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Humana jobs in Savannah, GA - 157 jobs

  • Primary Care Physician Lead

    Humana Inc. 4.8company rating

    Humana Inc. job in Savannah, GA

    Become a part of our caring community and help us put health first Humana's Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating over 340 centers across fifteen states under two brands: CenterWell & Conviva. Operating as a payor-agnostic, wholly owned subsidiary of Humana, our centers put the unique needs of seniors at the center of everything we do. Our Clinics offer a team-based care model where our physicians lead a multi-disciplinary care team supporting patient's physical, emotional, and social wellness. At CenterWell Senior Primary Care we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all. The Physician Lead serves as a health-care professional and capable of handling a variety of health-related problems. The Physician Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Physician Lead (PL) serves as a leader to a team of clinicians in a designated market responsible for handling a variety of health-related problems and educating patients and their families on wellness, prevention, and early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well as those of the clinicians whom they lead. The PL reports directly to the Market CMO and is directly responsible for * Administrative oversight and outcomes determined by the Clinical / Operational Leadership of the Market * Spend a portion of time clinically-focused on direct patient care, with the remaining time dedicated to administrative duties related to oversight of clinical provision of care including, but not limited to: Working collaboratively with Market CMO and Operational Leadership to: * Advance the Model of Care * Create profit improvement initiatives * Design operational implementations * Contribute to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: * Maintaining Collaborative / Supervisory Agreements per state protocols * Assisting with panel management * Providing direct education to clinicians around clinical protocols / disease * prevalence / appropriate levels of clinical quality care * Providing guidance to individual clinicians about patient terminations, in * collaboration with Compliance * Supporting clinicians with schedule templates, coverage, daily issues * Managing behavioral concerns of supervised staff * Assisting with PTO Management * Assisting with CME time and reimbursement requests * Assisting with completion of performance reviews * Assisting in resolution of inquiries, requests, and complaints from clinical staff * Assisting in organizing team building activities * Assisting in resolution of inquiries, requests, and complaints from patients * Ongoing chart review / audit of clinical staff to ensure quality care and identifying opportunities for education/coaching * Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member per Month (PMPM) costs while maintaining high quality care * Optimizing network; preferred network specialists - contributing to the identification of preferred network specialists to optimized delivery of care for ongoing maintenance / cost saving opportunities Making decisions related to the identification and mitigation of complex technical and operational problems within clinics/centers * Managing financial / operational performance of their assigned clinics to ensure success * Participating in provider committees (i.e. Technology Governance, EMR Optimization, etc.) and attending meetings regularly * Participating in Shared Service Strategy Meetings * Participating in quality improvement programs, population health programs, continuing education, and other patient care programs established by clinical requirements * Assisting in recruiting and interviewing of potential clinical staff * Participating in patient retention and marketing activities as required * Serving as a community representative in the media and press activities Other duties as directed by the Market CMO * Maintaining confidentiality of all patient information according to both state and federal guidelines and regulations * Maintaining medical history and medical records * Ordering studies, tests and ancillary services * Participating as a back-up on-call physician * Prescribing medical treatment and clinical drugs to patients * Referring patients to specialists as needed Use your skills to make an impact Required Qualifications * MD/DO * 8 or more years of technical experience * 2 or more years of project leadership experience * Licensure requirements of the state of jurisdiction * Graduate of accredited MD or DO program of accredited university * Prefer Internal Medicine specialty * Board Certification in Family Medicine, Internal Medicine or Geriatric Medicine * This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. * Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications * Active and unrestricted DEA license * Medicare Provider Number * Medicaid Provider Number * Minimum of three to five years directly applicable experience preferred * Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care environment in a value based relationship environment. * Knowledge of Medicare guidelines and coverage. * Knowledge of HEDIS quality indicators * Good understanding of best practice coding and documentation in value based environment * Leveraging Technology: You are technological savvy and know how to appropriately share and use your knowledge to improve business results. * Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over. * Accountable: You meet clearly stated expectations and take responsibility for achieving results. * Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs * Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience. #LI-KS3 Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $246,100 - $344,200 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
    $246.1k-344.2k yearly 60d+ ago
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  • Speech Language Pathologist, Home Health

    Humana Inc. 4.8company rating

    Humana Inc. job in Beaufort, SC

    Become a part of our caring community and help us put health first This role has an associated $5,000 sign-on bonus. As a therapist at CenterWell Home Health, you'll play a vital role in helping patients regain strength, mobility and independence-all from the comfort of their homes. By delivering personalized care that focuses on rehabilitation and functional improvement, you'll empower individuals to overcome physical limitations, perform everyday activities with confidence and enjoy a better quality of life. As a Home Health Speech Language Pathologist, you will: * Evaluate, direct and provide speech/language pathology service to patients in the home or facility * Participate in the development and periodic review of the Plan of Treatment and Plan of Care. * Utilize professional skills and judgment in assessing and treating disorders of speech, voice, language, hearing and swallowing to prevent, identify, evaluate and minimize the effects of such disorders and conditions. * Administer and interpret diagnostic tests and applications of therapeutic treatments including audio logic screening. * Observe, record and report changes in the patient's condition and response to treatment to supervisor and/or the physician. * Provide instruction and training to patients in use of alternative communication systems when appropriate. * Provide counsel and instruction to patients, families and healthcare staff. * Maintain and submit documentation as required by the Company and/or facility. Prepare and submit timely written reports of evaluations, visits, summaries, care plans, care coordination activities and progress reports as required by Company policy. * Participate in care coordination activities and discharge planning. * Maintain the highest standards of professional conduct in relation to information that is confidential in nature. Share information only when the recipient's right to access is clearly established and the sharing of such information is clearly in the best interests of the patient. * Attend, participate in and/or conduct internal staff development programs, obtain continuing education as required by Company policy, regulation. Use your skills to make an impact Required Experience/Skills: * Meet the education and experience requirements for Certification of Clinical Competence in Speech Language Pathology or Audiology granted by ASHA * Minimum of six months experience as a speech therapist / speech language pathologist * Home Health experience a plus * Current and unrestricted license * Current CPR certification * Good organizational and communication skills * A valid driver's license, auto insurance, and reliable transportation are required. Pay Range * $49.00 - $69.00 - pay per visit/unit * $77,200 - $106,200 per year base pay Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $85,400 - $117,500 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
    $85.4k-117.5k yearly 60d+ ago
  • Pharmacist - Sign-On Bonus Available

    Walgreens 4.4company rating

    Beaufort, SC job

    Join Our Team at Walgreens as a Pharmacist! Why Walgreens - For You, For Your Family, For Your Future At Walgreens, pharmacists are medication experts and trusted healthcare providers reshaping the future of patient-focused care. With industry-leading resources, career advancement opportunities, and a strong commitment to work-life balance, we invest in you so you can invest in your patients. For You - Competitive Pay & Flexible Scheduling Competitive pay - Competitive wage offered based on geography and other business-related factors Paid Time Off (PTO) - Available after three months of service (subject to state law) because work-life balance matters Flexible scheduling - Flexible scheduling options to fit your lifestyle For Your Family - Comprehensive Health & Wellness Benefits Comprehensive benefits package including medical, prescription drug, dental, vision, disability and life insurance for qualifying team members. Plus free flu shots for all team members and other voluntary benefits 365 Get Healthy Here & Life365 Employee Assistance Program (EAP) - Mental health support and wellness programs Family-forming support - Walgreens provides financial support for fertility treatments, including medical procedures and prescription medications. Eligible team members can also receive reimbursement for qualified adoption and surrogacy-related expenses For Your Future - Growth, Education & Exclusive Perks Opportunities for growth - Many pharmacists advance quickly into leadership roles in pharmacy operations, retail management, multi-site leadership, and corporate support functions Walgreens University - Free training, certifications, and leadership development, plus tuition discounts at 30+ universities Employee discounts - 25% off Walgreens brands and 15% off national brands, plus exclusive savings on electronics, travel, and more 401(k) with company match - Contribute to your retirement, and Walgreens provides matching contributions after one year and 1,000 hours of service. Additionally, Walgreens matches qualifying student loan payments as if they were 401(k) contributions What You'll Do Provide compassionate, expert-level pharmacy consulting services to patients Educate and consult patients on medication usage, side effects, and cost-effective options Deliver clinical healthcare services, including immunizations, diagnostic testing, and medication therapy management Ensure medication safety through accurate compounding, dispensing, and regulatory compliance Mentor and train pharmacy team members in a collaborative and supportive environment Who You Are Patient-focused & service-driven - You're committed to making healthcare personal A collaborative team leader - You support, inspire, and uplift those around you A lifelong learner - You stay ahead of industry advancements and professional growth A problem-solver - You navigate challenges, from insurance claims to medication management, with ease Apply Today & Build Your Future with Walgreens! This is more than just a job-it's a career with purpose. See below for more details! About Us Founded in 1901, Walgreens (****************** proudly serves more than 9 million customers and patients each day across its approximately 8,000 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 211,000 team members, including roughly 85,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities. Basic Qualifications BS in Pharmacy or Pharmacist Degree from an accredited educational institution. Current pharmacist licensure in the states within the district. Experience performing prescription dispensing activities that demonstrate a strong working knowledge of applicable state and federal controlled substance laws. Certified Immunizer or willing to become an immunizer within 90 days of hire. Preferred Qualifications At least 1 year experience as a pharmacist in a retail setting including prescription filling and verification, records and legal compliance, pharmacy operations, pharmacy software and technology systems and insurance. We will consider employment of qualified applicants with arrest and conviction records. An Equal Opportunity Employer, including disability/veterans. The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits Salary Range: Pharmacist Hourly $69.05-$75.95
    $69.1-76 hourly 1d ago
  • Pharmacist - Sign-On Bonus Available

    Walgreens 4.4company rating

    Beaufort, SC job

    Join Our Team at Walgreens as a Pharmacist! Why Walgreens - For You, For Your Family, For Your Future At Walgreens, pharmacists are medication experts and trusted healthcare providers reshaping the future of patient-focused care. With industry-leading resources, career advancement opportunities, and a strong commitment to work-life balance, we invest in you so you can invest in your patients. For You - Competitive Pay & Flexible Scheduling Competitive pay - Competitive wage offered based on geography and other business-related factors Paid Time Off (PTO) - Available after three months of service (subject to state law) because work-life balance matters Flexible scheduling - Flexible scheduling options to fit your lifestyle For Your Family - Comprehensive Health & Wellness Benefits Comprehensive benefits package including medical, prescription drug, dental, vision, disability and life insurance for qualifying team members. Plus free flu shots for all team members and other voluntary benefits 365 Get Healthy Here & Life365 Employee Assistance Program (EAP) - Mental health support and wellness programs Family-forming support - Walgreens provides financial support for fertility treatments, including medical procedures and prescription medications. Eligible team members can also receive reimbursement for qualified adoption and surrogacy-related expenses For Your Future - Growth, Education & Exclusive Perks Opportunities for growth - Many pharmacists advance quickly into leadership roles in pharmacy operations, retail management, multi-site leadership, and corporate support functions Walgreens University - Free training, certifications, and leadership development, plus tuition discounts at 30+ universities Employee discounts - 25% off Walgreens brands and 15% off national brands, plus exclusive savings on electronics, travel, and more 401(k) with company match - Contribute to your retirement, and Walgreens provides matching contributions after one year and 1,000 hours of service. Additionally, Walgreens matches qualifying student loan payments as if they were 401(k) contributions What You'll Do Provide compassionate, expert-level pharmacy consulting services to patients Educate and consult patients on medication usage, side effects, and cost-effective options Deliver clinical healthcare services, including immunizations, diagnostic testing, and medication therapy management Ensure medication safety through accurate compounding, dispensing, and regulatory compliance Mentor and train pharmacy team members in a collaborative and supportive environment Who You Are Patient-focused & service-driven - You're committed to making healthcare personal A collaborative team leader - You support, inspire, and uplift those around you A lifelong learner - You stay ahead of industry advancements and professional growth A problem-solver - You navigate challenges, from insurance claims to medication management, with ease Apply Today & Build Your Future with Walgreens! This is more than just a job-it's a career with purpose. See below for more details! About Us Founded in 1901, Walgreens (****************** proudly serves more than 9 million customers and patients each day across its approximately 8,000 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 211,000 team members, including roughly 85,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities. Basic Qualifications BS in Pharmacy or Pharmacist Degree from an accredited educational institution. Current pharmacist licensure in the states within the district. Experience performing prescription dispensing activities that demonstrate a strong working knowledge of applicable state and federal controlled substance laws. Certified Immunizer or willing to become an immunizer within 90 days of hire. Preferred Qualifications At least 1 year experience as a pharmacist in a retail setting including prescription filling and verification, records and legal compliance, pharmacy operations, pharmacy software and technology systems and insurance. We will consider employment of qualified applicants with arrest and conviction records. An Equal Opportunity Employer, including disability/veterans. The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits Salary Range: Pharmacist Hourly $69.05-$75.95 By applying, you consent to your information being transmitted by Veritone to the Employer, as data controller, through the Employer's data processor SonicJobs. See WALGREENS Terms & Conditions at ************************************************************************** and Privacy Policy at *********************************************************************** and SonicJobs Privacy Policy at ******************************************* and Terms of Use at ********************************************* PandoLogic. Category:Pharmaceutical, Keywords:Retail Pharmacist, Location:Beaufort, SC-29901
    $69.1-76 hourly 2d ago
  • Analyst, Data

    Molina Healthcare Inc. 4.4company rating

    Savannah, GA job

    JOB DESCRIPTIONJob Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates solutions from initial concept to fully tested production, and communicates results to a broad range of audiences. Effectively uses current and emerging technologies. KNOWLEDGE/SKILLS/ABILITIES * Extracts and compiles various sources of information and large data sets from various systems to identify and analyze outliers. * Sets up process for monitoring, tracking, and trending department data. * Prepares any state mandated reports and analysis. * Works with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes. * Implements and uses the analytics software and systems to support the departments goals. JOB QUALIFICATIONS Required Education Associate's Degree or equivalent combination of education and experience Required Experience 1-3 years Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 3-5 years To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $116,835 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $80.2k-116.8k yearly 2d ago
  • Medical Director, Behavioral Health (PST)

    Molina Healthcare 4.4company rating

    Savannah, GA job

    JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. - Facilitates behavioral health-related regional medical necessity reviews and cross coverage. - Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. - Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. - Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. - Provides second level behavioral health clinical reviews, peer reviews and appeals. - Supports behavioral health committees for quality compliance. - Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. - Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). - Assists with the recruitment and orientation of new psychiatric medical directors. - Ensures all behavioral health programs and policies are in line with industry standards and best practices. - Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications - At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. - Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. - Board Certification in Psychiatry. - Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. - Ability to work cross-collaboratively within a highly matrixed organization. - Strong organizational and time-management skills. - Ability to multi-task and meet deadlines. - Attention to detail- available to work PST zone. - Critical-thinking and active listening skills. - Decision-making and problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications - Experience with utilization/quality program management. - Managed care experience. - Peer review experience. - Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $186.2k-363.1k yearly 9d ago
  • Processor, Coordination of Benefits

    Molina Healthcare Inc. 4.4company rating

    Savannah, GA job

    Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records. Job Duties * Provides telephone, administrative and data entry support for the coordination of benefits (COB) team. * Phones or utilizes other insurance company portals to validate state, vendor, and internal COB leads. * Updates the other insurance table on the claims transactional system and COB tracking database. * Review of claims identified for overpayment recovery. Job Qualifications REQUIRED QUALIFICATIONS: * At least 1 year of administrative support experience, or equivalent combination of relevant education and experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Strong verbal and written communication skills. * Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders. * Microsoft Office suite proficiency. PREFERRED QUALIFICATIONS: * Health care experience To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $31.71 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-31.7 hourly 2d ago
  • Supervisor, Dental Provider Services

    Molina Healthcare 4.4company rating

    Savannah, GA job

    is March 2026.** Leads and supervises team responsible for enterprise network management and operations activities including network development, network adequacy, and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. **JOB QUALIFICATIONS** **Job Duties:** - Oversees national Molina network management and operations function and team. Responsible for the daily operations of the department, including leading and supporting various enterprise-wide provider services activities including education, outreach and resolving provider inquiries. - Develops and deploys strategic network planning tools to drive provider services and contracting strategy across the enterprise. - Facilitates strategic planning and documentation of network management standards and processes. - Develops standards and resources to help Molina health plans successfully develop and refine cost-effective and high-quality strategic provider networks, establishing both internal and external long-term partnerships. - Collaborates with health plan network leadership and operations teams and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives with an emphasis on developing and implementing standards, resources, tools and best practices sharing across the organization. - Develops and deploys strategic network planning tools to drive provider services and contracting strategies across the organization; facilitates planning and documentation of network management standards and processes for all line of business. - Oversees national network management and operations provider contracting strategies - identifying specialties and geographic locations to concentrate resources for purposes of establishing a sufficient network of participating providers to serve the health care needs of Molina members. - Oversees and leads the functions of the external provider representatives, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards. - Assists with ongoing enterprise-wide provider network development and the education of contracted network providers regarding various health plan procedures and claims payment policies. - Develops and implements tracking tools to ensure timely issue resolution and compliance with all network-related standards. - Oversees appropriate and timely intervention/communication when providers have issues or complaints (e.g. claims and encounter data, eligibility, reimbursement, and provider website). - Serves as a resource to support health plam initiatives and help ensure regulatory requirements and strategic goals are realized. - Ensures appropriate cross-departmental communication of provider network initiatives and contracted network provider issues. - Designs and implements enterprise-wide programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and health plans. - Develops and implements enterprise-wide strategies to increase provider engagement in Healthcare Effectiveness Data Information Set (HEDIS) and quality initiatives. - Provides matrixed team support including: new markets provider/contract support services, resolution support, and national contract management support services. - Builds, drafts and/or performs provider communications, training and education programs for internal staff, external providers, and other stakeholders. - Develops and implements strategies to reduce member access grievances with contracted enterprise providers. - Engages enterprise-wide contracted network providers regarding cost-control initiatives, medical cost ratio (MCR), non-emergent utilization, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) to positively influence future trends. - Ensures compliance with applicable company/plan business requirements including state/federal statutes, government sponsored program requirements, and network access standards. - Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. **Job Requirements:** - At least 5 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and or Marketplace products, or equivalent combination of relevant education and experience. - Understanding of the health care delivery system, including government-sponsored health plans. - Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Previous experience with community agencies and providers. - Organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to interface with providers and medical office staff. - Experience with preparing and presenting formal presentations. - Project management experience. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. **Preferred Qualifications:** - Management/leadership experience. - Contract negotiation experience. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $80.2k-128.5k yearly 5d ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Savannah, GA job

    Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 19d ago
  • Program Manager (Provider Network)

    Molina Healthcare 4.4company rating

    Savannah, GA job

    Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion within Provider Network department. Help facilitate corporate markets with obtaining SAI goals. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management. **Job Duties** + Provide project summaries that will be senior leadership facing with ties to market SAI goals. + Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. + Plans and directs schedules as well as project budgets. + Monitors the project from inception through delivery. + May engage and oversee the work of external vendors. + Focuses on process improvement, organizational change management, program management and other processes relative to the business. + Leads and manages team in planning and executing business programs. + Serves as the subject matter expert in the functional area and leads programs to meet critical needs. + Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed. + Works with operational leaders within the business to provide recommendations on opportunities for process improvements. + Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations. + Generate and distribute standard reports on schedule **JOB QUALIFICATIONS** **REQUIRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : + 3-5 years of Program and/or Project management experience. + Operational Process Improvement experience. + Healthcare experience. + Experience with Microsoft Project and Visio. + Excellent presentation and communication skills. + Experience partnering with different levels of leadership across the organization. **PREFERRED EDUCATION** : Graduate Degree or equivalent combination of education and experience. **PREFERRED EXPERIENCE** : - 5-7 years of Program and/or Project management experience. - Provider Network and SAI - Excel and PowerPoint - Managed Care experience. - Experience working in a cross functional highly matrixed organization. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $80.2k-155.5k yearly 60d+ ago
  • Medicare Sales Field Agent - Beaufort County, SC

    Humana 4.8company rating

    Humana job in Beaufort, SC

    Become a part of our caring community and help us put health first With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live in the designated territory to effectively serve their local community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll help bring Humana's strategy to life: Deliver on the fundamentals, differentiate through exceptional service, and grow by expanding our reach and impact. What You'll Do in This FIELD Based Role: Deliver: Build trust and educate individuals on Humana's Medicare Advantage plans and additional offerings like Life, Dental, Vision, and Prescription coverage. Differentiate: Create meaningful, face-to-face connections through grassroots marketing, community events, and in-home visits-providing a personalized experience that sets Humana apart. Grow: Drive self-generated sales, meet performance goals, and expand Humana's presence in the market by becoming a valued resource in your community. You'll engage with customers in the FIELD through a mix of in-person, virtual, and phone interactions. Face-to-face visits in prospective members' homes are a key part of this role. Why Join Humana? People-first culture that supports your personal and professional growth. Inclusive and diverse environment that values multilingual talent and cultural understanding. Autonomy and flexibility to manage your schedule and success. Purpose-driven mission to help people achieve their best health-and transform healthcare along the way. Benefits include: Medical, Dental, Vision, and a variety of other supplemental insurances Paid Time Off (PTO) and Paid Holidays 401(k) retirement savings plan with a competitive match Tuition reimbursement and/or scholarships for qualifying dependent children And much more! Use your skills to make an impact Required Qualifications Active Health Insurance License required. Must reside in the designated local territory to effectively serve the community. Comfortable with daily face-to-face interactions in prospective members' homes and at community-based events. Proven experience engaging with the community through service, organizations, volunteer work, or local events. Valid state driver's license and proof of personal vehicle liability insurance meeting at least 25/25/10 coverage limits (or higher, based on state requirements). Preferred Qualifications Active Life and Variable Annuity Insurance License. Prior experience selling Medicare products. Experience in public speaking or delivering presentations to groups. Associate's or Bachelor's degree. Experience using Microsoft Office tools such as Teams, Excel, Word, and PowerPoint. Bilingual in English and Spanish, with the ability to speak, read, and write fluently in both languages. Additional Information This position is in scope of Humana's Driving Safety and Vehicle Management Program and therefore subject to driver license validation and MVR review. Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Schedule: Meeting with members requires appointments and/or event times that may vary on nights and weekends. Flexibility is essential to your success. Training: The first five weeks of employment and attendance is mandatory. Interview Format: As part of our hiring process for this opportunity, we are using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward in the process, you will receive a text message inviting you to participate in a HireVue prescreen. In this prescreen, you will receive a set of questions via text and given the opportunity to respond to each question. You should anticipate this prescreen taking about 15 minutes. Your responses will be reviewed and if selected to move forward, you will be contacted with additional details involving the next step in the process. Pay Range The range below reflects a good faith estimate of total compensation for full time (40 hours per week) employment at the time of posting. This compensation package includes both base pay and commission with guarantee. The pay range may be higher or lower based on geographic location. Actual earnings will vary based on individual performance, with the base salary and commission structure aligned to company policies and applicable pay transparency requirements. $80,000 - $125,000 per year #medicaresalesrep Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
    $29k-37k yearly est. Auto-Apply 57d ago
  • Strategy Advancement Director

    Molina Healthcare Inc. 4.4company rating

    Savannah, GA job

    The Strategy Advancement Director is responsible for advancing Molina's growth strategy and positioning the company for success in Medicaid, CHIP, DSNP, and Marketplace procurements. Reporting to the Vice President, Business Development, this position plays a pivotal role in the pre-RFP and procurement phases, guiding and organizing the project, ensuring deliverables are met, conducting research, tracking Business Development and/or Health Plan steps and projects, owning the governance structure for every opportunity, pulling together all the supporting team activities and pieces and connecting the dots between winning strategy and the relationships and partnerships developed by the VP, Business Development. This role requires a deep understanding of Medicaid programs, the regulatory environment, and the unique challenges of populations (i.e. TANF, ABD, DSNP, Foster Care, and DD/IDD). The Strategy Advancement Director works collaboratively across departments, including Product Development, Business Development, and Health Plans, to ensure that strategic initiatives align with state-specific priorities and are positioned for success in competitive procurements. The Director partners with the VP Market Development to provide thought leadership and subject matter expertise, identifying trends, providing insights, and continuously innovating to strengthen Molina's market position. Job Duties * Strategy Development & Innovation * Collaborate on the development of state-specific strategies aligned with state priorities, procurement objectives, and evolving Medicaid needs. Translate state regulatory requirements into actionable go-to-market strategies that are innovative and differentiate Molina in competitive procurements * Collaborate with Product Development, Health Plan leaders, Growth Leaders and cross-functional teams to support integration of innovative care models, operational efficiencies, and value-based care solutions tailored to the unique needs of market specific Medicaid populations, especially high-risk or vulnerable groups such as dual-eligible members, foster care, and ABD * Conduct market research, analyze industry trends, and monitor competitor activities to identify innovation opportunities. Propose solutions that address Medicaid ecosystem pain points and enhance Molina's value proposition * Use insights from market research and competitive analysis to stay informed on state Medicaid trends, regulatory changes, and market conditions, and to guide strategic adjustments and future market positioning * Drive the development of win themes and strategy recommendations that align with state priorities, competitive dynamics, and the latest Medicaid trends, positioning Molina as a leader in Medicaid managed care * Track regulatory compliance and address any operational concerns or state-specific issues identified during the pre-procurement phase. Escalate issues when necessary and work to resolve them proactively * Market Development and Strategy Execution * Collaborate on the development of pre-RFP strategy and market readiness, creating and tracking playbooks, plans, and deliverables for Molina's strategy two to three years before RFP release. Ensure alignment with organizational goals and state requirements by collaborating with Market VPs, AVPs, and stakeholders * Identify and engage in thought leadership opportunities by representing Molina at state and national Medicaid conferences, industry forums, and other key events that enhance Molina's brand and expertise in Medicaid care delivery * Stakeholder Engagement & Thought Leadership * Support and track the development of relationships with state agencies, legislative leaders, regulatory bodies, and community organizations to enhance Molina's reputation and strengthen partnerships that could influence procurement outcomes * Represent Molina in strategic discussions with external partners and internal leadership, ensuring clear communication of strategy, innovation, and value propositions * Collaborate with internal stakeholders to influence thought leadership materials and content that showcase Molina's innovative approaches to Medicaid, particularly in high-needs areas like DSNP, ABD, and complex populations * Proposal Support & Competitive Differentiation * Serve as an expert on the pre-procurement process for the proposal team and closely collaborate with the Proposal Director to ensure consistency between market strategy, capture strategy and proposal content. Collaborate with the Proposal Director to ensure consistency between market strategy and RFP content * Track and support the execution of win strategy and strategic recommendations being incorporated throughout the proposal, ensuring Molina's proposals are differentiated and align with state-specific priorities and the competitive landscape * Actively participate in blue, pink, and red team reviews, providing strategic feedback to ensure proposal materials effectively communicate Molina's competitive advantages and compliance with RFP requirements * Support orals preparation, working across matrix partners to refine materials and messaging for presentations to state agencies * Operational Excellence & Cross-Functional Coordination * Use tools (i.e. Salesforce) to document market intelligence, track engagement activities, and share insights across departments. Ensure that data-driven insights are leveraged in proposal content development and strategic planning * Collaborate with the Growth Strategy, Competitive Intelligence and other stakeholders to leverage the competitive intelligence repository that informs decision-making and provides a strategic edge in Medicaid procurements * Develop project plans and roadmaps to guide the timely execution of pre-RFP and procurement activities, ensuring effective collaboration and alignment across functional teams * Facilitate cross-functional coordination for market entry, retention, and development strategies, ensuring that all teams are aligned and executing efficiently * Supports the VP Business Development as a SME during the "warranty period" post award through implementation to the IMO and health plan leadership * Mentorship & Team Development * Mentor junior staff and interns within the Business Development teams, fostering skills in strategic thinking, market research, and pre-procurement planning * Participate in business development activities on an ad-hoc basis, contributing to team knowledge and providing strategic insights to senior leadership * 50% or more Travel required Job Qualifications REQUIRED QUALIFICATIONS: * Bachelor's degree in business, Public Policy, Healthcare Administration or a related field or equivalent combination of education and experience * 7 years in market strategy, business development, or healthcare consulting, specifically within Medicaid managed care or equivalent related field * Proven experience in pre-RFP strategy development, with a strong understanding of Medicaid programs, including TANF, ABD, DSNP, and CHIP populations * Demonstrated ability to drive innovative solutions in the Medicaid space, leveraging market research and industry trends to inform strategic decisions * Experience with Salesforce or similar tools to track market insights, engagement activities, and manage data * Strong experience in stakeholder engagement, particularly with state Medicaid agencies, regulatory bodies, and community-based organizations * Advanced proficiency in Microsoft Office tools (Excel, PowerPoint, Word), including for strategy development, data analysis, and presentation creation PREFERRED QUALIFICATIONS: * Master's degree (MBA, MPH, MPA) in business, public policy, or healthcare administration * 7+ years in business development and Medicaid procurements, particularly with complex populations (e.g., DD/IDD, Foster Care, Dual-Eligible Members) * Experience with Salesforce or similar tools to track market insights, engagement activities, and manage data * Conference management experience and participation in industry forums To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $107,028 - $208,705 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $107k-208.7k yearly 2d ago
  • Lead Networx Analyst, Contract Configuration Info Mgmt

    Molina Healthcare 4.4company rating

    Savannah, GA job

    Provides lead level analyst support for configuration information management activities. Responsible for accurate and timely implementation and maintenance of critical information on claims databases, synchronizing operational and claims systems data and application of business rules as they apply to each database, validating data to be housed on databases, and ensuing adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **Essential Job Duties** - Analyzes and interprets data to determine appropriate configuration changes. - Accurately interprets specific state and/or federal benefits, in addition to other business requirements, and converts terms to configuration parameters. - Manages coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables in the user interface. - Applies experience and knowledge to research and resolve claim/encounter issues and pended claims, and updates system(s) as necessary. - Loads and maintains contracts, benefit and/or reference table information into the claims payment system and other applicable systems. - Participates in defect resolution for assigned component(s). - Participates in the implementation and conversion of new and existing health plans. - Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. - Assists with development of configuration standards and best practices, and suggests improvement processes to ensure systems are working efficiently and enhance quality. - Creates reporting tools to enhance communication on configuration updates and initiatives. - Negotiates expected configuration information management completion dates with health plans. - Collaborates with internal and external stakeholders to understand business objectives and processes. - Solutions with health plans and corporate functions to ensure all end-to-end business requirements have been documented. - Assists leadership in establishing standards, guidelines, and best practices for the configuration information management team. - Represents as a departmental configuration information management subject matter expert. - Supports various department-wide configuration information management projects. - Provides training and support to new and existing configuration information management team members, including configuration functionality, enhancements and updates - Manages fluctuating volumes of work, and prioritizes work to meet deadlines and needs of the configuration department and user community. **Required Qualifications** + At least 5 years of configuration information management experience maintaining databases, and/or analyst experience within a health care operations setting in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience. + Must have Contract configuration experience in Networx. + Experience with QNXT is preferred. + Advanced experience using a claims processing system. + Advanced experienced verifying documentation related to updates/changes within a claims processing system. + Advanced experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements. + Analytical and critical-thinking skills. + Flexibility to meet changing business requirements, and commitment to high-quality/on-time delivery + High attention to detail. + Effective verbal and written communication skills. + Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $80.2k-155.5k yearly 21d ago
  • Analyst, Compliance (Sales)

    Molina Healthcare Inc. 4.4company rating

    Savannah, GA job

    (Sales) Compliance Analyst Molina Healthcare's Medicare Compliance team supports sales operations for the Molina Medicare product lines. It is a centralized corporate function supporting compliance activities. KNOWLEDGE/SKILLS/ABILITIES is primarily responsible for Sales Oversight. * Provide regulatory expertise to the Sales Organization: both State and Federal * Have working knowledge of federal and state guidelines pertaining to Sales and Marketing. * Perform internal Sales/Marketing Compliance Reporting. * Perform internal Sales/Marketing monitoring. * Detailed oriented to conduct thorough Sales allegations investigations. * Recommend applicable corrective action(s) when applicable to business partners. * Process improvement driven. * Create, update, and retire P&Ps, Standard Operating Procedures and Training documents. * Lead regularly scheduled Sales & Compliance leadership meetings. * Interpret and analyze Medicare, Medicaid, and MMP Required Sales & Marketing Reporting Technical Specifications. * Create and maintain monthly and quarterly Sales Complaint Key Performance Indicator (KPI) reports. * Review and interpret internal Sales dashboards for outliers and deeper dive research. * Manage compliance Sales Allegations, Secret Shops, and recommend corrective action plans for deficiencies found. * Responds to legislative inquiries/ Sales complaints (state insurance regulators, Congressional, etc.). * Leads projects to achieve Sales compliance objectives. * Interprets and analyzes state and federal regulatory manuals and revisions. * Interpret and analyze federal and state rules and requirements for proposed & final rules for Sales Oversight. * Interact with Molina external customers, via verbal and written communication. * Ability to work independently and set priorities. Experience * 2-4 years' related compliance work experience * Exceptional communication skills, including presentation capabilities, both written and verbal. * Excellent interpersonal communication and oral and written communication skills. * High level Interaction with Leadership. * Sales Allegation Investigations * Policy & Procedures Pay Range: $80,168 - $116,835 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $80.2k-116.8k yearly 23d ago
  • National Contracting Director (Large Hospital Systems)

    Molina Healthcare Inc. 4.4company rating

    Savannah, GA job

    Molina's Provider Contracting function provides guidance, signature support services, standards and resources to help Molina Healthcare successfully establish and maintain distinct high performing networks of compassionate and culturally sensitive providers who: * Are aligned with our mission to provide quality health services to financially vulnerable families and individuals covered by government programs; * Help meet or exceed applicable access criteria and adequacy standards for covered services; * Agree to sign standard provider services agreements approved by applicable state/federal agencies and built on Molina's business standards that include sustainable value-based reimbursements; and * Are committed to providing quality healthcare for low income Members in an efficient and caring manner.' Knowledge/Skills/Abilities * Under the leadership of the AVP, Provider Network Management & Operations, oversees development and implementation of provider network and contract strategies, identifying those specialties and geographic locations upon which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of Molina membership. * Develops and maintains a standard provider reimbursement strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies). Obtains input from Corporate, Legal and other stakeholders regarding new reimbursement models and oversees their development. * Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the enterprise contract management system (Emptoris). * Directs the preparation of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines with physicians, hospitals, and other health care providers. * Contributes as a key member of the department's leadership team and participates in committees addressing the department's strategic goals and organization. * Oversees the maintenance of all provider contract information and provider contract templates and ensures that contracts can be configured within the QNXT system. Works with Legal, Corporate and other stakeholders as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. * Monitors and reports network adequacy for Medicare and Medicaid services. * Develops strategies to improve EDI/MASS rates. * Educates and works with assigned state Health Plans on any corporate changes or initiatives as necessary. * Works with assigned national vendors to improve contractual terms and maintain positive relationships. * Provides national contracts support for other Molina departments/functions, including: Provider Services (and activities with provider association(s) and Joint Operating Committee management); Delegation Oversight; Provider Network Administration (provider information management and business analyses of national contracts/benefits to support accurate configuration for claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances. * Coordinates with Corporate and Business Development teams to ensure that Molina grows faster (profitable growth) than our competitors in target new markets and expansion opportunities. * Provides training and guidance as needed to the Contract Managers and Contract Specialist(s). * Helps develop and utilize standardized contract templates and Pay for Performance strategies. * Utilizes sound reporting and analytical tools to develop and refine strategic work plans.. Job Qualifications Required Education Bachelor's Degree in a related field (Business Administration, etc.) or equivalent experience. Required Experience 7 - 10 years minimum experience in Healthcare Administration, Managed Care, and/or Provider Network Mgmt & Operations with an emphasis on value based provider contracting. Required License, Certification, Association N/A Preferred Education Master's Degree Preferred Experience 3-5 years minimum experience in contracting with hospitals, physician groups, high volume specialists and ancillary providers. Preferred License, Certification, Association N/A To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $107,028 - $250,446 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $69k-111k yearly est. 3d ago
  • Supervisor, Pharmacy Operations/Call Center

    Molina Healthcare 4.4company rating

    Savannah, GA job

    Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Essential Job Duties** - Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations. - Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. - Ensures that adequate staffing coverage is present at all times of operation. - Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. - Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis. - Participates, researches, and validates materials for both internal and external program audits. - Acts as liaison to internal and external customers to ensure prompt resolution of identified issues. - Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. - Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures. - Participates in the daily workload of the department, performing Representative duties as needed. - Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership. - Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership. - Communicates effectively with practitioners and pharmacists. - Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs. - Assists with development of and maintenance of pharmacy policies and procedures - Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. **Required Qualifications** - At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience. - Knowledge of prescription drug products, dosage forms and usage. - Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity. - Working knowledge of medical/pharmacy terminology - Excellent verbal and written communication skills. - Microsoft Office suite, and applicable software program(s) proficiency. **Preferred Qualifications** - Supervisory/leadership experience. - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Call center experience. - Managed care experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $55,706.51 - $80,464.96 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $27k-34k yearly est. 19d ago
  • RN Clinical Manager, Home Health

    Humana Inc. 4.8company rating

    Humana Inc. job in Savannah, GA

    Become a part of our caring community and help us put health first Reports To: Associate Director, Home Health Branch Administrator FLSA: Exempt Work Schedule: Full-time/40 Hours On-site $10,000 associated sign-on bonus This is not a remote or work-from-home position. This position requires you to sit on-site at our Savannah, GA branch location. The RN Clinical Manager coordinates and oversees all direct care patient services provided by clinical personnel. This role is a focused on both home health clinical quality assurance and home health clinical operations initiatives. * Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. * Conducts/delegates the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies. * Manages the assignment of caregivers. * Responsible for and oversees the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission criteria and make the decision to admit patients to service. Assigns appropriate clinicians to a case, as needed. * Instructs and guides clinicians to promote more effective performance and delivery of quality home care services and is available at all times during operating hours to assist clinicians as appropriate. * Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing patient Plan of Care (POC). * Monitors cases to ensure documentation is following compliance with regulatory agencies and requirements of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. * Coordinates communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning. * Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. * Participates in sales and marketing initiatives. * Supervises all clinical employees assigned to a specific location. Responsible for the overall direction, coordination, and evaluation of the location. Carries out supervisory responsibilities in accordance with Company policies and procedures. * Handles necessary employee corrective action and discipline issues fairly and objectively, in consultation with the Human Resources Department and the Executive Director/Director of Operations. * Participates in the interviewing, hiring, training, and development of direct care clinicians. Evaluates their performance relative to job goals and requirements. Coaches staff and recommends in-service education programs, when needed. Ensures adherence to internal policies and standards. * Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts regular staff education as needed. * Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. * Responsible for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, for appropriateness of care, delivery, and documentation requirements. * Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently performs patient care assignments and staff management activities. * Provides direct patient care on an infrequent basis and only in times of emergency. * Acts as Branch Director in his/her absence. * Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards. Use your skills to make an impact Education: * Associate degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred. License/Certifications: * Active and unrestricted Registered Nurse (RN) license or Compact State RN license with authorization to practice in the state of Georgia. * Proof of current CPR card and/or BLS certification. Required Experience/Skills: * Valid driver's license, auto insurance and reliable transportation. * A minimum of 2 years of experience as a Registered Nurse (RN). * Home health experience is highly desired. Previous experience in home-based care, including home health, hospice, and/or palliative care settings is strongly preferred. * Management and people leadership experience is required. * OASIS experience is highly desired. OASIS certification (HCS-O, COQS, and/or COS-C), preferred. * Homecare Homebase (HCHB) experience is preferred. * Foundational knowledge and basic understanding of CMS PDGM is preferred. Additional Information * Normal Hours of Operation: M-F / 8a-5p (ET) * On-Call Expectation: Yes, rotating on-call shift. * Branch Size: 170+ Census (4.0 STAR rating) * Annual Bonus Eligible: Yes, eligible for the annual incentive bonus which has pay-outs both quarterly and annually. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $77,200 - $106,200 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
    $77.2k-106.2k yearly 4d ago
  • Medical Lab Tech - PRN

    Community Health Systems 4.5company rating

    Bluffton, SC job

    The Medical Lab Technician is responsible for conducting routine and specialized diagnostic tests on blood, body fluids, and other specimens to support accurate and timely patient diagnosis and care. This role requires expertise in performing moderate and high-complexity tests while adhering to strict quality control standards, laboratory protocols, and regulatory guidelines. The Medical Lab Technician is also tasked with maintaining and troubleshooting laboratory equipment, ensuring a safe and compliant work environment, and collaborating with healthcare professionals to provide critical diagnostic information. Essential Functions Performs moderate and high-complexity laboratory tests accurately and efficiently, ensuring timely reporting of results with proper documentation. Adheres to quality control protocols, analyzing data, troubleshooting out-of-range results, and resolving issues promptly. Operates and maintains laboratory instruments, performing preventative maintenance and troubleshooting malfunctions, and communicates issues to supervisors as needed. Demonstrates proficiency in using laboratory computer systems for general and section-specific functions. Collects, processes, and documents chain-of-custody urine drug screens as required. Ensures compliance with laboratory safety standards by wearing appropriate Personal Protective Equipment (PPE) and following safety regulations. Assists with phlebotomy duties and collaborates with team members to complete departmental tasks. Maintains accurate records and statistical data in compliance with regulatory and departmental standards. Performs other duties as assigned. Complies with all policies and standards. Qualifications Associate Degree in Chemical, Physical, Biological, or Clinical Laboratory Science or Medical Laboratory Technology required or Technical School completion of an official military Medical Laboratory Procedures course (50 weeks minimum) and holding the military occupational specialty of Medical Laboratory Specialist required 0-2 years of acute care laboratory experience required Knowledge, Skills and Abilities Strong knowledge of laboratory testing principles, procedures, and quality control standards. Proficiency in laboratory equipment operation, troubleshooting, and maintenance. Ability to analyze and interpret quality control data and patient test results. Effective communication and teamwork skills to collaborate with healthcare professionals. Knowledge of laboratory safety regulations and infection control protocols. Attention to detail and organizational skills to maintain accurate records and ensure regulatory compliance. Licenses and Certifications MLT - Medical Lab Technician through ASCP, AMT, AAB, HEW, or equivalent certification agency required
    $28k-37k yearly est. Auto-Apply 60d+ ago
  • Pharmacy Technician / Pharm Tech Apprenticeship

    Walgreens 4.4company rating

    Savannah, GA job

    Our pharmacy technician positions have undergone an exciting transformation, moving from a transaction-based environment to a much more patient-centric one. As a Walgreens Pharmacy Technician or Pharmacy Technician Apprentice, you'll be front and center - interacting with our customers and developing strong patient relationships. Pharmacy is the core of our business, and our pharmacy technicians enjoy all the tools and support - including the latest technology - to grow their careers and reach their goals. Walgreens is proud to invest & champion an "earn while you learn" Pharmacy Technician Training Program recognized by ASHP & Department of Labor. This apprenticeship program gives you an entry point to a career in health care by guiding you in taking steps towards becoming a Pharmacy Technician Certification Board (PTCB) Certified Pharmacy Technician and helping you maintain the high level of skill required in the pharmacy care industry. Arming you with a nationally recognized, portable credential that will help you advance your career. Whether you are new to working in pharmacies or are an experienced Pharmacy Technician Apply Now! Walgreens will train you to use your skills and talents to serve and care for our patients and customers. The courses, learning activities, and resources provided to you in our pharmacy technician training program are designed to give you foundational and advanced knowledge, skills, and on-the-job experiences you need to prepare to become a certified pharmacy technician. * In accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy. Assists the pharmacist in the performance of other Pharmacy Department duties in accordance with Company policies and procedures. * Responsible for using pharmacy systems to obtain patient and drug information and process prescriptions. If PTCB certified, assists with and coaches pharmacy technicians in the operation of pharmacy systems and cashiers in the operation of the pharmacy cash registers. * Models and delivers a distinctive and delightful customer experience. Customer Experience * Engages customers and patients by greeting them and offering assistance with products and services. Resolves customer issues and answers questions to ensure a positive customer experience. * Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.). * Develops strong relationships with most valuable customers. Operations * Under the supervision by the pharmacist, assist in the practice of pharmacy, in accordance with state, federal, and company policy. Reviews and complies with the Walgreen Co. Pharmacy Code of Conduct. * Performs duties as assigned by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered correctly, filling prescriptions by retrieving, counting and pouring pharmaceutical drugs, verifying medicine is correct, and checking for possible interactions. Assists pharmacists in scheduling and maintaining work flow. * Reports, immediately, prescription errors to pharmacist on duty and adheres to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program. * Strictly adheres to the Walgreen Co. policy regarding Good Faith Dispensing during all applicable prescription dispensing activities. * Responsible and accountable for registering all related sales on assigned cash register, collects and handles cash as required. Takes customer to OTC aisle when possible to assist in locating products. * Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians. * Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager. * Assists and supports Pharmacy Department on inventory management activities, such as, ordering, unpacking, checking and storing shipment of pharmaceuticals. Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods involving Rx drugs. * May assist pharmacist in administering clinical services including the collection and proper labeling of blood/urine samples from patients and other clinical services as required; assists pharmacy staff in coordination of clinical services, Walgreens healthcare clinics and external providers. * Assists Pharmacy Manager and Staff Pharmacist in developing and maintaining good relationships with the local medical community, including physicians, nurses, and other health care providers, by medical provider detailing and outreach to health groups, retirement homes, nursing homes, and other forums for enhancing growth opportunities. * Assists with exterior and interior maintenance by ensuring the Pharmacy Department is stocked with adequate supplies, clean, neat and orderly in condition and appearance. * Complies with all company policies and procedures; maintains respectful relationships with coworkers. * Completes special assignments and other tasks as assigned. Training & Personal Development * Earns and maintains PTCB certification through the designated PTCB training program and/or state required certification/registration. Otherwise, earns PTCB certification as condition of promotion to senior technician. * Attends training requested by Manager and acquires continuing education credits. Maintains knowledge and skill in healthcare and pharmacy, including latest news and developments. Basic Qualifications * Must be fluent in reading, writing, and speaking English. (Except in Puerto Rico) * Requires willingness to work flexible schedule, including evening and weekend hours. Preferred Qualifications * Prefer six months of experience in a retail environment. * Prefer to have prior work experience with Walgreens. * Prefer good math skills so they can fill prescriptions accurately, including counting, measuring and weighing medications. * Prefer good computer skills. * Prefer the knowledge of store inventory control. * Prefer PTCB certification. We will consider employment of qualified applicants with arrest and conviction records. An Equal Opportunity Employer, including disability/veterans. The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits Salary Range: $16.5 - $20 / Hourly
    $16.5-20 hourly 34d ago
  • Licensed Practical Nurse, Home Health

    Humana Inc. 4.8company rating

    Humana Inc. job in Beaufort, SC

    Become a part of our caring community and help us put health first Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love. As a Home Health LPN, you will: * Provide professional nursing services under the direction of a RN in compliance with the state's Nurse Practice Act, any applicable licensure/certification requirement, applicable healthcare standards, governmental laws and regulations, and CenterWell Home Health policies and procedures. * Provide skilled nursing interventions in the treatment of the patient/clients illness, rehabilitative needs and preventative care. Utilize a holistic approach in the provision of problem specific therapeutic interventions, teaching and training activities in accordance with the plan of care. * Apply knowledge and skills in accordance with accepted standards of clinical practice to facilitate problem resolution and achieve individualized patient goals and outcomes. * Confer with the RN Supervisor regarding needed changes in the Plan of Treatment. Accept verbal orders from physician were permitted by state law/regulations/Nurse Practice Act and communicate these orders to the RN Supervisor. * Utilize a systematic, individualized goal/outcome driven approach in implementing the nursing plan of care. * Maintain contact with patients, physicians, clinical manager(s), other members of the healthcare team in a timely manner regarding patient/family needs and status changes. Participate in care coordination activities and discharge planning as appropriate. * Maintain the highest standards of professional conduct in relation to information that is confidential in nature. Share information only when the recipient's right to access is clearly established and the sharing of such information is dearly in the best interests of the patient. * Appropriately communicate to ensure adherence to professional standards in the provision of and availability of supplies, materials and equipment needed to safely and effectively implement the plan of care. * Prepare, submit and maintain documentation as required by the Company and/or facility. Visit/shift notes documented on day services are rendered. Use your skills to make an impact Required Experience/Skills: * Graduate of an accredited Licensed Practical Nursing Program or accredited School of Vocational Nursing. * Current nursing license in the practicing state. * Valid drivers license, auto insurance and reliable transportation. * Current CPR certification. * Two years experience as an LPN/LVN in a clinical setting, preferably in a home health or hospice setting. Pay Range * $28.00 - $40.00 - pay per visit/unit * $44,600 - $61,400 per year base pay Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $53,000 - $73,000 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
    $53k-73k yearly 60d+ ago

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