotely within regions to cover the needs across the state. Care Manager(s) will serve the population within Regions 1, 3, and 5. Remote and travel will be required within the region and/or the State. Preferred to reside in the following County: Cumberland County. Essential Functions Provide effective Care Management services based on case management standards of practice to enrolled populations. Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care. Work with members to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care. Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management. Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families. Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable. Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness. Utilize Hospital/Data or Electronic Medical Record system as available. Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies. Refer to appropriate clinical team members for interventions which are outside the Care Managers' scope of practice and/or expertise. Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes. Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization. Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication. Respect member's values, experience, and help to empower members to be an advocate for their own care. Maintain appropriate member documentation in the Care Management documentation platform, in accordance with organizational policies and procedures. Meet monthly productivity and role expectations. Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives. Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded. Attend departmental and corporate meetings, local and regional training, or other events as required. Travel using personal vehicle will be required within the region and/or the State. Perform all other duties as requested. Qualifications Registered Nurse (RN) Graduation from an accredited school of nursing BSN preferred Active, unrestricted RN license to practice in North Carolina Minimum 2 years' nursing experience; 1-year care management or community-based nursing preferred CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements Meets licensure or educational eligibility requirements as determined by The Commission for Case Management Certification Access to Hospital/Data or Electronic Medical Record system will be required, as necessary Maintain a valid driver's license with current auto liability insurance Social Worker Master's degree from an accredited school of social work Minimum 2 years' social work experience; 1-year case management or community-based social work preferred Active NC license as a Licensed Clinical Social Worker (LCSW) CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements Meets licensure or educational eligibility requirements as determined by The Commission for Case Management Certification Access to Hospital/Data or Electronic Medical Record system will be required, as necessary Maintain a valid driver's license with current auto liability insurance Knowledge, Skills, and Abilities Computer skills required including various office software and the internet; experience with MS Office software preferred Excellent communication skills - oral and written; Bilingual preferred Knowledge of government, private sector, and community resources Knowledge of Case Management principles Knowledge of and compliance with federal and state regulations applicable to the position Strong organizational and time management skills Skills in establishing rapport with a member and applying techniques of assessing comprehensive health care needs Critical thinking skills, effective clinical judgment, independent decision-making, and problem-solving abilities Sensitivity to diversity of cultures, language barriers, health literacy, and educational levels Ability to work independently and function as an integral part of a multi-disciplinary team Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives Able to shift strategy or approach in response to the demands of a situation Working Conditions The job environment is primarily an office or home environment Multiple contacts, face to face and/or telephonic, are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds Travel will be required within the region and/or the State

Job DescriptionBenefits: 401(k) Health insurance Are you an experienced RN with a passion for geriatric care? Join our team as a Full-Time RN Care Manager! Were looking for a compassionate, skilled professional with strong clinical judgment and excellent communication abilities. The ideal candidate will thrive in a collaborative, interdisciplinary environment working alongside physicians, nurses, social workers, and mid-level providers. Requirements: - Experience in geriatric care - Strong clinical and communication skills - Ability to work effectively within a team - Reliable transportation and willingness to travel throughout Monroe County and surrounding areas We offer competitive pay and the opportunity to make a real difference in patients lives. For more information or to apply, please call ************ today! Job Type: Full-time Pay: From $32.00 per hour Work Location: Hybrid remote in Monroe County, NY Flexible work from home options available.

Omatochi is actively seeking a compassionate and detail-oriented Care Manager to join our team. In this non-medical role, you will play a crucial part in coordinating and overseeing support services for our clients. The Care Manager will work closely with various stakeholders to ensure our clients receive the assistance and resources needed to improve their quality of life. The ideal candidate for this position is empathetic, organized, and possesses excellent communication skills. Responsibilities: Client Assessment and Support Planning: Conduct thorough assessments of clients' needs, considering their personal, social, and emotional requirements. Develop tailored support plans in collaboration with clients, their families, and relevant agencies. Coordinate with community resources to provide clients with appropriate services and assistance. Care Coordination and Advocacy: Serve as the main point of contact for clients, connecting them with relevant services and programs. Advocate for clients' needs, ensuring they receive timely and adequate support from various organizations and service providers. Monitor the progress of support plans and adjust them as necessary to meet clients' changing requirements. Client and Family Education: Educate clients and their families about available support services, community resources, and self-help techniques. Provide guidance on effective coping strategies and assist in developing life skills. Address clients' concerns and queries, building a trusting and supportive relationship. Documentation and Reporting: Maintain accurate records of client assessments, support plans, and interactions. Generate detailed reports on client outcomes, program effectiveness, and areas for improvement. Ensure compliance with organizational protocols and reporting requirements. Collaboration and Professional Development: Collaborate closely with community organizations, social workers, and relevant agencies to enhance the overall quality of client support. Participate in regular team meetings, training sessions, and workshops to stay informed about the latest developments in social services and care management. Pursue continuous professional development, seeking opportunities to expand knowledge and skills in the field of care management. Qualifications: Valid Drivers License and Vehicle Bachelor's degree in Social Work, Psychology, Counseling, Human Services, or a related field. Proven experience in non-medical care management, case management, or social services. Strong understanding of social service regulations, policies, and procedures. Excellent interpersonal skills, including active listening and empathy. Ability to work independently, prioritize tasks, and manage time efficiently. Proficiency in using case management software and other relevant tools. Benefits: Competitive salary and performance-based incentives. Comprehensive benefits package, including health, dental, and vision insurance. Generous paid time off, including vacation, personal days, and holidays. Ongoing professional development opportunities. Region and Travel: This is a position with a strong field-based component. While the incumbent will have flexibility to work from home, they are expected to travel extensively-approximately 50% to 80% of the time-within Santa Cruz County. This role requires a high level of mobility and availability to attend in-person visits, community events, and other field-based responsibilities throughout the geographic area of responsibility. Mileage Reimbursement / Vehicle Allowance: Travel-related expenses are reimbursed and whether a monthly stipend is provided for vehicle use. Scheduling Flexibility: Incumbent has autonomy over scheduling and is responsible for balancing field and administrative work. Omatochi is committed to creating an inclusive and diverse work environment. We encourage applications from candidates of all backgrounds and experiences.

Salvo is looking for an experienced Nurse to support our chronic disease patients. In this role, you'll be a key contributor to the management and delivery of our care program, working closely with our patients, registered dietitians, and partner physicians to provide best-in-class care. You'll use your medical knowledge and product expertise to help our members navigate Salvo Health, assisting in medical and administrative tasks to keep the member moving through the program. Additionally, you'll help shape how we build and scale our product and process. Our ideal candidate is someone who enjoys the challenges of an early-stage start up, is eager to learn, process oriented, and has a patient-first mindset. What You Will do: Provide exceptional care, disease management and health education to patients Support goal setting for individual patients asynchronously to help them better manage their chronic conditions Create personalized action plans with guidelines to reduce or eliminate unwanted behaviors Help clients understand their motivations and create behavior change plans Conduct regular outreach to patients, based on their needs and preferences, to support engagement and elicit behavior change Coordinate with other clinical team members to provide an exceptional patient experience Develop and maintain professional, support-oriented working relationships with patients and team members Create and distribute health education materials to individual members as necessary Work with a cross-functional product team to develop and constantly improve our in-app patient experience Qualifications: 2+ year of experience as Licensed Practical Nurse or any Nursing license 2+ years of experience in patient-facing or customer-facing roles Compact state license required, additional licensing may be needed Bilingual (spanish speaking) a plus Excellent customer relation skills, as well as written and verbal communication skills Knowledge of medical terminology and proficiency of general medical office procedures Familiarity with digital applications like Slack, Coda, Google Workspace, etc. Strong analytical and proactive problem solving skills Self-motivated, results-oriented and strategic thinker Personal passion for health and wellness topics Must be authorized to work in the United States Experience working in telehealth or healthcare startup environment preferred Bonus: Experience working in GI, weight management, and/or with anti-obesity medications such as GLP-1s Salvo is a new approach to help millions of Americans facing chronic health conditions, centered on chronic gut health and metabolic conditions from IBS to obesity. Our patients are assigned a “whole patient” care team and have seven day a week access to app-based care, using Remote Patient Monitoring (“RPM”) to bill under the patient's insurance. This is a major step forward to go beyond episodic appointments to continuous care at home, and deliver interdisciplinary wraparound care in partnership with the patient's existing local doctor. Salvo is backed by leading health care investors from innovators like Livongo, Ro, Ginger, Forward, Brightline, Tia, and others. Salvo care draws on expertise from Board-certified specialty physicians, registered dietitians, nurses, psychologists, and therapists who have developed our evidence-based protocols, for a personalized, multi-month journey to better health. Salvo is the first to bring a scalable and tech-enabled, more integrative approach to these chronic conditions, going beyond treating only the symptoms in order to identify and address the root causes of chronic illness. Salvo offers a competitive salary and health benefits, a remote work environment, flexible time-off, a larger sense of mission, and professional development and entrepreneurial opportunities. Working alongside a bunch of super talented and friendly people, in a culture that likes to drive constant innovation, and marked by relentless curiosity and a sense of empathy. Salvo is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Insight Global is hiring for a Remote Care Manager to support our micro clinic operations in Raleigh, NC. You will work in a virtual setting with providers, paramedics, and patients to partner in the care continuum process. You will lead the clinical onboarding of new contracts, handle referrals & authorizations, and ensure seamless communication with all stakeholders. Responsibilities will include: · Develop and monitor care plans in collaboration with multiple providers, adjusting as needed · Follow up on interventions to prevent unnecessary ER visits and hospital admissions · Serve as the primary liaison between patients, families, and healthcare staff to ensure seamless communication · Navigate multiple healthcare platforms including EHRs, payer portals, billing software, and patient messaging systems · Ensure timely and accurate documentation across systems to support care continuity and compliance · Verify provider participation, coverage, and pre-authorization requirements with insurance administrators and healthcare facilities · Optimize client contracts and referral workflows to enhance scalability and efficiency in care coordination · Schedule and manage appointments, follow-ups, and referrals to specialists and services · Educate patients on conditions, medications, and treatment plans to promote understanding and adherence · Track patient progress and address barriers to treatment plan compliance We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: **************************************************** Skills and Requirements · RN Licensure or Paramedic Licensure in North Carolina · Minimum of 3 years of experience in care coordination (care or case management) · Strong knowledge of insurance benefits, prior authorizations, and referral management · Proficiency with EMR/EHR systems, payer portals, and standard office software (60% of role) · Strong communicational & organizational skills - ability to work efficiently with a team

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

The Patient Access Manager (PAM) II-Adherence Specialist is a non-sales regional, field-based position that will work directly with patients, families, and their provider(s) to address barriers, through information and education, to patient starting on therapy and staying on therapy, if appropriate. This role demonstrates superior customer facing skills working directly with multiple external and internal stakeholders including patients, prescribers, and advocacy groups. The PAM II is a subject matter expert in navigating insurance coverage and assisting in securing reimbursement through prior authorizations and appeals. The PAM II will also provide patient education, disease state and product education as well as general support for the patients and their caregivers. This role will appropriately interact and engage internal and external with teams but will serve as the point person responsible for identifying and resolving issues impacting treatment initiation and ongoing therapy. This position will also serve as the primary source for all regional patient advocacy activities. The PAM II will leverage his/her overall business acumen, therapeutic area knowledge, and patient access expertise to provide developmental guidance to their Patient Access Manager I colleagues. Location: Nationwide Remote Responsibilities Upon confirming a valid consent, meet and work closely with patients/families to work through the steps required to gain access to therapy (insurance navigation, understanding of payer policy and procedure for prior authorization, denial appeals, disease and product education, site of care logistics, and other support services). Provide education and information through the prior authorization/appeal processes and coordinate the delivery of appropriate documentation to achieve and maintain coverage. Complete a comprehensive assessment of the individual needs of the patient. This assessment will include understanding the individual's payer policies, plan designs, including Medicaid coverage if applicable, as well as the healthcare system local to the patient. Develop and offer solutions to the family, when necessary, that may also include communication of alternative insurance options and how families can best connect to available resources including charitable organizations such as PAF and NORD. Appropriately interact with and engage internal teams including commercial and medical and external teams including patients and/or their caregivers; payers; specialty pharmacy, physician offices, charitable organizations and patient advocacy organizations; Serve as the point person responsible for identifying and resolving issues impacting treatment initiation and ongoing therapy Provide support for the caregivers and collaborate with them in a way that allows for forward progress. Be knowledgeable of any changes in the payer access environment to identify issues that may impact access and communicate information appropriately to colleagues. Facilitate rare disease network/relationships through local advocacy groups, rare disease related events, and attending national conferences. Support organizing and participating in patient-to-patient meetings and programs. Maintains up-to-date knowledge on product resources available to support patients/caregivers at the regional level and applies this knowledge in a way that supports patient care. Offers subject matter expertise on trends, compliance, and other disciplines that impact the Patient Access role to help elevate the overall performance of the Patient Access team. May support the Manager, Patient Access Readiness, in identifying and implementing strategies and programs that help the PAM team be maximally effective in their roles. Coaches and mentors new members of the team. Qualifications BS/BA or relevant four-year degree. Advanced degree preferred. Minimum of 5 years' total business experience in the healthcare or biotech industry with at least 3 years' field-based experience in account management, sales, or field reimbursement. Experience working directly with patients and caregivers and in rare disease experience a plus. A deep understanding of insurance products and medication reimbursement process with a successful track record in field reimbursement, clinical education or in pharmaceutical sales/management of products that required significant payer and reimbursement involvement Seasoned, mature pharmaceutical/biotech professional with a comprehensive understanding of field / patient reimbursement, charitable funding, non-profit organizations Experience leading cross functionally and influencing without authority Case management experience in rare disease a plus including experience dedicated to assisting patients/caregivers Must be familiar with relevant legal and regulatory environment in biotech industry such as the Food Drug and Cosmetic Act, Anti-Kickback Stature, HIPAA and other patient privacy guidance and regulations. Competencies: Written and Verbal Communications, Problem Solving, Presentation skills, Teamwork & Collaboration, Customer Service focus, Teamwork & Collaboration, Adaptability, Professionalism Working Conditions: Position may require periodic evening and weekend work, as necessary to fulfill obligations. Periodic overnight travel. Ability to Travel up to 10%. #LI-REMOTE As an equal employment opportunity and affirmative action employer, Xeris Pharmaceuticals, Inc. does not discriminate on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, veteran status, genetics or any other characteristic protected by law. It is our intention that all qualified applications are given equal opportunity and that selection decisions be based on job-related factors. The anticipated base salary range for this position is $100,000 - $180,000. Final determination of base salary offered will depend on several factors relevant to the position, including but not limited to candidate skills, experience, education, market location, and business need. This role will include eligibility for bonus and equity. The total compensation package will also include additional elements such as multiple paid time off benefits, various health insurance options, retirement benefits and more. Details about these and other offerings will be provided at the time a conditional offer of employment is made. Candidates are always welcome to inquire about our compensation and benefits package during the interview process. NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization. Direct Employers Posting: Nationwide Remote

About the role The April Parker Foundation is seeking compassionate, detail-oriented Care Managers (Generalists) to deliver Enhanced Care Management (ECM) and Community Supports (CS) services to Medi-Cal members with complex medical, behavioral, and social needs. You'll work directly with individuals experiencing housing insecurity, chronic illness, or behavioral-health challenges helping them navigate care, access community resources, and achieve stability in health and housing. This is a field-based / remote role ideal for professionals who value flexibility and meaningful impact. What you'll do Conduct outreach, assessments, and individualized care plans for ECM and CS members. Coordinate medical, behavioral, and social-service supports-including housing navigation and tenancy services. Complete timely documentation and progress tracking in APF systems. Provide in-person, telephonic, and virtual encounters based on member needs. Collaborate with health plans, community partners, and APF multidisciplinary teams. Maintain strict confidentiality and compliance with Medi-Cal, DHCS, and ILS guidelines. Compensation Base Salary (Straight-Time Pay) Salary is based on your caseload and is calculated using a simple, transparent formula: Each member = 2 paid hours per member per month (PMPM), at $25.00/hour ($50 PMPM) Your monthly salary increases as your caseload increases. Incentive Pay (Additional Earnings) You earn $40 per member per month for delivery qualified, on top of your base salary. Bringing total compensation to $90 PMPM, equivalent to $45/hour Reimbursements & Stipends Mileage reimbursement at the IRS rate $50/month phone stipend Reimbursement for approved work-related expenses Schedule Work hours are flexible and self-directed, provided Care Managers meet service delivery requirements and member availability Qualifications Minimum 2 years of experience in case management, care coordination, or related field Knowledge of Medi-Cal CalAIM programs, community resources, and social determinants of health Excellent documentation, organization, and communication skills Valid California Driver's License, auto insurance, and reliable transportation Preferred: Bachelor's degree or CHW certification; CA licensure (LCSW, LMFT, LPCC, RN, etc.)

Do you dream of a role where you can connect with people and transform lives - all while working remotely? We're looking for Care Managers who thrive on building relationships with families with adult neurodivergent children - understanding their goals and helping them access specialized resources. Join us and transform the lives of hundreds of adults with developmental disabilities as you scale with a high-growth, innovative company. At NeuroNav, we believe everyone deserves the opportunity to make their own choices and shape their story, regardless of disability. Our mission is to enhance the quality of life for adults with developmental disabilities through simplicity and choice. We specialize in helping families navigate a specific California state funded program called Self-Determination, which offers more creative and custom choice as to how to leverage state funds. This is a life-changing program and you will be the conductor, breaking down barriers for your client and ensuring his or her success. As one of our virtual Care Managers (the heart and soul of our team called “Navigators” internally), you'll create custom client plans and guide families in a step-by-step process to enter and maintain participation in this program. In this remote role, you will be able to leverage your creativity, kindness and relational skills in social work, case management, and service coordination to transform your clients' lives and help them write the stories they dream of. About NeuroNav Founded at Stanford in 2020, with support from the Stanford Innovation Fellowship, Pear VC and Core Innovation Capital, NeuroNav drives new vision and change in disability by creating personalized care plans and connecting our neurodivergent clients with virtual Care Navigators who help manage their benefits. Last year, we supported hundreds of individuals in accessing life-changing services, and we're on track to quadruple our impact next year. Responsibilities include: Person-centered Planning - you will be trained in a special facilitation framework to capture your client's unique strengths, goals, needs and desired outcomes and align them to a plan unique to them. Budget & Spending Management - you will help translate personalized plans into concrete support needs and advocate for those needs to local budget authorities. Project Management - you will be the driver that holds the process together and guides the client and other partner organizations. Service Provider Access - you will leverage NeuroNav's proprietary resources to search for and assist providers in implementing person-centered plans throughout the year. Special Projects - you will contribute your talent and insights from working with clients into key company strategy and initiatives each quarter. What You'll Bring Bachelor's Degree or equivalent work experience Social Work or case management experience in the disability or social services field Client-facing experience managing multiple relationships at one time Excellent written and verbal communication skills Must have computer, reliable high-speed internet connection, and a quiet work environment Fluent in Spanish and bilingual (strongly preferred) Experience in a performance-based culture with metrics attainment goals (preferred) Experience serving in the developmental disability field (preferred) Experience with Microsoft Office & Google Suite (preferred) Experience in person-centered planning and in the California developmental disability system (preferred) Experience in Case management: 2 years (Preferred) Benefits We believe in supporting our employees' well-being and work-life balance as part of our culture and offer the following benefits: Remote first - Ability to work from home Health, vision and dental insurance 401(k) 14 Paid Time Off (PTO) days per year 7 sick or flex days per year Annual company retreat Salary: $50-60k per year (depending on experience)

Hello, how are you? Are you a LPN that is looking to improve the health of patients that have complex conditions? Do you live within a reasonable driving distance to St. Joseph, MO? Would you like to work from home and travel for the training/occasional meetings? If you answered yes to the above and have/are: Savvy with basic software/services such as email, word, excel, etc. Detail oriented to the point of annoying people because you pick up on things that others don't. Partial to helping people that are unappreciated, overlooked, and may not have any other types of support. A solid home/office environment that enables you to get the job done correctly whenever it needs to be done. Naturally competitive and want to win. YOU want to be the best and enjoy working with others who are the same. An active LPN license that is in good standing. ****1000 imaginary bonus points if you have long-term care, skilled nursing, assisted living, care management, or other experience working with patients who have chronic conditions.**** At SparroWell, we want to win by helping others get the best care possible. Our awesome team works with physicians, nurse practitioners, and other clinical team members that specialize in taking care of people with chronic illnesses. Our advanced care team also supports patients, families, as well as their caregivers to provide additional resources whenever needed. On any given day, our team is coordinating care, reviewing medications, auditing charts like a BOSS, collaborating with medical providers, and ultimately making a difference in the lives of patients we serve. We work from home but do occasionally meet in person for meetings and training on the latest requirements/guidelines. Go ahead, start the conversation by sending us your resume today. We will consider all applicants even though we prefer to work with nurses that have long-term care or post-acute experience. If you would like to learn more about our company, please visit us at **************************** Thank you for reviewing our opportunity and we look forward to hearing from you.

We are a rapidly growing healthcare organization dedicated to supporting patients living with chronic conditions. Our mission is to deliver personalized, high-quality care that empowers individuals to take control of their health with confidence. Through a fully remote model, our Care Managers guide patients through their care journeys-educating, advocating, and coordinating support that leads to better outcomes and smoother day-to-day management. We're looking for a motivated Care Manager who is eager to apply their medical knowledge in a hands-on, patient-facing role. This position is ideal for someone with a healthcare diploma, training, or any form of medical education or clinical exposure who wants to put that foundation to meaningful use. You'll act as the central point of contact for patients, helping them understand their conditions, navigate care plans, and stay on track with treatment while working alongside providers, social workers, and community partners. Key Responsibilities: Monitor and coordinate care plans by tracking progress, adjusting interventions, and maintaining consistent patient support. Provide clear, accessible education about chronic conditions, treatment options, and lifestyle strategies. Coordinate appointments, follow-ups, and referrals, ensuring smooth connection to appropriate providers. Maintain accurate patient records, including health information, insurance details, and supporting documentation. Respond promptly and empathetically to patient questions, concerns, and urgent needs. Partner with care teams to develop, assess, and refine patient-centered interventions. Collaborate with behavioral health, disease management, home health, social work, and community organizations for holistic care. Ideal Qualities and Skills: Strong verbal and written communication skills and the ability to simplify medical information for patients. Fluency in Spanish (spoken and written), with the ability to support Spanish-speaking patients and families. Solid problem-solving instincts and a proactive approach to anticipating patient needs. Organized, detail-oriented, and reliable in managing patient caseloads and documentation. Comfortable prioritizing tasks and managing time effectively in a remote environment. Collaborative mindset with genuine care for patient well-being. Healthcare diploma or equivalent preferred. Any level of medical or healthcare experience-clinical rotations, internships, coursework, or similar-is welcomed. Compensation: Competitive hourly rate of $15-$20 per hour, based on experience and qualifications (Full Time). A supportive remote environment with opportunities for professional growth and development. Fully Remote opportunity.

Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this role is remote, travel is expected to be up to 10%, and the expected schedule is Monday - Friday 8:00am - 05:00pm central. Independently licensed in TX or MO (LCSW, LPC, LMHC, or LMFT) required. What You'll Do As the Manager, Behavioral Health Longitudinal at Imagine Pediatrics you will manage a team of supervisors overseeing three roles: Behavioral Health Therapists, Behavioral Health Care Managers, and Care Team Assistants who work as an interdisciplinary team to serve a patient population experiencing severe mental illness (SMI). This role oversees a regional behavioral health care team and is responsible for team metrics and program outcomes. 90% of Manager, Behavioral Health, longitudinal role will be administrative inclusive of the following: Manage a team of regional cross functional care team members with the support of supervisors. Provide oversight to a team of supervisors including 1:1 support, quarterly feedback, and typical functions of people management Provide guidance to supervisors regarding performance management of indirect reports. Uphold team members responsible to Imagine specific policies, clinical programming requirements, and utilization targets. Partner with talent acquisition to carry out hiring plans, interviews, and onboard new team members. Assist with strategic planning for expansion into new markets for company growth. Analyze programmatic metrics and individual metrics in order to utilize staff appropriately. Hold the team accountable for working at the top of their license and utilizing team functions as efficiently as possible Identify areas for improvement within team processes, clinical care, and action on projects to make them more efficient. Serve as the Behavioral Health Longitudinal representative in leadership meetings to provide feedback, improve patient experience, and support the development of new programs and services. Acts as the liaison for behavioral health services to all stakeholders taking a lead role in process and performance improvement and the delivery of high-quality services Collaborate with clinical education team for implementation of new trainings in alignment with care team and organizational needs. Create a positive and inclusive culture of teamwork and accountability Assist behavioral health team with navigating new processes, policies, and procedures. 10% of Manager, Behavioral Health - longitudinal role will be clinical and include but are not limited to the following responsibilities. Consult with market leaders on behavioral health cases. Manage patient escalations as needed. Support service recovery calls. What You Bring & How You Qualify First and foremost, you're passionate and committed to creating the world our sickest children deserve. You want an active role in building a diverse and values-driven culture. Things change quickly in a startup environment; you accept that and are willing to pivot quickly on priorities. A qualified candidate will be empathetic, caring, organized, and has strong relationship-building skills. In this role, you will need: Master's degree in social work, Marriage and Family Therapy, Counseling, or related area Must be licensed to independently practice in TX or MO (LCSW, LPC, LMHC, LMFT), openness to cross-state licensure. 5 years of experience post independent licensure in a behavioral health setting. 3 years of experience in management/supervision of mental health providers (experience in remote/start-ups environments preferred). Experience working with children, adolescents, and their caregivers inclusive of external systems involved in a minor's care. Experience with chart auditing and training to improvement-oriented outcomes. Certification/Training in evidence-based modalities including but not limited to cognitive behavioral therapy and dialectical behavioral therapy preferred Experience working with high-risk behavioral health populations including but not limited to suicidal ideation, homicidal ideation, severe persistent mental illness (SPMI), children in the foster care system. Strong preference and comfortability conducting triage assessments and crisis interventions. Diligent regarding documentation standards and accustomed to using electronic medical records. Experience working with a diverse population or demographics. Telehealth experience Familiarity with technology, Microsoft suites, and documenting in electronic health records. Fully remote with 10% travel for training/education What We Offer (Benefits + Perks) The role offers a base salary range of $88,000 - $107,000 in addition to annual bonus incentive, competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We're guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward - together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. Manages, coordinates, and evaluates all elements of financial, material and human resources in the provision of care coordination to assigned group of patients in accordance with the service and missions of the institution. Will have oversight of specific departmental role(s) and will work closely with other Population Health managers to ensure team continuity. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: 1. Bachelors of Science Degree in a healthcare field EXPERIENCE: 1. Five years of experience in a healthcare setting. PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Certified Case Manager (CCM) credential EXPERIENCE: 1. Three years of care coordination experience. 2. Two years in a leadership role. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Advises the Director on the hiring, retention, interviewing and recruitment of staff. 2. Initiates and maintains appropriate personnel records. 3. Assists in the development and implementation of on-going educational programs for professional and support staff which include new employee orientation, in-service continuing education, and new equipment and/or systems training which enables the staff to perform on the basis of current policy/procedures and state-of-the-art practices. 4. Provides ongoing feedback to employees concerning job performance through goal development, peer evaluation, and performance evaluations. Counsels and disciplines employees, under the direction of the Director. 5. Monitors on a continual basis all personnel and current expense budgets providing information and/or justification of variances to the Director. 6. Makes recommendations for preparation of the budget for cost center annually upon notification of the Director to assure cost effective operations. 7. Communicates effectively with physicians, nurses, and other personnel in problem identification and resolution in a timely manner. 8. Promotes customer satisfaction through response to customer perceptions of services provided in a professional and constructive manner. Ensures the establishment and implementation of a team culture that is patient centered. 9. Participates in various activities (i.e. staff meetings, in-services, etc.) to assist the Director in the dissemination of necessary information to staff, physicians, and others by written and/or verbal means. 10. Monitors current expense and human resource funds for his/her cost center cost effectively. 11. Spends funds in dollar amounts which are congruent with the departments' budget and is reflective of cost containment. 12. Maintains effective communication with fellow managers. Medical Staff, patients, staff, and other departments as necessary to assure identification of problems and provide problem resolution in support of the health system's mission of quality patient care delivery. 13. Facilitates the professional development of personnel. Oversees and participates in the orientation, training, and continuing education of the staff (departmental and interdepartmental) and other health related personnel. 14. Participates in outreach activities in the community in order to educate and/or promote good relationships. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office setting 2. Time will be spent traveling to physician practices SKILLS AND ABILITIES: 1. Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and health care team colleagues 2. Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change 3. Capable of independent judgment and action regarding psychosocial needs of patients. Additional Job Description: **RN PREFERRED This leadership position is responsible for overseeing a team of ambulatory nurse case managers who collaborate closely with Primary Care Physicians, PeakHealth, and a multidisciplinary care team to support patients in achieving their health goals. As Population Health continues to expand and evolve, we are seeking candidates with experience in the following areas: Ambulatory case management Collaboration with or employment within health insurance organizations Development and implementation of policies and procedures Leadership of both remote and on-site teams Familiarity with accreditation standards, including those from NCQA or comparable accrediting bodies Proficiency in EPIC and Compass Rose Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 415 POPH Population Health Management

This position consists of weekly in-person Care Management visits with the client, coordination with PCP and telephonic contact to ensure adherence to treatment plan. Also must be available to answer questions that the client may have between visits. During the visit CM will gather information and educate the patient on his or her disease management, medication administration, and home safety in order to the client remain safely at home. CM will assist patient and/or family member to connect with other needed resources such as meals, transportation to PCP, and insuring that all prescribed medications are in the home. At all times the Director of Healthcare Operations is available as a resource to CM. Requirements Must have at least 1 year verifiable experience as a RN, LPN or Social Worker Must have an active professional license in your state. Must have a good driving record, auto insurance, a reliable vehicle Must have internet access for visit and assessment logging Must be a dependable person The applicant must not have Disciplinary Actions against their professional license or be listed in the List of Excluded Individuals/Entities Search Responsibilities The RN, LPN or Social Worker will also be required to enter all assessment and visit information into the online system within 24 hours of the visit. Upon hire and prior to the first visit, a short online training session and webinar will need to be completed. You will be required to visit the client once a week, 4 times a month on going. Flexible schedule. Work from home.

LOCATION: Remote - must live in or near Rowan County, North Carolina. The person in this position must maintain residency in North Carolina or within 40 miles of the North Carolina border. This position requires travel. GENERAL STATEMENT OF JOB The Care Manager is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals receive appropriate assessment and services. The Care Manager works with the member and care team to alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member across the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs networks. Care Managers support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members' home communities. The Care Manager also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. As further described below, essential job functions of the Care Manager include, but may not be limited to: Utilization of and proficiency with Vaya's Care Management software platform/ administrative health record (“AHR”) Outreach and engagement Compliance with HIPAA requirements, including Authorization for Release of Information (“ROI”) practices Performing Health Risk Assessments (HRA): a comprehensive bio-psycho-social assessment addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care Adherence to Medication List and Continuity of Care processes Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management Transitional Care Management Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”). This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams. ESSENTIAL JOB FUNCTIONS Assessment, Care Planning, and Interdisciplinary Care Team: Ensures identification, assessment, and appropriate person-centered care planning for members. Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home) Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs. Administer the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings within their scope based on member's needs. The Care Manager uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports. The assessment process includes reviewing and transcribing member's current medication and entering information into Vaya's Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care. Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice. Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals Ensure the Care Plan includes all elements required by NCDHHS Use information collected in the assessment process to learn about member's needs and assist in care planning Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions Reviews clinical assessments conducted by providers and partners with Care Manager - LP and Care Manager Embedded - LP for clinical consultation as needed to ensure all areas of the member's needs are addressed. Help members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes (e.g., requirements for specific service), etc. Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process Works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed Solicits input from the care team and monitor progress Ensures that the assessment, Care Plan, and other relevant information is provided to the care team Reviews assessments conducted by providers and consults with clinical staff as needed to ensure all areas of the member's needs are addressed Updates Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member Supports and assists with education and referral to prevention and population health management programs. Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider's crisis plan. Provides crisis intervention, coordination, and care management if needed while with members in the community. Supports Transitional Care Management responsibilities for members transitioning between levels of care Coordinates Diversion efforts for members at risk of requiring care in an institutional setting Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care. Collaboration, Coordination, Documentation: Serves as a collaborative partner in identifying system barriers through work with community stakeholders. Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate. Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya's catchment. Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization. Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients' medical, behavioral health, intellectual /developmental disability, medication, and other needs. Works with Care Manager - LP and Care Manager Embedded - LP in participating in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards. Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed. Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders. Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues. Supports and assists members/families on services and resources by using educational opportunities to present information. Verifies member's continuing eligibility for Medicaid, and proactively responds to a member's planned movement outside Vaya's catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service. Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks. Maintains electronic AHR compliance and quality according to Vaya policy. Works with Care Manager - LP and Care Manager Embedded - LP to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya's contracts with NCDHHS. Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES Ability to express ideas clearly/concisely and communicate in a highly effective manner Ability to drive and sit for extended periods of time (including in rural areas) Effective interpersonal skills and ability to represent Vaya in a professional manner Ability to initiate and build relationships with people in an open, friendly, and accepting manner Attention to detail and satisfactory organizational skills Ability to make prompt independent decisions based upon relevant facts. Well-developed capabilities in problem solving, negotiation, arbitration, and conflict resolution, including a high level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance. A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change Thorough knowledge of standard office practices, procedures, equipment, and techniques and intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research Understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers. Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred. Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following: BH I/DD Tailored Plan eligibility and services Whole-person health and unmet resource needs (ACEs, trauma-informed care, cultural humility) Community integration (independent living skills; transition and diversion, supportive housing, employment, etc.) Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.) Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination) Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.) Serving members with I/DD or TBI (understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.) Serving children (child-and family-centered teams, Understanding the “System of Care” approach) Serving pregnant and postpartum women with SUD or with SUD history Serving members with LTSS needs (Coordinating with supported employment resources Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position. EDUCATION & EXPERIENCE REQUIREMENTS Bachelor's degree required, preferably in a field related to health, psychology, sociology, social work, nursing or another relevant human services area. Serving members with BH conditions: Two (2) years of experience working directly with individuals with BH conditions Serving members with LTSS needs Two (2) years of prior Long-term Services and Supports (LTSS) and/or Home Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working directly with individuals with BH conditions, an I/DD, or a TBI, described above --If graduate of a college or university with a Bachelor's degree in Human Services, then incumbent must have two years of full-time accumulated experience in mental health with population served. --If graduate of a college or university with a Bachelor's degree is in field other than Human Services, then incumbent must have four years of full-time accumulated experience in mental health with population served. --If a graduate of a college or university with a Bachelor's Degree in Nursing and licensed as RN, then incumbent must have four years of full-time accumulated experience in mental health with population served. Experience can be before or after obtaining RN licensure. --If graduate of a college or university with a Master's level degree in Human Services, although only one year of experience is needed to reach QP status, the incumbent must still have at least two years of full-time accumulated experience in mental health with the population served *Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104 Licensure/Certification Required: If Incumbent has a Bachelor's degree in nursing and RN, incumbent must be licensed by the North Carolina Board of Nursing to practice in the State of North Carolina. Preferred work experience: Experience working directly with individuals with I/DD or TBI PHYSICAL REQUIREMENTS Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. Ability to drive and sit for extended periods of time (including in rural areas) RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit ****************************************** Vaya Health is an equal opportunity employer.