Health care coordinator work from home jobs

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow. We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity. Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success. Job Description Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. This role promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Essential Functions: - Conducting in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. - Communicating and developing the treatment plan for authorization of services, and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services. Qualifications MUST have 5 TOTAL years of Post Masters Experience. Required licenses are: Licensed as a LCSW-C or LCPC or LCMFT HOURS: Mon-Thurs 8a-7p and Fri 8a-6p. With that being said they need to be flexible. He /She WILL work 2 evening shifts/week (evening shift defined as staying until 7 pm Mon-Thurs or staying until 6 pm on Friday). After the training a schedule will be developed for the worker. Training is 3 weeks Mon - Fri from 8:30 am - 5:00. However, the candidate will be assigned his/her fixed work schedule between the 4th and 6th week on the assignment. Additional Information All your information will be kept confidential according to EEO guidelines.

Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this role is remote, and expected schedule requirements are Monday to Friday, 8:00am - 5:00pm central. What You'll Do As a Behavioral Health Care Manager (BHCM) with Imagine Pediatrics, you will work with the families of medically complex children providing case management services in accordance with Case Management Society of American (CMSA) Standards of Practice for members enrolled in Imagine Pediatrics behavioral health program. You will work alongside pediatricians, nurses, care coordinators, and other healthcare professionals. Your primary responsibilities will include: Monitor high-risk pediatric patients (up to 19 years old), some recently discharged from the hospital, ensuring appropriate follow-up and clinical management, and adjusting care plans as needed. Conduct biopsychosocial assessments to address behavioral, social, emotional, and systemic needs of the patient and family. Create and evaluate the effectiveness of the patient/family's care plan and modify based on families evolving needs and goal progression. Provide intervention that is consistent with the social/emotional/physical needs of patients and caregivers such as mental health crises, behavioral issues, and family conflict. Facilitate case management and support that requires clinical expertise in various systems with focus on helping patients and families negotiate the complexities involved with a mental health diagnosis. Resource validated external services requested by the family to meet behavioral and social needs such as social services agencies and behavioral specialists. Provides interventions in response to crisis to de-escalate and stabilize patient and family members Provides psychoeducation on the nature of mental health diagnosis and progression, the importance of treatment adherence, and related information as appropriate Collaborate with external care team members regularly including school systems, specialists, and DFPS as needed. Participate in ongoing scheduled consultations with an interdisciplinary team to monitor patient progress Represent Imagine Pediatrics commendably to patients, families, providers, and community Performs other duties and assumes other responsibilities as assigned by manager What You Bring & How You Qualify First and foremost, you're passionate and committed to creating the world our sickest children deserve. You want an active role in building a diverse and values-driven culture. Things change quickly in a startup environment; you accept that and are willing to pivot quickly on priorities. In this role, you will need: Masters' degree with major course work in social work or related field required Provisional licenses (LMSW, PLPC, LAMFT) preferred Minimum 3-5 years of post-graduate experience in health care social work/Case management in behavioral health Required. Experience working with pediatric population and family systems required Proficiency in motivational interviewing practices and/or techniques; goal setting and intervention; assessment of needs Knowledge of social work including crisis prevention and intervention Experience with providing telehealth services Knowledge of MS Office Suite and ability to work in online platforms Bilingual Spanish required Strong knowledge of behavioral health principles and practices Proficient in trauma-informed care practices Strong knowledge of mental health common signs and symptoms and able to identify difficulties with coping Role is remote with 10% travel necessary for training/education purposes Ability to work afternoons and evenings What We Offer (Benefits + Perks) The role offers a base salary range of $70,000 - $77,000 in addition to annual bonus incentive, competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We're guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward - together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Location: This is a remote position. What You'll Do: Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). 1Provides patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. To Qualify For This Position, You'll Need The Following: Required Education: Associate's in a job related field. Degree Equivalency: Graduate of Accredited School of Nursing or 2 years job related work experience . Required Work Experience: 2 years clinical experience. Required Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in typing, spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire. We Prefer That You Have The Following: Preferred Education: Bachelor's degree- Nursing. Preferred Work Experience: work experience in healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. 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Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Alignment Virtual Care Center is a collaborative approach to providing patients telehealth services 24 hours a day, 7 days a week. It is intended to provide support for Alignment Healthcare patients by being available to address any concern at any time. This program provides patients with medical and social support through virtual visit when they need it, with the goal of preventing unnecessary hospitalizations, health complications, and unmanaged disease progression that can occur when timely clinical interventions are not provided or are not accessible. The virtual care center program is offered to eligible patients at no cost to them. In this role, Nurse provides triaging service for patients who call into the virtual care center. Expected to escalate patient calls to Advanced Practice Clinician (APC) when appropriate. Responsible for managing patient care and treatment in collaboration with the Physician and Nurse Practitioner/Physician Assistant. The Alignment Virtual Care Center is a collaborative approach to providing patients telehealth services 24 hours a day, 7 days a week. It is intended to provide support for Alignment Healthcare patients by being available to address any concern at any time. This program provides patients with medical and social support through virtual visit when they need it, with the goal of preventing unnecessary hospitalizations, health complications, and unmanaged disease progression that can occur when timely clinical interventions are not provided or are not accessible. The virtual care center program is offered to eligible patients at no cost to them. In this role, Nurse provides triaging service for patients who call into the virtual care center. Expected to escalate patient calls to Advanced Practice Clinician (APC) when appropriate. Responsible for managing patient care and treatment in collaboration with the Physician and Nurse Practitioner/Physician Assistant. General Duties/Responsibilities (May include but are not limited to): Answering all in bound calls into the virtual care center Expected to use clinical judgement to address patient concerns Collaborates with primary care physician, Extensivist, and Nurse Practitioner/PA, and Case Manager to develop care plan for members. For non- care anywhere patients Conduct outbound calls and virtual visits to complete patient follow up Daily review of vitals for patients enrolled in remote patient monitoring program Support disease management referrals Interprets and evaluates diagnostic tests to identify and assess patients' clinical problems and health care needs. Educates members on topics such as disease process, end of life, medication, and compliance. Discusses case with physician/Nurse Practitioner/PA when appropriate. Use of Electronic Medical Records required. SUPERVISORY RESPONSIBILITIES: N/A Minimum Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Minimum Experience: Knowledge of clinical standards of care Minimum 1- year experience as an RN Education/Licensure: Requires successful completion of an accredited Nursing Program; BSN preferred , Registered Nurse, required Current, unrestricted license for California, Nevada, and North Carolina Must have CPR certification Other: Experience in gerontology, adult care, preferred Experience in palliative/hospice and complex care management, preferred Experience in Home Health including wound care, preferred Knowledge of Medicare Managed Care Plans, preferred Excellent administrative, organizational and verbal skills Effective communication skills with seniors Computer literate and able to navigate the internet Ability to work independently Detail oriented Dependable and reliable EMR experience is strongly preferred Bilingual skills valued (Spanish preferred ) Must be flexible with schedule as position is active 24 hours 7 days a week This includes alternative shifts such as day, evening, or overnight, weekends, and holiday coverage. Shifts can be scheduled over 8 or 10 hours. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ****************** . Pay Range: $77,905.00 - $116,858.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.

Cardinal Health Sonexus Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient markers of success. We're continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products. **_Responsibilities_** + Investigate and resolve patient/physician inquiries and concerns in a timely manner + Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate + Proactive follow-up with various contacts to ensure patient access to therapy + Demonstrate superior customer support talents + Prioritize multiple, concurrent assignments and work with a sense of urgency + Must communicate clearly and effectively in both a written and verbal format + Must demonstrate a superior willingness to help external and internal customers + Working alongside teammates to best support the needs of the patient population or will transfer caller to appropriate team member (when applicable) + Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry + Must self-audit intake activities to ensure accuracy and efficiency for the program + Make outbound calls to patient and/or provider to discuss any missing information as applicable + Assess patient's financial ability to afford therapy and provide hand on guidance to appropriate financial assistance + Documentation must be clear and accurate and stored in the appropriate sections of the database + Must track any payer/plan issues and report any changes, updates, or trends to management + Handle escalations and ensure proper communication of the resolution within required timeframe agreed upon by the client + Ability to effectively mediate situations in which parties are in disagreement to facilitate a positive outcome + Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties + Support team with call overflow and intake when needed + Proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner. **_Qualifications_** + 3-6 years of experience, preferred + High School Diploma, GED or technical certification in related field or equivalent experience preferred **_What is expected of you and others at this level_** + Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments + In-depth knowledge in technical or specialty area + Applies advanced skills to resolve complex problems independently + May modify process to resolve situations + Works independently within established procedures; may receive general guidance on new assignments + May provide general guidance or technical assistance to less experienced team members **TRAINING AND WORK SCHEDULES:** Your new hire training will take place 8:00am-5:00pm CT, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CT. **REMOTE DETAILS:** You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. **Dial-up, satellite, WIFI, Cellular connections are NOT acceptable** . Download speed of 15Mbps (megabyte per second) + Upload speed of 5Mbps (megabyte per second) + Ping Rate Maximum of 30ms (milliseconds) + Hardwired to the router + Surge protector with Network Line Protection for CAH issued equipment **Anticipated hourly range:** $21.50 per hour - $30.70 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:** 2/11/2026 *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. _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 (***************************************************************************************************************************

Job Title: Work From Home-Online Hotel Coordinator-Entry Level About Destination Knot:Destination Knot is a travel planning company dedicated to creating unforgettable experiences for every type of traveler. From romantic getaways and family vacations to group trips and business stays, we provide personalized hotel and resort booking services with care and attention to detail. Position Overview: We're looking for a motivated and detail-oriented Online Hotel Coordinator to join our remote team. This is an entry-level role ideal for someone eager to begin a career in the travel industry. You'll help match clients with the perfect hotel accommodations, manage bookings, and provide outstanding customer support throughout the planning process. Key Responsibilities:Assist clients in researching and booking hotel and resort accommodations Respond to inquiries via email, phone, or chat in a timely, professional manner Review client preferences to recommend suitable lodging options based on budget, location, and travel dates Manage reservation details and updates using booking tools and systems Maintain accurate client records and documentation Support post-booking needs such as changes, special requests, or follow-up questions Stay informed on current travel trends, hotel promotions, and destination offerings Qualifications:No prior travel industry experience required-training provided Strong communication and customer service skills Organized, dependable, and detail-oriented Comfortable working remotely and managing tasks independently Tech-savvy with basic knowledge of online platforms (booking systems a plus) Must be 18 years or older with reliable internet access and a computer Passion for travel and helping others plan great experiences What We Offer:Remote, flexible work environment Entry-level onboarding and continuous training Supportive team and professional development opportunities Access to industry tools and hotel booking platforms Travel perks and performance-based incentives Work Environment: This is a remote position with flexible hours. It's perfect for individuals who are self-motivated, enthusiastic, and ready to start a fulfilling path in the travel and hospitality industry.

Are you a compassionate individual who enjoys helping others achieve their personal health and wellness goals? If so, a career as a CHOICES Care Coordinator might be perfect for you. As a Care Coordinator, you will make a lasting impact on members' lives by ensuring their safety at home or within a community setting. In this role, you'll travel to member's homes for visits, while managing various demands and requests from both internal and external stakeholders. We're seeking individuals who excel in problem-solving through critical thinking, and who are adept at time management and prioritizing daily tasks. You should be self-motivated, flexible, and thrive in a fast-paced environment. Most importantly, you should have a passion for improving the quality of life for diverse members in their communities. You will be a great match for this role if you have: • 3 years of experience in a clinical setting • Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). • Exceptional customer service skills • Must live within the following counties: Memphis/Shelby County • Available for an 8:00am - 5:00pm EST(no on call) schedule, with the option (upon management approval) to work a compressed work week after 1 year. Job Responsibilities Partnering with members and families to identify needed supports and direct services to meet personal goals for good health, employment and independent or community living. Collaborates with a team of clinical and social support colleagues to meet the physical, behavioral health and long term service needs of each member. Conduct thorough and objective face-to-face visits with and assess each members situation to determine current status and needs, including physical, behavioral, functional, psycho-social, financial, and employment and independent living expectations. Utilizing criteria for authorizing appropriate home and community based services and confirm those services are being provided and that members needs are being met. Valid Driver's License. TB Skin Test (applies to coordinators that work in the field). Position requires 24 months in role before eligible to post for other internal positions. Various immunizations and/or associated medical tests may be required for this position. Job Qualifications Experience 2 years - Clinical experience required Skills\Certifications PC Skills required (Basic Microsoft Office and E-Mail) Effective time management skills Excellent oral and written communication skills Strong interpersonal and organizational skills License Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Reimbursement Coordinator, Home Infusion Peachtree Corners, GA remote hold Experience level: Mid-senior Experience required: 2 Years Education level: High school or equivalent Job function: Finance Industry: Accounting Compensation: position: 1 Visa sponsorship eligibility: No Note: When submitting your candidates, please include their answers to the 5 prescreen questions and please ensure you are asking the pre-screening questions LIVE instead of via email. Job Description: Are you an experienced professional with a minimum of 2 years of home infusion billing and accounts receivable experience? If so, we have an exciting opportunity for you as a Home Infusion Reimbursement Coordinator. In this role, you will be a key player in ensuring accurate and timely reimbursement for home infusion services navigating the complexities of billing, claims, and compliance. Key Responsibilities: As a Home Infusion Reimbursement Coordinator, your primary focus will be on orchestrating the reimbursement process for home infusion services. This includes managing billing procedures, resolving complex claims, and staying abreast of regulatory changes to maintain compliance. Engage with internal and external stakeholders to streamline processes and optimize revenue outcomes. Your role will also involve collaborating with cross-functional teams to achieve service and sales goals. Lets talk about Qualifications and Experience Required: Minimum of 2 years of home infusion billing experience. 2 years of experience in maintaining HIPAA standards. Proficient in using computers and Microsoft products (Excel and Word). Strong motivation in billing, claims, and document management. Effective communication skills and problem-solving abilities. High school diploma required; equivalent education and experience considered. Preferred: Broad knowledge of routines and procedures. Proven track record of working towards and exceeding metrics. PMO Notes: This is a high-priority role. The team is in severe need of additional support and is looking to move quickly to fill these openings. When submitting your candidates, please include their answers to the 5 prescreen questions. Please ensure you are asking the pre-screening questions LIVE instead of via email. We want to know that the candidates are able to be successful in this position and knowing basic Home Infusion will help with the process. It is a remote position; the candidate can be located anywhere in the U.S. No timezone preference. Flexible schedule to work MondayFriday with adjustable hours. The approved compensation range is up to $25/hour. This pay rate is firm. We highly recommend posting the job under a different title. Some examples: "Billing Coordinator, Home Infusion" OR "Payor Analyst, Home Infusion" OR "Reimbursement Coordinator, Home Infusion" OR "RCM Specialist, Home Infusion" The candidate must have Home Infusion experience. We are looking for at least 2 years of experience as they have to understand the home infusion reimbursement process. At least 1 year of experience must be recent/current exp. In addition to Home Infusion experience, they should have knowledge from a Front End Billing perspective. The team clarified that the Front End Billing exp they need is not intake (qualifying patients, test claims, etc.). They need the skillset to create infusion claims (bill medical payors, not the RX payors/NCPP). In an ideal world, they also have knowledge of Collections. This is a plus, but not required. Both Home Infusion and Front End Billing experience are required. Soft Skills: The candidate should be motivated, have critical thinking skills, and be able to take ownership of their job duties. Recommended to target candidates from CVS Health/Quorum, as their home infusion departments are closing. Emphasize reaching out directly to potential candidates, especially via LinkedIn searches and personalized messages. MUST HAVE: High school diploma required; equivalent education and experience considered. 2 years of home infusion billing experience. 2 years of experience in home infusion reimbursement process. 2 years of experience in maintaining HIPAA standards. This role primarily focuses on Accounts Receivable, so candidates should have relevant experience in this area. Accounts Receivable and Collections (specifically Payor Collections, not Patient Collections). Experience in Front-End Billing. Proficient in using computers and Microsoft products (Excel and Word). Strong motivation in billing, claims, and document management.

The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our practice engagement team. Clover has built one of the most proactive, data-driven health care services platforms and is excited about how technology impacts our ability to bring transformative results to both patients and providers. As a In-Home Care Admin Coordinator, you will: Answer member calls, demonstrating our value of caring as you work to assist members and escalate appropriately based on protocols for emergent, urgent and non-urgent calls. Receive inbound warm transfers from other Clover teams. Confirm patient appointments for provider schedules. Outreach patients not recently seen to ensure continuous care. Prepare travel routes for clinicians based on daily scheduled visits. Communicate effectively with care team members via team huddles and EHR documentation. Navigate multiple computer platforms throughout the day. Ensure team escalations are addressed timely and accurately. Other administrative duties as assigned. You should get in touch if: You have high School Diploma and/or GED. You are bilingual in English/Spanish (strongly preferred). You have direct experience working in the healthcare setting, bonus points if in an ambulatory/outpatient practice. You have strong administrative and computer skills, especially Google Apps (Mail, Calendar, Sheets, etc). You have experience working with an EHR and/or Carelink. You have customer service experience answering a large volume of incoming calls. Benefits Overview: Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive hourly rate. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare. Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, company holidays, access to mental health resources, and a generous time-off policy. Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities Reimbursement for office setup expenses Monthly cell phone & internet stipend Remote-first culture, enabling collaboration with global teams Paid parental leave for all new parents And much more! #LI-Remote Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company. A reasonable estimate of the base salary range for this role is $45,000 to $55,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant's education, work experience, certifications, etc.

Become part of our passionate travel team as a Client Care Coordinator! Youll help clients create stress-free vacations while enjoying the freedom of working from home. Responsibilities: Provide high-touch client care from first inquiry to trip completion. Assist with reservations, documentation, and itinerary planning. Proactively address client needs and concerns. Build strong relationships through excellent communication. Qualifications: Exceptional customer service and communication skills. Reliable and detail-oriented. Independent worker with strong organizational skills. Enthusiastic about travel and hospitality. What We Offer: Remote flexibility and mentorship. Inclusive, team-oriented culture. Continuous learning opportunities. Travel discounts and industry incentives.

Job Description Care Coordinator - MAT Duties: In this role, you will be providing care coordination services to adult clients with substance abuse and mental health issues. Implements monitoring system, determines clients' needs and ensures delivery of needed treatment. The Organization: Since 1955, Behavioral Health Care Partners (Formally known as Moundbuilders Guidance Center) has been providing integrated mental health and addiction treatment services for youth, adults and families. In addition, we offer: Exceptional pay Great benefits including health, dental, vision, life insurance 403b retirement plan with matching funds CEUs and Licensure/Certification Reimbursements, Multiple Loan Forgiveness Programs, and employee discounts Accrued paid time off including 2 weeks' vacation, 12 sick days per year, and 10 paid holidays for fulltime staff Flexible schedule and the ability to work remotely 40 hours per week (Monday-Friday) various shifts available Sign on bonus may be available Our Location: We are located at 65 Messimer Drive in Newark, Ohio, a short 30-minute scenic commute from Columbus, Zanesville, Lancaster, and Mount Vernon. Qualifications: Candidates must possess strong written and oral communication skills and the ability to collaborate with other service providers. CMA certification is required. Associates Degree preferred. CPR/BLS required. Basic computer, phone and typing skills are necessary for all positions. To Apply: Online at *************************** BHP is an EEO and ADA compliant organization.

Benefits: 401(k) 401(k) matching Bonus based on performance Competitive salary Dental insurance Flexible schedule Health insurance Opportunity for advancement Paid time off Benefits/Perks Flexible Scheduling Competitive Compensation Careers Advancement Job SummaryWe are seeking a Spanish Speaking Care Coordinator who will be responsible for overseeing our remote patient monitoring (RPM) program. In this fully remote, flexible, role, you will work collaboratively with patients to determine their medical needs, develop the best course of action, and oversee their treatment plans, ensuring each client gets high-quality, individualized care. The ideal candidate is compassionate, patient, and knowledgeable about healthcare practices. Responsibilities Collaborate with physicians, patients, families, and healthcare staff Coordinate a variety of healthcare programs Review daily measures Oversee a monthly patient roster, ensuring comprehensive care for each individual Aiming for a patient engagement rate of 90% or higher Develop individualized care plans Educate patients on their healthcare options Create goals and monitor progress toward goals Recruit and train staff Qualifications Previous experience as a Care Coordinator or in a similar position is preferred Comprehensive knowledge of Hypertension and Diabetes Certification as a medical assistant or higher is required (licensing required in NY and NJ) Fluency in second language is a plus Strong problem-solving and organizational skills Ability to manage multiple projects or tasks and prioritize appropriately Ability to work in fast-paced situations and make sound decisions quickly Excellent interpersonal skills and high level of compassion Strong verbal and written communication skills Comfortable learning and using EHR platforms This is a remote position. Compensation: $18.00 - $23.00 per hour

Benefits: Competitive salary Flexible schedule Opportunity for advancement Training & development SEEKING CANDIDATES WITH CURRENT CASELOAD or CLIENTS (Ohio Residents Only) No Family Members Medicare and Medicaid Billing Job Description The Qualified Behavioral Health Specialist (QBHS) will report directly to the Clinical Supervisor. This role supports the delivery of behavioral health services and may be assigned to one of the following departments: Direct Service, Day Treatment, Therapeutic Behavioral Services (TBS), Substance Use Disorder (SUD) Services, or Group Therapy. Responsibilities Provide support to individuals and groups experiencing behavioral health challenges. Communicate, support and implement the clients individualized treatment plan. Collaborate with clients and other professionals to establish treatment goals, objectives, and measurable milestones. Prepare accurate and timely progress reports, correspondence, and documentation for relevant stakeholders. Educate individuals, families, and groups on behavioral health conditions, treatment options, and prevention strategies. Facilitate referrals to appropriate healthcare providers or counseling professionals when necessary. Maintain accurate, up-to-date, and Medicaid-compliant clinical documentation and client demographics. Manage and maintain a consistent caseload of a minimum of 10 clients. Perform other duties as assigned by the Clinical Supervisor. Qualifications Minimum of 12 years of experience in case management, clinical documentation, social work, or a related behavioral health field. Proficiency with Microsoft Office application Electronic Health Record (EHR) systems. Experience completing Medicaid-billable progress notes. Demonstrated skills in conflict resolution and crisis management. Compassionate, empathetic, and client-centered approach to care. Strong ability to build rapport and maintain positive relationships with clients. Excellent written and verbal communication skills. Reliable transportation, a valid drivers license with fewer than 4 points, and proof of insurance. Minimum of a high school diploma or equivalent w/ 2 + years case management experience required. Associate or bachelor's degree (preferred) in Social Sciences, Psychology, Sociology, Social Work, or a related field. Job Types: Full-time, Part-time Ohio Residents Only Flexible work from home options available.

Are you looking for a role in a company that's solving one of the greatest challenges of our lifetime? Ophelia helps people end their opioid use and restore their quality of life with respect for their time and dignity. Our mission is to make evidence-based treatments for opioid use disorder (OUD) accessible to everyone... and we're looking to bring more people onto our team to help us achieve it. Ophelia is a venture-backed, healthcare startup that helps individuals with OUD by providing FDA-approved medication and clinical care through a telehealth platform. Our approach is discreet, convenient, and affordable. We've been successfully operating in 14 states for almost four years and we're excited to continue our growth. We are a team of physicians, scientists, entrepreneurs, researchers and White House advisors, backed by leading technology and healthcare investors working to re-imagine and re-build OUD treatment in America. Important Role Note: We are looking for someone who is interested in becoming a Certified Recovery Specialist to support our patients in care coordination. We will cover your training to become certified. Please note that there are several requirements to enroll in a Certified Recovery Specialist program. They are: 1. Must either live or work in Pennsylvania. 2. A minimum of 18 months of recovery in a continuous manner of personal, lived experience. 3. Minimum high school diploma/GED. Veterans may provide discharge documentation in lieu of a high school diploma/GED. If you meet these above requirements and are interested in working on our fast-paced Care Coordination team, please read on! Care Coordination at Ophelia As one of the first members of the Ophelia team that a patient will interact with, our Care Coordinators are integral to creating a best-in-class patient experience that supports Ophelia's ability to grow and achieve our mission. Care Coordinators work directly with patients to take care of a wide variety of non-clinical needs, as well as collaborating with clinicians to ensure patients are safe and delighted with their care. In this role, you will be responsible for following defined processes and protocols that ensure our patients receive consistent, high quality care. You will engage directly with Ophelia patients providing support across a wide range of areas including successfully filling pharmacy prescriptions, obtaining prior authorizations from a patient's health insurance plan, rescheduling an upcoming visit with a member of the Ophelia clinical team, collecting required documentation to allow members of Ophelia's clinical team to coordinate care with other health care providers the patient is seeing outside of Ophelia and providing quality referrals. To be successful in this role you must become proficient in various technology platforms and channels of communication that Ophelia team members use to both provide support to our patients and to partner with cross-functional teams on improving processes and workflows. This role reports to the Lead Care Coordinator. In this role, you will: Practice active listening, empathy, and solution-focused approaches to collaboratively engage with patients seeking support on a wide range of issues Use effective written skills to complete professional documentation and to interact with patients, clinicians and external stakeholders through various communication channels Prioritize effectively across multiple channels: switching between calls, messages, meetings, texts, and Slack to deliver patient-centered care Follow care team protocols and utilize good judgment to identify barriers or disruptions to care and use appropriate strategies to overcome those barriers Interact and problem-solve with multi-disciplinary teams such as Enrollment Coordinators, Financial Counselors, Clinicians and Tech team to ensure a safe and excellent patient experience Resolve issues related to prescriptions and insurance/pharmacy authorizations Follow Ophelia's policies and maintain all confidentiality, compliance, and ethical standards Work autonomously and as part of a team within established procedures and practices Consistently practice our cultural values: champion our patients, communicate with kindness, learn and share freely, and get results We're looking for someone who has: Experience delivering outstanding patient experience or customer support, ideally at a consumer-focused healthcare company Experience de-escalating highly emotional conversations and communicating with empathy and respect to vulnerable patient populations A collaborative mindset and ability to build rapport in a remote first work environment The ability to remain calm and composed under pressure; experience in a fast-paced, frequently changing start-up environment a plus Strong organizational skills and a keen eye for detail: experience maintaining patient records and accuracy in responses High integrity, honesty, ability to build trust and maintain a strong sense of accountability A bias for action and getting things done: proactively taking on work without prompting, swiftly implement solutions, and achieving results efficiently and effectively Tech-savvy: you must be comfortable using various computer platforms and navigating new systems, and efficient in tech-related tasks Experience solving problems that do not have clear or obvious solutions Required: Meets criteria for CRS as outlined above, or has CRS certification already Our Benefits Include: Remote work anywhere in the United States Competitive medical, vision, and health insurance (many plans are fully covered for the employee!) 20 days of PTO per year 10 company holidays 401k Contribution Platform Additional benefits offered through our benefits provider such as life insurance, short and long term disability, financial wellness, virtual primary care, among others! Ophelia Compensation Overview We set compensation based on the level and skills required for the role. We value pay transparency and equity, and are committed to fair pay. In order to prevent pay disparities and reduce time spent in negotiations, we take a “first and best” offer approach: this means we're not holding any compensation back from our candidates, and you can feel confident that our pay is fair and does not vary based on the strength of someone's negotiation skills. Compensation is dynamic at Ophelia: as long as the company performs well and meets our targets, there will be opportunities for increased compensation annually. We're happy to discuss this approach and our bands if you have questions during the interview process. Compensation Range$45,000-$48,000 USD Interested in learning more about Ophelia and this role? Apply to work with us!

Exceptional benefits worth $13,000-$18,000 per year (100% paid health/dental/vision/life, up to 26 days PTO + all federal holidays, 401(k) match) Seasons Psychotherapy Associates is a growing, mission-driven mental health group practice serving clients across Florida. We are looking for a warm, organized, fully bilingual (English/Spanish) Client Care Coordinator to be the welcoming first point of contact for our clients - entirely from home. This is a full-time, 100% remote position (Monday-Friday, typical shifts 9 AM-6 PM ET). No commuting, no required office days ever. You'll spend your day: Answering phones and emails with genuine care Conducting new-client intakes and scheduling appointments Verifying insurance, explaining services, and easing anxious callers Keeping clinician calendars and EHR notes accurate Collaborating with our supportive remote team We need: Full professional fluency in English and Spanish (spoken and written) Excellent phone voice and true empathy Strong multitasking and organization skills Reliable home office with high-speed internet Ability to pass a Level 2 fingerprint background check Current Florida residency Nice to have (but not required): 1+ years in medical office, mental health, or high-volume client service Experience with EHR or scheduling systems This role is perfect for you if you value stability, outstanding benefits, work-life balance, and helping people more than the absolute highest hourly rate - especially parents, military spouses, medical assistants wanting to leave the office, or anyone who wants fully covered healthcare and generous time off. If that sounds like you, we'd love to meet you. Apply today - we review applications daily and move quickly.

The Service Agent provides excellent experience for patients and providers by fielding and responding to their requests. They help keep provider schedules full and optimized, and guide patients through the intake process. They also ensure all patients are matched appropriately to a provider, and take care of administrative tasks like faxes, emails, and authorizations. The successful candidate must be available to work one of the following shifts:· 9:30am - 6:00pm EST· 7:30am - 4:00pm EST About us:Talkiatry transforms psychiatry with accessible, human, and responsible care. We're a national mental health practice co-founded by a patient and a triple-board-certified psychiatrist to solve the problems both groups face in accessing and providing the highest quality treatment. 60% of adults in the U.S. with a diagnosable mental illness go untreated every year because care is inaccessible, while 45% of clinicians are out of network with insurers because reimbursement rates are low and paperwork is unduly burdensome. With innovative technology and a human-centered philosophy, we provide patients with the care they need-and allow psychiatrists to focus on why they got into medicine. You will: Answer incoming inquiries from patients, answer questions, and schedule appointments Make outbound phone calls to patients, pharmacies, and insurance companies Create and triage tickets in ServiceNow Ensure that providers are scheduled for best use of time Schedule appointments as needed in eClinicalWorks Support clinicians via Microsoft Teams Chat to: Schedule patient follow-up appointments Reach out to patients who are late to tele visits Send referral information to patients Send discharge letters Monitor and complete tickets in ServiceNow to: Inform patients of insurance benefits Respond to patient inquiries Add copies of insurance cards/IDs to patient documents Troubleshoot minor technological issues or escalate them to our helpdesk You have: Strong written and verbal communication skills Excellent customer service skills Ability to multitask while maintaining accuracy Enjoy working in team-based environment Must have: Experience providing phone, email and chat-based customer service Experience answering phones and multitasking in a fast-paced environment Experience scheduling appointments Medical Reception experience and experience using an Electronic Health Record (EHR) is a plus, but not required Microsoft Office (M365), plus if you have worked with Microsoft Teams Why Talkiatry: Top-notch team: we're a diverse, experienced group motivated to make a difference in mental health care Collaborative environment: be part of building something from the ground up at a fast-paced startup Excellent benefits: medical, dental, vision, effective day 1 of employment, 401K with match, generous PTO plus paid holidays, paid parental leave, and more! Grow your career with us: hone your skills and build new ones with our Learning team as Talkiatry expands It all comes back to care: we're a mental health company, and we put our team's well-being first Talkiatry participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. only after a job offer is accepted and Form I-9 is completed. For more information on E-Verify, please visit the following: EVerify Participation & IER Right to Work. At Talkiatry, we are an equal opportunity employer committed to a diverse, inclusive, and equitable workplace and candidate experience. We strive to create an environment where everyone has a sense of belonging and purpose, and where we learn from the unique experiences of those around us. We encourage all qualified candidates to apply regardless of race, color, ancestry, religion, national origin, sexual orientation, age, citizenship, marital or family status, disability, gender, gender identity or expression, pregnancy or caregiver status, veteran status, or any other legally protected status.

Description & Requirements Maximus is looking for a limited-service Bilingual Health Specialist position to fill. The Health Specialist role will support our CDC INFO program and will provide advanced and accurate clinical inquiry responses to health related, disease control and prevention issues, including questions related to bioterrorism, first responders and national emergency situations from medical and other health care professionals, educators, and government agencies. - Must hold a current, active RN license - Position is remote and temporary through August 31, 2026 - Must be available to work the occasional weekend or holiday depending on business needs - Computer equipment is not provided for this project. See below for equipment requirements - Will work an 8-hour day between Monday - Friday 8:00 AM - 8:00 PM EST - Must pass a bilingual Spanish/English assessment Essential Duties and Responsibilities: - Provides advanced clinical inquiry responses (verbal and written) to health-related inquiries from consumers, educators or medical/health professionals. - Provides medical subject matter expertise. - Performs advanced database searches. - Composes documents, reports, and correspondence. - Documents all incoming inquiries. - Participates in special projects as required. Duties and Responsibilities: - Provide subject matter expertise on CDC topics covered by CDC-INFO which includes, for example, HIV/AIDS, Immunizations, Environmental Health, NIOSH; Tuberculosis and Statistics. - Respond to inquiries resulting from current events, such as food outbreaks, natural disasters and other events. - Perform advanced database searches - Perform assigned work in accordance with quality assurance measures - Respond to medical personnel and clinicians in both verbal and written formats Education and Experience Requirements: - Bachelor's Degree in Nursing and current RN license is required. - The ability to Read, Speak and Write in both English and Spanish is required. - Experience in medical, scientific and public health discipline - Clinical knowledge of and experience in CDC related topics. - Proficient internet search skills. - Working knowledge of Microsoft Office and ability to learn and utilize software applications - Excellent listening, comprehension, communications (verbal and written), problem solving and customer service skills - Ability to work independently and communicate effectively - Must have demonstrated excellent interpersonal and leadership skills and the ability to organize simultaneous tasks Please Note: This position requires a personal computer or laptop (Chromebooks, tablets, and notebooks are not allowed) with one of the following operating systems: Windows: 10 or 11 or Mac: Big Sur (11.0.1+), Catalina (10.15), or Monterey (12.3). Home Office Requirements: - Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to ****************** - Minimum 5mpbs upload speed - Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router - Personal computer or laptop (Chromebooks, tablets, and notebooks are not allowed) with one of the following operating systems: Windows: 10 or 11 or Mac: Big Sur (11.0.1+), Catalina (10.15), or Monterey (12.3) - Private and secure work area and adequate power source - Must currently and permanently reside in the Continental US Minimum Requirements - High School diploma or equivalent with 2-4 years of experience. - May have additional training or education in area of specialization. - Must be fluent in English and specified secondary language. EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 34.85 Maximum Salary $ 68.55

LOCATION: Remote - must live in or near Franklin, Granville, or Vance County, NC. Incumbent in this role is required to reside in North Carolina or within 40 miles of the North Carolina border. This position requires travel. GENERAL STATEMENT OF JOB The 1915(i) Waiver Care Coordinator (“Care Coordinator”) is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals receive appropriate assessment and services. Care Coordinator is also responsible for providing care coordination activities and monitoring to individuals who have been deemed eligible for 1915i services by North Carolina Department of Health and Human Services (DHHS). Care Coordinator works with the member and care team to alleviate inappropriate levels of care or care gaps, coordinate multidisciplinary team care planning, linkage and/or coordination of services across the 1915i service array and other healthcare network(s) including the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs. Care Coordinator support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members' home communities. The Care Coordinator also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. As further described below, essential job functions of the Care Coordinator include, but may not be limited to: Utilization of and proficiency with Vaya's Care Management software platform/ administrative health record (“AHR”) Outreach and engagement Compliance with HIPAA requirements, including Authorization for Release of Information (“ROI”) practices Performing NC Medicaid 1915i Assessment tool to gather information on the member's relevant diagnosis, activities of daily living, instrumental activities of daily living, social and work-related needs, cognitive and behavioral needs, and services the member is interested in receiving Adherence to Medication List and Continuity of Care processes Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management Transitional Care Management Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”). ESSENTIAL JOB FUNCTIONS Assessment, Care Planning and Interdisciplinary Care Team : Ensures identification, assessment, and appropriate person-centered care planning for members. Meets with members to complete a standardized NC Medicaid 1915i Assessment Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home) Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice. Ensure the Care Plan includes specific services, including 1915(i) services to address mental health, substance use or I/DD, medical and social needs as well as personal goals Ensure the Care Plan includes all elements required by NCDHHS Use information collected in the assessment process to learn about member's needs and assist in care planning Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions Reviews clinical assessments conducted by providers and partners with licensed staff for clinical consultation as needed to ensure all areas of the member's needs are addressed. Help members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes (e.g., requirements for specific service), etc. Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process Works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed Solicits input from the care team and monitors progress Ensures that the assessment, Care Plan, and other relevant information is provided to the care team Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care/planning process Support Monitoring/Coordination, Documentation and Fiscal Accountability : Serves as a collaborative partner in identifying system barriers through work with community stakeholders. Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya's catchment. Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization. Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients' medical, behavioral health, intellectual /developmental disability, medication, and other needs. Works with 1915 (i) Care Coordination manager in participating in high-risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. Ensure that services are monitored (including direct observation of service delivery) in all settings at required frequency and for compliance with standards Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards. Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed. Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders. Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues. Supports and assists members/families on services and resources by using educational opportunities to present information. Make announced/unannounced monitoring visits, including nights/weekends as applicable. Promote satisfaction through ongoing communication and timely follow-up on any concerns/issues Monitor services to ensure that they are delivered as outlined in individualized service plan and address any deviations in service Verifies member's continuing eligibility for Medicaid, and proactively responds to a member's planned movement outside Vaya's catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service. Alerts supervisor and other appropriate Vaya staff if there is a change in member Medicaid eligibility/status. Maintain electronic health record compliance/quality according to Vaya policy Proactively monitor own documentation to ensure that issues/errors are resolved as quickly as possible Ensure accurate/timely submission of Service Authorization Requests (SARS) for all Vaya funded services/supports Proactively monitors own documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks. Works with 1915 (i) Care Coordination Manager to ensure all clinical and non-clinical documentation (e.g., goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya's contracts with NCDHHS. Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Other duties as assigned . KNOWLEDGE, SKILLS, & ABILITIES Ability to express ideas clearly/concisely and communicate in a highly effective manner Ability to drive and sit for extended periods of time (including in rural areas) Effective interpersonal skills and ability to represent Vaya in a professional manner Ability to initiate and build relationships with people in an open, friendly, and accepting manner Attention to detail and satisfactory organizational skills Ability to make prompt independent decisions based upon relevant facts. A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change Thorough knowledge of standard office practices, procedures, equipment, and techniques and intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research Understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers. Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred. Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following: BH I/DD Tailored Plan eligibility and services Whole-person health and unmet resource needs (Adverse Childhood Experiences, Trauma, cultural humility) Community integration (Independent living skills; transition and diversion, supportive housing, employment, etc) Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc) Health promotion (Common physical comorbidities, self-management, use of IT, care planning, ongoing coordination) Other care management skills (Transitional care management, motivational interviewing, Person-centered needs assessment and care planning, etc) Serving members with I/DD or TBI (Understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc) Serving children (Child and family centered teams, understanding of the “System of Care” approach) Serving pregnant and postpartum women with Substance Use Disorder (SUD) or with SUD history Serving members with LTSS needs (Coordinating with supported employment resources) Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position. EDUCATION & EXPERIENCE REQUIREMENTS Bachelor's degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area is preferred. Required years of work experience (include any required experience in a specific industry or field of study): Serving members with BH conditions: Two (2) years of experience working directly with individuals with BH conditions Serving members or recipients with an I/DD or Traumatic Brain Injury (TBI) Two (2) years of experience working directly with individuals with I/DD or TBI Serving members with LTSS needs Minimum requirements defined above Two (2) years of prior Long-tern Services and Supports and/or Home Community Based Services coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working directly with individuals with BH conditions, an I/DD, or a TBI, described above OR a combination of education and experience as follows: A graduate of a college or university with a Bachelor's degree in a human services field and two years of full-time accumulated experience with population served OR A graduate of a college or university with a Bachelor's degree is in field other than Human Services and four years of full-time accumulated experience with population served OR A graduate of a college or university with a Bachelor's Degree in Nursing and licensed as RN, and four years of full-time accumulated experience with population served. Experience can be before or after obtaining RN licensure. OR Please note, if a graduate of a college or university with a Master's level degree in Human Services, although only one year is needed to reach QP status, the incumbent must still have at least two years of experience with the population served *Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104 Licensure/Certification Required: If Bachelor's degree in nursing and RN, incumbent must be licensed to practice in the State of North Carolina by the North Carolina Board of Nursing. PHYSICAL REQUIREMENTS Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. Ability to drive and sit for extended periods of time (including in rural areas) RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit ****************************************** Vaya Health is an equal opportunity employer.

Nerve Health Protocol Review Specialist - Part-Time (Remote) Join Tribe Wellness as a Part-Time Nerve Health Protocol Review Specialist Hi, my name is Christopher Wilbourn, Founder and CEO of Tribe Wellness Sales in Austin, TX. I am seeking experienced Nerve Health and Wellness Professionals to become a Nerve Health Protocol Review Specialists for Tribe Wellness Sales on a part-time or full-time basis, working remotely from any location in the US. This role focuses on providing our nerve health product customers with a 20 minute phone call that guides them through a carefully scripted Nerve Health Protocol Review to help them achieve their health goals. If you are a professional in the sciatic nerve pain field and passionate about guiding individuals toward better health outcomes, and you want an excellent second income stream, we invite you to apply. The Challenge We Address At Tribe Wellness Sales, our mission is to empower individuals to lead healthier lives with effective wellness solutions. However, many customers encounter difficulties after purchase, such as uncertainty in product usage or how to adjust their lifestyle to see the best results. Our Nerve Health Protocol Review Specialists play a critical role in bridging this gap, ensuring customers receive the guidance needed for success, and the supplements that will help them fill the nutritional gaps. Your passion and expertise helps transform their purchases into meaningful health improvements. Your Responsibilities In this part-time or full-time position, you will handle 4 to 14 Pre-Scheduled 20-minute Nerve Health Protocol Review Appointment phone calls per day, entirely based on your availability. You will provide step-by-step guidance on personalized nerve health protocols using our products, following a structured script. Additionally, you will close sales of supplements that help customers fill nutrition gaps. Supplements such as Greens, Omegas, Collagen, and Probiotics to name a few. Here is What You Will Do Every Day: Tell us the time blocks where we should schedule 20 minute Nerve Health Protocol Review Appointments for you Follow a specific script on every appointment Closing sales of supplements that fill nutrition gaps for the customer. Participate in ongoing training to refine sales efficiency. Use our CRM and phone system for efficient remote operations. Earn a Commission on Every Appointment by Closing Sales Flexible Scheduling: Inform us of your preferred times for appointments, and we will coordinate them accordingly. No fixed schedule is required. Qualifications: We are looking for candidates who are currently working in the sciatic nerve pain field, such as chiropractors, physical therapists, or related professionals and would like to earn extra income. You should have a strong passion for wellness, excellent communication skills, and the ability to build genuine connections with customers. Sales experience is not essential, as comprehensive sales training will be provided. If you do not feel comfortable offering supplements to customers to help them fill their nutritional gaps and closing high ticket sales over $1k, this is not the role for you. The income offered is 100% commission based and we will give you every tool that you need to be successful. Requirements: Active professional experience in sciatic nerve pain management. Proficiency in English and strong interpersonal skills. Technical setup: High-speed internet (minimum 20 Mbps), reliable computer, headset, and backup power source. Must be willing to follow the Nerve Health Protocol Review Script Must be comfortable in a commission only role Why Join Us This opportunity allows you to leverage your expertise in sciatic nerve pain to make a tangible impact in the wellness industry. As a part-time role, it offers a commission on all of your sales while contributing to a growing organization dedicated to health improvement. You will be part of a supportive team with access to proven tools and resources. How to Apply If you meet the qualifications and are interested in this role, please apply via the link below. We welcome applicants with relevant experience and a commitment to ethical wellness support. Referrals are appreciated. Let's advance health together. #TribeWellness #RemoteJobs #WellnessCareers