HIMS jobs - 48 jobs

The BJC Group, Inc. is a comprehensive construction management and contracting company specializing in commercial and residential construction, pre-construction services, and maintenance. The company provides end-to-end solutions, encompassing design, permitting, construction, and building occupancy. Backed by a highly experienced team, The BJC Group is dedicated to delivering superior quality projects at competitive prices, catering to a diverse range of project sizes and requirements. Role Description This is a full-time hybrid role for a Business Development Manager, located in Nashville, TN, with flexibility for some remote work. The Business Development Manager will be tasked with identifying and securing new business opportunities, building and maintaining client relationships, and collaborating with internal teams to ensure client satisfaction. Daily responsibilities include market research, preparing sales presentations, negotiating contracts, and contributing to strategic business planning efforts to support company growth. Qualifications Strong business development, client relationship management, and negotiation skills Experience in sales strategy, market research, and lead generation Ability to analyze market trends and develop actionable insights for business growth Excellent verbal and written communication skills for preparing proposals, presentations, and reports Organizational and project management skills to oversee multiple deals and client accounts Proficiency with CRM software and other digital tools for tracking sales processes and customer interactions Self-motivated with a proactive approach to achieving business goals Bachelor's degree in Business Administration, Marketing, Sales, Construction, or a related field is a plus Industry experience in construction management or contracting is a plus

As a Healthcare Economics Analyst at Wellbe you will play a pivotal role in shaping the organization's healthcare strategy through advanced analytics and economic modeling. You will lead high-impact initiatives, provide strategic insights to senior leadership, and serve as a trusted advisor across departments.In this role, you will collaborate with cross-functional teams and serve as a subject matter expert, providing valuable insights and guidance to inform strategic initiatives. This role is ideal for a seasoned analyst with a strong blend of technical expertise, business acumen, and leadership capability. Lead complex analyses of medical and pharmacy claims, enrollment, and provider data to uncover cost drivers and utilization trends. Develop and implement innovative tools and methodologies to monitor healthcare trends and identify affordability opportunities. Deliver actionable insights to support contract negotiations, care management programs, and network optimization strategies. Build and maintain predictive models to assess the financial and clinical impact of strategic initiatives. Design executive-level dashboards and reports to monitor performance and diagnose cost trend anomalies. Partner with actuarial, clinical, data science, and business teams to forecast medical costs and evaluate risk adjustment performance. Present findings and strategic recommendations to senior leadership using clear, compelling visualizations and narratives. Conduct pro forma and sensitivity analyses to estimate the financial value of proposed cost containment initiatives. Mentor and guide junior analysts, establishing best practices in data validation, analytical methods, and reporting standards. Ensure all analyses adhere to regulatory requirements and industry best practices. Champion a culture of collaboration, innovation, and continuous improvement across the analytics team. Promote data governance, security, and compliance across all analytics workflows. Strong sense of ownership, bias for action, and drive Strong verbal and written communication Excellent analytical and problem-solving skills Strong work ethic and attention to detail Job Requirements Advanced proficiency in SQL, Tableau, and Snowflake; experience with enterprise reporting tools. Working knowledge of Python or R for statistical modeling and automation. Deep understanding of CMS programs (Medicare Advantage, Medicaid) and HCC risk adjustment methodologies. Experience with statistical modeling, forecasting, and predictive analytics. Strong communication skills with the ability to translate complex data into strategic insights for non-technical audiences. Proven ability to lead cross-functional projects and influence decision-making at the executive level. High level of ownership, initiative, and attention to detail. QUALIFICATIONS Bachelor's degree in Economics, Mathematics, Statistics, Public Health, Health Administration, or related field (Master's preferred). 5-7 years of progressive experience in healthcare analytics, medical economics, actuarial analysis, or health plan finance. Extensive experience working with medical and pharmacy claims, risk adjustment, and value-based care data. Strong understanding of healthcare reimbursement models (FFS, capitation, shared savings, risk contracts). Experience with cloud-based data platforms (Snowflake or similar). Demonstrated ability to lead and mentor teams, and drive strategic initiatives. Excellent problem-solving, interpersonal, and stakeholder management skills. Travel requirements: Travel may be required up to 15% locally or nationally Work Conditions: Ability to lift up to 20lbs. Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 50lbs. Ability to stand for extended periods Ability to drive to patient locations (ie. home, hospital, SNF, etc) Fine motor skills Visual acuity Work Environment: Remote Pay Range $ 110,000-$165,000 Sponsorship Statement WellBe does not offer employment-based visa sponsorship for this position. Applicants must be legally authorized to work in the United States without the need for employer sponsorship now or in the future. Pay Transparency Statement Compensation for this position will be disclosed in accordance with applicable state and local pay transparency laws. Drug Screening Requirement: As a condition of employment, WellBe Senior Medical requires all candidates to successfully complete a pre-employment drug screening. Ongoing employment may also be contingent upon compliance with the company's Drug-Free Workplace Policy, which includes random, post-accident, and reasonable suspicion drug testing. The company reserves the right to test for substances that may impair an employee's ability to safely and effectively perform their job duties. Background Check Statement Employment is contingent upon successful completion of a background check, as permitted by law. As a healthcare organization, WellBe conducts monthly FACIS (Fraud and Abuse Control Information System) checks on all employees. Continued employment is contingent upon satisfactory results of these checks, in accordance with applicable laws and regulations. Equal Employment Opportunity (EEO) Statement WellBe 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, protected veteran status, or any other legally protected status. Americans with Disabilities Act WellBe Senior Medical is committed to complying with the Americans with Disabilities Act (ADA) and applicable state and local laws. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the job. If you require an accommodation during the application, interview or employment process, please contact Human Resources at *********************** At-Will Employment Statement Employment with WellBe is at-will unless otherwise specified by contract. This does not constitute an employment contract. Disclaimer This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary. The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role.

About Us: Come reimagine care with us! We're on a mission to change the way medical care is delivered around the country. By supplying home-based medical care to patients who need it most, WellBe is changing lives by providing care wherever our patients call home. WellBe's primary care services are delivered by a team of licensed clinicians in the comfort of the patient's home. By combining the strength of physicians, nurse practitioners, social workers, paramedics, and other healthcare professionals, WellBe delivers an extra level of support to the patients we serve in their communities. This high-risk population is typically underserved and challenged with access to care which we provide. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. WellBe's clinician-led geriatric care teams provide concierge-level medical care and social support in the home as well as delivering and coordinating across the entire care continuum - from chronic care and urgent care in the home to hospital to skilled nursing facility to assisted living to palliative care, to end-of-life care. Joining WellBe means joining a growing, purpose-driven organization to deliver the highest quality care to our senior communities and to make an impact on lives every day. Why WellBe? WellBe's Culture is Welcoming Be part of something important: Be part of pioneering a new way of healthcare that is revolutionizing the industry. A patient-focused environment that ensures patients can live a fulfilling life whatever their health level is. Our focus is to give our patients more good days. Give yourself incredible opportunities: Growth and development opportunities across expanding markets in the company and celebrate success on a global scale. Training in the WellBe model and team-based care. Full in-person orientation, vision, mission, and values introduction, and instilling cultural ideals. Respect and trust for how you work and how you make a difference. Work as part of a collaborative team with a strong team culture. You own your role, contribute to the team, and feel the enormous impact on lives. Leadership that listens, trusts, empowers, and supports. Empowerment and ownership for solving problems that arise and doing the right thing in each interaction. Pioneering a new way of healthcare that is revolutionizing the industry. What we offer: Full-time permanent, work seeing patients in their home, traveling around to other home locations. Work during the daytime, flexible schedule, and on-call rotation. Rich and competitive total rewards package including health benefits, dental, vision, life insurance, dependent care reimbursement, STD/LTD, 401k match with immediate vesting, paid time off / floating holidays, commuter/transportation (mileage) reimbursement, and educational reimbursement. The opportunity to work with a progressive company, who is making a difference each day with every patient. About the Position: Our LCSWs are part of a team that provides compassionate care to the frailest elderly who have chronic and acute illnesses or injuries living in their homes. Our LCSW delivers primary, urgent and acute care and counseling to a wide variety of patients with social and behavioral problems. The LCSW will be accountable for caring for patients, connecting patients and their families to support services, maintaining accurate and current patient records and scheduling and administering initial, urgent, and follow-up appointments to patients as required. The successful candidate will work as a team with our physicians, advanced practice clinicians, and care team coordinator will assist in delivering quality care to every patient. We offer a positive, upbeat work environment where all medical personnel work together for the good of the patient. WellBe LCSW - Social Worker - What to Expect: Practices the WellBe mission: To help our patients lead healthier, meaningful lives by delivering the most Complete Care. Performs psychosocial assessments and provides therapeutic services to patients and their families. Work closely with Behavioral Health Medical Director to manage complex patient cases and transitions of care A resource for the WellBe communities in managing complex Behavioral Health cases. Manages complex behavioral and psychosocial needs that result in improved clinical and financial outcomes Maintains constant communication with patients when addressing their concerns and goals and helping them keep positive attitudes Builds rapport with patients and their families and relay all concerns to WellBe provider/IDT Assists members to effectively utilize available resources to meet their personal health goals and help them develop their own capabilities. Monitors patient progress and adjusts patient treatment plan as needed Coordinates with other healthcare providers, agencies and community resources in order to create a thorough treatment plan addressing social, cultural, and financial needs Collaborates with the interdisciplinary team and participate in regularly scheduled team meetings Ensures compliance with regulatory agencies and WellBe clinical guidelines Following a thorough assessment completed by an Advanced Practice Clinician (APC), the WellBe social worker partners Partner with community team to refer patients to appropriate no or low-cost community services that support health and independence such as Meals On Wheels (MOW), local Area Agencies on Aging (AAA), Senior & Assistance Programs, and transportation resources. Involves the patients' families and primary caregiver(s) as needed to achieve the best care decisions and outcomes. Effectively collaborates with all those involved in the members' care, including health services contractors (i.e., Home Health, Hospice, Community Agencies), to meet the patients' care goals. Consults with and advises the Clinical Team regarding the relationship of social, emotional, and cultural factors to health and medical care, and to the availability of social services in the community. Complies with safety policies and procedures, identifying and immediately reporting any potential or actual unsafe acts or conditions to their supervisor/team. Takes necessary measures to ensure a safe environment for oneself, co-workers, contractors, participants, visitors and others. Consistently meets or exceeds WellBe targets for productivity, customer service, quality assessment, and performance targets. Understands the importance of community involvement and participates as appropriate in activities that link WellBe to its communities. Maintains current written progress notes and other documentation on the member Medical Record including signed and dated documentation for all service performed the day the service is provided. Participates in program and policy development of the WellBe Social Work program. Other tasks needed to accomplish team's objectives/goals Job Requirements Must Haves: Educational/ Experience Requirements: Master's Degree in Social Work 5+ years clinical social work experience with the geriatric population Two years social work experience, preferably in health care, and minimum one-year experience working with a frail/elderly population. License, Certification, Registration LCSW/LISW/LICSW Licensure required Required Skills and Abilities: Current unrestricted LCSW license in applicable state(s) required. Age specific competency in working with the elderly and knowledge of community services for the elderly and their families. Ability to make psychosocial assessments and develop and implement viable care plans Must be familiar with EHR medical documentation Strong computer skills, including Word, Excel, and Powerpoint Strong verbal, written, presentation, and interpersonal communication skills Bilingual in English/Spanish preferred. Ability to work effectively in a team environment. Knowledge of social work principles and practices, including case management and counseling techniques. Ability to empathize with clients Ability to provide after-hours services as needed Ability to leverage internal and external resources as part of a patient's treatment plan Experience writing assessments and reports to monitor client progress Valid driver's license, have access to a car and willingness to drive to patient homes/patient location as well as an active auto insurance policy Work Environment: Field, will be traveling locally to patient's homes Pay Range: $85K to $92K Sponsorship Statement WellBe does not offer employment-based visa sponsorship for this position. Applicants must be legally authorized to work in the United States without the need for employer sponsorship now or in the future. Pay Transparency Statement Compensation for this position will be disclosed in accordance with applicable state and local pay transparency laws. Safety-Sensitive Statement This position has been designated as safety-sensitive. As such, the employee must be able to perform job duties in a manner that ensures the safety of themselves, coworkers, patients, and the public. The role requires full cognitive and physical functioning at all times. Employees in safety-sensitive positions are subject to drug and alcohol testing, including substances that may impair judgment or motor function, in accordance with applicable federal and state laws and company policy. Due to the safety-sensitive nature of this role and in alignment with federal law and workplace safety standards, the use of marijuana-including medical or recreational use-is prohibited. WellBe Senior Medical will comply with applicable state laws regarding medical marijuana and reasonable accommodations, where such laws do not conflict with safety requirements or federal regulations. Drug Screening Requirement As a condition of employment, WellBe Senior Medical requires all candidates to successfully complete a pre-employment drug screening. Ongoing employment may also be contingent upon compliance with the company's Drug-Free Workplace Policy, which includes random, post-accident, and reasonable suspicion of drug testing. The company reserves the right to test for substances that may impair an employee's ability to safely and effectively perform their job duties. Background Check Statement Employment is contingent upon successful completion of a background check, as permitted by law. As a healthcare organization, WellBe conducts monthly FACIS (Fraud and Abuse Control Information System) checks on all employees. Continued employment is contingent upon satisfactory results of these checks, in accordance with applicable laws and regulations. Equal Employment Opportunity (EEO) Statement WellBe 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, protected veteran status, or any other legally protected status. Americans with Disabilities Act WellBe Senior Medical is committed to complying with the Americans with Disabilities Act (ADA) and applicable state and local laws. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of the job. If you require an accommodation during the application, interview or employment process, please contact Human Resources at *********************** At-Will Employment Statement Employment with WellBe is at-will unless otherwise specified by contract. This does not constitute an employment contract. Disclaimer This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.

About Us: Come reimagine care with us! We're on a mission to change the way medical care is delivered around the country. By supplying home-based medical care to patients who need it most, WellBe is changing lives by providing care wherever our patients call home. WellBe's primary care services are delivered by a team of licensed clinicians in the comfort of the patient's home. By combining the strength of physicians, nurse practitioners, social workers, paramedics, and other healthcare professionals, WellBe delivers an extra level of support to the patients we serve in their communities. This high-risk population is typically underserved and challenged with access to care which we provide. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. WellBe's clinician-led geriatric care teams provide concierge-level medical care and social support in the home as well as delivering and coordinating across the entire care continuum - from chronic care and urgent care in the home to hospital to skilled nursing facility to assisted living to palliative care, to end-of-life care. Joining WellBe means joining a growing, purpose-driven organization to deliver the highest quality care to our senior communities and to make an impact on lives every day. Why WellBe? WellBe's Culture is Welcoming Be part of something important: Be part of pioneering a new way of healthcare that is revolutionizing the industry. A patient-focused environment that ensures patients can live a fulfilling life whatever their health level is. Our focus is to give our patients more good days. Give yourself incredible opportunities: Growth and development opportunities across expanding markets in the company and celebrate success on a global scale. Training in the WellBe model and team-based care. Full in-person orientation, vision, mission, and values introduction, and instilling cultural ideals. Respect and trust for how you work and how you make a difference. Work as part of a collaborative team with a strong team culture. You own your role, contribute to the team, and feel the enormous impact on lives. Leadership that listens, trusts, empowers, and supports. Empowerment and ownership for solving problems that arise and doing the right thing in each interaction. Pioneering a new way of healthcare that is revolutionizing the industry. What we offer: Full-time permanent, work seeing patients in their home, traveling around to other home locations. Work during the daytime, flexible schedule, and on-call rotation. Rich and competitive total rewards package including health benefits, dental, vision, life insurance, dependent care reimbursement, STD/LTD, 401k match with immediate vesting, paid time off / floating holidays, commuter/transportation (mileage) reimbursement, and educational reimbursement. The opportunity to work with a progressive company, who is making a difference each day with every patient. About the Position:Our Community Medical Directors oversee the clinical” Community Team” dedicated to a patient community population. Community Medical Director will be expected to manage, mentor, and guide the clinical “Community Team” as well as deliver primary, urgent, and acute medical care to an assigned population of patients. A successful candidate will collaborate with various clinicians along with administrative/operational team(s) to deliver exceptional clinical, operational outcomes to WellBe patients and their families. The Community Medical Director will be a WellBe Ambassador responsible for working with community physicians, hospitals, and other medical facilities including SNF's. Community Medical Director at WellBe will be expected to contribute to our culture of collaboration, innovation, significant impact to the lives of our patients while experiencing personal growth within the organization. Job Description WellBe Community Medical Director - What to Expect: Practices the WellBe mission: To help our patients lead healthier, meaningful lives by delivering the most Complete Care. Collaborates with a clinical “Community Team” consisting of interdisciplinary team in managing the health and wellbeing of patients living in their homes. Has a successful relationship with the Market GM, and Senior Medical Officer to achieve quality outcomes and growth in the community. Understanding the impact on local and national landscape involving the WellBe clinical model consisting of: Health Policy, Socioeconomics, competition, CMS, regulatory, and other clinical data relevant to quality patient care. Prioritizes and acts on the most promising opportunities to improve outcomes/performance of the Community metrics (i.e. clinical, cost/revenue, partnerships, and quality measures). Spends time fostering key relationships in the Community Network For Hospitals and SNFs, where WellBe is not the attending, Community Medical Director will identify Hospitalists and SNFist groups, build individual relationships where mutual patient outcomes are achieved and creating contractual relationships when additional alignment is needed Partner with WellBe Leadership to grow the organization, innovate the model and improve execution Develops constructive Cross-functional / Matrix Relationships with WellBe business partners to enable the model. Community Medical Director will be responsible for floating within the community physician role as needed Other tasks needed to accomplish team's objectives/goals Job Requirements Must Haves: Educational/Experience Requirements: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) Current and valid state medical license required 5+ years' experience managing an interdisciplinary team 5+ years' minimum experience as a community physician providing geriatric care. 3+ years' responsibility for managing a P&L Required Skills and Abilities: Geriatric certified preferred Palliative care certified/focus preferred Basic Life Support (BLS) certified Have a valid driver's license, have access to a car and willingness to drive to patient homes/patient location as well as an active auto insurance policy EHR medical documentation experience Strong computer skills, including Word, Excel, and PowerPoint Strong verbal, written, presentation, and interpersonal communication skills Excellent bedside manner and time management skills Supervisory Responsibility: This position will have direct management authority. Travel Requirements: Travel may be required up to 100% locally. Compensation $193,600-$387,200 Work Conditions: Ability to lift up to 20lbs. Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs. Ability to stand for extended periods. Ability to drive to patient locations (ie. home, hospital, SNF, etc). Fine motor skills/visual acuity WellBe Senior Medical is an equal opportunity employer. We embrace diversity, inclusion, and equity and encourage all interested readers to apply at wellbeseniormedical.com/careers. The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change, or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role. City, State Zip Code Primary Location: City, State Zip Code Job: Clinical-Medical Doctor MD, Doctor of Osteopath DO, Regular Physician Shift. Full Time Job Level: Day Job, 8am, 5pm, Travel, Monday, Friday. No evening, no weekend hours unless desired. Job, Clinical, Nursing, Regular, Job Type, Physician Standard, Pay, Hours. Geriatric population

Starting at $19.50 hourly Join Our Team as a Referrals Specialist! Are you passionate about providing excellent patient care and making a difference in your community? Hawaii Island Community Health Center is looking for a dedicated Referrals Specialist to join our team! Position Summary: As a Referrals Specialist, you will play a crucial role in managing external patient referrals and follow-up in collaboration with the provider and other members of the patient care team. Under the general direction of the Health Services Manager and Referrals Supervisor, you will maintain electronic patient files, respond to and fulfill requests for medical records, and assist in the collection of data. Additionally, you will coordinate travel for patients to and from appointments. Schedule: Monday-Friday (most weekends off) Work hours are between 6:00 AM and 6:00 PM, with shifts totaling either 8 hours or 10 hours per day. Opportunity to work from home on occasions, following work from home guidelines. Benefits Include: Retirement plan Medical, Vision, and Dental Insurance Pet insurance Paid time off Employee Assistance Program Other ancillary benefits Education and Experience: High School graduate or GED certificate One year of related clinical office experience and/or training; OR any equivalent combination of experience, training, and/or education Desirable experience includes: Familiarity with QUEST and other insurance programs Familiarity with Hawaiʻi Health Care Networks Knowledge of ICD-10 and CPT coding Key Responsibilities: Prioritize patient referrals to manage patient flow for maximum efficiency and optimum care provision Utilize medical records appropriately to document care within the scope of job duties Coordinate referrals, preauthorization, and follow-up with appropriate external resources Develop and maintain tracking systems for referrals to outside resources Actively participate in quality improvement and risk management programs Participate as an active team member on the patient care team Engage in continuing education activities Demonstrate competency in managed care preauthorization for travel Document appropriately in the patient medical record Facilitate quality specialty medical, diagnostic, and therapeutic services via appropriate referral and tracking for follow-up Maintain positive interpersonal relations with physicians, patients, patient families, visitors, and co-workers in a professional and confidential manner Embrace the philosophy of continuous quality improvement Maintain a safe, clean, and confidential working environment consistent with OSHA, HIPAA, and HHC standards Communicate accurate and pertinent information with patient care providers and other members of the care delivery team to facilitate effective and efficient patient referrals and tracking Apply age-specific/cultural considerations to the referral process Manage changes in work demand during the workday Ensure patient/family satisfaction with referral services Keep supervisor informed of problems or issues; monitor supplies needed; perform other duties as assigned Why Join Us? At Hawaii Island Community Health Center, we are committed to providing high-quality healthcare services to our community. Join our team and be part of a supportive and dynamic environment where you can grow professionally and make a meaningful impact. Apply Today! If you are ready to take on this rewarding role, please submit your application and resume. We look forward to welcoming you to our team!

- not eligible for benefits Projected Hiring Range : Depending on Experience Closing Date : Open Until Filled Work Schedule: Mon-Fri, 9:30a-6p (PRN) Primary Purpose of Position: This position provides the initial screening, referral and or scheduling of members who call the toll-free PartnersACCESS Member Services number seeking health and behavioral health services and as appropriate, transfers the member to a clinician who will clinically triage/assess the member's acuity and will determine what type and intensity of service the member needs and/or is eligible to receive. Role and Responsibilities: Screening, scheduling and referral: Initial screening of Health/Mental Health (MH)/Substance Use (SU)/Traumatic Brain Injury (TBI)/Intellectual/Developmental Disability (I/DD) treatment needs, benefit information and referral of members calling to determine if they may potentially qualify for services Collect and enter demographic data into the electronic record, completion of appropriate forms, explanation of services, benefits and resources, verifies Medicaid and dispatch Provide follow up calls to referral sources and members to ensure that members have been successfully engaged in services Make referrals to clinical homes and crisis providers that meet the timeliness standards as defined by NC Medicaid Provide information about local community resources, independent practitioners, and related providers for referrals for basic benefit services This position demands a high level of accuracy and confidentiality. Information must be handled according to NC standards and rules, state and federal laws and LME/MCO and NCQA standards, procedures, policies and protocol Authorizations: Assists with authorizations/admissions to state hospitals, ADATC, Three Way Hospitals, Level III Detox, Facility Based Crisis and all referrals to crisis services Process other acute care authorizations as requested by supervisor or other Access to Care Licensed Clinician Automation: Screenings are completed using standard and specialized computer programs Inputs accurate information into the system and unlocks electronic service records with appropriate consents, enters all necessary data elements into data systems Provide technical assistance to First Responders, clinical home providers, and Mobile Crisis Management Cooperative Efforts: Establish and maintain effective working relationships within the unit, agency, and service system Consistently demonstrate professionalism, tact and diplomacy in handling irate callers and/or working with contract providers and other external parties Participate in Unit Staff meeting, Agency Staff meetings, (All staff meetings) and assigned committees Knowledge, Skills and Abilities: Sound knowledge of health/MH/SU/TBI/I/DD for the appropriate determination of eligibility for Medicaid and State supported services, appropriateness of referrals for treatment and assessment and the level of danger of the members calling for assistance Knowledge of the laws governing the treatment of health, mental illness, substance abuse and intellectual/developmental disabilities as well as the resources available in the community for treatment Knowledge of call center functions, member population, potential for crisis issues, confidentiality laws and program protocols/policies Excellent computer skills Ability to complete tasks independently, define problems, apply laws, policies and procedures to agency activities and must use sound judgment in conducting screening, triage and referral Ability to use sound judgment when conducting a screening and be able to determine when it is necessary and appropriate to transfer a member to a Licensed Access to Care Clinician Ability to communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task (that is: converse while entering screening information into the electronic medical record and evaluating the member's need) Ability to take highly complicated criteria and apply it to cases in determining eligibility for services and appropriate scheduling referrals Ability to assist members in highly stressful situations which may be life threatening to the member or public while at the same time facilitating a connection to crisis services and/or a Licensed Access to Care Clinician Ability to provide technical assistance to both members and Providers Ability to maintain confidentiality when screening and referring calls/callers Education/Experience Required: Bachelor's Degree in related field or Licensed Practical Nurse (LPN) and at least two (2) years of healthcare or MH/SU/IDD experience. Education/Experience Preferred: Licensed practical nurses (LPNs) and at least four (4) years of healthcare and/or MH/SU/IDD experience. Licensure/Certification Requirements: N/A

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Hybrid option; Available for the Gastonia, NC location Closing Date: Open Until Filled Primary Purpose of Position: To provide executive-level paralegal and administrative services for the Office of Legal Affairs (OLA), including Chief Legal Officer/General Counsel (CLO/GC), Director of Legal Services, staff attorney(s), legal specialist(s) and waiver contract manager. Highly collaborative culture. Under licensed-attorney supervision where required, this position entails professional legal work in a variety of legal/operational areas or functions, including but not limited to legal research; and drafting, reviewing, proofing and communicating legal/regulatory matters regarding litigation, transactions/contracts, regulation, legislation, internal and external dispute resolution, grievances/complaints, and related legal projects. As detailed further below, key role will be managing Partners many complex policies and procedures (P&Ps), as well as program descriptions, plans and even assisting with board guidelines. In addition, position will require successful applicant to field, route and/or address (or to ensure attorney and/or OLA team addresses) legal issues and questions from various Partners' business units and staff. Examples of work include coordinating all aspects of the internal Policy and Procedure process (with assistance of waiver contract manager); preparation and occasional participation in board level and committee meetings; assist legal team with their projects, including, e.g., key OLA metrics and ensure monitoring, prompt routing, payment and reimbursement of legal bills and expenses. Works with extremely sensitive and confidential information and records. Perform other duties as needed consistent with an executive level paralegal. Work closely with Associate General Counsel, Director of Legal Services, Waiver Contract Manager, Legal Specialist, Program Integrity Director, and their teams, also located in OLA. Position reports directly to Director of Legal Services. NOTE: Representation of Partners in a court of law and other acts constituting the practice of law are the responsibilities of attorneys in or for OLA. Position will cooperate with, assist and take significant responsibility for preparation of work by attorneys, but have no authority to act as legal counsel for Partners or to practice law without a license. Role and Responsibilities (percentages are approximations): 50% Policies and Procedures (P&Ps): With assistance and guidance of waiver contract manager, will be directly responsible for Partners' almost 300 P&Ps, that must be regularly reviewed, vetted and approved by management, leadership and Board. This includes oversight of revision and creation of P&Ps by Partners' staff for accreditation, certification, contract and regulatory compliance. Also, can include Program Descriptions, Plans and perhaps assisting with board guidelines. Assist with and/or manage automation and process improvement of P&Ps. As detailed below, this role requires extensive organizational skills, knowledge and comfort with software, critical thinking, and strong writing and collaborative communications skills. 35% Traditional Paralegal Services: With assistance from attorneys, legal specialists, waiver contract manager, and program integrity investigators, provides moderate to complex legal support services. Examples include: performing legal research, both formal from traditional legal research databases (currently Lexis) and from non-traditional resources such as State and Federal legislative and regulatory websites. assisting with obtaining, reviewing, proofing, executing and interpreting contracts and transactions. assisting with drafting, review, proofing and issuing communications with staff, outside counsel and opposing counsel regarding contracts, litigation (subpoenas, hearing notices, pleadings, motions) and related legal projects; assisting with or fielding, routing and and/or addressing legal issues and questions from various Partners' business units and staff, and/or ensuring appropriate OLA staff does so; attending and or assisting attendees with key meetings, hearings and conferences, providing insights to and taking notes for OLA team and Partners. gather, organize and marshal on demand relevant documents, information and evidence to support OLA work and obligations. liaising with Program Integrity staff on legal matters arising to legal staff from or related to investigations of alleged fraud, waste and abuse; consulting OLA attorneys for supervision on matters and in any instance that might be construed as the practice of law. 10% Administrative Support: Provides comprehensive and often sophisticated/complex administrative support to OLA team. Examples include assisting OLA staff or directly to: maintain OLA legal files and records. create, maintain, analyze and report key OLA metrics using various OLA-specific resources and interdepartmental support. routing, payment and reimbursement of legal bills and expenses, including potential assistance with the OLA legal matters management and invoicing software and database (currently CounselLink). communicate with outside counsel regarding pending assigned cases and legal matters, billing guidelines and other needs. coordinate and support highly visible functions and events, including preparation for board, executive, management level and other meetings; provider forums, council and other meetings; legal trainings; and other events involving Team OLA. reserve and arrange meeting space, including IT needs. schedule and coordinate select conference calls, meetings, mediations, and hearings. handle staff expense reimbursements, travel reservations, supplies and miscellaneous OLA operational matters. 5% Other Duties as Assigned: In all roles and responsibilities, assures confidentiality of information of a sensitive nature within the department and organization. Adheres to court, regulatory, Partners' and other deadlines. Highly organized and digitally proficient, and able to multitask in fast-paced, detail-oriented -- but highly collaborative, team-oriented and cross-functional -- environment. Maintains a thorough understanding of legal procedures and documents. Able and authorized to exercise good judgment in a variety of situations when communicating directly with persons within and outside Partners, including leadership, healthcare professionals, attorneys, judges, regulators and others. Strong oral and written communication skills essential. Significant attention to accuracy. Excellent people skills. Knowledge, Skills and Abilities: Considerable knowledge of the principles and practices of NC administrative law specifically and general knowledge of the laws, rules, and regulations applicable to LME/MCOs. Ability to maintain effective working relationships with the public and other persons contacted in the course of work. Ability to anticipate and timely meet deadlines and projects. Considerable knowledge of office practices, techniques, and technology. Working knowledge of and the ability to understand legal documents, contractual language, legal processes and other complex or sophisticated topics and materials. Excellent communication skills, both orally and in writing. Detail oriented with excellent organizational skills, including ability to manage multiple schedules and tasks. Proficiency in Word, Excel, Outlook and PowerPoint, including the ability to design reports and presentations for internal and external recipients; excellent typing skills. Proficiency in law-related and P&P software and database resources, including or comparable to LexisNexis and CounselLink. Ability to manage and uphold integrity and confidentiality of sensitive data, internally and externally. Ability to analyze, understand, and complete tasks related to state and federal rules, regulations and laws. Ability to establish and maintain effective, positive working relationships with staff, other members of the organization and stakeholders. Ability to analyze, interpret and recommend policy, rules, and procedural guidelines. Ability to complete non-routine activities and tasks that might require deviation from established procedures; must be able to choose the appropriate course of action and recognize the existence of and differences among situations; sound judgment and critical thinking. Ability to plan and carry out the day-to-day work of the office based on priorities and knowledge of the departments; and Ability to recognize sensitive or unusual situations that should be referred to another more appropriate staff member or to the supervisors. Commitment to Partners' core culture values. Education and Experience Required: A minimum experience of two years in a law-related role with law firm or law department. Working knowledge of legal database software, e.g., LexisNexus or Westlaw. Extensive knowledge and proficiency of Microsoft Office products (Word, Excel, Outlook, PowerPoint, etc.). Comfort and experience with electronic modes of communication, filing, record keeping and office management. While not frequent, must have ability to travel between counties. Must reside in North Carolina or within 40 miles from its border. Education and Experience Preferred: Associate or higher degree in Legal Studies, Business, Office Administration, Healthcare, Human Services or other relevant field, including, paralegal/legal studies, Criminal Justice, Political Science, or legal assistant. Experience in healthcare, especially public behavioral health, managed Medicaid, and healthcare payor systems and law. Knowledge of and experience/proficiency with LexisAdvance, CounselLink, WestLaw and e-OAH. Substantial prior paralegal, legal assistant or related working experience or credentialing highly preferred, especially certification as paralegal or legal assistant, e.g., NCCP. Licensure/Certification Requirements: Paralegal, Legal Assistant, or similar recognized certification, e.g. NCCP (out of state certification acceptable). Law license not required. JDs welcomed to apply but should not expect promotion to attorney position with or without license.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Remote Option; Available for any of Partners' NC locations Projected Hiring Range : Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: This position is responsible for ensuring that providers receive timely and accurate payment. Role and Responsibilities: 50%: Claims Adjudication Responsible for finalizing claims processed for payment and maintaining claims adjudication workflow, reconciliation and quality control measures to meet or exceed prompt payment guidelines. Responsible for reconciling provider claims payments through quality control measures, generally accepted accounting principles and agency's policies and procedures. Assess Title XIX and non-Title XIX claims adjustments for correction or recoupment and will coordinate the recoupment process to ensure payment is recovered for inappropriately paid claims. Provide back up for other Claims Analysts as needed. 40%: Customer Service Maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interacting in a professional manner; providing information and assistance; and answering incoming calls. Assist providers in resolving problem claims and system training issues. Serve as a resource for internal staff to resolve eligibility issues, authorization, overpayments, recoupments or other provider issues related to claims payment. 10%: Compliance and Quality Assurance Review internal bulletins, forms, appropriate manuals and make applicable revisions Review fee schedules to ensure compliance with established procedures and processes. Attend and participate in workshops and training sessions to improve/enhance technical competence. Knowledge, Skills and Abilities: Working knowledge of the Medicaid Waiver requirements, HCPCS, revenue codes, ICD-10, CMS 1500/UB04 coding, compliance and software requirements used to adjudicate claims General knowledge of office procedures and methods Strong organizational skills Excellent oral and written communication skills with the ability to understand oral and written instructions Excellent computer skills including use of Microsoft Office products Ability to handle large volume of work and to manage a desk with multiple priorities Ability to work in a team atmosphere and in cooperation with others and be accountable for results Ability to read printed words and numbers rapidly and accurately Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules Ability to manage and uphold integrity and confidentiality of sensitive data Education and Experience Required: High School graduate or equivalent and three (3) years of experience in claims reimbursement in a healthcare setting; or an equivalent combination of education and experience. Education and Experience Preferred: N/A Licensure/Certification Requirements: N/A

**City/State:** Saint Louis, Missouri **Categories:** Clinical Services and Support **Job Status:** Full-Time **Req ID** : 102678 **Pay Range:** $63,024.00 - $102,627.20 / year (Salary or hourly rate is based on job qualifications and relevant work experience) **Additional Information About the Role** + **Up to a $2800 Sign on Bonus** + **Shift:** Day Shift Monday - Friday 8 AM - 5 PM + **Location:** (Hybrid position) 3 days in office and 2 days' work from home - will work from other BJC Behavioral Health locations as needed + **Client Group** : You and your Staff are working with adults with severe and persistent mental illness You will work on outpatient Competency Restoration that will be used by our programs services like CPR. + **Team Dynamic - (number of direct reports):** 6 staff working in the St. Louis City Jails and the St. Louis County Jails + **MUST HAVE skills for this position:** Must be fully licensed - LPC or LCSW and preferred to have previous leadership/supervisory experience + **Job responsibilities:** + Manages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership. Reviewing notes, audit records. + May participate in the development of departmental staffing, revenue and/or expense budgets and having direct responsibility for adhering to those goals. This includes responding to changes in the business which may affect the ability to achieve the budget goals. + Supervises and oversees operational services that build on the strengths of clients and their families as they deal with the effects of serious mental illness. + Trains and coaches' direct reports on clinical and case management skills. **Overview** **BJC Behavioral Health** is a community health center that provides and coordinates behavioral health services for more than 8,000 seriously mentally ill adults and seriously emotionally disturbed children in St. Louis City, St. Louis County, St. Francois, Iron and Washington counties. As an Administrative Agent of the Missouri Department of Mental Health (DMH), BJC Behavioral Health serves as a major point of entry for people eligible for mental health services funded by DMH and is responsible for serving as gatekeeper to the public mental health system. **Preferred Qualifications** **Role Purpose** Provides clinical supervision and hands on instruction of sound, effective clinical skills to direct reports so that services provided build on strengths of clients and their families as they deal with the effects of serious mental illness. **Responsibilities** + Manages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership. + May participate in the development of departmental staffing, revenue and/or expense budgets and having direct responsibility for adhering to those goals. This includes responding to changes in the business which may affect the ability to achieve the budget goals. + Supervises and oversees operational services that build on the strengths of clients and their families as they deal with the effects of serious mental illness. + Trains and coaches direct reports on clinical and case management skills. + Partners with community resources to specifically address treatment needs of the patients. **Minimum Requirements** **Education** + Master's Degree - Social Work **Experience** + 2-5 years **Supervisor Experience** + No Experience **Licenses & Certifications** + LCSW or LPC **Preferred Requirements** **Experience** + 5-10 years **Supervisor Experience** + < 2 years **Benefits and Legal Statement** **BJC Total Rewards** At BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being. + Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date + Disability insurance* paid for by BJC + Annual 4% BJC Automatic Retirement Contribution + 401(k) plan with BJC match + Tuition Assistance available on first day + BJC Institute for Learning and Development + Health Care and Dependent Care Flexible Spending Accounts + Paid Time Off benefit combines vacation, sick days, holidays and personal time + Adoption assistance **To learn more, go to our** **Benefits Summary** **.** *Not all benefits apply to all jobs The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer

The WellBe care model is a Physician Led Advanced Practice clinician driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients. This population is typically underserved and very challenged with access to care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care - from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care. WellBe's physician/advanced practicing clinician led geriatric care teams' partner with the patient's primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum WellBe Senior Medical is looking for an experienced contact center leader to partner with the VP of call center operations. As partners the leaders will be responsible for contact center performance, operations, strategy, and change management. This leader specifically will be responsible for contact center projects, quality, training, and contact center strategy. Responsibilities Lead the development and strategy for contact center projects. Lead the implementation and refinement of contact center quality & training. Build and manage a high performing team, fostering an environment of continuous improvement. Collaborate with the other leaders of contact center operations to ensure high quality, and member experience. Provide mentorship and guidance to team members and colleagues, enhancing their skills and career growth. Serve as a thought leader for contact center enablement. Establish operational targets, best practices, and training programs that support service quality and efficiency standards. Identify and adopt models and tools that enhance the member experience and drive conversions. Provide oversight to engagement ecosystem projects organization wide. Serve as a thought leader for engagement ecosystem. Performs other duties as assigned. Job Requirements QUALIFICATIONS Educational Requirements: Master's degree in business, operations, or healthcare (MBA, MSOM, MHA, MPH). Required Skills and Abilities: 10+ years Call/Contact center background experience, prefer experience in health care. Deep knowledge of call center strategy. Deep knowledge of organizational change management. Entrepreneurial mindset. Exceptional communication skills and emotional intelligence, with the desire to help patients live a meaningful life. Discretion and confidentiality. Supervisory Responsibility: TBD Travel requirements: Travel may be required up to 25% locally or nationally Work Environment: Remote Pay Range: $145,000- $217,000 Sponsorship Statement WellBe does not offer employment-based visa sponsorship for this position. Applicants must be legally authorized to work in the United States without the need for employer sponsorship now or in the future. Pay Transparency Statement Compensation for this position will be disclosed in accordance with applicable state and local pay transparency laws. Safety-Sensitive Statement This position has been designated as safety-sensitive. As such, the employee must be able to perform job duties in a manner that ensures the safety of themselves, coworkers, patients, and the public. The role requires full cognitive and physical functioning at all times. Employees in safety-sensitive positions are subject to drug and alcohol testing, including substances that may impair judgment or motor function, in accordance with applicable federal and state laws and company policy. Due to the safety-sensitive nature of this role and in alignment with federal law and workplace safety standards, the use of marijuana-including medical or recreational use-is prohibited. WellBe Senior Medical will comply with applicable state laws regarding medical marijuana and reasonable accommodations, where such laws do not conflict with safety requirements or federal regulations. Drug Screening Requirement As a condition of employment, WellBe Senior Medical requires all candidates to successfully complete a pre-employment drug screening. Ongoing employment may also be contingent upon compliance with the company's Drug-Free Workplace Policy, which includes random, post-accident, and reasonable suspicion of drug testing. The company reserves the right to test for substances that may impair an employee's ability to safely and effectively perform their job duties. Background Check Statement Employment is contingent upon successful completion of a background check, as permitted by law. As a healthcare organization, WellBe conducts monthly FACIS (Fraud and Abuse Control Information System) checks on all employees. Continued employment is contingent upon satisfactory results of these checks, in accordance with applicable laws and regulations. Equal Employment Opportunity (EEO) Statement WellBe 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, protected veteran status, or any other legally protected status. Americans with Disabilities Act WellBe Senior Medical is committed to complying with the Americans with Disabilities Act (ADA) and applicable state and local laws. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of the job. If you require an accommodation during the application, interview or employment process, please contact Human Resources at *********************** At-Will Employment Statement Employment with WellBe is at-will unless otherwise specified by contract. This does not constitute an employment contract. Disclaimer This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary. . The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Available for any of Partners locations; Remote Option Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: The Provider Engagement & Outreach Specialist serves as a liaison between Partners Health Management and healthcare/physical health providers to drive quality improvement, practice transformation, and provider engagement. This role supports physical health providers in implementing evidence-based workflows, optimizing care delivery models, and aligning with value-based care initiatives. The Specialist also leads outreach efforts to foster collaborative relationships, deliver educational resources, and support providers in meeting performance and compliance benchmarks. Roles and Responsibilities: Support medical providers in transforming care delivery through implementation of patient-centered medical home (PCMH), value-based care models, and quality improvement initiatives. Engage directly with providers and healthcare teams across North Carolina to build strong partnerships, understand their unique challenges, and provide tailored assistance Conduct on-site and virtual practice visits to assess workflows, identify improvement opportunities, and provide technical assistance and resources. Analyze and utilize performance data (e.g., HEDIS, Medicaid measures) to collaborate with providers to design targeted interventions that improve care quality and patient outcomes. Assist practices with change management strategies to enhance patient outcomes and operational efficiency Act as a liaison in supporting providers in adopting value-based care practices, that enhance clinical efficiency and patient outcomes Develop and disseminate outreach materials, toolkits, and communication strategies to strengthen provider relationships. Stay abreast of emerging best practices, payer requirements, and regulatory changes affecting provider performance and transformation. Deliver training and coaching on practice transformation topics, data use, and workflow redesign Track provider progress, document interactions, and report outcomes and barriers to leadership for continuous program improvement. Work directly with physicians, clinical teams, and administrative staff to improve care delivery, enhance patient outcomes, and increase performance. Collaborate with internal stakeholders to align resources and interventions Support practice transformation initiatives that drive sustained improvements in care quality and operational efficiency Work with providers to encourage preventive service utilization and effective chronic condition management among their patient populations Assist clinicians achieve measurable improvements in health outcomes and patient satisfaction by fostering patient engagement and adherence to recommended care plans Knowledge, Skills and Abilities: • Deep understanding of value-based care models, and healthcare quality programs. • Experience in healthcare practice transformation, care delivery redesign or clinical operations • Experience engaging and coaching clinical teams (physicians, nurses, and practice managers) • Familiarity with health equity initiatives and strategies to address social drivers of health. • Experience in Project Management and familiarity in process mapping and workflow analysis tools. • Knowledge of and ability to explain and apply the provisions of contractual practices adopted by Partners Health Management and required by NC Division of Health Benefits. • Demonstrate working knowledge of HEDIS quality measures and reporting requirements to support accurate provider education and engagement • Collaborate with providers and internal teams to close care gaps and ensure compliance with HEDIS and other quality initiatives. • Experience working with large multi-site practices. • Ability to analyze clinical and operational data to drive improvement initiatives. • Excellent facilitation and project management skills and familiarity in process mapping and workflow analysis tools. • Strong problem solving, decision-making and negotiating skills. • Exceptional interpersonal skills and strong written and verbal communication skills. • Excellent organizational skills. • Ability to multi-task and meet deadlines. • Considerable knowledge of the laws, regulations and policies that govern the program, which includes and is not limited to contractual requirements adopted by NC Division of Health Benefits and other governmental oversight agencies. • Strong problem solving, negotiation, arbitration, and conflict resolution skills. • Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint. • Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements. • Ability to make prompt independent decisions based upon relevant facts. • Ability to establish rapport and maintain effective working relationships. • Ability to act with tact and diplomacy in all situations. • Ability to maintain strict confidentiality in all areas of work. • Experience with Electronic Health Records (HER) for clinical processes Education and Experience Required: Bachelor's degree and a minimum of four years of experience in managed care or a related field with a healthcare provider or insurer/payer. Relevant areas may include provider relations, network development or design, provider engagement services, contract management, or patient financial services. Experience in auditing, accounting, or finance is also applicable. A combination of relevant education and experience may be considered in lieu of a Bachelor's degree. Must be able to travel as required. 4 years of significant and relevant work experience in medical practice management in lieu of educational requirements may be accepted, particularly with significant administrative experience in a clinic setting. Must have the ability to travel as indicated. Other requirements: Must reside in North Carolina or within 40 miles of the NC border. Education and Experience Preferred: Bachelor's degree in Nursing, Public Health, Healthcare Administration, or a related field (Master's degree preferred). Deep understanding of value-based care models, healthcare quality programs, and population health initiatives. Demonstrated experience in practice transformation roles and practice support. Licensure/Certification Requirements: None

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Remote Option; Available for any of Partners' NC locations (or within 40 miles of NC border) Closing Date: Open Until Filled Primary Purpose of Position: The HEDIS Coding Specialist plays a critical role in ensuring accurate and compliant coding, documentation improvement, and adherence to National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. With a background in medical coding and clinical practice, the specialist is responsible for reviewing medical records, identifying appropriate diagnosis codes, and ensuring documentation supports coding accuracy. Additionally, they collaborate with healthcare providers to address incomplete or missing clinical documentation, educate on proper coding practices, and facilitate training sessions as needed. By conducting audits, analyzing data, and communicating with internal and external stakeholders, the specialist helps improve coding accuracy, optimize revenue, and enhance the quality of care delivered to patients. Their meticulous attention to detail, strong analytical skills, and compliance expertise contribute to the organization's success in meeting HEDIS reporting requirements and achieving quality improvement goals. Role and Responsibilities: 1. Coding Review: Conduct thorough reviews of medical records to ensure accurate coding and documentation in compliance with National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. 2. Documentation Improvement: Identify opportunities for documentation improvement to support accurate coding and ensure alignment with coding guidelines and regulatory standards. 3. Provider Education: Collaborate with healthcare providers to educate them on proper documentation practices, coding guidelines, and HEDIS measures. Provide guidance and support to facilitate accurate coding and documentation. 4. Auditing: Perform audits to assess coding accuracy and completeness. Identify discrepancies, coding errors, and areas for improvement through audit findings. 5. Risk Adjustment Coding: Apply expertise in risk adjustment coding to accurately capture and report diagnosis codes relevant to Hierarchical Condition Categories, Risk Adjustment and Managed Care Contract reimbursement initiatives. 6. Data Analysis: Analyze coding and documentation data to identify trends, patterns, and opportunities for improvement. Use data-driven insights to develop strategies for enhancing coding accuracy and documentation completeness. 7. Quality Assurance: Ensure compliance with coding and documentation guidelines, regulatory requirements, and organizational standards. Monitor coding practices and documentation processes to maintain quality and integrity. 8. Provider Support: Serve as a resource for healthcare providers, offering guidance, feedback, and assistance with coding-related inquiries, coding challenges, and documentation queries. 9. Training and Development: Develop and deliver training sessions, workshops, or educational materials to healthcare providers and coding staff on coding best practices, documentation requirements, and HEDIS measures. 10. Collaboration: Collaborate with cross-functional teams, including Quality Improvement, Provider Relations, and Data Analytics, to support quality improvement initiatives, address coding-related issues, and achieve organizational goals. 11. Reporting: Generate reports and documentation to track coding accuracy, documentation improvement efforts, and compliance with HEDIS measures. Communicate findings and recommendations to stakeholders as needed. 12. Continuous Learning: Stay abreast of updates, changes, and advancements in coding guidelines, documentation standards, and regulatory requirements. Continuously enhance knowledge and skills through professional development opportunities. Knowledge, Skills and Abilities: Knowledge: 1. Medical Coding: Comprehensive understanding of ICD-10-CM, CPT, and HCPCS coding systems, including knowledge of coding conventions, guidelines, and updates. 2. HEDIS Measures: Familiarity with National Committee for Quality Assurance (NCQA) HEDIS measures, specifications, and reporting requirements. 3. Risk Adjustment: Understanding of risk adjustment methodologies and concepts, including Hierarchical Condition Categories (HCCs) and CMS risk adjustment models. 4. Clinical Documentation: Knowledge of clinical documentation standards, terminology, and practices to ensure accurate coding and documentation. 5. Regulatory Compliance: Understanding of healthcare regulations, coding guidelines, and compliance standards related to HEDIS reporting, risk adjustment, and medical coding. Skills: 1. Coding Proficiency: Strong coding skills with the ability to accurately assign diagnosis and procedure codes based on clinical documentation. 2. Attention to Detail: Meticulous attention to detail to identify coding discrepancies, documentation deficiencies, and coding errors. 3. Analytical Skills: Ability to analyze coding and documentation data, identify trends, and draw insights to support quality improvement initiatives. 4. Communication Skills: Effective communication skills, both verbal and written, to convey coding guidelines, provide feedback to providers, and collaborate with cross-functional teams. 5. Problem-Solving: Strong problem-solving skills to address coding challenges, resolve discrepancies, and implement solutions to improve coding accuracy and documentation completeness. Abilities: 1. Adaptability: Ability to adapt to changes in coding guidelines, regulatory requirements, and organizational processes related to HEDIS reporting and risk adjustment. 2. Time Management: Effective time management skills to prioritize tasks, meet deadlines, and manage multiple coding projects simultaneously. 3. Collaboration: Ability to collaborate with healthcare providers, coding staff, quality improvement teams, and other stakeholders to achieve coding accuracy and documentation improvement goals. 4. Continuous Learning: Commitment to continuous learning and professional development to stay updated on coding guidelines, HEDIS measures, risk adjustment methodologies, and regulatory changes. 5. Quality Focus: Strong commitment to quality and accuracy in coding and documentation practices to ensure reliable data for HEDIS reporting and support quality improvement efforts. Education Required: Bachelor's degree in health information management (HIM), Health Information Technology, Medical Coding, Nursing, or related healthcare field; OR Associate's degree in health information management or medical Coding with minimum 3 years of medical coding experience Experience Required: Minimum 2-3 years of experience in medical coding and documentation Minimum 1 year of experience with HEDIS measures and reporting Experience with risk adjustment methodologies and HCC coding preferred Technical Skills: Proficiency in ICD-10-CM/PCS, CPT, and HCPCS coding systems Experience with coding software and audit tools Advanced Excel skills for data analysis and reporting Performance Metrics: Demonstrated coding accuracy rate of 95% or higher Ability to code minimum of 20-25 charts per day while maintaining quality standards Education/Experience Preferred: Master's degree in health information management or related field 5+ years of medical coding experience Previous experience in managed care or health plan environment Experience with Epic, Cerner, or other major EHR systems Knowledge of Medicare Advantage and Medicaid managed care operations Knowledge of SQL or other database query languages preferred Licensure/Certifications Required: Current certification from AHIMA (CCS, RHIA, RHIT) or AAPC (CPC, CRC) HEDIS certification or ability to obtain within 6 months of hire

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Remote option; Available for any of Partners' NC locations Closing Date: Open Until Filled Primary Purpose of Position: This position provides nonclinical administrative support to the PartnersACCESS call center. The Call Center Representative primary responsibility is to answer inbound calls and assist callers by connecting them to the appropriate party, sharing information, providing technical assistance, answering questions, handling and/or resolving complaints. Must maintain a high level of professionalism, patience and empathy working with callers who may be frustrated and may have complex medical, behavioral health, intellectual and other developmental conditions; and must still maintain the highest level of customer satisfaction by seeking first call resolution. Must live in North Carolina and preferably in Partners counties. Role and Responsibilities: Ability to learn complex information about two Medicaid health plans and their benefits. Work in a call center environment and interact with callers who are generally members and providers, to deliver information, answer frequently asked questions, and address complaints. Route calls to the appropriate resource. Including appropriately identifying and elevating those more complex or crisis calls. Understand Health/Mental Health (MH)/Substance Use (SU)/Traumatic Brain Injury (TBI)/Intellectual/Developmental Disability (I/DD) treatment needs, benefit information and referral of members calling to determine if they may potentially qualify for services. Review call notes, enrollments, registrations, or other identified documents for completeness and/or accuracy. Collect and enter demographic data into the electronic record, completion of appropriate forms, explanation of services, benefits and resources, verifies Medicaid and dispatch. Provide follow up calls. This position demands a high level of accuracy and confidentiality. Information must be handled according to NC standards and rules, state and federal laws and LME/MCO and NCQA standards, procedures, policies and protocol. Trained on the requirements, policies and procedures of the BH I/DD Tailored Plan operating in North Carolina and can respond to all areas within the Member Handbook and Provider Manual, including resolving claims payment inquires in one touch. Automation: Screenings are completed using standard and specialized computer programs. Inputs accurate information into the system and unlocks electronic service records with appropriate consents, enters all necessary data elements into data systems. Cooperative Efforts: Must be a team player and have a positive attitude. Establish and maintain effective working relationships within the unit, agency, and service system Consistently demonstrate professionalism, tact and diplomacy in handling volatile callers and/or working with contract providers and other external parties. Participate in Unit Staff meeting, Agency Staff meetings, (All staff meetings) and assigned committees. Interacts by phone with providers to provide information in response to inquiries, concerns, and questions. Interact with providers to provide information in response to inquiries about services and other resources. BH I/DD Tailored Plan eligibility and services. Knowledge, Skills and Abilities: Knowledge/Ability to Learn: Health, mental health, substance use, traumatic brain injury and intellectual/developmental disability service delivery and NC Medicaid Managed Care system as well as the resources available in the community. Call center functions, member population, potential for crisis issues, confidentiality laws and program protocols/policies. High level computer skills. Ability communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task. Ability to provide technical assistance to both members and Providers. Ability to maintain confidentiality when screening and referring calls. Education/Experience Required: High School diploma and at least (1) year of healthcare and/or MH/SU/IDD/TBI experience. Education/Experience Preferred: Associate degree or higher and one (1) year of healthcare or MH/SU/IDD/TBI experience, or Associates Degree in Nursing (ADNs) and at least one (1) year of healthcare and/or MH/SU/IDD/TBI experience. Bilingual preferred (for one of the positions). Licensure/Certification Requirements: N/A

If you are interested in joining the team, please submit a cover letter with your resume for consideration. Best for consideration: 1/16/2026 What We Seek: The University of New Mexico Foundation (UNMF) seeks an experienced, strategic, and collaborative Senior Associate Vice President for Development (Senior AVP). Reporting directly to the Senior Vice President of the UNM Foundation, the Senior AVP serves as a key member of the Foundation's leadership team overseeing multiple units: Regional Development, Branch Campuses, Corporate Foundations & Relations (CFR), Gift Planning, Acquisitions, Donor Engagement, and Events/Programs. This senior leader is responsible for driving fundraising strategy, ensuring operational excellence across multiple development functions, fostering a culture of accountability and collaboration, and personally managing a portfolio of principal gift prospects. This role plays a central part in advancing UNM's mission and expanding philanthropic support across the University. What We Require: The successful candidate will bring a strong foundation in advancement practices, demonstrated experience guiding development teams, and the ability to navigate complex organizational environments with professionalism and discretion. This role requires someone who can interpret and apply best practices in fundraising, communicate effectively with a wide range of stakeholders, and make informed decisions grounded in data, ethics, and sound judgment. Candidates should demonstrate the capacity to manage competing priorities, mentor staff, and maintain a high level of organization while supporting a mission-driven work environment. The minimum education and experience required: Baccalaureate degree from an accredited institution required; Masters Degree preferred. Eight (8) or more years related development experience. Six (6) or more years experience in major gift fundraising. Six (6) or more years experience in management. Experience in higher education or other non-profit organization. Compensation Salary Range: The expected salary for this position is $137,000 - $205,600+. This range is an estimate, and the final salary will be determined based on the selected candidate's experience and qualifications, consideration of any approved geographic salary differential, and alignment with internal equity guidelines to ensure consistency across similar roles. Why Join the Foundation: The UNM Foundation is a diverse, inclusive, and mission-driven community dedicated to advancing the University's impact through research, education, and service. Our staff collaborate with passionate development professionals and enjoy competitive benefits, including healthcare, professional development, flexible paid leave, paid holidays, wellness programs, and strong retirement contributions. We value diverse perspectives and unique experiences, fostering a welcoming environment where you can make a lasting difference in New Mexico and beyond. Benefits: 403(b) Dental insurance Employee assistance program Flexible spending accounts Health insurance Health savings account Life insurance Paid time off Tuition reimbursement Vision insurance Business Hours: Monday through Friday Operating Hours from 8:00am - 5pm (MST) Weekend availability for some positions Hybrid/Remote work available as appropriate for the role Work Location: 700 Lomas Blvd. NE, Two Woodward Center, Albuquerque, NM 87102 Accessibility : The University of New Mexico Foundation is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. If you are interested in applying for employment with us and need special assistance or an accommodation to use our website or to apply for a position, please contact Robert Moreno, Talent Acquisition, Human Resources Generalist, at **************. The University of New Mexico Foundation participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. This role does not offer visa sponsorship.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Hybrid/Remote option; Available for any of Partners' NC locations Closing Date: Open Until Filled Primary Purpose of Position: This position will assist the Provider Network Contract Manager in identifying, negotiating, and contracting with Medicaid healthcare providers to join Partners' health plan network. This position will be responsible for drafting, implementing, and monitoring of all provider contracts, ensuring all financial requirements and obligations are accurately identified and executed. Role and Responsibilities: Perform healthcare provider contracting services. Recruitment and contracting efforts may include, but not be limited to, telephone calls, email, regular mail, facsimile transmissions and visits to targeted provider offices to initiate, negotiate, and procure executed participating provider agreements. Leads all aspects of negotiations for facility, physician and network managed care agreements under general supervision from management Coordinates, analyzes and develops all financial and operational aspects of contract proposals, including drafting and nominally redlining agreements and amendments. Works with the Contracts Managers and Contracting Director for Provider Network to develops a negotiation strategy, assessing the strengths of each party in the negotiation. Coordinates with internal departments and contracted providers to implement and maintain contract compliance. Prepares correspondence to managed care providers. Works with the Contract Coordinators to ensure a workflow and contract management process follows the contracting to include loading into contract management system and preparation of contract summaries outlining contract terms for internal stakeholders. Establishes and maintains relationships with providers and support them through connection with the Provider Relations team. Acts as a professional resource to answer all contractual questions and facilitate issue resolution with internal and external stakeholders. Assists with development and maintenance of reports used to track contracting activity and report outcomes. Performs other duties as assigned. Knowledge, Skills and Abilities: Considerable knowledge of state and federal fiscal rules and regulations Knowledge of and ability to explain and apply the provisions of contractual practices adopted by State Government Strong problem solving, decision-making and negotiating skills Strong written and verbal communication skills Excellent organization skills Ability to multi-task and meet deadlines Considerable knowledge of the laws, regulations and policies that govern the program Exceptional interpersonal and communication skills Strong problem solving, negotiation, arbitration, and conflict resolution skills Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements Ability to make prompt independent decisions based upon relevant facts Ability to establish rapport and maintain effective working relationships Ability to act with tact and diplomacy in all situations Ability to maintain strict confidentiality in all areas of work Education and Experience Required: Bachelor's Degree and four years of negotiation experience in managed care or a related field (such as healthcare finance or patient financial services) with a healthcare provider or insurer/payer, auditing, accounting, finance, or contract management; or an equivalent combination of education and experience. A combination of relevant experience may be considered in lieu of a Bachelor's degree. Must have ability to travel as indicated. Must reside in North Carolina or within 40 miles of the NC border. Education and Experience Preferred: Familiarity with State health care programs preferred.

**This is a mobile position which will work primarily out in the assigned communities.** Join a Mission That Moves With You: Mobile/Remote Care Management across NC Why You'll Love Working Here In 2026, the future of healthcare is in the community. As an I/DD Care Manager at Partners, you aren't just managing files-you are the architect of a better life for individuals with Intellectual and Developmental Disabilities. We offer a role that balances clinical excellence with geographic flexibility , supported by one of the most stable and competitive benefits packages in North Carolina. The Perks of Joining Our Team: Work Where You Live: Fully mobile/remote role serving the counties you live in, work in and call home. Financial Security: State Retirement Pension plan, 401(k) with employer match, company paid life and disability insurance, and an annual incentive bonus. Health & Wellness: Low-deductible medical/dental plans and generous vacation + sick time accruals. Student Loan Relief: We are a Public Service Loan Forgiveness (PSLF) Qualifying Employer -let your work pay off your education. Celebrate Life: 12 paid holidays and dedicated wellness programs. See attachment for additional details. Location: Available for Gaston, Cleveland, Rutherford NC locations; Mobile/Remote position Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Your Impact & Role As a Partners Care Manager, you will serve as the primary point of contact and navigator for members with I/DD and/or dually diagnosed members. You will lead "Team Based Care," ensuring our members receive holistic support that integrates physical health, behavioral health, and long-term supports and services. What a Typical Week Looks Like: Meet Members Where They Are: Meet members in their communities to assess their current and projected needs to build Person-Centered Care Plans/Individual Support Plans (ISP) to get them closer to achieving their vision for their lives. Integrative Leadership: Facilitate interdisciplinary team meetings to ensure doctors, specialists, providers and families are all moving in the same direction to meet the member's needs. Transition Expert: Guide members through life's big changes-moving from school to adulthood, returning home from care facilities, gaining optimal independence and finding the right combination of paid supports to maintain or increase overall health and wellness. Empowerment: Educate members and families on their rights and connect them to the array of services and our network of providers to secure their future. Who You Are A Mobile Professional: A North Carolina resident and you thrive on the road and value the autonomy of a community-based role. Travel is an essential part of how you connect with those you serve. A Systems Navigator: You understand (or are eager to master) Medicaid regulations, 1915i services, and the Tailored Plan landscape. A Person-Centered Planner: You believe there is no "one size fits all" solution in care management. You bring a voice to vulnerable individuals through your strengths of observation, connecting the dots, supporting their journey through your planning skills. Qualified Candidate to apply : You've earned your degree and put it to work! Congratulations! You are who we are looking for if one of these many different scenarios describe you… You have earned a Bachelor's degree in a human services field like psychology, social work, nursing or other relevant human services field: and you bring with you a minimum of 2 years full-time experience working with individuals with Intellectual and Developmental Disabilities and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community OR You earned a Bachelor's degree outside the human services field and you have at least 4 years full-time experience working with individuals with Intellectual and Developmental Disabilities. and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community OR You earned a Master's degree and have a minimum of 1 year full time experience working with individuals with Intellectual and Developmental Disabilities and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community

- not eligible for benefits Projected Hiring Range: Depending on Experience Primary Purpose of Position: This position provides the initial screening, referral and or scheduling of members who call the toll-free PartnersACCESS Member Services number seeking health and behavioral health services and as appropriate, transfers the member to a clinician who will clinically triage/assess the member's acuity and will determine what type and intensity of service the member needs and/or is eligible to receive. Role and Responsibilities: Screening, scheduling and referral: Initial screening of Health/Mental Health (MH)/Substance Use (SU)/Traumatic Brain Injury (TBI)/Intellectual/Developmental Disability (I/DD) treatment needs, benefit information and referral of members calling to determine if they may potentially qualify for services Collect and enter demographic data into the electronic record, completion of appropriate forms, explanation of services, benefits and resources, verifies Medicaid and dispatch Provide follow up calls to referral sources and members to ensure that members have been successfully engaged in services Make referrals to clinical homes and crisis providers that meet the timeliness standards as defined by NC Medicaid Provide information about local community resources, independent practitioners, and related providers for referrals for basic benefit services This position demands a high level of accuracy and confidentiality. Information must be handled according to NC standards and rules, state and federal laws and LME/MCO and NCQA standards, procedures, policies and protocol Authorizations: Assists with authorizations/admissions to state hospitals, ADATC, Three Way Hospitals, Level III Detox, Facility Based Crisis and all referrals to crisis services Process other acute care authorizations as requested by supervisor or other Access to Care Licensed Clinician Automation: Screenings are completed using standard and specialized computer programs Inputs accurate information into the system and unlocks electronic service records with appropriate consents, enters all necessary data elements into data systems Provide technical assistance to First Responders, clinical home providers, and Mobile Crisis Management Cooperative Efforts: Establish and maintain effective working relationships within the unit, agency, and service system Consistently demonstrate professionalism, tact and diplomacy in handling irate callers and/or working with contract providers and other external parties Participate in Unit Staff meeting, Agency Staff meetings, (All staff meetings) and assigned committees Knowledge, Skills and Abilities: Sound knowledge of health/MH/SU/TBI/I/DD for the appropriate determination of eligibility for Medicaid and State supported services, appropriateness of referrals for treatment and assessment and the level of danger of the members calling for assistance Knowledge of the laws governing the treatment of health, mental illness, substance abuse and intellectual/developmental disabilities as well as the resources available in the community for treatment Knowledge of call center functions, member population, potential for crisis issues, confidentiality laws and program protocols/policies Excellent computer skills Ability to complete tasks independently, define problems, apply laws, policies and procedures to agency activities and must use sound judgment in conducting screening, triage and referral Ability to use sound judgment when conducting a screening and be able to determine when it is necessary and appropriate to transfer a member to a Licensed Access to Care Clinician Ability to communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task (that is: converse while entering screening information into the electronic medical record and evaluating the member's need) Ability to take highly complicated criteria and apply it to cases in determining eligibility for services and appropriate scheduling referrals Ability to assist members in highly stressful situations which may be life threatening to the member or public while at the same time facilitating a connection to crisis services and/or a Licensed Access to Care Clinician Ability to provide technical assistance to both members and Providers Ability to maintain confidentiality when screening and referring calls/callers Education/Experience Required: Bachelor's Degree in related field or Licensed Practical Nurse (LPN) and at least two (2) years of healthcare or MH/SU/IDD experience. Education/Experience Preferred: Licensed practical nurses (LPNs) and at least four (4) years of healthcare and/or MH/SU/IDD experience. Licensure/Certification Requirements: N/A

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Hybrid option; Available for the Gastonia, NC location Closing Date: Open Until Filled Primary Purpose of Position: To provide executive-level paralegal and administrative services for the Office of Legal Affairs (OLA), including Chief Legal Officer/General Counsel (CLO/GC), Director of Legal Services, staff attorney(s), legal specialist(s) and waiver contract manager. Highly collaborative culture. Under licensed-attorney supervision where required, this position entails professional legal work in a variety of legal/operational areas or functions, including but not limited to legal research; and drafting, reviewing, proofing and communicating legal/regulatory matters regarding litigation, transactions/contracts, regulation, legislation, internal and external dispute resolution, grievances/complaints, and related legal projects. As detailed further below, key role will be managing Partners many complex policies and procedures (P&Ps), as well as program descriptions, plans and even assisting with board guidelines. In addition, position will require successful applicant to field, route and/or address (or to ensure attorney and/or OLA team addresses) legal issues and questions from various Partners' business units and staff. Examples of work include coordinating all aspects of the internal Policy and Procedure process (with assistance of waiver contract manager); preparation and occasional participation in board level and committee meetings; assist legal team with their projects, including, e.g., key OLA metrics and ensure monitoring, prompt routing, payment and reimbursement of legal bills and expenses. Works with extremely sensitive and confidential information and records. Perform other duties as needed consistent with an executive level paralegal. Work closely with Associate General Counsel, Director of Legal Services, Waiver Contract Manager, Legal Specialist, Program Integrity Director, and their teams, also located in OLA. Position reports directly to Director of Legal Services. NOTE: Representation of Partners in a court of law and other acts constituting the practice of law are the responsibilities of attorneys in or for OLA. Position will cooperate with, assist and take significant responsibility for preparation of work by attorneys, but have no authority to act as legal counsel for Partners or to practice law without a license. Role and Responsibilities (percentages are approximations): 50% Policies and Procedures (P&Ps): With assistance and guidance of waiver contract manager, will be directly responsible for Partners' almost 300 P&Ps, that must be regularly reviewed, vetted and approved by management, leadership and Board. This includes oversight of revision and creation of P&Ps by Partners' staff for accreditation, certification, contract and regulatory compliance. Also, can include Program Descriptions, Plans and perhaps assisting with board guidelines. Assist with and/or manage automation and process improvement of P&Ps. As detailed below, this role requires extensive organizational skills, knowledge and comfort with software, critical thinking, and strong writing and collaborative communications skills. 35% Traditional Paralegal Services: With assistance from attorneys, legal specialists, waiver contract manager, and program integrity investigators, provides moderate to complex legal support services. Examples include: performing legal research, both formal from traditional legal research databases (currently Lexis) and from non-traditional resources such as State and Federal legislative and regulatory websites. assisting with obtaining, reviewing, proofing, executing and interpreting contracts and transactions. assisting with drafting, review, proofing and issuing communications with staff, outside counsel and opposing counsel regarding contracts, litigation (subpoenas, hearing notices, pleadings, motions) and related legal projects; assisting with or fielding, routing and and/or addressing legal issues and questions from various Partners' business units and staff, and/or ensuring appropriate OLA staff does so; attending and or assisting attendees with key meetings, hearings and conferences, providing insights to and taking notes for OLA team and Partners. gather, organize and marshal on demand relevant documents, information and evidence to support OLA work and obligations. liaising with Program Integrity staff on legal matters arising to legal staff from or related to investigations of alleged fraud, waste and abuse; consulting OLA attorneys for supervision on matters and in any instance that might be construed as the practice of law. 10% Administrative Support: Provides comprehensive and often sophisticated/complex administrative support to OLA team. Examples include assisting OLA staff or directly to: maintain OLA legal files and records. create, maintain, analyze and report key OLA metrics using various OLA-specific resources and interdepartmental support. routing, payment and reimbursement of legal bills and expenses, including potential assistance with the OLA legal matters management and invoicing software and database (currently CounselLink). communicate with outside counsel regarding pending assigned cases and legal matters, billing guidelines and other needs. coordinate and support highly visible functions and events, including preparation for board, executive, management level and other meetings; provider forums, council and other meetings; legal trainings; and other events involving Team OLA. reserve and arrange meeting space, including IT needs. schedule and coordinate select conference calls, meetings, mediations, and hearings. handle staff expense reimbursements, travel reservations, supplies and miscellaneous OLA operational matters. 5% Other Duties as Assigned: In all roles and responsibilities, assures confidentiality of information of a sensitive nature within the department and organization. Adheres to court, regulatory, Partners' and other deadlines. Highly organized and digitally proficient, and able to multitask in fast-paced, detail-oriented -- but highly collaborative, team-oriented and cross-functional -- environment. Maintains a thorough understanding of legal procedures and documents. Able and authorized to exercise good judgment in a variety of situations when communicating directly with persons within and outside Partners, including leadership, healthcare professionals, attorneys, judges, regulators and others. Strong oral and written communication skills essential. Significant attention to accuracy. Excellent people skills. Knowledge, Skills and Abilities: Considerable knowledge of the principles and practices of NC administrative law specifically and general knowledge of the laws, rules, and regulations applicable to LME/MCOs. Ability to maintain effective working relationships with the public and other persons contacted in the course of work. Ability to anticipate and timely meet deadlines and projects. Considerable knowledge of office practices, techniques, and technology. Working knowledge of and the ability to understand legal documents, contractual language, legal processes and other complex or sophisticated topics and materials. Excellent communication skills, both orally and in writing. Detail oriented with excellent organizational skills, including ability to manage multiple schedules and tasks. Proficiency in Word, Excel, Outlook and PowerPoint, including the ability to design reports and presentations for internal and external recipients; excellent typing skills. Proficiency in law-related and P&P software and database resources, including or comparable to LexisNexis and CounselLink. Ability to manage and uphold integrity and confidentiality of sensitive data, internally and externally. Ability to analyze, understand, and complete tasks related to state and federal rules, regulations and laws. Ability to establish and maintain effective, positive working relationships with staff, other members of the organization and stakeholders. Ability to analyze, interpret and recommend policy, rules, and procedural guidelines. Ability to complete non-routine activities and tasks that might require deviation from established procedures; must be able to choose the appropriate course of action and recognize the existence of and differences among situations; sound judgment and critical thinking. Ability to plan and carry out the day-to-day work of the office based on priorities and knowledge of the departments; and Ability to recognize sensitive or unusual situations that should be referred to another more appropriate staff member or to the supervisors. Commitment to Partners' core culture values. Education and Experience Required: A minimum experience of two years in a law-related role with law firm or law department. Working knowledge of legal database software, e.g., LexisNexus or Westlaw. Extensive knowledge and proficiency of Microsoft Office products (Word, Excel, Outlook, PowerPoint, etc.). Comfort and experience with electronic modes of communication, filing, record keeping and office management. While not frequent, must have ability to travel between counties. Must reside in North Carolina or within 40 miles from its border. Education and Experience Preferred: Associate or higher degree in Legal Studies, Business, Office Administration, Healthcare, Human Services or other relevant field, including, paralegal/legal studies, Criminal Justice, Political Science, or legal assistant. Experience in healthcare, especially public behavioral health, managed Medicaid, and healthcare payor systems and law. Knowledge of and experience/proficiency with LexisAdvance, CounselLink, WestLaw and e-OAH. Substantial prior paralegal, legal assistant or related working experience or credentialing highly preferred, especially certification as paralegal or legal assistant, e.g., NCCP. Licensure/Certification Requirements: Paralegal, Legal Assistant, or similar recognized certification, e.g. NCCP (out of state certification acceptable). Law license not required. JDs welcomed to apply but should not expect promotion to attorney position with or without license.

**This is a mobile position which will work primarily out in the assigned communities.** Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Mobile/Remote position; Available for any of Partners' NC locations Projected Hiring Range : Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: The Mental Health Substance Use Care Manager focuses on working closely with community hospitals, providers, and stakeholders to engage adults and/or children/adolescents in mental health/substance use services. This position is responsible for providing proactive intervention and care management (treatment planning, assessment, referral/linkage, and monitoring) to ensure that members and recipients receive appropriate assessment, oversight and services. This is a mobile position with work done in a variety of locations. Role and Responsibilities: Provide education, referrals, care management activities surrounding available services and supports including Physical Health, Behavioral Health, I/DD, LTSS, TBI, Pharmacy, Vision, and Dental services/supports. Link to needed behavioral health and physical health care services and facilitating appropriate connections to primary healthcare services through Community Care of North Carolina, the Health Department, or other community health resources Coordinating and linking members to benefits Complete initial and yearly Care Management Comprehensive Assessment and Care Plan Conduct Care Team meetings and ensure treatment team members participate in treatment team meetings to address the needs of the member Conduct continuous monitoring of progress towards goals identified in Care Plan through in-person and collateral contacts with the member and member's supports, including family, information and formal caregivers and routine care team reviews Identify the gaps in needed services and intervene as needed to ensure the member receives appropriate care Identify and refer member to community resources Oversee care transitions for members who are moving from one clinical setting to another Maintain accurate tracking and data information for care management activities and outcomes including tracking of individuals in and out of services, those who are on waiting lists, those who need follow-up, and those on outpatient commitments Collaboration Serves as a collaborative partner in identifying system barriers through work with community stakeholders Manages and facilitates Child/Adult High Risk Team meetings in collaboration with DSS, DJJ, school systems, CCNC Care Managers, and other community stakeholders as appropriate The MHSU Care Manager may work with members in the communities Works in partnership with other LME/MCO departments to address identified needs within the catchment area Knowledge, Skills and Abilities: Extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) Considerable knowledge of the MHSU/IDD service array provided through the network of the LME/MCO's providers Knowledge of LME/MCO's implementation of the 1915(b/c) waivers and accreditation Highly skilled at assuring that both long and short-range goals and needs of the individual are addressed and updated, while assuring through monitoring activities that service implementation occurs appropriately Exceptional interpersonal and communication skills Excellent computer skills including proficiency in Microsoft Office products (Word, Excel, Outlook, and PowerPoint) Excellent problem solving, negotiation, arbitration, and conflict resolution skills Detail-oriented, able to organize multiple tasks and priorities and effectively manage projects from start to finish Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships Ability to change the focus of his/her activities to meet changing priorities A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance Education/Experience Required: *Qualified Professional Care Manager: Bachelor's degree in a human service field and at least two years of full-time experience with the population served -or- Bachelor's degree in a field other than human services with at least four years of full-time experience with the population served -or- Master's degree in a human service field and one year of full-time experience with the population served *Provisionally Licensed Care Manager: Master's degree in a human service field and one year of full-time experience with the population served Current unrestricted LCSW-A, LCMHC-A, LCAS-A, LMFT-A Employee is responsible for complying with respective licensure board's continuing education/training requirements in order to maintain an active provisional license (prior to obtaining full licensure). *Licensed Care Manager: Master's degree in a human service field and one year of full-time experience with the population served -or- Licensure as a registered nurse (RN) and four (4) years of full-time accumulated experience with the population served Current unrestricted LCSW, LCMHC, LPA, LMFT, LCAS, or RN licensure with the appropriate professional board of licensure in the state of North Carolina. Employee is responsible for complying with respective licensure board's continuing education/training requirements in order to maintain an active license. Other requirements: Must reside in North Carolina. Must have ability to travel as needed to perform the job duties Education/Experience Preferred: Above requirements Licensure/Certification Requirements: Above requirements