Home care coordinator work from home jobs - 112 jobs

About the Role Check out the role overview below If you are confident you have got the right skills and experience, apply today. At Care Options for Kids, we provide 1:1 care in the home, and we do things a little differently. There's no revolving door of patients or hospital setting chaos blinking call lights, scurrying doctors, and wards bursting at the seams. Instead, you work with self-sufficient autonomy, empowered to make a real difference in your clients' lives. We value your clinical knowledge and respect the deep one-on-one bond you establish with the families you care for. Of course, if you need anything, your Director of Nursing is only a phone call away we offer 24-hour, 365-day support and on-demand clinical resources. Benefits for Licensed Practical Nurses (LPNs) Paid Time Off (PTO) and flexible schedule Medical, Dental and Vision Coverage 401k Weekly pay and direct deposit 24/7 On Call for support Career advancement Nurse Referral bonus Training opportunities Respiratory therapists on staff to provide training and mentorship Responsibilities of Licensed Practical Nurses (LPNs) Providing one-to-one nursing care in a home environment Taking direction from clinical team and being overseen by a registered nurse Following the plan of care Following all clinical and office policies Requirements for Licensed Practical Nurses (LPNs) Valid New Jersey LPN License or Multistate License Physical from within three years TB Skin Test (PPD) or TB Blood Test (QF) Valid BLS CPR card (obtained in person not online) Valid driver's license G-tube, trach, vent experience or willing to train About Care Options for Kids Care Options for Kids is the leading provider of pediatric nursing services. Our mission is to provide high-quality pediatric services that help children and families live their best lives. Achieving that mission can only be accomplished with talented and caring nurses like you. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapies, ABA therapy, nursing, Family Caregiver Services, and school-based services. We value the health and well-being of our nurses and understand the vital role you play in caring for our clients. PPE is provided in each home including masks, gloves, and hand sanitizer. xevrcyc We follow CDC guidelines to ensure you, your client, and your family stays healthy. #APPNUNEP #RDNUNEP Salary: $66560.00 - $70720.00 / year

HealthPartners is looking for a Certified Adult/Geriatric or Family Nurse Practitioner to join our Home-Based Medicine Team. Being a part of our team means you will have an impact on the care that our patients receive every day. As a Home-Based Medicine Nurse Practitioner/Care Coordinator, you will be part of the largest multi-specialty care system in the Twin Cities. This position will provide both telehealth and fieldwork with seeing patients in their homes. Local travel required. This individual will provide the primary health care for patients at home. * Provide care coordination to achieve patient centered, high quality and cost-effective care across the continuum * Provide nursing leadership in defining and achieving program goals in a changing healthcare environment * Utilizes principals of quality of life, maintenance of optimal function and the patient's advanced directives in developing plan of care * Supportive, patient-centered practice * MN RN and APRN licensure required along with prescriptive authority * Home Based Medicine experience (NP or RN) preferred * Must be able to provide own transportation for local travel. You will be joining a team that is supportive and respectful of one another and deeply committed to the mission of HealthPartners. Here, you'll become a partner for good, helping to improve the health and well-being of our patients, members and community. Our commitment to excellence, compassion, partnership and integrity is behind everything we do. It's the type of work that makes a difference, the kind of work you can be proud of. We hope you'll join us. WORK SCHEDULE: 8am - 5:00 pm BENEFITS: HealthPartners benefit offerings (for 0.5 FTE or greater) include medical insurance, dental insurance, 401k with company contribution and match, 457(b) with company contribution, life insurance, AD&D insurance, disability insurance, malpractice insurance for work done on behalf of HealthPartners as well as a CME reimbursement account. Our clinician well-being program provides a wealth of information, tools, and resources tailored to meet the unique needs of our health care professionals, including physicians, advanced practice clinicians (APCs) and dentists. HealthPartners is a qualified non-profit employer under the federal Public Service Loan Forgiveness program. TO APPLY: For additional information, please contact Judy Brown, Sr. Physician and APC Recruiter, *********************************. For immediate consideration, please apply online.

OUR PURPOSE We are focused on Good Living for the Greater Good. This means providing a true sense of home and belonging for our Neighbors and Prometheans and giving our time and resources to bring positive change locally and beyond. It also means supporting you in your career goals with the very best working experience, and that starts with us having fun in the work we do together. YOUR ROLE AND IMPACT Some companies call them “Property Administrators”, but at Prometheus our Home Base Coordinators do so much more. Our Senior Home Base Coordinators focus on the administration of multiple properties, and your role is a constant blend of: Financial Administration - Whether it is managing rent collections, reviewing ledgers, processing final account statements, or tracking invoices, you are on top if it all. You make every detail count and count every detail. Leasing Administration - You will provide support to the leasing team in qualifying future Neighbors - verifying applications, performing credit investigations, creating all associated documentation accompanying the rental agreements, and recertifications specifically related to Below Market Rate Housing or similar. Customer Service - You are a problem solver that makes renting easy. When Neighbors have questions about policies or deposit charges, you help them find the answers. When the office gets busy, you are the first one to jump in and answer the phones and provide support to the leasing team in qualifying future Neighbors. JOB QUALIFICATIONS Your Experience - Prometheans come from all walks of life and from all over the globe. We're also very diverse in that we hire talent with experience in other industries and who bring different skill sets and ideas to our company. You should bring a passion for working in a customer service, working knowledge of housing rental laws & ordinances, and enjoy solving problems. Your Cultural Traits - Although we're a highly dispersed organization by the nature of our business, our Prometheans are strongly united by our Purpose, Mission and our Cultural Traits. These are the defining characteristics of a Promethean: Team Oriented, Communicator, Entrepreneurial, Passionate, Self-Starter, Creative, Principled, and Brand Ambassador. Your Education - A Bachelor's degree is preferred and a High school diploma or general education degree (GED) is required. COMPENSATION & BENEFITS We offer a variety of benefits that take compensation well beyond a paycheck. This includes traditional benefits and benefits you might not expect or know about. The provided salary range is based on a number of factors, including location, job-related skills, experience and qualifications. Compensation Pay Range: $33.25 to 40.25 per hour Discretionary Semi-Annual Bonus Plan Benefits & Perks Medical; Vision; Dental:100% Company-paid plans (including eligible dependents) and affordable buy-up options Life insurance; Accidental Death & Dismemberment Insurance; Long Term Disability Behavioral Health Program Accessible 24/7 Tax-Free Flexible Spending Accounts 401(K) Retirement Plan with Employer Matching Recognition & Rewards Program (Torch) Vacation: 10 days per year with accrual increasing over time Anniversary Vacation: 40-hour Vacation Granted at Tenured Milestones Sick Leave: 9 days per year 12 paid holidays, including your birthday! Paid Volunteer Time Tenured-based Housing discounts Educational Assistance, Tuition Reimbursement Learn more about these and other perks of being a Promethean by exploring our full Benefits Guide. Prometheus is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, veteran status, or any other status protected under federal, state or local law. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you'd like more information about your EEO rights as an applicant under Federal Employment Laws, please check out these FMLA, EEO, and EPPA pages.

Job Title: Work From Home-Online Hotel Coordinator-Entry Level About Destination Knot:Destination Knot is a travel planning company dedicated to creating unforgettable experiences for every type of traveler. From romantic getaways and family vacations to group trips and business stays, we provide personalized hotel and resort booking services with care and attention to detail. Position Overview: We're looking for a motivated and detail-oriented Online Hotel Coordinator to join our remote team. This is an entry-level role ideal for someone eager to begin a career in the travel industry. You'll help match clients with the perfect hotel accommodations, manage bookings, and provide outstanding customer support throughout the planning process. Key Responsibilities:Assist clients in researching and booking hotel and resort accommodations Respond to inquiries via email, phone, or chat in a timely, professional manner Review client preferences to recommend suitable lodging options based on budget, location, and travel dates Manage reservation details and updates using booking tools and systems Maintain accurate client records and documentation Support post-booking needs such as changes, special requests, or follow-up questions Stay informed on current travel trends, hotel promotions, and destination offerings Qualifications:No prior travel industry experience required-training provided Strong communication and customer service skills Organized, dependable, and detail-oriented Comfortable working remotely and managing tasks independently Tech-savvy with basic knowledge of online platforms (booking systems a plus) Must be 18 years or older with reliable internet access and a computer Passion for travel and helping others plan great experiences What We Offer:Remote, flexible work environment Entry-level onboarding and continuous training Supportive team and professional development opportunities Access to industry tools and hotel booking platforms Travel perks and performance-based incentives Work Environment: This is a remote position with flexible hours. It's perfect for individuals who are self-motivated, enthusiastic, and ready to start a fulfilling path in the travel and hospitality industry.$40,000 - $60,000 a year We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Part-time Description We're pleased to announce an opportunity for the position of Health Home Care Coordinator within the Community Based Teams Department. The Health Home Care Coordinator provides comprehensive care coordination services to eligible individuals and their families. This role involves assessing member needs, developing and monitoring individualized service plans, making appropriate referrals, and advocating on behalf of members with other service providers. Care Coordinators maintain a dedicated caseload and ensure consistent monthly engagement with assigned members across various settings. Health Home Care Coordinator's support members in identifying and accessing resources, delivering health education, and applying motivational interviewing techniques to foster goal achievement, resilience, and healthy lifestyle choices. The Care Coordinator promotes wellness through coaching and awareness of chronic health conditions, aiming to reduce emergency service usage and prevent hospital readmissions. *Prefer that the candidate resides in Whitman County, WA (or nearby) to provide in-person support as needed. Position is primarily remote but includes local travel (Whitman County) for member meetings. Benefits Information Medical and Dental insurance options for employees and families Vision and Life insurance as well as other auxiliary insurance options 403(b) retirement plan with up to 6% matching contribution Health Savings Account and Flexible Spending Account options Paid vacation earned on a pro-rated basis according to worked/paid leave hours Paid Sick leave earned on a pro-rated basis according to actual hours worked Eleven paid holidays per year on a pro-rated basis according to hours worked *Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Salary Description Offered At: $21.65 - $23.42 per/hr.

is Remote (US/Canada) No agencies please Maximus (****************************** is a mission-driven consumer performance medicine telehealth company that provides men and women with content, community, and clinical support to optimize their health, wellness, and hormones. Maximus has achieved profitability, 8-figure ARR, and is doubling year over year - with a strong cash position. We have raised $15M from top Silicon Valley VCs such as Founders Fund and 8VC as well as leading angel investors/operators from companies like Bulletproof, Tinder, Coinbase, Daily Stoic, & Shopify. Position Summary In this role as a Care Coordinator supporting Maximus patients, you will be instrumental in delivering a seamless care experience. Your primary responsibilities include managing provider video conferencing schedules, coordinating with lab and pharmacy partners, and overseeing patient messaging queues. You will also serve as a key contributor to our patient concierge experience. The ideal candidate is driven by a passion for lifestyle, wellness, and fitness, constantly seeks innovative approaches to their work, and is eager to shape the overall patient journey. Key Responsibilities Video Conferencing & Scheduling Coordinate and maintain provider schedules for video consultations, ensuring efficient appointment booking and minimizing scheduling conflicts. Monitor upcoming telehealth appointments, confirm patient/provider availability, and troubleshoot any technical issues that may arise. Lab & Pharmacy Coordination Liaise with laboratory partners to manage test orders, track results, and ensure timely communication of lab outcomes to providers and patients. Collaborate with pharmacy partners to facilitate prescription orders, refills, and medication-related inquiries. Messaging Queue Management Oversee and triage patient messages in digital platforms, ensuring inquiries are addressed promptly and directed to the appropriate clinical team member. Escalate urgent or complex issues to the appropriate care team members, keeping patients informed of next steps. Patient Communication & Support Provide friendly and empathetic support to patients, answering questions related to appointments, lab tests, prescriptions, and follow-ups. Educate patients on the use of telehealth platforms, including troubleshooting basic technical issues and sharing best practices for virtual visits. Digital Healthcare Administration Maintain accurate and up-to-date electronic health records (EHR), ensuring data integrity and confidentiality. Identify opportunities to streamline workflows and enhance patient experiences, bringing recommendations to leadership. Quality Assurance & Compliance Ensure compliance with all relevant healthcare regulations and company policies, including HIPAA and data privacy laws. Participate in team meetings to review patient feedback, address operational challenges, and discuss quality improvement initiatives. Qualifications Experience: 1-3 years of experience in a care coordinator, healthcare administration, or telehealth support role. Education: Associate's or Bachelor's degree in Healthcare Administration, Public Health, or a related field preferred. Technical Skills: Familiarity with EHR systems, telehealth platforms, scheduling software, and basic troubleshooting of common technical issues. Communication Skills: Excellent verbal and written communication skills to effectively coordinate with patients, providers, and partners. Organizational Skills: Strong attention to detail and ability to manage multiple tasks efficiently in a fast-paced, digital environment. Interpersonal Skills: Empathetic, patient-focused approach with a commitment to delivering high-quality care and exceptional patient experiences. Compliance Knowledge: Understanding of healthcare regulations, especially HIPAA and data privacy guidelines. What We Offer (Benefits): Full Suite: Medical, Dental, Vision, Life Insurance Flexible vacation/time-off policies Fully remote work environment Maximus is an equal opportunity employer, which not only includes standard protected categories, but the additional freedom from discrimination against your free speech and beliefs, as long as they are aligned with company values. We celebrate intellectual diversity. Note: We utilize AI note-taking technology during our interview sessions to ensure we capture all answers and details accurately. Candidates are also encouraged to use AI note-takers for their own records if they wish.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. The Care Coordinator will coordinate the with the Care Team Lead and Care Team Member Services Manager to ensure the team has the resources required to satisfy member enrollment and maintenance in the IPC Copay Assistance Program. The Care Coordinator will respond accordingly to incoming and make external calls to client members to ensure appropriate processing of copay assistance. Essential Duties and Functions: Provide client support where needed Coordinate member implementation calls with Care Team Lead Provide adhoc claims review as required Identify utilizing patients, review history, determine next coverage date Assist patient with enrollment in the manufacturer's program Maintain patient database for follow-up, tracking and reporting Receive notification of new patient's prior authorization/or review daily rejected and paid claims This position will include job duties that require risk designations for access to Electronic Protected Health Information (PHI) in the course of their job responsibilities Other duties may be assigned Competencies: Planning/organizing-the individual prioritizes and plans work activities and uses time efficiently. Makes good and timely decisions that propels our company forward Interpersonal skills-the individual maintains confidentiality, remains open to others' ideas and exhibits willingness to try new things. Creates an environment where teammates feel connected and energized. Written and Oral communication-Communicate a concise message that resonates every time. The individual speaks clearly and persuasively in positive or negative situations and demonstrates group presentation skills. Problem solving-Create innovative ways for our customers and our company to be successful. The individual identifies and resolves problems in a timely manner, gathers and analyzes information skillfully and maintains confidentiality. Quality control-the individual demonstrates accuracy and thoroughness and monitors own work to ensure quality. Adaptability-the individual adapts to changes in the work environment, manages competing demands and is able to deal with frequent change, delays or unexpected vents. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Required Certified Pharmacy Technician (CPhT.) License or 2-5 years of experience in a retail pharmacy or pharmacy benefit management environment Excellent communication skills Proficient with MS Office Suite Professional telephone demeanor Ability to maintain a high level of confidentiality Pay Range 18.00 - 20.00 Hourly The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

Mission 💪 Our mission is to ensure that no one in the world has to suffer from a treatable skin disease because of an access issue ever again. 👋 Honeydew is building a platform for hundreds of millions of people globally to access expertise and science-backed skin treatments, from prescription to retail. Our tech-forward dermatology experience helps people with chronic skin conditions access licensed specialists, FDA-approved treatment, and ongoing support in record time (24 hours vs an industry average of 6 months). Honeydew is the future of skin health - digitally native, scientifically rooted, integrated end-to-end (evaluation + treatments + lab tests), and powered by AI. About the Role Start Being The Reason Someone Finally Feels Seen. As a Care Coordinator at Honeydew, you'll be the thoughtful voice during someone's treatment - the person who crafts messages that make patients feel heard, supported, and confident in their skincare journey. This isn't just customer service, it's healthcare. You know that feeling when someone actually listens to your healthcare concerns? When you're not just another ticket number or appointment slot? That's what you'll create every single day at Honeydew - one message at a time. If you join us, you'll be central to our mission as a trusted guide helping people navigate one of the most frustrating parts of modern life: getting healthcare that works. Your Day-to-Day You'll be the empathetic problem-solver behind the screen: Master the art of written communication - crafting clear, warm, professional messages via app chat that make patients feel supported (this is 99% of your patient interaction) Turn healthcare chaos into clarity through thoughtful, detailed written responses that anticipate questions before they're asked Coordinate directly with pharmacies and labs via phone to troubleshoot prescription issues, insurance hiccups, and delivery problems Connect with dermatology providers as needed to ensure care plans stay on track Keep meticulous records because details matter when it's someone's health on the line Bridge the gap between patients, providers, and insurance companies through strategic communication across channels Partner with medical teams to communicate care plans that actually fit into people's real lives Monitor patient progress through ongoing messaging, troubleshoot obstacles, and celebrate wins along their journey Important to Keep in Mind about the Schedule Honeydew is open, serving patients between 9am and 10pm Eastern every day, and Care Coordinators can choose the structure of their workday on their own. However, Care Coordinators have a responsibility to respond to patients within 4 hours on weekdays and within 6 hours on weekends. Abiding by these response times is crucial to success. As part of the initial onboarding and training process, Care Coordinators are expected to be available 7 days a week in order to ramp up to a full-time (35+ hours/week) schedule. You Might Be Our Person If… You genuinely like people, even when they're frustrated and it's coming through in ALL CAPS You're comfortable with async communication You can read tone and emotion in written messages and respond appropriately You find satisfaction in solving problems that don't have obvious solutions You like to be proactive in offering advice, rather than just following a template You believe healthcare should be accessible to everyone, not just the privileged few You find joy in doing work that matters What We're Looking For... The Non-Negotiables: High school diploma or equivalent You're an exceptional writer and speaker - clear, warm, professional across every channel You type at least 40 WPM You're comfortable with Gmail and Chrome (or similar) Rock-solid internet and a private workspace - HIPAA compliance isn't optional, and dropped connections aren't an option You have a customer service mentality but understand healthcare isn't retail - empathy and professionalism are your baseline, not your ceiling You thrive working independently - no one's looking over your shoulder, and you don't need them to You're coachable and collaborative - you take feedback as fuel, not criticism, and communicate openly with the team We're Looking For At Least Two Of These: Customer service experience - you've turned "difficult customers" into your happiest ones Healthcare or clinical support background - you speak the language and understand the stakes Remote work experience - you've already figured out how to stay focused when Netflix is two clicks away The Nice-to-Haves (But Honestly, You'll Pick These Up Fast): Comfortable with Slack and Zoom - if you're not, no stress, you'll be fluent in a week What You Get Full remote flexibility Direct impact you can measure Ability to grow within the company $100 monthly tech stipend Free Honeydew membership Direct access to new dermatology treatments 20% off Honeydew products Bi-monthly get togethers Peer-to-peer recognition through Motivosity Full-time employees also get: Health insurance & HSA match 401(k) retirement savings with employer match Unlimited time off Hourly pay: $15/hour (or the applicable state or local minimum wage, if higher) Our Process Application Skills assessment (async) - max 30 minutes Screening interview - 20-30 minutes Team Lead interview - 30 minutes CEO interview - 30 minutes Offer Candidates must be authorized to work for any employer in the US. This role is not eligible for visa sponsorship. Candidates residing in the following states will be considered for this role: AL, AZ, DC, FL, GA, ID, MD, MI, MO, NJ, NY, NC, OH, PA, TX, UT, VA, WA, WI

Are you looking for a work "home" where you can use your communication skills to help people find the best solutions for their dental needs? Are you a professional and motivated team member who is outgoing and enjoys developing relationships? Are you professional, service-minded and willing to go above and beyond the basic responsibilities of the job to help someone? You can work flexible days and hours...early morning, evening and weekend opportunities if you'd like to supplement your current job or if you are looking for full-time hours. If this sounds like "you," send your resume today. Full-time team benefits include, but are not limited to: CE, in-house training, Paid Time Off, paid holidays, 401K, vision insurance, life insurance and the best dental insurance in town! No previous dental experience required. Job Types: Full-time, Part-time

Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient markers of success. We're continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products. Responsibilities Investigate and resolve patient/physician inquiries and concerns in a timely manner Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate Proactive follow-up with various contacts to ensure patient access to therapy Demonstrate superior customer support talents Prioritize multiple, concurrent assignments and work with a sense of urgency Must communicate clearly and effectively in both a written and verbal format Must demonstrate a superior willingness to help external and internal customers Working alongside teammates to best support the needs of the patient population or will transfer caller to appropriate team member (when applicable) Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry Must self-audit intake activities to ensure accuracy and efficiency for the program Make outbound calls to patient and/or provider to discuss any missing information as applicable Assess patient's financial ability to afford therapy and provide hand on guidance to appropriate financial assistance Documentation must be clear and accurate and stored in the appropriate sections of the database Must track any payer/plan issues and report any changes, updates, or trends to management Handle escalations and ensure proper communication of the resolution within required timeframe agreed upon by the client Ability to effectively mediate situations in which parties are in disagreement to facilitate a positive outcome Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties Support team with call overflow and intake when needed Proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner. Qualifications 3-6 years of experience, preferred High School Diploma, GED or technical certification in related field or equivalent experience preferred What is expected of you and others at this level Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments In-depth knowledge in technical or specialty area Applies advanced skills to resolve complex problems independently May modify process to resolve situations Works independently within established procedures; may receive general guidance on new assignments May provide general guidance or technical assistance to less experienced team members TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CT, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CT. REMOTE DETAILS: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. Download speed of 15Mbps (megabyte per second) Upload speed of 5Mbps (megabyte per second) Ping Rate Maximum of 30ms (milliseconds) Hardwired to the router Surge protector with Network Line Protection for CAH issued equipment Anticipated hourly range: $21.50 per hour - $30.70 per hour Bonus eligible: No Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being. Medical, dental and vision coverage Paid time off plan Health savings account (HSA) 401k savings plan Access to wages before pay day with my FlexPay Flexible spending accounts (FSAs) Short- and long-term disability coverage Work-Life resources Paid parental leave Healthy lifestyle programs Application window anticipated to close: 3/6/2026 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply. Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law. To read and review this privacy notice click here

Job DescriptionHome Care Coordinator (Remote) America's Home Health Services is seeking a motivated and organized Home Care Coordinator to join our growing team. This is a remote position supporting daily operations and ensuring high-quality service for our patients and caregivers. Key Responsibilities Answer and manage all incoming phone calls in a professional and timely manner Assist the team in meeting weekly and monthly performance goals Accurately enter and maintain new patient information in internal systems Verify employee visits for payroll processing on a weekly basis Create, manage, and adjust caregiver and patient schedules Effectively multitask in a fast-paced, deadline-driven environment Collaborate closely with the recruitment team to support office staffing needs Participate in occasional travel as business needs require Qualifications Strong organizational and time-management skills Excellent communication and customer service abilities Ability to work independently in a remote environment Proficiency with scheduling systems and data entry (home health experience a plus) Detail-oriented with the ability to manage multiple priorities Benefits Health, dental, and vision insurance Retirement savings program 11 paid holidays Generous PTO package Monthly bonus incentives Apply today and start your career with America's Home Health Services, where we are committed to quality care and professional growth. America's Home Health Services is an Equal Opportunity Employer (EEO).

An ECM Coordinator supports department staff with administrative tasks related to a member's medical condition(s), department case work, communication with internal and external stakeholders, and manage audits. This role will engage with members to offer support and resources related to their medical condition(s) through Allied Care. ESSENTIAL FUNCTIONS Facilitate reviews, referrals, and outreach for referral-based proprietary strategies as well as engaging with members across Medical Management products Document all engagement accurately and concisely within the Microsoft Customer Relationship Management (CRM) system Manage escalated and time sensitive case management questions received from members, broker relationships, and internal and external Allied stakeholders Collaborate with strategic vendor partners to provide supportive services and support to members Lead and facilitate claims auditing in conjunction with ECM Coordinators. Complete department auditing related to daily tasks to ensure accuracy and identify escalations Identify impactful scenarios through appropriate closing summaries in timely fashion. Share impactful scenarios with the department's leadership team to deliver to internal departments, such as Sales, Operations, and Executive leadership Identifying escalations for department leadership team, as appropriate Other duties as assigned EDUCATION Bachelor's Degree or equivalent work experience, required EXPERIENCE AND SKILLS At least 3-5 years of administrative support experience required. Focus on patient-provider engagement, needs assessments, coordination of care, and or patient treatment adherence within the healthcare or social service industry preferred Understanding of intermittent medical terminology such as CPT, HCPC, and diagnostic codes Understanding of basic benefit plan design terminology such as deductible, out-of-pocket, prescription drugs, physical medicine services, etc. Strong verbal and written communication skills Strong analytical and problem-solving skills COMPETENCIES Communication Customer Focus Accountability Functional/Technical Job Skills PHYSICAL DEMANDS This is a standard desk role - long periods of sitting and working on a computer are required. WORK ENVIROMENT Remote Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Protect Yourself from Hiring Scams Important Notice About Our Hiring Process To keep your experience safe and transparent, please note: All interviews are conducted via video. No job offer will ever be made without a video interview with Human Resources and/or the Hiring Manager. If someone contacts you claiming to represent us and offers a position without a video interview, it is not legitimate. We never ask for payment or personal financial information during the hiring process. For your security, please verify all job opportunities through our official careers page: Current Career Opportunities at Allied Benefit Systems Your security matters to us-thank you for helping us maintain a fair and trustworthy process!

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

Job DescriptionBenefits: 401(k) Competitive salary Flexible schedule Free uniforms Paid time off Benefits/Perks Flexible Scheduling Competitive Compensation Careers Advancement Job Summary We are seeking a Client Care Coordinator to join our team. In this role, you will work collaboratively with clients to determine their home care needs, develop the best course of action, and oversee their treatment plans, ensuring each client gets high-quality, individualized care. The ideal candidate is compassionate, patient, and knowledgeable about healthcare practices. Responsibilities Collaborate with physicians, patients, families, and healthcare staff Coordinate a variety of healthcare programs Develop individualized care plans Educate patients on their healthcare options Create goals and monitor progress toward goals Recruit and train staff Create schedules Qualifications Previous experience as a Care Coordinator or in a similar position is preferred Strong problem-solving and organizational skills Ability to manage multiple projects or tasks and prioritize appropriately Ability to work in fast-paced situations and make sound decisions quickly Excellent interpersonal skills and high level of compassion Strong verbal and written communication skills Work remote temporarily due to COVID-19.

LOCATION: Remote - the is a home-based, virtual position that operates Monday - Friday from 8:30am-5:00pm (EST). The person in this position must live in North Carolina or within 40 miles of the NC border. GENERAL STATEMENT OF JOB The Care Coordinator is responsible for providing proactive intervention and telephonic coordination of care to eligible members to ensure that they receive appropriate screening, assessment, services, and care transitions. Responsibilities include administering screenings and assessments, developing care plans to achieve a member's health goals, and managing discharges/transitions between care settings. Care coordinators possess customer service and active listening skills needed to guide individuals of varying backgrounds towards their goals for whole person health. Care Coordinators perform telephonic outreach and engagement activities for members who are eligible for Tailored Care Management and also provide care coordination for members who qualify for supportive Social Determinants of Health services. Note: This position requires access to, and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health. ESSENTIAL JOB FUNCTIONS Outreach and Engagement: Telephonic outreach and engagement for members eligible for plan-based Tailored Care Management (TCM). Referring members who opt in to TCM for assignment to a care manager. Provide telephonic outreach and administration of Care Needs Screenings to all Vaya Medicaid plan members. Provide telephonic outreach and engagement to members eligible for care coordination. Conducting the above activities according to applicable rules, regulations, and contract requirements as outlined in Vaya policy and procedure Documenting above activities in designated software platforms according to Vaya policy and procedure Care Coordination and Transition of Care Management : Provide telephonic assessment and person-centered care planning for members who opt in to Care Coordination. Link members to appropriate care to meet their care plan goals, coordinate member care including locating appropriate providers and services, assisting with appointment reminders, and providing education about relevant health topics and recommended screenings and immunizations Manage transitions of care between settings ensuring that members receive appropriate discharge planning and follow up with discharge appointments Assessing eligibility for the NC Healthy Opportunities Pilot and linking eligible members to these services using the NCCARE360 software platform Conducting above activities in the designated software platform according to Vaya policy and procedure. Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. Exceptional interpersonal skills, effective oral and written communication skills, and the ability to make prompt independent decisions based upon relevant facts Problem solving, negotiation, and conflict resolution skills are essential to balance the needs of both internal and external customers. The employee must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish. Work activities quickly change according to mandated changes and changing priorities. The employee must be able to shift focus to meet changing priorities. Knowledge of Behavioral Health/I/DD Tailored Plan (Tailored Plan) eligibility and services Working understanding of the concepts of whole-person health and health-related resource needs (formerly known as social determinants of health) Community integration (Independent living skills; transition and diversion, supportive housing, employment, etc.) Health promotion (Common physical comorbidities, self-management, use of IT, care planning, ongoing coordination) Person-centered needs assessment and care planning, etc. Serving pregnant and postpartum women with SUD or with SUD history Thorough knowledge of standard office practices, procedures, equipment, and techniques and have intermediate to advanced proficiency in Microsoft Office products (Word, Excel, Power Point, Outlook, Teams, etc.) EDUCATION & EXPERIENCE REQUIREMENTS Bachelor's Degree in Human Services and at least two (2) years of progressive experience providing similar services to the population served. OR Bachelor's Degree in a field other than Human Services and at least four (4) years of progressive experience providing similar services to the population served. To meet federal requirements for Care Coordination, the incumbent must be qualified as a Qualified Professional according to 10A NCAC 27G .0104. Preferred work experience: Call Center (inbound/outbound) experience Tailored Care Management experience Care Coordination experience SDoH experience Medical Administration or Assessment Customer Success At least four (4) years of post-degree experience in customer success management, communications, and/or administrative care) PHYSICAL REQUIREMENTS Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit ****************************************** Vaya Health is an equal opportunity employer.

Care Coordinator Are you passionate about making a meaningful impact in women's mental health care? Here's your chance to be a vital part of FamilyWell's mission to transform women's mental health across the reproductive journey, from fertility through menopause. We embed evidence-based, insurance-covered mental health care directly into women's health practices and health systems. By seamlessly integrating a virtual team of care managers, coaches, therapists, and psychiatric providers into clinical workflows, FamilyWell is improving patient outcomes and reducing medical provider workloads. Through the FamilyWell Academy, we are educating the next generation of women's mental health providers to solve the growing workforce gap. Learn more at familywellhealth.com. Role: The Care Coordinator (CC) is a core member of the collaborative care team and plays a pivotal role in supporting patients within OB/Gyn clinics. This role involves supporting patients in FamilyWell's collaborative care program and ensuring high engagement and satisfaction. Care Managers are responsible for managing the full spectrum of patient acuity levels, providing compassionate support, coordinating referrals, and tracking patient progress. This position emphasizes program engagement, communication, and care navigation, rather than direct clinical intervention. Reports To: Lead Care Manager Compensation: Based on caseload Hours: 20-25 hours/week between 9-5pm EST; W2 Hourly Location: Remote Key Responsibilities: Patient Engagement: Communicate with patients through various channels (text, phone) to facilitate program engagement, provide reminders, and follow up on care. Maintain strong engagement and satisfaction among patients through ongoing support and education Care Coordination and Documentation: Update patient records in Electronic Health Records (EHRs) and communicate care plans to referring clinic partners. Maintain a collaborative care registry to track patient follow-up and clinical outcomes. Prepare and submit routine progress reports in the EHR. Facilitate outside referrals for community-based social services as clinically indicated (e.g., housing assistance, vocational rehabilitation, mental health specialty care, substance abuse treatment). Reporting and Collaboration: Compose, prepare, and communicate timely patient and provider responses to questions. Report directly to the Lead Care Manager and provide regular updates on patient engagement and clinical outcomes. Collaborate with OB clinic staff to ensure coordinated care and support for patients. Qualifications Education: Required: Bachelor's degree in nursing, social work, psychology OR formalized training in mental health Clinical licensure not required for this role Skills: Strong understanding of women's mental health conditions, treatments, and community resources. Excellent communication, organizational, and problem-solving skills. Comfortability with managing a high volume caseload of patients across varying acuity levels. Ability to engage and educate patients in a compassionate and supportive manner. Strong ability to collaborate across departments including Care Operations and Partner Success Proficiency in using EHR systems and maintaining accurate patient records. Proficiency in using Google Suite. Key Competencies: Empathy and Compassion: Ability to understand and support the unique challenges of pregnant/ postpartum patients and patients experiencing menopause. Engagement Skills: Proficient in maintaining patient engagement and satisfaction with the program. Communication: Strong verbal and written communication skills for effective patient and provider interactions. Organizational Skills: Ability to manage patient records, track outcomes, and ensure timely follow-up. Cultural Sensitivity: Respectful of diverse backgrounds and experiences, particularly in a perinatal and menopause context. Adaptability: We're a fast growing company, constantly looking to make improvements as we go. Our team is smart, resilient, and always iterating to make our program even better for our patients. Please be aware of recruitment scams. FamilyWell will never ask candidates to pay money, request sensitive personal information early in the process, or conduct interviews over unsecured platforms. All official communication will come from an @ familywellhealth.com email address.

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: About this position: Title: Coordinator, Utilization Management Location: Remote within US ONLY (equipment provided, work must be done within the US only) Required Schedule: Full-time shifts from 8:00 AM to 5:00 PM EST (Sunday - Thursday or Tuesday - Saturday) some holiday coverage required. Hourly Salary: $19.00 - $20.00 ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. About this position: Title: Coordinator, Utilization Management Location: Remote within US ONLY (equipment provided, work must be done within the US only) Required Schedule: Full-time shifts from 8:00 AM to 5:00 PM EST (Sunday - Thursday or Tuesday - Saturday) we cannot guarantee preferred shift and some holiday coverage required. Hourly Salary: $19.00 - $20.00 Responsibilities: Manage the Authorization process end to end, from initial notification, entry and submission of required information, follow up all the way to determination and discharge. Maintain detailed documentation of the record in the EMR system, in the internal CorroHealth system and in the Health Payer portals. Verify correct eligibility and benefits for patients. Act as a liaison between the hospital staff and the Health Payer to facilitate information sharing and successful process completion within allocated timeframe. Review timely filing guidelines regarding the utilization management process. Track and follow up with payers on pending authorizations to ensure timely responses. Contact payer to elicit further information regarding status, decisions and remove hurdles in the processing. Identify and escalate issues that may result in delays or denials. Manage assigned workload of accounts through timely follow up and accurate record keeping. Maintain compliance with HIPAA and other healthcare regulations. Minimum Qualifications: High School Diploma or equivalent. Associate degree in healthcare administration or equivalent preferred. 2 years of experience in hospital related billing/follow-up/healthcare setting/authorization field. Knowledge of/experience working with managed care contracts Experience working with customer support/client issue resolution management. Strong understanding of medical terminology and insurance processes. Experience working in EMR systems, Epic preferred. Excellent communication and organization skills. Strong multi-tasking skills, working in a face paced environment. Proficiency with MS Office and web systems. What we offer: Hourly pay: $19.00 - $20.00 (firm) Remote within US ONLY Equipment provided Medical/Dental/Vision Insurance 401k matching (up to 2%) PTO: 80 hours accrued, annually 9 paid annual holidays Life Insurance Short/Long term disability options Tuition reimbursement Professional growth and more! PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

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

Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Location: This is a remote position. What You'll Do: Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). 1Provides patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. To Qualify For This Position, You'll Need The Following: Required Education: Associate's in a job related field. Degree Equivalency: Graduate of Accredited School of Nursing or 2 years job related work experience . Required Work Experience: 2 years clinical experience. Required Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in typing, spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire. We Prefer That You Have The Following: Preferred Education: Bachelor's degree- Nursing. Preferred Work Experience: work experience in healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. 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