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Senior Counsel - Healthcare IT and AI Technology Contracts
Akron Children's Hospital 4.8
North Canton, OH jobs
Full-Time, 40 hours/week
Monday - Friday 8 am - 5 pm
Onsite
The Senior Associate Counsel provides legal support for hospital information technology operations, including comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence. This position reports to the Vice President, Senior Associate Counsel with a reporting matrix to the Chief Information Officer.
Responsibilities:
Advise hospital leadership and procurement teams on the legal implications of acquiring new technologies, such as electronic health records (EHR), telemedicine platforms, cybersecurity tools, and medical devices and the implementation of artificial intelligence tools.
Draft, review, and negotiate a broad array of information technology contracts-such as software-as-a-service (SaaS) agreements, cloud hosting terms, data processing addenda, and business associate agreements. Identify and address legal risks in vendor offerings and technology solutions.
Advise hospital leadership on legal considerations surrounding digital transformation initiatives, innovation adoption, and strategic partnerships with technology providers.
Collaborate with hospital IT and security teams to develop policies and protocols for safeguarding patient data and critical systems. Advise on incident response plans, breach notification procedures, and risk mitigation strategies. Stay abreast of emerging threats and evolving best practices.
Provide legal support for hospital-wide policies on technology use, social media, device management, remote work, mobile access to sensitive information, and enterprise risk for information technology. Ensure policies reflect current legal requirements and operational needs.
Support the hospital in managing disputes or litigation related to technology vendors, data breaches, intellectual property claims, and other technology-related matters. Coordinate with litigation counsel as needed.
Education and Training: Provide ongoing education to staff and leadership on legal implications of technology adoption, emerging regulatory requirements, and evolving risks in the health technology landscape.
Identify and assess legal, operational, and compliance risks in IT contract.
Other duties as assigned.
Other information:
Technical Expertise
Openness to learning and keeping pace with rapid changes in both healthcare delivery and technological innovation.
Aptitude for working effectively with clinicians, IT professionals, administrators, vendors, and regulators.
Capacity to guide organizational leadership through complex legal and strategic decisions regarding technology investments.
Resourcefulness and creativity in navigating novel legal challenges emerging from digital health transformation.
Education and Experience
Education: Juris Doctor (JD) degree from an accredited law school; Ohio bar admission or ability to obtain admission prior to start date.
Experience: Minimum of 5 years of legal practice advising in healthcare Information technology contracts is required.
Technical Knowledge: Familiarity with healthcare IT systems, data privacy and security laws, and emerging technologies (such as artificial intelligence, cloud computing, and IoT).
Skills: Strong contract negotiation, drafting, and analytical skills. Excellent verbal and written communication abilities. Competency in risk assessment and strategic thinking.
Demonstrated integrity, discretion, and ability to work collaboratively with multidisciplinary teams.
Full Time
FTE: 1.000000
Status: Onsite
$97k-148k yearly est. 17d ago
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Quality Improvement Supervisor
Carestar, Inc. 4.0
Columbus, OH jobs
Company: CareStar, Inc. Job Type: Full-time Industry: Healthcare / Social Services / Case Management About the Opportunity at CareStar Founded in 1988 in Cincinnati, Ohio, CareStar, Inc. is a recognized leader in long-term care case management and population health. With a mission to Improve Communities by Improving Lives, we proudly serve individuals across Ohio through compassionate, high-quality care coordination. We are currently seeking a Quality Improvement Supervisor to join our Quality Improvement Department. This is a meaningful opportunity for professionals who are passionate about helping others live healthier, more independent lives. As a Quality Improvement Supervisor, you'll work directly with individuals to assess their needs, develop personalized care plans, and connect them with essential services and supports. You'll be part of a mission-driven team that values your expertise, supports your growth, and empowers you to make a real difference in your community.
Key Responsibilities
Directly supervises, manages, and oversees staff, including hiring and providing performance evaluations, salary recommendations, and individual development goals and objectives.
Oversees quality improvement activities in assigned area of the State, such as data collection, monitoring, and reporting quality improvement functions.
Leads and/or participates in key committees associated with continuous quality improvement, staff education, and/or consumer health and safety issues.
Collaborates with Directors to design and conduct reviews of select processes and/or areas of operation to measure performance on quality and compliance indicators; assimilates data from these reviews, provides recommendations for improvement and presents findings to senior management.
Develops and implements quality improvement related processes and tools such as chart audits, consumer satisfaction surveys, focused reviews, ongoing data monitoring mechanisms, etc.
Monitors compliance of After-Hours requirements, including the review of the On-Call Log for complete and appropriate responses; oversees the preparation of summary records for annual reviews; monitors and facilitates reporting of incidents per protocols.
Adheres to the CareStar Rule in performance of job responsibilities.
Understands and complies with CareStar Policies and Procedures.
Maintains confidentiality as related to patient information. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense.
Follows the Acceptable Use Policy while using any information systems owned or controlled by CareStar, Inc.
Minimum Qualifications
Licensed Social Worker, Licensed Independent Social Worker, Registered Nurse and at least 36 months of experience in the home and community-based services within the last 10 years; OR Bachelor's Degree in Business, Nursing, Social Services, or related field and at least 60 months of program management or program analysis experience.
Experience with continuous quality improvement principles, data analysis and basic statistics. • Supervisory experience preferred.
Strong organizational, critical thinking, and problem solving skills.
Effective oral and written communication skills.
Familiarity with suite of Microsoft Office programs.
Valid driver's license and car insurance as required by State law.
Why Join CareStar?
Competitive salary based on experience and education
Comprehensive benefits: Medical, dental, vision, life insurance
401(k) with a generous company match
Paid time off + 10 paid holidays
Employee Stock Ownership Plan (ESOP) - become a part-owner in the company
Supportive, mission-driven culture focused on improving lives
Apply Today
Ready to make a difference? Visit ************************************************ to apply and learn more about joining our team.
Department Quality Improvement Role QI Supervisor Locations Franklin County Remote status Fully Remote Employment type Full-time Employment level Professionals
$50k-65k yearly est. 6d ago
Representative II, Customer Service Operations
Cardinal Health 4.4
Phoenix, AZ jobs
**_What Customer Service Operations contributes to Cardinal Health_**
Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution.
Customer Service Operations is responsible for providing outsourced services to customers relating to medical billing, medical reimbursement, and/or other services by acting as a liaison in problem-solving, research and problem/dispute resolution.
**_Job Summary_**
The Representative II, Customer Service Operations processes orders for distribution centers and other internal customers in accordance to scheduling, demand planning and inventory. The Representative II, Customer Service Operations administers orders in internal systems and responds to customer questions, clearly communicating delays, issues and resolutions. This job also processes non-routine orders, such as product samples, and ensures that special requirements are included in an order.
**_Responsibilities_**
+ Processes routine customer orders according to established demand plans, schedules and lead times using SAP and other internal systems. Enters all necessary order information, reviews order contents, and ensures that orders are closed once completed.
+ Responds to inquiries from internal customers, such as Distribution Centers, regarding order tracking information as well as on-hold, back order and high priority statuses.
+ Identifies and communicates resolutions to order delays, missing information, and product availability based on customer profiles.
+ Uses dashboards and reporting from internal systems to identify causes of order issues, such as lack of inventory or invalid measures or requirements in the order. Creates visuals and conducts analyses as necessary to understand and communicate order data and issues.
+ Coordinates with a variety of internal stakeholders, including Planners and externally-facing Customer Service Representatives, regarding customer issues.
+ For international shipping and in cases of special order requirements, coordinates with Quality and Global Trade teams in order to ensure compliance of orders.
+ Processes orders for product samples and trials, coordinating with Marketing teams as necessary to understand the purpose and requirements of the samples.
**_Qualifications_**
+ High school diploma, GED or equivalent, or equivalent work experience, preferred
+ 2-4 years' experience in high volume call center preferred where communication and active listening skills have been utilized
+ Previous experience working in a remote/work from home setting is preferred
+ Prior experience working with Microsoft Office is preferred
+ Prior experience working with order placement systems and tools preferred
+ Customer service experience in prior healthcare industry preferred
+ Root cause analysis experience preferred
+ Familiarity with call-center phone systems preferred
+ Excellent Phone Skills with a focus on quality
+ Previous experience being able to achieve daily call center metrics including but not limited to average handle time, adherence, average speed to answer, QA
**_What is expected of you and others at this level_**
+ Applies acquired job skills and company policies and procedures to complete standard tasks
+ Works on routine assignments that require basic problem resolution
+ Refers to policies and past practices for guidance
+ Receives general direction on standard work; receives detailed instruction on new assignments
+ Consults with supervisor or senior peers on complex and unusual problems
**Anticipated hourly range:** $15.75 per hour - $18.50 per hour
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with my FlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 03/13/2026 *if interested in opportunity, please submit application as soon as possible.
_The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity._
\#LI-DP1
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (***************************************************************************************************************************
$15.8-18.5 hourly 6d ago
CAPA & Complaints Analyst (Hybrid)
Caris Life Sciences 4.4
Phoenix, AZ jobs
**At Caris, we understand that cancer is an ugly word-a word no one wants to hear, but one that connects us all. That's why we're not just transforming cancer care-we're changing lives.**
We introduced precision medicine to the world and built an industry around the idea that every patient deserves answers as unique as their DNA. Backed by cutting-edge molecular science and AI, we ask ourselves every day: _"What would I do if this patient were my mom?"_ That question drives everything we do.
But our mission doesn't stop with cancer. We're pushing the frontiers of medicine and leading a revolution in healthcare-driven by innovation, compassion, and purpose.
**Join us in our mission to improve the human condition across multiple diseases. If you're passionate about meaningful work and want to be part of something bigger than yourself, Caris is where your impact begins.**
**Position Summary**
The CAPA & Complaints Analyst provides day-to-day quality oversight for Corrective and Preventive Actions (CAPA) and Complaint Handling processes within Caris Life Sciences. This position integrates investigation management, trending analysis, and effectiveness verification to ensure product, process, and service issues are identified, resolved, and prevented.
The CAPA & Complaints Analyst works cross-functionally with internal partners across laboratory, operational, and customer-facing functions to maintain compliance with FDA, ISO 13485, CAP, and CLIA requirements while driving data-informed continuous improvement.
This position serves as a key contributor to Caris' enterprise Quality System, ensuring compliant, accurate, and timely complaint resolution and CAPA integration. The analyst supports complaint investigations through closure while partnering with internal teams to identify systemic trends, drive corrective actions, and strengthen audit readiness.
The role operates within Caris' global Quality System and Regulatory framework, maintaining compliance with applicable FDA, ISO 13485, CAP, and CLIA standards. The analyst contributes to continuous improvement initiatives that enhance data integrity, product quality, and patient safety across all business lines.
**Job Responsibilities**
+ Manage CAPA and Complaint records in alignment with Caris' Quality System procedures and applicable external requirements and standards, including FDA (21 CFR), ISO 13485, CMDCAS, PMDA, CAP/CLIA, New York State and other national and/or worldwide regulatory agencies, Health & Safety Practices, and other applicable standards as pertaining to medical devices.
+ Lead complaint investigations from intake through closure, ensuring accurate classification, documentation, and root cause analysis within required timelines.
+ Support trending and data analysis to identify recurring issues, systemic gaps, and opportunities for preventive or corrective actions.
+ Liaise with internal partners across laboratory, operational, and customer-facing functions to facilitate investigations, gather evidence, and verify effectiveness of implemented actions.
+ Maintain audit-ready documentation and records through all stages of Complaints Handling, ensuring completeness, traceability, and timely updates.
+ Review reportable and potentially reportable complaints, collaborating with the Quality and Regulatory teams to ensure proper evaluation and submission to applicable authorities.
+ Evaluate information from both clinical and technical perspectives to confirm appropriate investigation, resolution, and closure documentation.
+ Serve as a Subject Matter Expert (SME) for Complaint Handling, CAPA integration, and related regulatory reporting (MDR, PMS), ensuring compliance, accuracy, and consistency in all related activities and documentation.
+ Provide input to training materials and participate in quality training initiatives to support enterprise complaint management and CAPA effectiveness.
+ Collaborate with Quality leadership to drive continuous improvement and standardization of CAPA and Complaint processes across departments.
+ Contribute to internal and external audit readiness by maintaining up-to-date documentation and supporting audit responses as needed.
+ Ensure personal and company compliance with all Federal, State, and international regulations, as well as Caris policies and procedures for Health, Safety, and Environmental compliance.
+ Perform other duties as assigned to support the Quality Management System and enterprise quality objectives.
**Required Qualifications**
+ Bachelor's degree in a related scientific or technical field (e.g., biology, biotechnology, chemistry, medical technology, or engineering).
+ 3-5 years of professional Quality experience within Medical Devices, Clinical Laboratories, or IVD environments.
+ Direct experience supporting Complaint Handling, CAPA, Deviations, or related Quality System processes.
+ Working knowledge of applicable regulatory standards and frameworks, including FDA (21 CFR), ISO 13485, CAP/CLIA, and other international regulations.
+ Proficiency in QMS and data management systems, such as DOT Compliance, Master Control, Veeva, Trackwise or equivalent platforms, with strong understanding of investigation workflows and record traceability.
+ Strong analytical and documentation skills with attention to accuracy, completeness, and regulatory integrity.
+ Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and comfortable using digital dashboards or analytics tools for trending and reporting.
**Preferred Qualifications**
+ Demonstrated success working independently and collaboratively within cross-functional and matrixed teams.
+ Exceptional communication and problem-solving skills, with the ability to translate complex quality or technical information for diverse stakeholders.
+ Strong data-driven mindset with experience using analytics to identify trends, assess root causes, and propose continuous improvement opportunities.
+ Proven ability to manage multiple priorities in a regulated environment while maintaining accuracy, compliance, and documentation discipline.
+ Experience supporting global Quality Systems and understanding of U.S. and international medical device and laboratory regulations.
+ Drive for Results - consistently delivers on quality and compliance objectives through initiative, accountability, and proactive engagement.
+ Commitment to Continuous Improvement - seeks innovative, efficient solutions that enhance quality performance and audit readiness.
+ Customer and Stakeholder Focus - builds trusted relationships through responsiveness, transparency, and data-supported decision-making.
+ Strong written and verbal communication skills, including preparation of audit responses, CAPA summaries, and management presentations.
+ Ability to adapt to evolving priorities, work under minimal supervision, and thrive in a fast-paced environment requiring attention to both detail and timelines.
**Physical Demands**
+ Work is primarily performed in an office environment requiring routine use of standard office equipment (computer, phone, copier, etc.).
+ Must be able to sit or stand for extended periods while reviewing documents, conducting investigations, or entering data.
+ Occasional lifting of up to 20 pounds may be required for document files or equipment.
+ Visual acuity and manual dexterity required to review quality records, enter data, and prepare reports.
+ Must be able to work at a computer for prolonged periods and perform repetitive keyboarding and data-entry tasks.
**Training**
+ Completion of all assigned Quality System, regulatory, and safety training prior to assuming role responsibilities.
+ Ongoing participation in continuing education and internal training programs to maintain up-to-date knowledge of applicable regulatory and compliance standards (e.g., FDA, ISO 13485, CAP/CLIA).
+ Participation in cross-functional or role-specific training may be required to support continuous improvement, audit readiness, and employee development initiatives.
**Other**
+ May require flexible scheduling or limited travel (
+ Must adhere to Caris Life Sciences' policies, code of conduct, and confidentiality requirements.
+ Position may occasionally require evening or weekend hours during audits, regulatory inspections, or critical quality events.
**Conditions of Employment:** Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification.
This reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
Caris Life Sciences 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.
Caris Life Sciences is a leading innovator in molecular science and artificial intelligence focused on fulfilling the promise of precision medicine through quality and innovation.
Caris is committed to quality and excellence at our state-of-the-art laboratories. Learn more about our tissue lab and the advanced technologies that are helping improve the lives of cancer patients.
$48k-73k yearly est. 6d ago
Admissions Specialist- Specialty
Acadia Healthcare Inc. 4.0
Franklin, TN jobs
100% Remote "Work from Home" Opportunity
Schedule:Sat - Weds scheduled (Thurs and Fri off) 11a - 7:30p CST
PURPOSE STATEMENT:
As one of the nation's leaders in treating individuals with co-occurring mood, addiction, eating disorders and trauma, Acadia Healthcare places a strong emphasis on our admissions and inside sales functions to allow us to help every possible person in need. To this end, Acadia Healthcare is currently interested in hearing from dynamic candidates with proven track record of hitting sales goals, closing skills, prospecting skills who may be a fit for the Admissions Specialist position. The Admissions Specialist will be primarily responsible for converting inquiries into scheduled admissions at our Acadia facilities, and maintaining communications between the organization, referral source, patient and family.
ESSENTIAL FUNCTIONS:
Support multiple facilities' admissions functions within a given region in an effort to promptly assist clients and their family's seeking treatment.
Review prospective admissions against approved admission criteria, policies, and procedures.
Initiate contact to gather required clinical and demographic data from patient and other sources.
Respond promptly to inquiry calls.
Schedule assessments.
Assist prospective patients and significant others in seeking treatment.
Refer inquiries to other agencies and community resources when not appropriate for facility assistance or admission.
Coordinate with referral sources.
Responsible for maintaining all the documentation involved with the admissions process.
OTHER FUNCTIONS:
* Perform other functions and task as assigned
STANDARD EXPECTATIONS:
Complies with organizational policies, procedures, performance improvement initiatives and maintains organizational and industry policies regarding confidentiality.
Communicate clearly and effectively to person(s) receiving services and their family members, guests, and other members of the health care team.
Develops constructive and cooperative working relationships with others and maintains them over time. Encourages and builds mutual trust, respect, and cooperation among team members.
Maintains regular and predictable attendance.
Conscientious, highly organized and able to prioritize multiple tasks when busy.
Ability to work well under pressure and in crisis situations.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
* College degree preferred
* Two years' experience in healthcare admissions, preferably in the mental health or substance use field, or related experience preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
* Registered, Certified or Licensed Addictions Counselor a plus
Employee Perks
Ability to work 100% remotely
Competitive wage
Strong incentive bonus plan
Tuition reimbursement program
Full benefits package including Health/Dental/Eye/Life Insurance; FSA & Dependent Care FSA; 401K and EAP services
Opportunity to work with a team of enthusiastic individuals who collaborate well together.
Acadia is a leading provider of behavioral healthcare services in the United States and Puerto Rico, operating 253 treatment facilities across 38 states.
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
AHCORP
#LI-TB1
$27k-33k yearly est. 5d ago
Hybrid Outpatient Psychiatrist - Erie, PA
Allegheny Health Network 4.9
Erie, PA jobs
The Allegheny Health Network (AHN) Psychiatry & Behavioral Health Institute is seeking a motivated psychiatrist eager to work at the forefront of behavioral health care as we continue growing our presence in the Erie region. AHN will support the continued expansion of your skillset as you build a patient panel with myriad diagnoses or craft a sub-specialty niche. Join a vertically integrated fiscal and clinical delivery system that is revolutionizing behavioral health service models, providing evidence-based treatments, and measurement-based care.
Highlights:
Flexible, hybrid options for in-person and virtual work
Bi-monthly, multidisciplinary treatment team meetings which include peer case consultation
Onsite opportunity for interventional psychiatry with transcranial magnetic stimulation (TMS)
Continuing Medical Education (CME) allowance: $3500 and five paid CME days annually
Emphasis on collaboration between behavioral health disciplines, including psychiatry and psychology, within the Institute
Weekly Grand Rounds with free CME offerings
Opportunities to train and supervise advanced practice providers (APPs), psychiatry residents, medical students, and APP students
Qualifications:
Completion of ACGME approved Psychiatry residency program
Board eligible/board certified in Psychiatry
Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
Licensed in the state of Pennsylvania prior to employment
AHN Proudly Offers
Competitive salary and comprehensive medical benefits
Sign-on bonus
CME allowance
EY Financial Planning Services - student loan, PSLF assistance
Retirement plans; vested immediately in 401K, 457B.
Malpractice insurance with tail coverage
A diverse & inclusive workforce with respective loan repayment for qualified candidates
Why Erie?
Located directly on one of our Great Lakes, Erie is home to Presque Isle State Park offering 7 miles of beaches, 14 miles of trails, and endless water activities. Enjoy our local wineries and breweries, diverse eateries and ski resorts. The city has become home to a variety of educational institutions including top ranked school system. Benefit from the area's low cost of living and international airport. Erie's cultural scene and diverse job market make it an ideal place for healthcare professionals to grow.
Why Saint Vincent Hospital?
Nationally recognized for innovative practices and quality care, Allegheny Health Network is one of the largest healthcare systems serving Western PA. AHN's Saint Vincent Hospital is a 350- bed tertiary care hospital currently serving the tristate area. Our facilities are equipped with state-of-the-art technology and robotic capabilities
.
Saint Vincent Hospital has been proud to open a brand new 39-bed Emergency Department, on-site Cancer Institute facility, four state-of-the art 700 sq. ft. Operating Rooms and more! Recently voted Erie's Choice as the ‘Best Hospital' and ‘Best Place to Work', AHN Saint Vincent continues to shine in its commitment to its employees and the Erie community.
Email your CV and direct inquiries to:
Carissa Johnston | Physician Recruiter
************************
$222k-320k yearly est. 2d ago
Business Development Manager
The BJC Group, Inc. 4.6
Nashville, TN jobs
The BJC Group, Inc. is a comprehensive construction management and contracting company specializing in commercial and residential construction, pre-construction services, and maintenance. The company provides end-to-end solutions, encompassing design, permitting, construction, and building occupancy. Backed by a highly experienced team, The BJC Group is dedicated to delivering superior quality projects at competitive prices, catering to a diverse range of project sizes and requirements.
Role Description
This is a full-time hybrid role for a Business Development Manager, located in Nashville, TN, with flexibility for some remote work. The Business Development Manager will be tasked with identifying and securing new business opportunities, building and maintaining client relationships, and collaborating with internal teams to ensure client satisfaction. Daily responsibilities include market research, preparing sales presentations, negotiating contracts, and contributing to strategic business planning efforts to support company growth.
Qualifications
Strong business development, client relationship management, and negotiation skills
Experience in sales strategy, market research, and lead generation
Ability to analyze market trends and develop actionable insights for business growth
Excellent verbal and written communication skills for preparing proposals, presentations, and reports
Organizational and project management skills to oversee multiple deals and client accounts
Proficiency with CRM software and other digital tools for tracking sales processes and customer interactions
Self-motivated with a proactive approach to achieving business goals
Bachelor's degree in Business Administration, Marketing, Sales, Construction, or a related field is a plus
Industry experience in construction management or contracting is a plus
$58k-79k yearly est. 1d ago
Licensed Clinical Social Worker (LCSW) - Remote
Brave Health 3.7
New Mexico jobs
Why We're Here: At Brave Health, we are driven by a deep commitment to transform lives by expanding access to compassionate, high-quality mental health care. By harnessing the power of technology, we break down barriers and bring mental health treatment directly to those who need it most-wherever they are. As a community health-centered organization, we are dedicated to ensuring that no one is left behind. Nearly 1 in 4 people in the U.S. receive healthcare through Medicaid, yet two-thirds of providers don't accept it. Brave Health is stepping up to close this gap by making mental health care accessible, affordable, and life-changing for all.
Job description
We are looking for full-time Licensed Therapists to join our team and provide outpatient services through our telehealth program!
Benefits: Our team works 100% remotely from their own homes!
W2, Full-time
Compensation package includes base salary plus bonus!
Monday - Friday schedule; No weekends! Shift options include 9am-6pm MST
Comprehensive benefits package including PTO, medical, dental, vision benefits along with liability insurance covered and annual stipend for growth & education opportunities
Additional compensation offered to bilingual candidates (Spanish)!
We not only partner with commercial health plans, but are also a licensed Medicaid and Medicare provider and see patients across the lifespan
Requirements:
Master's level degree and licensure
Eligibility to work in the United States
Work from home space must have privacy for patient safety and HIPAA purposes
Fluency in English, Spanish preferred; proficiency in other languages a plus
Meets background/regulatory requirements
Skills:
Knowledge of mental health and/or substance abuse diagnosis
Treatment planning
Comfortable with utilizing technology at all points of the day, including telehealth software, video communication, and internal communication tools
Experience working in partnership with clients to achieve goals
Ability to utilize comprehensive assessments
Ready to apply? Here's what to expect next:
It's important to our team that we review your application and get back to you with next steps, fast! To help with that, and be most considerate of your time (which we value and know is limited), you may receive a call from Phoenix - our AI Talent Scout. She'll ask for just 5 minutes of your time to gather some information about you and your job search to get the basics out of the way. If there is a mutual fit we'll match you to the right senior recruiter on our team.
Brave Health is very proud of our diverse team who cares for a diverse population of patients. We are an equal opportunity employer and encourage all applicants from every background and life experience to apply.
$62k-73k yearly est. 7d ago
Part Time Remote Psychiatric Nurse Practitioner - Fee For Service
Thriveworks 4.3
Idaho City, ID jobs
Thriveworks is currently seeking Psychiatric Mental Health Nurse Practitioners in Idaho. ***Clinicians need to be licensed and living in the state in which they will be practicing.*** Compensation: This is a Fee for Service (W2) position, the range for this position is $65,000-$94,000 per year based on 15-20 clinical hours per week.
To maintain safety and best practices for our clinicians and patients via telemedicine, Thriveworks does not push or incentivize the use of stimulant medications; instead, we offer them as an option based on the client's specific symptoms and diagnosis, with prescribing decisions left to the discretion of the clinician. We do not currently treat substance use disorders, and make every effort to refer out to an in-person provider when symptoms arise that are too severe to be treated via telemedicine only.
Thriveworks Nurse Practitioners are expected to provide care to a diverse population of clients with mental health conditions such as depression, anxiety, ADHD, and more. They work with a broad range of age groups, primarily adults and adolescents, with a future focus on expanding care across the lifespan.
Qualifications:
Licensed Psychiatric Mental Health Nurse Practitioner - Board Certification required
Master's in Nursing with active prescriptive authority required in the state
Understanding of AdvancedMD (AMD) EMR is a plus
Three years of experience is a plus; 1 year of psychiatry practice is required
Licensed Psychiatric Mental Health Nurse Practitioners need to be licensed and live in the state in which they will be practicing
Part-time requires 15 - 20 hours of availability per week
All clinicians are required to complete an in-house training on our ADHD treatment standards, guidelines, and approach, followed by a brief exam. While all new hires are enrolled in the ADHD Clinic and expected to accept and treat ADHD clients, there are no quotas for the number of clients or prescriptions.
What We Need:
Make Psychiatric assessments and evaluations of clients in an ongoing telemedicine capacity
Willingness to treat 14 years old and up
Prescribe medication to reduce mental health symptoms, as needed
Create and collaborate with clients on care plans
Complete and/or administer appropriate paperwork and assessment tools for clients
Adhere to Thriveworks' Clinical Practice Guidelines
Consult with Regional Clinic Directors and staff on clients, programs, and services at the various sites
What We Give:
We are dedicated to taking great care of our employees and empowering them to succeed. This enables them to focus on providing excellent care to our clients. We offer the following benefits:
Fully Remote
Remote Medical Assistants
Guaranteed, bi-weekly pay (no need to wait on reimbursement)
401K with 3% employer match
Paid orientation and annual pay increases
Flexible scheduling (Sessions are available from 7 am-10 pm, 7 days/week)
Paid orientation, Paid Credentialing, Paid Malpractice Coverage, In-house professional development, including case consultation groups
Annual pay increases and Bonus Opportunities
Schedule Flexibility with No Show Protection and No required on-call
Amazing team culture and clinical support
Who we are - about Thriveworks:
Thriveworks is a trusted mental health provider with 340+ locations and a nationwide hybrid care model. We serve over 175,000 clients annually through more than 1.7 million sessions, and these numbers continue to grow. As a clinician-founded and clinician-led organization, we offer the tools, support, and community you need to build a fulfilling, long-term career.
A career at Thriveworks isn't just about finding a job that pays the bills. It's about helping others, joining a community, and learning to thrive both personally and professionally. We believe that the success of our employees is just as important as the success of our organization; they go hand in hand.
So, what do you say? Are you interested in joining our team? Apply today.
#LI-Remote #LI-MS1
Interested in joining Team Thriveworks? We're thrilled to meet you!
With Job scams becoming more and more frequent, here's how to know you're speaking with a real member of our team:
Our recruiters and other team members will only email you from ************************* or an @thriveworks.com email address.
Our interviews will take place over Google Meet (not Microsoft Teams or Zoom)
We will never ask you to purchase or send us equipment.
If you see a scam related to Thriveworks, please report to ***********************. You can contact ************************** with any questions or concerns.
Thriveworks is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team.
By clicking Apply, you acknowledge that Thriveworks may contact you regarding your application.
$65k-94k yearly 7d ago
Senior Manager, Clinical Science, Medical Affairs
Edwards Lifesciences Corp 4.6
Phoenix, AZ jobs
Edwards Lifesciences is the leading global structural heart innovation company, driven by a passion to improve patient lives.
The Transcatheter Mitral and Tricuspid Therapies (TMTT) division is dedicated to solving the complex challenges of mitral and tricuspid disease in order to transform treatment and significantly improve patients' lives. This is an exciting opportunity for an exceptional Clinical Scientist professional to join a team that is boldly designing transcatheter mitral and tricuspid therapies from the ground up.
How you'll make an impact:
As a key member of the Medical Affairs Clinical Science team, the Senior Manager (formal internal title is Senior Manager, Medical Affairs) is responsible for providing scientific expertise throughout the development and implementation of clinical studies and clinical evaluations for a dynamic portfolio of products across TMTT. The Senior Manager will be an experienced medical device professional with strong scientific acumen and a commitment to putting patients first.
This position can be an onsite or a hybrid role based at Edwards Lifesciences' corporate headquarters in Irvine, California, or can be a remote based role in the U.S.
Contribute to strategy and planning of clinical science and medical writing deliverables.
Lead clinical study design and clinical protocol development.
Independently author complex documents including clinical study protocols (pre-market and post-market), clinical study reports, annual progress reports, post-approval study reports, clinical evaluation plans, clinical evaluation reports, post-market clinical follow-up plans and reports, and other scientific documents (as appropriate).
Independently author complex regulatory responses.
Perform systematic literature reviews from initiation to completion (develop search strategies, manage associated documentation, and prepare literature summaries).
Independently review raw and summary clinical data for accuracy; resolve potential discrepancies.
Interpret safety and effectiveness results from pre-market and post-market data sources; conduct systematic data appraisals to support overall benefit-risk assessments.
Independently review and collaborate with cross-functional teams on the review, analysis, and interpretation of study results, including exploratory endpoints and assuring appropriate data review and accurate data reporting.
Summarize key data from clinical studies and published literature and provide updates to internal and external stakeholders (as appropriate).
Ensure documents comply with regulatory guidelines.
May travel up to 15% to attend scientific conferences.
What you'll need (Required):
* Bachelor's Degree in a related field with 10 years of related experience working in clinical science or medical/scientific writing; OR
* Master's degree in a related field with 8 years of related experience working in clinical science or medical/scientific writing; OR
What else we look for (preferred):
Doctorate degree (PhD, MD, PharmD) with 8 years of related experience working in clinical science or medical/scientific writing.
Familiarity with the coronary interventional and/or structural heart environments and current treatment options or have other clinical and/or clinical trial experience.
Experience in the application of MEDDEV 2.7/1 and EU MDR for clinical evaluations.
Experience with FDA PMA applications.
Strong knowledge of scientific research methodology, device development process, GCP, ICH guidelines and Global (US FDA, EU MDR, Japan PMDA, China NMPA) regulations.
Experience working in a cross functional, collaborative environment and comfortable interacting with R&D engineers, regulatory specialists, statisticians, physicians, and support personnel.
Excellent communication skills and experience influencing and guiding stakeholders.
Recognized as an expert in own subject area with specialized depth within current or previous organization(s).
Expert understanding of related aspects of clinical science and/or scientific/medical writing.
Expert knowledge of regulatory requirements and study execution.
Demonstrated ability to work independently, ability to prioritize and manage multiple tasks simultaneously.
Excellent oral and written communication skills.
Demonstrated experience with maintaining current, in-depth product knowledge including current developments, clinical literature review, as well as therapeutic and product operation knowledge.
Strong knowledge of statistical analyses, study design methodologies, and clinical trial protocol development.
Advanced working knowledge with the use of MS PowerPoint, MS Word, MS Excel, EndNote, and Adobe Acrobat.
Strong analytical, problem-solving, and scientific writing skills.
Aligning our overall business objectives with performance, we offer competitive salaries, performance-based incentives, and a wide variety of benefits programs to address the diverse individual needs of our employees and their families.
For California (CA), the base pay range for this position is $142,000 to $201,000 (highly experienced).
The pay for the successful candidate will depend on various factors (e.g., qualifications, education, prior experience). Applications will be accepted while this position is posted on our Careers website.
Edwards is an Equal Opportunity/Affirmative Action employer including protected Veterans and individuals with disabilities.
COVID Vaccination Requirement
Edwards is committed to protecting our vulnerable patients and the healthcare providers who are treating them. As such, all patient-facing and in-hospital positions require COVID-19 vaccination. If hired into a covered role, as a condition of employment, you will be required to submit proof that you have been vaccinated for COVID-19, unless you request and are granted a medical or religious accommodation for exemption from the vaccination requirement. This vaccination requirement does not apply in locations where it is prohibited by law to impose vaccination.
$142k-201k yearly 7d ago
Maternity Care Authorization Specialist (Hybrid Potential)
Christian Healthcare Ministries 4.1
Barberton, OH jobs
This role plays a key part in ensuring maternity care bills are processed accurately and members receive timely support during an important season of life. The specialist serves as a detail-oriented professional who upholds CHM's commitment to excellence, compassion, and integrity.
WHAT WE OFFER
Compensation based on experience.
Faith and purpose-based career opportunity!
Fully paid health benefits
Retirement and Life Insurance
12 paid holidays PLUS birthday
Lunch is provided DAILY.
Professional Development
Paid Training
ESSENTIAL JOB FUNCTIONS
Compile, verify, and organize information according to priorities to prepare data for entry
Check for duplicate records before processing
Accurately enter medical billing information into the company's software system
Research and correct documents submitted with incomplete or inaccurate details
Verify member information such as enrollment date, participation level, coverage status, and date of service before processing medical bills
Review data for accuracy and completeness
Uphold the values and culture of the organization
Follow company policies, procedures, and guidelines
Verify eligibility in accordance with established policies and definitions
Identify and escalate concerns to leadership as appropriate
Maintain daily productivity standards
Demonstrate eagerness and initiative to learn and take on a variety of tasks
Support the overall mission and culture of the organization
Perform other duties as assigned by management
SKILLS & COMPETENCIES
Core strengths like problem-solving, attention to detail, adaptability, collaboration, and time management.
Soft skills such as empathy (especially important in maternity care), professionalism, and being able to handle sensitive information with care.
EXPERIENCE REQUIREMENTS
Required: High school diploma or passage of a high school equivalency exam
Medical background preferred but not required.
Capacity to maintain confidentiality.
Ability to recognize, research and maintain accuracy.
Excellent communication skills both written and verbal.
Able to operate a PC, including working with information systems/applications.
Previous experience with Microsoft Office programs (I.e., Outlook, Word, Excel & Access)
Experience operating routine office equipment (i.e., faxes, copy machines, printers, multi-line telephones, etc.)
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other's medical bills. The mission of CHM is to glorify God, show Christian love, and experience God's presence as Christians share each other's medical bills.
$31k-35k yearly est. 1d ago
Pharmacist, Remote - PRN
Cardinal Health 4.4
Nashville, TN jobs
This 100% remote position will support prescription processing for a Cardinal-owned specialty pharmacy. Schedule will be Monday through Friday, either daylight or evenings based on needs currently being assessed. An active Pharmacist License in the State of TN is required.
_MMS Solutions, a division of Cardinal Health, is a specialty pharmacy serving nephrology physician offices and clinics. Located in La Vergne, Tennessee, MMS Solutions is a full-service closed-door specialty pharmacy dedicated in dispensing renal-specific medications, nutritional's, and ancillary supply orders directly to the patient's_ _homes._
**Schedule: PRN, Flexible Schedule to cover business hours as needed between Monday-Friday 8:00am - 10:00pm CST**
**Projected PRN-basis Hours per Week: 6 to 15 Hours per Week**
**_What Health System Pharmacy contributes to Cardinal Health_**
Pharmacy Operations is responsible for the safe, efficient and effective coordination of Cardinal Health's pharmacy operations that service acute care hospitals, hospital retail customers, ambulatory care and alternate site facilities, oncology and cardiology practices as well as retail customers.
Health System Pharmacy is responsible for providing customized pharmacy program solutions that reduce costs and improve patient care quality for hospitals, health systems and other integrated healthcare providers may also consult with and advise healthcare team on prescribed medications, supplies and related processes.
**_Job Summary_**
The pharmacist in this role will provide prescription order entry, verification, and processing for medications specific to treating renal disease.
**_Responsibilities_**
+ Applies expert knowledge of drugs and related protocols, to verify physician orders for medications using pharmacy information system. Checks drug and dose in relation to stated patient issue and addresses automated alerts from the system regarding drug type, dose, and other metrics.
+ Enter/validate medication orders in the client facility pharmacy information system via emulation capabilities
+ Prioritize based on time in queue and/or status of order (e.g. STAT orders)
+ Comply with State Board of Pharmacy rules and regulations, Remote Pharmacy Services policies and procedures and the client facility policies and procedures when performing pharmacist duties
+ Communicate professionally with colleagues, patients and healthcare providers.
+ Perform clarifications, interventions and provision of drug information and ensure all consults are accurate and complete
+ Answering the telephone and accepting a referring call
+ Obtain all initial state licensure required within the timeframe determined by the Remote Pharmacy Services Director and maintain said licensure in good standing
+ Assist with training and education of new team members and existing staff members as needed or assigned
+ Review orders entered by pharmacy technicians/clerks for accuracy and appropriateness (if applicable)
+ Attendance at staff meetings and/or training will be periodically required in addition to regularly scheduled staffing requirements
+ Complete all required training and competencies in a timely manner
+ Other tasks as assigned by management
**_Qualifications_**
+ 1-2 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred
+ TN Pharmacist License Required
+ May require vendor credentialing
**_What is expected of you and others at this level_**
+ Applies working knowledge in the application of concepts, principles and technical capabilities to perform varied tasks
+ Works on projects of moderate scope and complexity
+ Identifies possible solutions to a variety of technical problems and takes action to resolve
+ Applies judgment within defined parameters
+ Receives general guidance and may receive more detailed instruction on new projects
+ Work reviewed for sound reasoning and accuracy
Anticipated hourly range: $35.60 per hour - $58.81 per hour based on experience
Bonus eligible: No
Benefits: Paid Time Off, in compliance with applicable laws
Application window anticipated to close: 2/1/2026 *if interested in opportunity, please submit application as soon as possible
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skill and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (***************************************************************************************************************************
$35.6-58.8 hourly 8d ago
Senior Counsel - Healthcare IT and AI Technology Contracts
Akron Children's Hospital 4.8
Akron, OH jobs
Full-Time, 40 hours/week
Monday - Friday 8 am - 5 pm
Onsite
The Senior Associate Counsel provides legal support for hospital information technology operations, including comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence. This position reports to the Vice President, Senior Associate Counsel with a reporting matrix to the Chief Information Officer.
Responsibilities:
Advise hospital leadership and procurement teams on the legal implications of acquiring new technologies, such as electronic health records (EHR), telemedicine platforms, cybersecurity tools, and medical devices and the implementation of artificial intelligence tools.
Draft, review, and negotiate a broad array of information technology contracts-such as software-as-a-service (SaaS) agreements, cloud hosting terms, data processing addenda, and business associate agreements. Identify and address legal risks in vendor offerings and technology solutions.
Advise hospital leadership on legal considerations surrounding digital transformation initiatives, innovation adoption, and strategic partnerships with technology providers.
Collaborate with hospital IT and security teams to develop policies and protocols for safeguarding patient data and critical systems. Advise on incident response plans, breach notification procedures, and risk mitigation strategies. Stay abreast of emerging threats and evolving best practices.
Provide legal support for hospital-wide policies on technology use, social media, device management, remote work, mobile access to sensitive information, and enterprise risk for information technology. Ensure policies reflect current legal requirements and operational needs.
Support the hospital in managing disputes or litigation related to technology vendors, data breaches, intellectual property claims, and other technology-related matters. Coordinate with litigation counsel as needed.
Education and Training: Provide ongoing education to staff and leadership on legal implications of technology adoption, emerging regulatory requirements, and evolving risks in the health technology landscape.
Identify and assess legal, operational, and compliance risks in IT contract.
Other duties as assigned.
Other information:
Technical Expertise
Openness to learning and keeping pace with rapid changes in both healthcare delivery and technological innovation.
Aptitude for working effectively with clinicians, IT professionals, administrators, vendors, and regulators.
Capacity to guide organizational leadership through complex legal and strategic decisions regarding technology investments.
Resourcefulness and creativity in navigating novel legal challenges emerging from digital health transformation.
Education and Experience
Education: Juris Doctor (JD) degree from an accredited law school; Ohio bar admission or ability to obtain admission prior to start date.
Experience: Minimum of 5 years of legal practice advising in healthcare Information technology contracts is required.
Technical Knowledge: Familiarity with healthcare IT systems, data privacy and security laws, and emerging technologies (such as artificial intelligence, cloud computing, and IoT).
Skills: Strong contract negotiation, drafting, and analytical skills. Excellent verbal and written communication abilities. Competency in risk assessment and strategic thinking.
Demonstrated integrity, discretion, and ability to work collaboratively with multidisciplinary teams.
Full Time
FTE: 1.000000
Status: Onsite
$97k-148k yearly est. 17d ago
Denial Coordinator - Hybrid
Community Health Systems 4.5
Tennessee jobs
The Denial Coordinator is responsible for reviewing, tracking, and resolving denied claims, ensuring that appropriate appeals are submitted, and working closely with payers, internal departments, and revenue cycle teams to identify and address denial trends. This role plays a critical part in the denials management process, supporting efforts to improve claims resolution, reduce future denials, and ensure compliance with payer guidelines.
**Essential Functions**
+ Monitors assigned denial pools and work queues in Artiva, HMS, Hyland, BARRT, and other host systems, ensuring timely follow-up on denials and appeals.
+ Conducts follow-up calls and payer portal research to track the status of submitted appeals and claim determinations, documenting all actions taken.
+ Communicates with key stakeholders across revenue cycle, billing, and clinical teams to resolve denial trends and improve claim submission accuracy.
+ Tracks and documents all denial and appeal activity, maintaining accurate records in system logs, account notes, and tracking reports.
+ Ensures compliance with all payer guidelines and regulatory requirements, keeping up to date with policy changes and appeal submission rules.
+ Manages BARRT requests (Outbound/Inbound) in a timely manner, ensuring that all required documentation and system updates are completed.
+ Identifies root causes of denials and collaborates with internal teams to implement process improvements that reduce future denials.
+ Prepares and submits appeal documentation, ensuring that all required medical records, forms, and supporting materials are included.
+ Performs other duties as assigned.
+ Maintains regular and reliable attendance.
+ Complies with all policies and standards.
+ This role requires at least 1 day onsite per week.
**Qualifications**
+ H.S. Diploma or GED required
+ Associate Degree or higher in Healthcare Administration, Business, Finance, or a related field preferred
+ 1-3 years of experience in denials management, insurance claims processing, or revenue cycle operations required
+ Experience in revenue cycle processes in a hospital or physician office required
+ Experience with payer appeals, claim resolution, and healthcare billing systems preferred
**Knowledge, Skills and Abilities**
+ Strong understanding of payer guidelines, claim adjudication processes, and denial management strategies.
+ Proficiency in Artiva, HMS, Hyland, BARRT, and other revenue cycle applications.
+ Excellent problem-solving skills, with the ability to analyze denial trends and recommend corrective actions.
+ Strong written and verbal communication skills, with the ability to engage effectively with payers, internal teams, and leadership.
+ Detail-oriented with strong organizational and documentation skills, ensuring compliance with payer appeal deadlines.
+ Ability to work independently and manage multiple priorities in a fast-paced environment.
Equal Employment Opportunity
This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.
$25k-29k yearly est. 4d ago
RN, Registered Nurse - Pre-Certification - Hybrid
Quantum-Health 4.7
Dublin, OH jobs
is located at our Dublin, OH campus with hybrid work from home flexibility. Who we are Founded in 1999 and headquartered in Central Ohio, w e're a privately-owned , independent healthcare navigation organization . We believe that no one should have to navigate the cost and complexity of healthcare alon e, and w e're on a mission to make healthcare simpler and more effective for our millions of members . Our big-hearted, tech-savvy team fight s to ensure that our members get the care they need, when they need it, at the most affordable cost - that's why we call ourselves Healthcare Warriors .
We're committed to building diverse and inclusive teams - more than 2,000 of us and counting - so if you're excited about this position, we encourage you to apply - even if your experience doesn't match every requirement.
About the role
The Pre-Certification Nurse is responsible for all aspects of the prior authorization process for members of Quantum Health's employer groups. The nurse is responsible for acquiring all clinical documentation to appropriately process the service request within the designated time frames indicated. This includes verbal and written engagement with members, providers, clients, third party vendors. The Pre-certification Nurse also functions as a clinical resource to other staff in the company such as Utilization Review, Patient Services, Personal Care Guide nurses, and Client Services. The Pre-Certification nurse provides the highest level of clinical service both internally and externally to promote quality, medically necessary, cost-effective care.
What you'll do
Assess and review all requests for medical services requiring clinical review against Quantum Health adopted clinical review criteria. Communicate with patient, provider, facility, and internal work groups regarding outcome of requests.
Coordinate health management services to provide integrated health services for each patient and provide benefit and health information to patients, caregivers, providers and facilities to enable informed health decisions. Identify care coordination opportunities for patients admitted for elective surgical procedures. Communicates and works effectively with colleagues and other teams within the organization.
Utilize subject matter expertise, critical thinking, and clinical knowledge to render independent decisions and determinations, following Quantum Health workflows.
Direct out of network requests to in-network providers to ensure members secure the optimum desired benefits. Facilitate the discharge planning process during pre-service review and coordinate with other clinical work teams.
Promote the mission and core values of Quantum Health by proactively managing client/member expectations as it related to the pre-certification process.
Act as clinical resource for all Quantum health work groups.
Maintain a working knowledge of all Quantum Health's workflows.
Provide monitoring and oversight of non-clinical staff activities and be available to non-clinical staff during Quantum Health's business hours.
Identify potential high risk/high-cost cases and chronic condition cases and refer to the appropriate case management team.
Research status of vague or questionable procedures and present to the Chief Medical Officer/Physician Peer Reviewer for review.
Prepare and present high-quality medical reviews for MD collaboration and determination.
Facilitate communication between medical providers including external review agencies.
Notify Chief Medical Officer/Physician Peer Reviewer of all requests you are unable to certify within specified time frames.
All other duties as assigned.
What you'll bring
Active license as a Registered Nurse (RN) in the state of Ohio. Licensed Practical Nurses (LPNs) currently employed by Quantum Health may also be considered.
Minimum of two years clinical experience with direct patient care required in a hospital setting
Experience in health management preferred
Strong ability to communicate effectively with patients, employer groups, and physicians
Driven to work independently with limited need for daily supervision
Aptitude to research and identify issues using critical thinking
Outstanding computer skills including Microsoft applications
Possess excellent time management skills
Ability to make decisions that are timely and achieve results consistent with business goals and organizational culture
Protect and take care of our company and member's data every day by committing to work within our company ethics and policies
Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.
What's in it for you
Compensation: Competitive base and incentive compensation
Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!
What you should know
Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check.
Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we're committed to empowering our ERGs, and we're proud to be an equal opportunity employer .
Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.
Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate's unique combination of experience and qualifications related to the position.
Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.
Reasonable Accommodation: Should you require reasonable accommodation(s) to participate in the application/interview/selection process, or in order to complete the essential duties of the position upon acceptance of a job offer, click here to submit a recruitment accommodation request.
Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment. If you believe you've encountered a recruiting scam, report it to the Federal Trade Commission and your state's Attorney General .
$60k-92k yearly est. 5h ago
Senior Coding Quality Educator - Onsite
Providence Health & Services 4.2
New Mexico jobs
Senior Coding Quality Educator _Remote - Most states eligible._ _Providence caregivers are not simply valued - they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them._
Providence is calling a Senior Coding Quality Educator who will:
+ Assist with the day-to-day operations of the Coding Integrity, Knowledge Management team
+ Assist with research and developing coding guidance based on local, state and federal healthcare coding regulations and other payor guidelines as applicable
+ Obtain, interpret, analyze and communicate information regarding coding matters with all internal and external revenue cycle and coding teams
+ Collaborate with various departments e.g., Physician Network Operations, Revenue Cycle, Compliance, Practice Operations, and other key stakeholders on all coding matters
We welcome 100% remote work for residents in the United States with the exception of the following States:
+ Colorado
+ Hawaii
+ Massachusetts
+ New York
+ Ohio
+ Pennsylvania
Essential Functions:
+ Assist with the identification, development and delivery of new and ongoing coding changes and updates to all regional coding teams
+ Collaborate with various departments e.g., regional coding teams, revenue cycle, compliance, practice operations, and other key stakeholders on all coding matters
+ Respond timely (either orally or written) to coding inquiries from coders, educators, and other teams across Providence enterprise
+ Serve as a resource and subject matter expert for all coding matters
+ Provide coding support to regional coding teams as needed
+ Maintain relevant documentation and data as required
+ Review and update coding guidance annually or as necessary
+ Maintain document control
+ Develops action plans as necessary to resolve complex coding cases and to address the implementation of new service offerings or code changes
+ Facilitates education to support Medicare Risk requirements & organization goals
+ Review relevant patient details from the medical record based on coding and documentation guidelines
+ Participate in monthly progress meetings to discuss process improvements, updates in technology, along with any job related details
+ Communicate any coding updates published in third-party payer newsletters and bulletins and provider manuals to coding and reimbursement staff
+ Assists management in identifying and creating standardized workflows
+ Reviews EMR templates and identifies areas of improvement for provider documentation
+ Attends and presents at regional meetings as needed
Required qualifications for this position include:
+ High School Diploma or GED Equivalency
+ National Certification from American Health Information Management Association upon hire or National Certification from American Health Information Management Association upon hire.
+ 6+ years of experience in professional fee inpatient, surgical, outpatient coding, E/M, auditing and related work
+ 5+ years of experience providing provider education and feedback to facilitate improvement in documentation and coding
+ Strong experience in Excel (e.g., pivot tables), database, e-mail, and Internet applications on a PC in a Windows environment
Preferred qualifications for this position include:
+ Associate Degree in Health Information Technology or another related field of study
+ Bachelor's Degree in Health Information Technology or another related field of study
+ 5+ years of experience in coding for multispecialty practice
+ 2+ years of experience in professional fee billing methodologies
+ Experience with IDX, Allscripts, Advanced Web, Meditech
+ Experience with project management
Salary Range by Location:
AK: Anchorage: Min: $40.11, Max: $62.27
AK: Kodiak, Seward, Valdez: Min: $41.81, Max: $64.91
California: Humboldt: Min: $40.98, Max: $64.88
California: All Northern California - Except Humboldt: Min:$46.91, Max: $72.82
California: All Southern California - Except Bakersfield: Min: $41.81, Max: $64.91
California: Bakersfield: Min: $40.11, Max: $62.27
Idaho: Min: $35.69, Max: $55.41
Montana: Except Great Falls: Min: $32.29, Max: $50.13
Montana: Great Falls: Min: $30.59, Max: $47.49
New Mexico: Min: $32.29, Max: $50.13
Nevada: Min: $41.81, Max: $64.91
Oregon: Non-Portland Service Area: Min: $37.39, Max: $58.05
Oregon: Portland Service Area: Min: $40.11, Max: $62.27
Texas: Min: $30.59, Max: $47.49
Washington: Western - Except Tukwila: Min: $41.81, Max: $64.91
Washington: Southwest - Olympia, Centralia & Below: Min: $40.11, Max: $62.27
Washington: Tukwila: Min: $41.81, Max: $64.91
Washington: Eastern: Min: $35.69, Max: $55.41
Washington: South Eastern: Min: $37.39, Max: $58.05
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.
About Providence
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Requsition ID: 411100
Company: Providence Jobs
Job Category: Coding
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Day
Career Track: Business Professional
Department: 4010 SS PE OPTIM
Address: TX Lubbock 3615 19th St
Work Location: Covenant Medical Center
Workplace Type: On-site
Pay Range: $See posting - $See posting
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
$40.1 hourly Auto-Apply 9d ago
Billing Coordinator I (Healthcare Billing Specialist HYBRID Role -Knoxville TN)
Labcorp 4.5
Knoxville, TN jobs
At Labcorp, you are part of a journey to accelerate life-changing healthcare breakthroughs and improve the delivery of care for all. You'll be inspired to discover more, develop new skills and pursue career-building opportunities as we help solve some of today's biggest health challenges around the world. Together, let's embrace possibilities and change lives!
Billing Coordinator I (Healthcare Billing Specialist Hybrid Role -Knoxville TN)
Labcorp is seeking an entry level Billing Coordinator I to join our team! Labcorp's Revenue Cycle Management Division is seeking individuals whose work will improve health and improve lives. If you are interested in a career where learning and engagement are valued, and the lives you touch provide you with a higher sense of purpose, then Labcorp is the place for you!
Responsibilities:
Billing Data Entry involved which requires 10 key skills
Compare data with source documents and enter billing information provided
Research missing or incorrect information
Verification of insurance information
Ensure daily/weekly billing activities are completed accurately and timely
Research and update billing demographic data to ensure prompt payment from insurance
Communication through phone calls with clients and patients to resolve billing defects
Meeting daily and weekly goals in a fast-paced/production environment
Ensure billing transactions are processed in a timely fashion
Requirements:
High School Diploma or equivalent required
Minimum 1 year of previous working experience required
Specific work in medical billing, AR.AP, Claims/Insurance will be given priority
Previous RCM work experience preferred
Alpha-Numeric Data Entry proficiency (10 key skills) preferred
Remote Work:
Must have high level Internet speed (50 MBPS) connectivity
Dedicated work from home workspace
Ability to manage time and tasks independently while maintaining productivity
Strong attention to detail which requires following Standard Operating Procedures
Ability to perform successfully in a team environment
Excellent organizational and communication skills; ability to listen and respond
Basic knowledge of Microsoft office
Extensive computer and phone work
Why should I become a Billing Coordinator at Labcorp?
Generous Paid Time off!
Medical, Vision and Dental Insurance Options!
Flexible Spending Accounts!
401k and Employee Stock Purchase Plans!
No Charge Lab Testing!
Fitness Reimbursement Program!
And many more incentives.
Application Window Closes: 1/24/2026
Pay Range: $ 17.75 - $21.00 per hour
Shift: Mon-Fri, 9:00am - 6pm Eastern Time
HYBRID ROLE; Rotating 2 Days On-Site Knoxville TN / 3 Days Remote
All job offers will be based on a candidate's skills and prior relevant experience, applicable degrees/certifications, as well as internal equity and market data.
Benefits: Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. Employees who are regularly scheduled to work a 7 on/7 off schedule are eligible to receive all the foregoing benefits except PTO or FTO. For more detailed information, please click here.
Labcorp is proud to be an Equal Opportunity Employer:
Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law.
We encourage all to apply
If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site or contact us at Labcorp Accessibility. For more information about how we collect and store your personal data, please see our Privacy Statement.
$17.8-21 hourly Auto-Apply 4d ago
Intensive Home-Based Therapist
Integrated Services for Behavioral Health 3.2
Zanesville, OH jobs
We are seeking an Intensive Home-Based Therapist! Muskingum County, OH
Intensive Home-based Treatment
is eligible for a sign-on bonus of $5,000!
Join our team!
Do you have a passion for working with children and families? Integrated Services for Behavioral Health is looking for compassionate, dedicated people in Franklin County who want to empower youth and families by creating strength-based behavior change that will be sustained long after treatment ends.
You will receive ongoing training in the Intensive Family and System Treatment (I-FAST) as you work with families, youth, their communities, and other key members of their ecology to implement I-FAST as designed.
The salary range for this position is based on experience, education, and/or licensure:
Dependently Licensed: $70,000-$74,295.45/year
Independently Licensed: $80,000-84,909.08/year
Essential Functions:
Provide direct clinical treatment using the I-FAST model and principles, including but not limited to leveraging strengths and focusing on the positive, understanding frames, patterns, and increasing mature behavior.
Conduct a thorough assessment of the client and family that gathers information on behaviors of concern and strengths in the family and their ecology to inform conceptualization of the problem behaviors and interactions within the family's ecological context.
Works with families to define cultural factors that influence strengths, functioning, and family behaviors to ensure ongoing engagement and success in care.
Provide individual and family psychotherapy services that support the identified needs.
Develop collaborative and creative partnerships with community resources to meet the needs of each family.
Continuously work to engage the primary caregiver, family members, supports, and community agency staff (school, probation, child welfare) in change-oriented treatment.
Dedicate time to weekly case planning and evaluation of case progress, with ongoing support from your supervisor and team members.
Receive regular training, professional development, supervision, and consultation activities designed to help you acquire extensive clinical skills within the I-FAST model.
Work collaboratively with the team to ensure that clients have access to support 24 hours/day, 7 days/week as needed.
Maintains necessary documentation, participates in program evaluation, attends team and program planning meetings, cross-systems training, and acquires knowledge of community resources.
Meets billing productivity requirements established by Integrated Services for Behavioral Health.
Other duties as assigned.
Minimum Requirements:
Must meet requirements for licensure as defined by the Ohio Counselor, Social Worker, and Marriage & Family Therapist Board.
Experience and passion for delivering services to youth and families.
Demonstrated a high degree of cultural awareness.
Comfortable working with a diverse community of clients.
Knowledge of or experience engaging with families in the community.
Experience with multi-need individuals and families.
Broad knowledge of community service systems.
Willing to participate in and lead cross-systems team-building activities.
Able to effectively communicate through verbal/written expression.
Must be able to operate in an Internet-based, automated office environment.
Enjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package.
Benefits include:
Medical
Dental
Vision
Short-term Disability
Long-term Disability
401K w/ Employer Match
Employee Assistance Program (EAP) provides support and resources to help you and your family with a range of issues.
To learn more about our organization: *****************
OUR MISSION
Delivering exceptional care through connection
OUR VALUES
Dignity - We meet people where they are on their journey with respect and hope
Collaboration - We listen to understand and ask how we can best support the people and communities we serve
Wellbeing - We celebrate one another's strengths, and we support one another in being well
Excellence - We demand high-quality care for those we serve, and are a leader in how we care for one another as a team
Innovation - We deeply value a range of perspectives and experiences, knowing it is what inspires us to stretch past where we are and reach towards what we know is possible
We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
$80k-84.9k yearly 4d ago
Executive, Client Delivery
Ensemble Health Partners 4.0
Toledo, OH jobs
Thank you for considering a career at Ensemble Health Partners!
Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!
O.N.E Purpose:
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.
The Opportunity:
Join an award-winning company
Five-time winner of “Best in KLAS” 2020-2022, 2024-2025
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Energage Top Workplaces USA 2022-2024
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Great Place to Work certified 2023-2024
Innovation
Work-Life Flexibility
Leadership
Purpose + Values
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:
Associate Benefits - We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
Our Culture - Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
Growth - We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
Recognition - We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.
Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact *****************.
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role's range.
EEOC - Know Your Rights
FMLA Rights - English
La FMLA Español
E-Verify Participating Employer (English and Spanish)
Know your Rights
$94k-126k yearly est. Auto-Apply 60d+ ago
Collections Specialist
Vital Care Infusion Services 4.8
Glendale, AZ jobs
Recognized as a “Best Place to Work Modern Healthcare” - Join a team where people come first. At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters. Vital Care is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations. What we offer:
Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
Paid time off, personal days, and company-paid holidays.
Paid Paternal Leave.
Volunteerism Days off.
Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
401(k) matching and tuition reimbursement.
Employee assistance programs include mental health, financial and legal.
Rewards programs offered by our medical carrier.
Professional development and growth opportunities.
Employee Referral Program.
Job Summary:
Perform duties to collect Home Infusion claims, focusing on accuracy, timeliness, and adherence to processes to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities and improve collection rates; perform revenue cycle collection duties within standard or accepted practice limits.
Position is 100% remote
Duties/Responsibilities:
Review claims with outstanding balances and identifies actions to successfully collect revenues. Follow up with insurers and patients to collect outstanding balances in an environment focused on building enduring customer and business relationships. Utilize Payer Portals via the internet for claim disposition.
Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs), and other documents indicating denials or claims acceptance. Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection.
Analyze denials, identify trends, and recommend process improvement opportunities that will result in DSO reduction, superior collection rate, intervals reduced bad debt and simplified processes that are responsive to the requirements of specific payers.
Identify payor requirements for submittal of appeals for denied claims. Verify insurance information with patients, order medical records, review original claim coding, compile other validating documentation required, and submit appeals in keeping with payor requirements and VCI processes.
Communicate effectively with franchise partners and other VCI departments regarding the status of collections. Resolve payer issues/concerns timely.
Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity and actions are taken to resolve outstanding claims issues. Schedule follow-ups in required intervals.
Investigate and verify benefits for pharmacy and medical third-party claims.
Communicate billing problems found during collection process as to avoid the same issues in the future.
Communicate financial obligation information with patients so that they have a clear understanding of all costs of therapy prior to starting service.
Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures to improve the efficiency and effectiveness of the RCM team. Assist with the processing of online adjudication of collection issues and nurse billing as assigned.
Perform other related duties as assigned.
Required Skills/Abilities:
Excellent communications skills; listening, speaking, understanding, and writing English while influencing patients, caregivers, payer representatives, and others, answering questions, and advancing reimbursement and collection efforts.
Proven understanding of processes, systems, and techniques to ensure successful billing and collection working with all payer types.
Proven ability to identify gaps and problems from the review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action.
Strong organization skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
Proven knowledge and skill in the utilization of MS Office suite of software and pharmacy applications.
Ability to complete job duties in a designated workspace outside the dedicated RCM location
Disciplined work ethic with ability to work remotely with minimum direct supervision, to effectively meet production and collection targets.
Education and Experience:
2-5 years home infusion billing and/or collections experience required.
High School Diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections.
Previous remote work environment is a plus but not required.
Detailed oriented with post-billing and post-payment investigative experience preferred.
Physical Requirements:
Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
Keyboarding: Frequent use of a keyboard for typing and data entry.
Reaching: Occasionally reaching for items such as files, documents, or office supplies.
Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork
Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.
Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews.
Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status, or any other basis protected by applicable federal, state, or local law.
Vital Care Infusion Services participates in E-Verify. This position is full-time. #LI-remote