Health Care Manager remote jobs - 553 jobs

This role works closely with Care Team Operations, Clinical Operations, Behavioral Health clinicians (LMFT/LCSW/LPCC), Community Health Workers (CHWs), Compliance, Finance (for authorizations), Care Operations Associates, and external partners including hospitals, primary care providers, behavioral health agencies, housing providers, and community-based organizations. Responsibilities Serve as the primary point of contact for assigned members with behavioral health and psychosocial complexity, building trust through consistent, trauma-informed engagement. Conduct comprehensive, holistic assessments addressing behavioral health, substance use, functional status, social determinants of health, safety risks, and care gaps. Develop, implement, and maintain person-centered care plans that integrate behavioral, medical, and social goals; update plans following transitions of care or changes in condition. Coordinate services across the continuum of care, including behavioral health providers, primary care, hospitals, housing supports, transportation, social services, and community-based organizations. Conduct required in-person home or community visits based on acuity, risk stratification, and payer requirements. Support Transitions of Care (TOCs) by completing timely follow-up, coordinating post-discharge services, and reinforcing discharge instructions and medication understanding. Utilize motivational interviewing, behavioral coaching, and health education to promote engagement, adherence, self-management, and long-term member stability. Identify, escalate, and address behavioral health risks, safety concerns, service delays, benefit lapses, and environmental barriers using HHN escalation protocols. Coordinate and track referrals, appointments, transportation, and follow-ups to ensure continuity and timeliness of care. Maintain accurate, timely, and audit-ready documentation of all assessments, encounters, and interventions in eClinicalWorks (ECW) and other HHN systems. Meet or exceed HHN and health plan productivity standards, including outreach cadence, encounter requirements, documentation timeliness, TOC completion, and quality measures. Actively participate in multidisciplinary case reviews, care conferences, team huddles, and escalations with nurses, behavioral health clinicians, CHWs, care operations, and compliance. Assist members with plan navigation, eligibility redeterminations, social service applications, housing resources, and crisis intervention support. Communicate professionally with members and care partners using HHN-approved channels, including phone, RingCentral, secure messaging, and SMS workflows. Contribute to continuous quality improvement efforts by identifying workflow gaps, documenting barriers, and sharing insights to improve care delivery. Uphold confidentiality and comply with all HIPAA, Medi-Cal, ECM, and payer regulatory requirements. Remain flexible and responsive to member needs, including field-based work and engagement in community settings. Skills Required Bilingual (English/Spanish) proficiency required to support member engagement and care coordination. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field. Licensure: Licensed LMFT, LCSW, LPCC.; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

A strategic marketing agency based in Brooklyn is searching for a Strategy Director who excels in crafting brand narratives and shaping impactful strategies for healthcare clients. This role requires over 10 years of experience in the field, strong storytelling skills, and the ability to lead collaborative workshops. The agency offers a flexible hybrid work schedule, excellent benefits, and values a culture that promotes diversity and innovation. Join a dynamic team dedicated to driving positive change in its industry. #J-18808-Ljbffr

The Telephonic Case Manager RN in Medical Oncology provides remote nursing support by coordinating patient care, educating members, and ensuring adherence to treatment plans. This role involves assessing patient health, identifying barriers, and connecting patients with necessary resources to improve health outcomes. Working primarily via telephone, the position requires strong clinical expertise, communication skills, and proficiency in healthcare technology systems. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The Telephonic Case Manager RN Medical/Oncology will identify, coordinate, and provide appropriate levels of care. The Telephonic Case Manager RN Medical/Oncology is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This is a full-time, Monday - Friday, 8am-5pm position in your time zone. You'll enjoy the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in state of residence Active Compact RN License or ability to obtain upon hire 3+ years of experience in a hospital, acute care or direct care setting Proven ability to type and have the ability to navigate a Windows based environment Have access to high-speed internet (DSL or Cable) Dedicated work area established that is separated from other living areas and provides information privacy Preferred Qualifications BSN Certified Case Manager (CCM) 1+ years of experience within Medical/Oncology Case management experience Experience or exposure to discharge planning Experience in a telephonic role Background in managed care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: telephonic case management, oncology nurse, patient education, care coordination, medical management, healthcare advocacy, remote nursing, chronic disease management, UnitedHealth Group, RN license

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

Contract Duration: 03 Months Location: Miami-Dade County (Hialeah: 33010, 33012, 33013, 33014, 33015, 33016, 33018, 33142, 33147). We are seeking a Bilingual Case Management Coordinator (Spanish/English) to support Medicaid Long Term Care/Comprehensive Program members in Miami-Dade County, FL. This is a work-from-home position that requires significant field travel (50-75%) for face-to-face member visits in homes, Assisted Living Facilities, and Skilled Nursing Facilities. The Case Management Coordinator is responsible for assessing, planning, implementing, and coordinating care management activities for members with supportive and medically complex needs. The role focuses on improving short- and long-term health outcomes through care coordination, education, and integration of community resources. Key Job Duties Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program members Conduct telephonic and face-to-face comprehensive member assessments Develop, implement, and monitor individualized care plans Coordinate care with Primary Care Providers, skilled providers, and interdisciplinary teams Facilitate services including prior authorizations, condition management support, medication reviews, and community resources Conduct multidisciplinary reviews to achieve optimal healthcare outcomes Utilize motivational interviewing and influencing skills to promote member engagement and behavior change Educate and empower members to make informed healthcare and lifestyle decisions Experience & Qualifications Required Qualifications Bilingual (Spanish/English) - fluent in speaking, reading, and writing 1+ year of experience in behavioral health, long-term care, or case management Preferred Qualifications Managed care experience Case management and discharge planning experience Long-term care experience Education Bachelor's degree required, preferably in Social Work or a related field About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ************************ US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Recruter Details: Name: Umar Farooq Email: ********************************** Internal Id #26-00632

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

This position is a temporary role facilitated through one of our contracted agencies and is not a direct employment opportunity with IEHP. The contracted agency offers an assignment length of up to six months, during which the candidate will provide support for IEHP. What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of department leadership, this position focuses on a person-centered model of care which takes in to account the Member's medical, behavioral, and social needs. This position provides high quality, effective care management to IEHP members ensuring coordinated continuous care. Care Management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. As a licensed clinician, this position provides clinical expertise, clinical leadership, and clinical oversight in a variety of ways within the department. The individual in this position is to utilize their clinical expertise to support and engage Members to promote positive health behaviors, assist with coordination of care, provided resource linkages, and collaborate with other Team Members within their care team, as well as external partners, to ensure a seamless transitions of care experience. This position is expected to model behavioral health principles of relationship-based care, as well engage in promoting education and understanding of Behavioral health and its importance in whole health, to those within IEHP and in the community. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Key Responsibilities Establish and continuously model supportive and collaborative relationships with members, colleagues, and external partners. Model the highest ethical behavior in care for Members, as well as in relationships with co-workers, Leaders, internal, and external partners. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving the outcomes of the Enhanced Care Management team. Participates in Health Plan staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Team Members. Working in a lead training capacity by providing formal and informal clinical training and other learning and development activities to support department Team Members on behavioral health conditions, including treatments and evidence-base for treatment (within areas of expertise/scope) as well as provide onboarding and ongoing training to department Team Members. Promote a collaborative and effective working environment within the department or those outside BH discipline by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions to provide integrated care to IEHP members. Participate in committees, conferences, and any other meetings as required or directed by department managers or directors. Responsible for primarily working with a caseload of Members with behavioral health needs. Advocate for Members to receive the highest quality care, in a timely manner, within IEHP's network by referring to appropriate internal partners such as behavioral health, Enhanced Care Management, and complex care management. In conjunction with department leadership, the Licensed Behavioral Health Care Manager is responsible for providing consultation for the non-licensed Members of the team when discussing tasks of a clinical nature. Responsible for engaging with Members to provide effective care management, both in-person and on the phone, including linkage to resources and support in transitions of care, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, facilitating member self-efficacy and self-management to improve the Member's ability to manage their own health, and all other activities associated with high quality, evidenced-based care management. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards. Assist Members with care coordination needs, including, but not limited to the following: Conduct comprehensive, holistic assessment both telephonically as well as in person (facility or home visits). Assimilate assessment information to assist, in collaboration with the ITC Team and the facility, in developing a discharge plan or an individualized care plan (ICP). Communicate ICP or discharge plan with Member, approved family or caregiver and other Members of the care team. Coordinate with internal and external health partners to support Members' comprehensive care needs. Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services. Participate in inter/transdisciplinary care team meetings to share information, update and inform care plan. Participate and lead (as necessary) care transition plan responsibilities. Engage in proactive, member-centered utilization and quality review of Behavioral Health services by members. Provide crisis intervention to individuals, as well as providing support and clinical guidance to others who engage in this work. Responsible for any other duties as required to ensure successful care management processes and Member outcomes. Provide transitional care services to Members transitioning from one care setting to the next such as assisting the Member with PCP appointments, transportations, and coordination of DME and home health. Support Member through all care transitions by making outreach to ensure all care needs are met before closing the Member out to transitions of care. providing care coordination, linkage to resources, and facilitating Member self-efficacy and self-management. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements Minimum of three (3) years of experience performing or facilitating Behavioral Health/Medical Social Work services Experience in motivational interviewing and/or other evidenced-based communication strategies Experience working successfully within a team, and experience in developing and maintaining effective relationships with both clients and coworkers is mandatory Master's degree in Social Work or related field from an accredited institution required Possession of an active, unrestricted, and unencumbered license in a Social Services related field issued by the California Board of Behavioral Sciences required (LCSW or LMFT preferred) Key Qualifications Must have a valid California Driver's License Behavioral Health/Medical Social Work services experience in a health clinic psychiatric hospital, medical facility, or health care clinic strongly preferred Experience in clinical services, both mental health and substance use preferred Familiarity with providing Behavioral Health Care and discharge planning is required Knowledgeable and skilled in evidenced-based communication such as Motivational Interviewing, or similar empathy-based communication strategies Understanding of and sensitivity to multi-cultural communities Deep understanding and knowledge of mental health and substance use conditions, including both acute and chronic management Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both Must have knowledge of whole health and integrated principles and practices Bilingual (English/IEHP Threshold Language) - written and verbal is highly preferred Highly skilled in interpersonal communication, including conflict resolution Effective written and oral communication skills, as well as reasoning and problem-solving skills Skillful in informally and formally sharing expertise. Must have the resiliency to tolerate and adapt to a moderate level of change and development around new models of care and care management practices Proficient in the use of computer software including, but not limited to, Microsoft Word, Excel, PowerPoint Demonstrated proficiency with all electronic medical management systems (e.g., Cisco, MHK/Care Prominence, MediTrac, SuperSearch and Web Portal) is preferred Proven ability to: Sufficiently engage Members and providers on the phone as well as in person Work as a member of a team, executing job duties and making skillful decisions within one's scope Establish and maintain a constructive relationship with diverse Members, Leadership, Team Members, external partners, and vendors Prioritize multiple tasks as well as identify and resolve problems Have effective time management and the ability to work in a fast-paced environment Be extremely organized with attention to detail and accuracy of work product Have timely turnaround of assignments expected To form cross-functional and interdepartmental relationships Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute Pay Range USD $43.87 - USD $58.13 /Hr.

The Care Manager II services youth and adults in their community setting with the goal of reducing and preventing emergency room visits, hospitalizations, and decreasing overall Medicaid costs as a lead member of the team responsible for the client. This role utilizes assessments, care planning, linkage to services and community resources, advocacy, and support to coordinate services for adults, youth, and families using person centered and family driven care strategies. This is a Monday-Friday, full-time (40 hours) position with a flexible schedule based on client/staff needs. After an initial training period, this role can be a hybrid mobile/on the road & remote/work from home blend. The area of coverage is Livingston, Genesee, and Orleans counties. Essential Job functions Responsible for, but not limited to comprehensive assessments, outreach and engagement, service and treatment linkage and coordination for assigned youth, adults and families. Partner with referral sources to engage youth, adults and families and build an interdisciplinary care team to support the member in meeting their needs. Facilitate monthly face-to-face visits with adults, youth, family, and their interdisciplinary care team, for assigned caseload. Conduct initial and ongoing assessments to assist with accomplishing member's goals and needs within program requirements. Create, implement, evaluate, and modify, as required and needed, individual service plans to meet assessed client's unique needs as a member of a multi-disciplinary team. Refer members to applicable agency services and community programs, such as outpatient counseling, dental provider, and primary care providers. Support members who transition between systems and services (i.e. hospitalizations, inpatient stays, residential settings, housing needs, etc.). Establish and maintain productive working relationships with community service providers to facilitate referrals and service evaluations. Maintain required contact with members, families, and the interdisciplinary team and facilitate team meetings. Serve as a liaison between the program and other internal and external resources, ensuring information is shared with the Care Team. Maintain and update all necessary records, forms, reports, and summaries in member files according to agency and funders standards. Travel across different counties within respective region to serve members, as required. While this job description covers many aspects of the role, employees may be required to perform other duties as assigned. Education & Experience Bachelor's degrees required. Minimum 2 years of experience working in a human services or related position supporting youth, adults and families required. SPECIAL REQUIREMENTS Unrestricted, valid NYS driver's license for minimum of 1 year with a clean driving record and minimum insurance coverage that meets agency standards. Children's Health Home only : Must receive CANS (Child and Adolescent Needs and Strengths Assessment) certification score of 70 within 3 months of hire and annually thereafter. Knowledge, Skills & Abilities In addition to demonstrating the Hillside Professional Competencies of Communicates Effectively, Personal Excellence, Cultural Competence, Builds and Leverages Relationships, and Optimizes Decision Making, the following occupational competencies must be demonstrated: Demonstrate the highest standards for ethical and professional conduct at all times Knowledge of all federal, state, and local statutes, regulatory agency standards and Hillside policies. Ability to manage multiple tasks and large caseloads simultaneously. Ability to manage scheduling visits with high volume caseload and complete tasks by funder deadlines. Ability to de-escalate and manage crisis situations both in-person and by phone. Physical Demands & Work Environment 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. Must be able to work a variable scheduling including evenings and weekends The following daily physical demands are required: Sitting (up to 6 hours) Occasional standing (up to 2 hour) Occasional walking (up to 2.5 hours) Driving (several times a week up to 6 hours) Continuous balancing (up to 8 hours) Occasional balancing, bending, stooping, climbing, kneeling, pushing, pulling, reaching forward or down, reaching overhead, running, and twisting (up to 2.5 hours) Weekly lifting up to 10-15 lbs. on a daily basis Manual dexterity is required, including the frequent ability to grasp in both hands and continuous use of fine manipulation skills in both hands (approximately 1-2.5 hrs.) Occasional exposure to dust, fumes, gases, chemicals, or smoke is apparent Ability to change positions as needed SPECIAL CONSIDERATIONS While Hillside is a restraint free environment, there may be times in a “life or limb” situation, that staff may be required to physically restrain clients weighing between 50 lbs. and 300 lbs. and guide them safely to the floor. In some circumstances, restraints can last up to 15 minutes and may require repetition as necessary. $21.40 Minimum pay rate, $31.00 Maximum pay rate, based on experience.

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.

Join our mission to provide governments with exceptional experiences so they can do the same for their communities! What do we do?💥 We empower governments to deliver exceptional citizen experiences. Check out our ‘About Us' page for a deep dive into our product and what makes us exceptional. How will you help us make an impact? 👩 💻👨 💻 Reporting to the Director of Professional Services, the Delivery Practice Manager, Professional Services will lead the strategic and operational delivery of customer projects within the Professional Services organization. You'll be responsible for building and scaling delivery excellence, ensuring that every engagement drives measurable value for customers and aligns with Clariti's business objectives.This role combines delivery leadership, practice development, and customer and partner relationship management. You'll guide a team of consultants and/or engagement managers to deliver successful implementations while shaping methodologies, tools, and processes that enhance efficiency, quality, and customer satisfaction.You are a people-first leader with strong customer-facing acumen, operational rigor, and a track record of transforming Professional Services into a trusted partner function that accelerates customer outcomes and organizational growth. As a Delivery Practice Manager at Clariti, you'll get to : Delivery Leadership Lead the successful delivery of all customer implementation and service engagements for Tier 1 and Tier 2 customers, ensuring outcomes exceed expectations in quality, timeliness, and value realization. Oversee and guide partner-led and joint delivery efforts, ensuring seamless collaboration between Clariti and its delivery ecosystem. Establish and maintain delivery methodologies, governance frameworks, and best practices that ensure scalability, predictability, and repeatable success across all projects. Collaborate with Sales, Solution Engineering, and partners during pre-sales to assist in defining project scope, delivery models, and implementation strategies that align with customer objectives. Contribute to RFP responses and scoping efforts by providing delivery perspective, resource planning input, and realistic timelines to set achievable customer expectations. Manage key customer escalations and coordinate with internal and partner stakeholders to ensure timely, empathetic resolution and sustained customer confidence. Analyze and execute on strategic delivery initiatives, ensuring alignment with corporate goals and consistent communication of project priorities, value, and success metrics. Practice Development Build and continuously refine Clariti's delivery framework, including playbooks, tools, and templates, to enable repeatable, high-quality engagements. Develop scalable delivery models that integrate partner capabilities and accelerate time-to-value for customers. Partner with cross-functional leaders to align delivery strategy with Clariti's product roadmap, customer success goals, and business growth initiatives. Identify and implement process improvements that increase efficiency, profitability, and customer satisfaction. Establish measurable success metrics (e.g., utilization, margin, NPS, on-time delivery) and track team and partner performance against goals. Capture and document lessons learned from customer projects to strengthen delivery methodology and partner enablement. Partner Management Own and nurture relationships within Clariti's partner ecosystem, including delivery, integration, and system implementation partners, to ensure alignment with delivery standards and customer experience objectives. Engage partners early in the sales and solutioning process to support scoping, RFP responses, and proposal development. Oversee partner delivery performance, resource capacity, and quality assurance to maintain consistent, high-value outcomes. Collaborate with partner organizations on enablement, training, and certification to expand Clariti's delivery reach and maintain alignment with evolving methodologies. Serve as the primary point of contact for partner engagement, ensuring open communication, mutual accountability, and continuous improvement across all delivery collaborations. Customer Engagement Act as a strategic advisor to customers, fostering trusted, long-term partnerships that drive adoption, expansion, and advocacy. Manage the overall services relationship among strategic customers, partners, and Clariti throughout transformations, from pre-sales through post-go-live. Represent Clariti in executive engagements to communicate value realization, delivery performance, and roadmap alignment. Ensure a consistent and transparent customer experience across all engagements, whether delivered directly or through partners. People Leadership Attract, onboard, and develop top talent across Clariti's Professional Services organization. Provide ongoing coaching and mentorship to build delivery excellence and partner collaboration skills within the team. Foster a culture of accountability, innovation, and continuous learning across both internal and partner delivery teams. Champion inclusive leadership and diversity of thought in all aspects of people development and practice growth. What do you bring to the team? 🧠 5+ years in Professional Services delivery, consulting, or implementation management within a SaaS, cloud, or enterprise software environment. 3+ years leading high-performing teams, scaling a practice & functional ownership, and managing customer-facing delivery operations Demonstrated financial acumen and a track-record with managing and leading P&L with accountability for revenue, cost control, forecasting, and overall financial performance. Experience developing and managing relationships with third-party or channel partners to enhance delivery capacity and capability. Proven ability to build trusted relationships with executive-level clients and drive customer success outcomes. Deep understanding of project management methodologies (Agile, Waterfall, Hybrid) and enterprise solution delivery. Ability to translate business goals into actionable delivery plans and scalable operational processes. Exceptional executive-level communication, negotiation, and conflict resolution skills; thrives in dynamic, customer-centric environments. Familiarity with system integrations, data migrations, and enterprise SaaS architectures. What's in it for you?🫵 We invest in and empower our team members with competitive compensation packages, well deserved time off and benefits to keep you and your family healthy! * 💰 The base salary range for this role is expected to be between $124,000-$175,000 CAD based on the candidate's skills, experience, and qualifications while considering internal pay equity and our broader pay philosophy. 💰 Our compensation bands are based on various factors, including the labour market (as informed by our business stage and industry), job type and job level. Exact salary offers will be determined by factors such as the candidate's qualifications, experience, knowledge and skills. If you have questions about compensation as we move through the process, we're happy to discuss further. Things to Note 📝 Background checks - Because our customers trust us with sensitive information, we require all successful candidates to undergo comprehensive background checks before joining our team. We focus strictly on global sanctions and criminal offences that are directly relevant to employment at Clariti, and follow all applicable privacy and human rights legislation. Travel- Although we operate as a remote company, all roles are expected to participate in occasional travel for in-person company-wide or departmental meetings, typically 1-2 times per year. Additional travel requirements specific to the role, if any, will be outlined in the job description. We're committed to building an inclusive culture where our team members take ownership over projects, tasks, and outcomes; bring a growth mindset to drive continuous learning and self-development; have the ability to communicate courageously in a direct but respectful way; and are customer-focused by keeping the customer at the heart of decision-making. It's the diversity of our team that helps us make better decisions, by leveraging the diversity in thought & experience across to create impactful solutions as we explore new paths & challenges as we grow. We're working to create a workplace and team that is as diverse as the communities we serve. We welcome and encourage candidates of all backgrounds to apply. Questions? We are here to help If you require accommodations in completing an application, interviewing, completing any pre-employment testing, or otherwise participating in our hiring process for any reason, please direct your questions to ********************** and we'll be happy to support you.

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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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 and 10:30-7:00pm 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.

Unless otherwise noted, all positions are fully remote with work permitted from the following states: CA, CO, HI, IL, MA, MD, NJ, NM, NY, OR, and WA. We are living through a pivotal moment for reproductive and sexual health-and Hey Jane is uniquely positioned to help. From day one, we've been committed to providing safe, discreet medication abortion treatment-and have helped more than 100,000 people get the care they need. Today, we offer a range of reproductive and sexual health care services from the comfort and convenience of your phone. Our in-house clinical care team, composed of board certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away. We're committed to helping our patients get safe, discreet, judgment-free virtual health care, from a team that truly cares. Role Overview We are seeking a compassionate, detail-oriented, and experienced APC Manager who thrives in a fast-paced clinical environment and is motivated by the opportunity to expand access to high-quality, patient-centered care. In this role, you will lead and manage a team of nurse practitioners and certified midwives, ensuring the delivery of safe, compliant, and compassionate care across all aspects of our services. You will oversee day-to-day clinical operations, drive performance management for your team, and serve as a critical bridge between the clinical team and organizational leadership-translating strategy into action through strong communication, sound judgment, and operational excellence. Working in a startup telehealth environment requires flexibility and adaptability, while offering the unique opportunity to shape and refine clinical workflows. The ideal candidate is both a skilled Nurse Practitioner and an empathetic leader-comfortable mentoring others, managing tough conversations, and steering the team through change with grace and accountability. You'll excel at building trust within your remote team, fostering a culture of continuous improvement, and ensuring that every patient receives timely, evidence-based care delivered with empathy and respect.Qualifications 5+ years of clinical experience as a NP or CNM with 1+ years in reproductive or sexual health 2+ years of experience managing clinical teams, preferably in telehealth, reproductive healthcare, or a startup environment Proven ability to motivate, mentor, and support clinical staff with a focus on team morale, development, and accountability Proven ability to foster collaboration, trust, and a supportive team culture Experience documenting protocols, implementing process updates, and training teams through changes in clinical or operational systems Strong interpersonal and communication skills, with the ability to collaborate effectively across clinical, operational, and leadership teams Knowledge of healthcare compliance, regulatory requirements, and quality assurance frameworks Ability to analyze clinical and performance data and translate insights into actionable improvements Deep understanding of trauma-informed care principles Comfortable working in a fast-paced, mission-driven startup environment Able to travel to on-site location at least once a quarter At Hey Jane, we work towards the vision of having equitable healthcare, changing the status quo, and rebuilding the way people experience healthcare-and bring that same vision to our workplace. We're an equal opportunity employer committed to building an inclusive environment, and encourage all applicants from every background and life experience.

inst ED provides patient-centered, high-quality acute care in place to adults with complex medical needs. Reporting to the Manager, Network Delivery, the inst ED Mobile Health Coordinator (MHC) is the first point of contact for patients who are seeking an inst ED visit. The Mobile Health Coordinator warmly greets all callers and completes a thorough and accurate intake for callers requesting a referral for an inst ED visit. The MHC assigns the visit to one of inst ED's paramedic partners based on geography and availability and monitors the physician assignment algorithm. In addition, the MHC monitors visit progression to ensure timely service delivery. Finally, the MHC assists the nursing team with non-clinical administrative support and serves as the main point of contact for paramedic partner dispatchers, paramedics, and the inst ED Virtual Medical Control (VMC) team for all non-clinical issues. Essential Functions: Answer incoming phone calls in a timely manner using a cloud-based platform. Collect accurate patient information and document in the inst ED NOW platform and Athena medical record to process an inst ED referral. Collect, review, and accept written consent from patients, upload consents from paramedics. Verify patient eligibility using inst ED NOW, Athena, or external payor portals. Collect payment(s) from patients (e.g., copay, co-insurance). Assign visits to one of inst ED's ambulance partners based on geography and availability; collaborate with nursing staff to prioritize high acuity patients. Communicate with the dispatchers from the ambulance partners to facilitate throughput of inst ED visits; convey clinical concerns/questions to the nursing team. Maintain awareness of all ambulance partner vehicle's status and location. Call patients if mobile health providers are unable to reach patients with an updated ETA; escalate to the nursing team when patients cannot be reached via phone. Make recommendations to improve the inst ED NOW platform. Monitor that VMC providers are checked in and out of inst ED NOW in a timely manner and outreach to them if this does not occur. Monitor VMC auto-assignments and manually re-assign if needed when a VMC provider is nearing the end of shift and cannot complete a visit. Complete an end of shift report before logging off at the end of a shift. Ensure that mobile health providers have completed all documentation by the end of their shift and outreach to the paramedic partner when there is outstanding documentation. Perform any other job related duties as requested. Education and Experience: High School or GED required Associates degree preferred Five (5) years professional work experience in a healthcare setting with at least one (1) year of remote work experience required Customer service experience via phone communications, preferably in a health care call center setting interacting with patients required Process improvement experience required Experience working closely with colleagues at all levels of a company including front-line staff to senior leaders required Medical assistant, or other related experience in an urgent care, emergency or home care setting preferred Administrative support to clinicians in healthcare setting preferred 911 Telecommunicator or Emergency Medical Dispatcher Certification preferred Mobile integrated health experience preferred Competencies, Knowledge and Skills: Ability to communicate effectively without judgment to a diverse patient population while demonstrating empathy Highly adaptable to frequent workflow changes in a fast-paced environment Willing to learn and utilize several different software applications (e.g., proprietary inst ED NOW platform, Teams, etc.) Proficient with Microsoft Outlook Superb verbal communication skills and strong written communication skills Computer and phone system proficiency (e.g., Ring Central or other cloud communications platform) Power BI or other business intelligence software knowledge preferred Proficient in Excel preferred Process improvement training (e.g., lean, six sigma, etc.) preferred Medical terminology preferred Athena (electronic medical record) knowledge preferred Bilingual (Spanish), bicultural preferred Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Must be willing to work weekends, evenings, and holidays Travel is not typically required Compensation Range: $41,200.00 - $66,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Are you passionate about helping people navigate their healthcare journey? Do you thrive in a dynamic environment where you can make a real difference? We are seeking a bilingual Care Coordinator who is fluent in both Spanish and English to join our team. Be part of a mission-driven organization dedicated to improving patient outcomes and providing exceptional care. About Us: Honeydew is transforming skincare by making it accessible and affordable for everyone. Our team is dedicated to providing compassionate, personalized care to help patients achieve their skin health goals. We're seeking a highly organized and empathetic Care Coordinator to join our team and be a vital part of our mission. Job Description: As a Care Coordinator, you'll play a critical role in ensuring our patients receive the support and guidance they need throughout their skincare journey. This full-time, fully remote role focuses on patient communication, coordinating care, and managing essential administrative tasks to provide a seamless experience. Responsibilities: Serve as the primary point of contact for patients, providing guidance, support, and information about their care plans - in both English and Spanish. Answer patient inquiries related to appointments, medical services, and treatment options with empathy and professionalism. Ensure that all patient information and communications are accurately documented in our healthcare system. Act as a liaison between patients, insurance providers, and medical teams to facilitate seamless care delivery. Collaborate with healthcare professionals to develop personalized care plans for patients. Continuously monitor patient progress and provide ongoing support, addressing any concerns or obstacles that arise. Provide translating services between the patient and provider during initial consultations as needed. Qualifications: Previous experience in a healthcare setting, preferably in a care coordination, patient support, or administrative role. Fluency in both Spanish and English is required. Exceptional communication skills, both verbal and written, with the ability to convey complex information clearly. Strong organizational skills and attention to detail to manage multiple tasks and priorities. Proficiency in using healthcare management software or similar systems. Ability to work independently and as part of a multidisciplinary team. A positive attitude, empathy, and a genuine passion for helping others. Benefits: • Flexible remote schedule. • Opportunity to make a meaningful impact on patients' lives. • Join a mission-driven, innovative team dedicated to revolutionizing skincare. Pay: $16.00 per hour

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

Job Description Our Office, NRV Oral & Maxillofacial Surgery LTD - Blacksburg, a busy specialty practice in Blacksburg, VA, is looking for a talented and skilled Practice Manager to help us fulfill our mission of improving the lives of our patients by providing a world-class specialty experience at the Blacksburg and Radford locations. If you're passionate about delivering exceptional patient care and leading a dynamic team, we'd love to connect with you! At NRV Oral & Maxillofacial Surgery LTD - Blacksburg & Radford, we believe in the power of collaboration and continuous learning. Our diverse team includes Dental Assistants, Sterilization Technicians, Specialists, Office Managers, and Patient Care Coordinators who work together to ensure exceptional patient experience and outstanding clinical results. We're committed to fostering an environment where all employees are valued, respected, and given the opportunity to thrive-at work, at home, and everywhere in between. Your Role: Practice Manager As our Practice Manager, you will play a crucial role in ensuring our operations run smoothly, efficiently, and in compliance with all regulations. You'll be responsible for mentoring team members, enhancing patient experiences, and implementing best practices across all levels of our organization. Here's what you can expect in this role: Travel to the Radford location Overseeing daily operations to ensure they are carried out in a cost-effective manner. Managing budgets, financial data, and forecasts to improve profitability. Purchasing materials, planning inventory, and optimizing warehouse efficiency. Ensuring the practice remains compliant with all legal and healthcare regulations. Implementing quality controls and monitoring key performance indicators (KPIs). Training and supervising staff, while fostering a culture of continuous improvement. Enhancing the quality of patient care through innovative and compassionate leadership. Coordinating and facilitating additional office responsibilities as needed. Your Background: We're looking for a resourceful and compassionate Practice Manager who excels at leading teams and achieving financial goals. You thrive on seeing patients leave our office healthier and happier, and you're a problem-solver who can adapt to changing priorities. Here's what we're looking for: 3-5 years of experience managing a dental or OS practice. WinOMS experience a plus Expertise in insurance verification, claims, and resolution processes. Strong understanding of patient and insurance accounts receivable (AR) management. Proven ability to maintain positive employee relations and oversee payroll. Solid knowledge of profit and loss (P&L) management, with a focus on controlling expenses. Familiarity with standard OSHA and HIPAA practices and policies. If this describes you, you'll fit right in with our team! Your Benefits & Perks: We offer a comprehensive benefits package designed to support you in all aspects of your life, including: Sign on bonus offered! BCBS High Deductible & PPO Medical insurance Options VSP Vision Coverage Principal PPO Dental Insurance Complimentary Life Insurance Policy Short-term & Long-Term Disability Pet Insurance Coverage 401(k) HSA / FSA Account Access Identity Theft Protection Legal Services Package Hospital/Accident/Critical Care Coverage Paid Time Off Diverse and Inclusive Work Environment Strong culture of honesty and teamwork #priority We believe in transparency through the talent acquisition process; we support our team members, past, future, and present, to make the best decision for themselves and their families. Starting off on the right foot with pay transparency is just one way that we are supporting this mission. Position Base Pay Range$45,000-$55,000 USDSpecialty1 Partners is the direct employer of non-clinical employees only. For clinical employees, the applicable practice entity listed above in the job posting is the employer. Specialty1 Partners generates job postings and offer letters to assist with human resources and payroll support provided to the applicable practice. Clinical employees include dental assistants and staff assisting with actual direct treatment of patients. Non-clinical employees include the office manager, front desk staff, marketing staff, and any other staff providing administrative duties. Specialty1 Partners and its affiliates are equal-opportunity employers who recognize the value of a diverse workforce. All suitably qualified applicants will receive consideration for employment based on objective criteria and without regard to the following (which is a non-exhaustive list): race, color, age, religion, gender, national origin, disability, sexual orientation, gender identity, protected veteran status, or other characteristics in accordance with the relevant governing laws. Specialty1 Partners' Privacy Policy and CCPA statement are available for view and download at ************************************************** Specialty1 Partners and all its affiliates participate in the federal government's E-Verify program. Specialty1 further participates in the E-Verify Program on behalf of the clinical practice entities which are supported by Specialty1. E-Verify is used to confirm the employment authorization of all newly hired employees through an electronic database maintained by the Social Security Administration and Department of Homeland Security. The E-Verify process is completed in conjunction with a new hire's completion of Form I-9, Employment Eligibility Verification upon commencement of employment. E-Verify is not used as a tool to pre-screen candidates. For up-to-date information on E-Verify, go to **************** and click on the Employees Link to learn more. 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Advance public health impact with data, strategy and execution. Premier's Community Health Advisory Team helps state agencies and health leaders modernize systems, strengthen equity and turn policy into measurable performance through analytics, collaboration and hands-on expertise. What will you be doing: The Manager works collaboratively within a team of highly qualified Advisory consultants to deliver performance improvement to healthcare systems. This position will be primarily responsible for performing billable work for clients. The role of the Manager is to actively lead and manage a significant workstream or project. Responsibilities include determining client needs in terms of the engagement statement of work; lead, guide, complete and provide quality assurance over data analyses; interpret data analyses and form initial recommendations; develop final recommendations and solutions for client consideration; develop deliverables and presentations materials for various audiences; assist in the implementation of recommended improvements; assist and manage risk and issues with project leadership; manage project or workstream economics and project administrative activities and logistics. The Manager participates and oversees all aspects of the workstream, or project assigned. They are responsible for the day-to-day management of all activities and staff assigned to their workstream or project. The Manager works in a team environment to provide input, guidance, and quality assurance to team deliverables and presentations during each phase of a project. The Manager will provide mentorship and guidance to all staff working with them on projects. The Manager is responsible for building strong, referenceable client relationships. The Manager is required to also participate in Premier internal activities including practice development, required, and approved educational opportunities throughout the year and learning the various technologies Premier offers to its clients. Additionally, the Manager should: • Maintain utilization targets for client billable projects • Create value through meaningful client relationship management, solution development and implementation delivery • Create a positive team environment by enriching staff skills and knowledge and creating a productive and collaborative environment • Create value for the Advisory practice through meaningful participation in practice related activities aimed at growing and enriching the Practice as a whole or individual Service Lines within the Practice Key Responsibilities Responsibility #1- 60% • Execute/direct/oversee data analyses, initiate interpretations, and conclusions, and prepare verbal and graphic presentations, using methods that are professionally sound and efficient relative to project objectives and conform to standards. Perform quality assurance on project deliverables. • Assist in determining client needs by effectively leading client interviews and utilizing various tools and analytical methods. Summarize analytical findings in a coherent manner and draws insight from observations, interviews, and data analyses. Develops accurate conclusions from findings. Draft's recommendations and potential solutions for team leadership review. Develops final recommendations and solutions for client review. • Effectively execute on project plans in accordance with engagement statements of work and to client satisfaction. • Develop presentations and deliverables for client audiences that communicate strategy and outcomes. • Generate billings revenue by conducting assigned analyses, write and prepare reports, and assist clients in implementing desired changes. • Guide and lead project management related activities for assigned projects. • Manage the budget and expenses for their assigned projects and manage project profitability. • Manage staff assigned to their projects including providing mentoring and education for staff. • Participate in risk and issue identification and mitigation along with the project leadership team. Responsibility #2 - 15% • Participate in practice development activities for the Advisory Services Practice overall or for the Service Lines within the Practice. Responsibility #3 - 10% Learn Premier based technologies and services. Responsibility #4 - 10% • Actively listen for market opportunities on current engagements and collaborative networks and communicates potential leads to managers. • Contribute to the development of sales presentation deliverables using prescribed formats and technology; proactively seeks out opportunities to participate. • Identifies opportunities to improve profitability Responsibility #5 - 5% Complete all required training requirements on an annual basis. Required Qualifications Work Experience: Years of Applicable Experience - 5 or more years Education: Bachelors (Required) Preferred Qualifications Skills: • Coordinate and deliver effective presentations (verbal and written) to client audiences to communicate project outcomes, recommendations, and strategy • Ability to conduct analyses, oversee, and mentor others in the delivery and production of client deliverables • Ability to relate to clients and team members in an effective and collaborative manner • Ability to lead work groups to successful outcomes Experience: • Experience in Health Systems Finance, Operations (clinical, support or operations), Operational or Strategic Consulting, Strategic Planning or Decision Support Analytics • Experience leading cross-functional teams Education: Master's Degree; RN license or other professional license in clinical area of expertise; PMP/Lean Certification This is a remote position and requires up to 75% travel. Additional Job Requirements: Remain in a stationary position for prolonged periods of time Be adaptive and change priorities quickly; meet deadlines Attention to detail Operate computer programs and software Ability to communicate effectively with audiences in person and in electronic formats. Day-to-day contact with others (co-workers and/or the public) Making independent decisions Ability to work in a collaborative business environment in close quarters with peers and varying interruptions Working Conditions: Remote Travel Requirements: Travel 61-80% within the US Physical Demands: Sedentary: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time. Jobs are sedentary if movement is required only occasionally, and all other sedentary criteria are met. Premier's compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier's internal salary range for this role is $113,000 - $188,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges. Employees also receive access to the following benefits: · Health, dental, vision, life and disability insurance · 401k retirement program · Paid time off · Participation in Premier's employee incentive plans · Tuition reimbursement and professional development opportunities Premier at a glance: Ranked #1 on Charlotte's Healthiest Employers list for 2019, 2020, 2022, and 2023 and 21st Healthiest Employer in America (2023) Named one of the World's Most Ethical Companies by Ethisphere Institute for the 16th year in a row Modern Healthcare Best in Business Awards: Consultant - Healthcare Management (2024) The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting For a listing of all of our awards, please visit the Awards and Recognition section on our company website. Employees receive: Perks and discounts Access to on-site and online exercise classes Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people. Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply. EEO / AA / Disabled / Protected Veteran Employer. Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply to diversity_and_accommodations@premierinc.com or contact Premier Recruiting at ************. Information collected and processed as part of any job application you choose to submit to Premier is subject to Premier's .

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.