Magellan Health Remote jobs - 124 jobs

Independently coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties performed are either during face-to-face home visits or facility based depending on the assignment. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. May act as a team lead for non-licensed care coordinators. Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately (e.g., during transition to home care, back up plans, community based services). Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for members' care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan. Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary. Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases. Provides assistance to members with questions and concerns regarding care, providers or delivery system. Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources. Generates reports in accordance with care coordination goals. Other Job Requirements Responsibilities Associate's Degree in Nursing required for RNs, or Master's Degree in Social Work or Healthcare-related field, with an independent license, for Social Workers. Licensed in State that Services are performed and meets Magellan Credentialing criteria. 2+ years' post-licensure clinical experience. Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required. Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment. Knowledge of referral coordination to community and private/public resources. Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data. Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking. Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols. Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures. Ability to establish strong working relationships with clinicians, hospital officials and service agency contacts. Computer literacy desired. Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills. General Job Information Title CISC Care Coordinator, Licensed Grade 24 Work Experience - Required Clinical Work Experience - Preferred Education - Required Associate - Nursing, Master's - Social Work Education - Preferred License and Certifications - Required DL - Driver License, Valid In State - Other, LISW - Licensed Independent Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $58,440 Salary Maximum: $93,500 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Exemption Status:United States of America (Exempt)$85,356 - $115,232 - $145,107 “Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.” This position is not eligible for Sponsorship. MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description Account Executive I or II- Hospital & Health-Systems (Self-Insured) Account Executive I - $82,074 - $110,800 - $139,526 Account Executive II - $98,327 - $135,200 - $172,073 The Scoop: The Account Executive is responsible for the success of the overall client business relationship of Complex Accounts, Strategic Key Accounts, and entire assigned book of business. Provides proactive and strategic support for achieving financial goals resulting from successful oversight of client deliverables, renewals and upsell activity. Manages all aspects of business relationships with minimal management involvement and exhibits a track record of performance that exceeds expectations. Ensures customer satisfaction, and effectively leads the account client team focusing on service, revenue, and operational efficiency as identified in strategic plans for the client and MedImpact. This position operates with a very high level of autonomy on complex business issues while requiring minimal management oversight. What You Get To Do: Level I Manage book of business in pursuit of fiscal revenue targets as set by management Develop and manage the account team annual strategic plan for assigned book of business to address all aspects of client lifecycle, including but not limited to service, financial, growth and clinical initiatives based on an understanding of each client's business needs Ensure high degree of client satisfaction and retention through demonstrable results and by effectively leading the service team to achieve client service goals Effectively utilize MedImpact forums and resources to proactively address client needs and to escalate issues where appropriate Provide timely feedback of strategic plan performance and outcomes to the management to ensure service and growth opportunities are maximized and incorporated into the organizational strategy planning process Provide oversight of projects and client initiatives and assists in the interpretation and context of client requests Maintain the integrity of the annual strategic business plan and manage the fiscal revenue plan Manage client renewal process, including participation in development and review of proposal of pricing terms in lieu of the fiscal revenue plan, mitigate organizational risks with respect to performance guarantees, and unveil opportunities for MedImpact product usage as well as client growth and expansion Lead renewal presentations. Utilize all internal pro-forma financial tools and forums to ensure preparedness and success Support the implementation process for assigned clients, including oversight of implementation and contract terms Negotiate and manage client contract throughout the lifecycle of the account Build strong and positive internal relationships with your account service matrix team in order to realize the full potential of the assigned book of business Coordinate with MedImpact subject matter experts to increase knowledge of MedImpact products, services, and industry information to be incorporated into and strengthen client relationship Organize and lead client business planning meetings, quarterly and annual executive pharmacy briefings, client leadership councils and internal team strategy planning discussions Demonstrate proficiency in Excel, Word and PowerPoint, organizational web-based tools in support of these functions Supports and assists in sales and prospect presentations Develops and maintains effective relationships with client consultants as appropriate Level II Develops and manages client specific, strategic, financial, and business relationship plans that encompass client's goals, performance expectations and growth in membership and profitability in pursuit of meeting department and organizational business metrics Manages large, highly complex clients that have complex business needs Consistently ensure that deliverables are on time, within budget, and meet the quality levels expected by MedImpact's internal and external customers Optimizes potential for sustainable growth and profitability for assigned book of business Develops and maintains solid business relationships with clients at the executive level and with critical decision-makers Determines where to make “focused investments” for each account Utilize financial and pricing models to analyze and present business and clinical scenarios to client illustrating different benefit strategies and advantages of adoption Organizes and leads client business planning meetings, financial performance reviews, leadership summits and internal strategy planning discussions Researches and understands market trends and competitive practices to in order to share opportunities based on client needs and strategic objectives Mentors new Account Executives through on boarding process Proactively monitors client service continuum to identify and address service delivery issues and escalate concerns appropriately Collaborates with internal leaders throughout other business units for problem solving, planning and successful outcomes Demonstrates ability to manage challenging situations in a positive and constructive manner Ensures client retention and oversee client contract renewals including managing the RFP and negotiation process Manages and prioritizes elements of negotiations within scope of total client relationship Organizes and develops assigned Book of Business presentations Maintains thorough understanding of clients' business and financial goals and the relationship to MedImpact goals in sustaining a profitable partnership Provides regular feedback of strategic plan performance and outcomes to management to ensure service and growth opportunities are maximized and incorporated into the organizational strategy planning process Provides oversight of projects and client initiatives and assist in the interpretation and context of client requests Provide support to matters escalated by the client team Participates in and support the implementation process for new clients assigned, including collaboration with the Sales and Implementation teams on contract terms Supports and assists in sales and prospect presentations, including participation in and travel to Best and Final meetings Develops and maintains effective relationships with client consultants as appropriate Completes assignments, Salesforce cases and training including stretch assignments Supervisory Responsibilities This job has no supervisory responsibilities. Education and/or Experience For consideration candidates will need: Level I: Bachelor's Degree from four-year college or university Three (3) to seven (7) years related PBM experience, or equivalent combination of education and experience Self-Insured - Experience in the Self-Insured benefits arena, 340B or clients with owned & operated pharmacies, preferably with Hospitals and Health Systems. Level II: Bachelor's degree from four-year college or university Seven (7) to ten (10) plus years related experience in a PBM environment, or equivalent combination of education and experience Self-Insured - Experience in the Self-Insured benefits arena, 340B or clients with owned & operated pharmacies, preferably with Hospitals and Health Systems. Computer Skills Intermediate to advanced skill set in MS Office, Word, Excel, PowerPoint, Project, Salesforce and Outlook. Certificates, Licenses, Registrations Other Skills and Abilities Outstanding knowledge of the health benefits arena, government prescription programs, preferably in pharmacy benefits management. Strong consultative selling and negotiation skills, Strong computer, and analytic skills, including experience creating and delivering client presentations using MS Office programs and use of internal system reporting tools and databases. Knowledge of healthcare products and contracts preferred. Strong verbal, written, interpersonal, presentation, persuasion and consulting skills required. Excellent communication, writing and public presentation skills essential. Travel This position may require domestic travel up to 35% of the time, with little or no advance notice and depending on client contractual requirements. The Perks: Medical / Dental / Vision / Wellness Programs Paid Time Off / Company Paid Holidays 401K with Company match Life and Disability Insurance Tuition Reimbursement Employee Referral Bonus This position is eligible for Employee Referral Bonus at Level I To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to ************************* MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers, and consumers of healthcare in the U.S. and foreign markets. Equal Opportunity Employer, Male/Female/Disabilities/Veterans OSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The Perks: Medical / Dental / Vision / Wellness Programs Paid Time Off / Company Paid Holidays Incentive Compensation 401K with Company match Life and Disability Insurance Tuition Reimbursement Employee Referral Bonus To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to ************************* MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Exemption Status:United States of America (Exempt)$130,148 - $182,208 - $234,267 “Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.” This position is not eligible for Sponsorship. MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description Essential Duties and Responsibilities include the following. Other duties may be assigned. Manages Account Executive development of client-specific business plans focused on the client's goals, performance expectations, growth in membership and profitability. Ensures that deliverables are on time, within budget, and meet the quality levels expected by MedImpact's internal and external customers. Provides direction and management over Key and LAMP Account Management teams to monitor the quality of products and services being offered to the client. Trains new staff members and provides on-going coaching to existing Account Management teams. Optimizes potential for sustainable growth and profitability. Identifies and aligns required resources to achieve business goals in book-of-business. Develop and maintain solid business relationships with region's clients at the executive and key decision-maker levels. Determines where to make “focused investments” for each account. Utilizes financial and pricing models to analyze and present business and clinical scenarios to client illustrating different benefit strategies and advantages of adoption. Researches and analyzes market trends and competitive practices to ensure client strategy is placed in context of client's industry and marketplace. Monitors client service continuum including proactive and reactive components. Resolves escalated issues, while ensuring ongoing issues are resolved expeditiously. Performs 360o review of performance on account, from operational service delivery to relationship management. Identifies gaps and sources of corrective action to ensure milestones are met. Collaborates with leaders in Operations, IT, Health Services and the other Directors. Supervisory Responsibilities Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of this unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary. Client Responsibilities This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience Bachelor's degree (Master's degree preferred) and a minimum of ten (10) years related experience and eight (8) years of SME in respective area(s); (or equivalent combination of education and experience) with at least eight (8) years leading individual contributors, leaders, and leaders of leaders; which may be substituted with an appropriate mix of leadership experience and 10 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (VP+ level) that must completed within 12 months in new position Required experience depends on assigned book of business. Self-Insured - Experience in the Self-Insured benefits arena, experience with health plans/white label required. Location - Remote - Eastern or Central Region Computer Skills Intermediate to advanced computer skills; proficient with MS Office/Outlook and client databases Certificates, Licenses, Registrations None currently required. Other Skills and Abilities: Working knowledge of the health benefits arena, government prescription programs, preferably in pharmacy benefits management required; knowledge of healthcare products and contracts preferred; Consultative selling and negotiation skills; Demonstrated experience creating and delivering client presentations using; Strong verbal, written, interpersonal, presentation, persuasion and consulting skills required; Good interpersonal skills, excellent communication, writing and presentation skills essential; Other Qualifications Outstanding knowledge of the health benefits arena, preferably in pharmacy benefits management “PBM” or other managed healthcare services to national and regional managed care organizations, insurance companies, and other health related entities. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Mathematical Skills Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Business Acumen Directing Others Organizational Agility Conflict Management Drive for Results Political Savvy Customer Focus Innovation Management Strategic Agility Decision Quality Managerial Courage Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is occasionally exposed to moving mechanical parts; fumes or airborne particles and risk of electrical shock. The noise level in the work environment is usually moderate. Work Location This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders. Working Hours This is an exempt level position requiring one to work the hours needed to get the job done. Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. This may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm, often supporting multiple time zones depending on assigned book of business. Travel This position requires domestic travel of up to 50% of the time with little or no advance notice. The Perks: Medical / Dental / Vision / Wellness Programs Paid Time Off / Company Paid Holidays Incentive Compensation 401K with Company match Life and Disability Insurance Tuition Reimbursement Employee Referral Bonus To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to ************************* MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Exemption Status:United States of America (Exempt)$83,426 - $114,712 - $145,997 “Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.” This position is not eligible for Sponsorship. MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description Summary Prescient Holdings Group (PHG) is a healthcare company providing pharmaceutical management solutions to payers, patients, and providers. We are focused on developing the most effective strategies for optimizing drug access and spend through our suite of formulary and rebate services. Client Services Business Systems Analyst ensures timely, accurate service delivery as a liaison between client(s), client team members, and IT staff. Essential Duties and Responsibilities include the following. Other duties may be assigned. Provide technical consultation to clients during onboarding & on an ongoing basis Review and analyze client data by developing SQL queries to address client/client services team requests Monitor & support monthly & quarterly client operational processes Collaborate with IT Business Systems Analysts & Engineering team to create new and/or enhance systems to meet client needs Collaborate with internal and external stakeholders to create best-in-class solutions that integrate technology, information, and business processes. Maintain current understanding of client file layouts, relationships, & logic and how they operate in business applications. Provides technical consultation to the client team and related internal stakeholders. Translates client needs into functional requirements and partners with Engineering Team in translating requirements into design specifications. Performs gap, impact, risk, and other required analysis related to business and system changes/enhancements . Utilizes planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources to achieve reporting timeliness and accuracy. Maintains commitment to operational goals in the face of obstacles. Collaborates and cultivates positive relationships with internal and external customers through delivery of sustainable, measurable, accurate, reliable, and timely results that meet or exceed customer expectations. Promptly responds to service failures, resolves issues, and escalates concerns as appropriate. Promotes continuous improvement by ensuring adherence to quality principles. Seeks out and actively participates in business initiatives that contribute to service excellence. Actively participates in continued professional development to stay up to date on the latest technical and information management enhancements and data management best practices. Supervisory Responsibilities No supervisory responsibilities Client Responsibilities This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BS/BA and 4+ years' experience or equivalent combination of education and experience. PBM or healthcare industry experience preferred. Computer Skills Strong proficiency with MS Office / Word, PowerPoint, Excel, Visio and Outlook to create complex documents, manage schedules, and analyze data. Hands on experience writing SQL queries and familiarity with data models. Certificates, Licenses, Registrations None currently required. Other Skills and Abilities Ability to effectively balance a high volume of work and a variety of tasks; ability to prioritize urgent issues effectively. Strong analytic, verbal and written communication skills. Detail-oriented with high degree of accuracy and organizational skills. Able to effectively work as a team player as well as independently. Excellent investigative, problem resolution, judgment and decision-making skills required. Excellent presentation and consultative skills, working with internal and external clients at various levels in the organization. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Mathematical Skills Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Composure Decision Quality Organizational Agility Problem Solving Customer Focus Drive for Results Peer Relations Time Management Dealing with Ambiguity Learning on the Fly Political Savvy Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic). Work Location This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders. Working Hours This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm. Travel This position requires no travel however attendance maybe required at various local conferences and meetings. The Perks: Medical / Dental / Vision / Wellness Programs Paid Time Off / Company Paid Holidays Incentive Compensation 401K with Company match Life and Disability Insurance Tuition Reimbursement Employee Referral Bonus To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to ************************* MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets. Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

The Quality Coordinator-Transitions of Care is dedicated to managing quality assurance processes and ensuring compliance with industry standards. This role involves coordinating with various departments to integrate quality systems, facilitating continuous improvement initiatives, and maintaining comprehensive documentation to support assessments and audits. The Quality Coordinator plays a crucial role in fostering a culture of quality and excellence within the organization, driving efforts to meet and exceed quality targets. Essential Functions Implements and monitors quality improvement initiatives to ensure adherence to best practices, policies, and regulatory requirements. Supports teams as a subject matter expert on quality-related workflows, ensuring staff adherence to established procedures. Coordinates and tracks patient outreach efforts to close gaps in care, ensuring timely follow-up on quality attribution reports. Optimizes provider schedules by ensuring appointments address preventive care and chronic disease management gaps. Monitors and analyzes key performance indicators (KPIs) related to quality measures, providing feedback and accountability to stakeholders. Conducts regular rounding with providers and staff to reinforce best practices and identify workflow improvement opportunities. Assists in medical record audits, ensuring compliance with payer requirements and timely submission of quality-related documentation. Facilitates training sessions and provides ongoing support to enhance staff competency in quality care initiatives. Collaborates with data analytics and population health teams to ensure accurate reporting and performance tracking. Maintains compliance with all payer-specific quality programs, ensuring proper documentation and adherence to incentive program requirements. Performs other duties as assigned. Complies with all policies and standards. Qualifications Associate Degree in Healthcare Administration, Nursing, Public Health, or a related field required Bachelor's Degree in Nursing or a related field preferred 2-4 years of experience in quality improvement, population health, or clinical operations within a healthcare setting required Experience in working with payer quality programs and regulatory reporting preferred Knowledge, Skills and Abilities Strong knowledge of quality improvement methodologies and healthcare regulatory requirements. Proficiency in electronic medical records (EMR) systems and quality reporting tools. Excellent communication and interpersonal skills to collaborate effectively with providers, staff, and leadership. Ability to analyze data, identify trends, and develop action plans for performance improvement. Strong organizational skills and attention to detail to ensure compliance with quality initiatives. Ability to adapt to evolving healthcare regulations and payer requirements. Strong problem-solving skills and the ability to drive accountability in a healthcare setting. Licenses and Certifications Certified Medical Assistant (CMA)-AAMA preferred or LPN - Licensed Practical Nurse - State Licensure preferred or RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred CPHQ - Certified Professional in Healthcare Quality preferred

The Ultrasound Technologist performs high-quality diagnostic ultrasound examinations to assist physicians in the evaluation and treatment of patients. This role requires independent judgment, technical expertise, and a commitment to patient safety and comfort. The Ultrasound Technologist ensures all procedures are appropriately ordered, patient identification is verified, and imaging protocols are followed to produce accurate and reproducible results. Essential Functions Performs all ultrasound procedures independently, adhering to department protocols and ensuring high-quality, diagnostic imaging results. Verifies patient identification and ensures the appropriate procedures are ordered and acknowledged prior to conducting imaging. Recognizes and documents pathologies during scanning for interpretation by the radiologist, following established protocols. Assumes responsibility for patient care, safety, and comfort during all imaging procedures. Maintains a clean, safe, and organized work environment, ensuring compliance with safety and infection control guidelines. Operates ultrasound equipment safely and effectively, following departmental policies and manufacturer guidelines. Accurately documents imaging procedures and patient information in the electronic health record system, ensuring all associated documents are scanned into PACS for radiologist interpretation. Monitors and maintains an adequate supply of imaging materials and coordinates inventory replenishment as needed. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications 1-3 years of clinical experience as an Ultrasound Technologist required 2-4 years of clinical experience as an Ultrasound Technologist preferred Knowledge, Skills and Abilities Proficiency in ultrasound imaging techniques and equipment operation. Knowledge of anatomy, physiology, and pathology relevant to diagnostic sonography. Strong interpersonal and communication skills to interact effectively with patients and healthcare teams. Attention to detail and organizational skills to ensure accurate imaging and documentation. Ability to work independently and make informed decisions within the scope of practice. Commitment to maintaining patient confidentiality and adhering to ethical standards. Licenses and Certifications (S) - ARDMS or ARRT - Sonography certification or registry eligible required BCLS - Basic Life Support obtained within the 7 days of employment required

The Remote Medical Billing Specialist is responsible for processing, auditing, and submitting primary and secondary insurance claims, ensuring accuracy, compliance, and timely reimbursement. This role utilizes electronic claims management systems to review, correct, and resolve billing errors, denials, and rejections. The Billing Specialist I collaborates with internal teams, facility liaisons, and payers to ensure clean claim submission and adherence to federal, state, and payer-specific regulations. As a Billing Specialist at Community Health Systems (CHS) - Shared Services Center, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental, and vision insurance, paid time off (PTO), 401(k) with company match, tuition reimbursement, and more Essential Functions Processes and submits primary and secondary insurance claims accurately and in a timely manner, ensuring compliance with payer guidelines and regulatory requirements. Reviews and resolves claim errors, rejections, and denials, making necessary corrections and resubmitting claims as needed. Demonstrates working knowledge of billing forms, including UB-04, CMS-1500, or state-specific billing forms, ensuring claims are submitted with the appropriate documentation. Audits claims for accuracy, checking for duplicate charges, overlapped accounts, and missing information before submission. Investigates and processes rebill requests, verifying claim accuracy and making necessary updates per facility or coding liaison direction. Maintains knowledge of billing regulations, payer policies, and electronic submission guidelines, staying up to date with federal, state, and local billing requirements. Utilizes electronic billing systems to analyze, research, and transmit claims, ensuring proper documentation of actions taken in the collection system. Monitors and reports charging or edit trends, collaborating with internal teams (such as coding, patient access, and ancillary departments) to improve billing accuracy. Performs daily balancing tasks using SSI and other billing systems, escalating unresolved issues or billing delays to the Billing Services Manager. Communicates professionally with payers, facility representatives, and internal teams, ensuring efficient issue resolution and proper follow-up on outstanding claims. Performs other duties as assigned. Complies with all policies and standards. This is a fully remote opportunity. Qualifications H.S. Diploma or GED required Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred 0-1 years of experience in medical billing, insurance claims processing, or revenue cycle operations required 1-3 years of billing experience in a medical facility, ambulatory surgery facility, or acute-care preferred Experience with hospital or physician billing, including knowledge of payer policies and electronic claims systems preferred Knowledge, Skills and Abilities Basic understanding of insurance claim processing, medical billing, and reimbursement guidelines. Familiarity with billing software, electronic claims management systems (e.g., SSI, Pulse/DAR), and eligibility tools. Knowledge of CMS, Medicaid, Medicare, and commercial insurance billing regulations. Ability to analyze and resolve claim errors, denials, and rejections efficiently. Strong attention to detail, organizational skills, and ability to meet deadlines. Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems. Excellent communication and problem-solving skills, with the ability to interact professionally with internal teams and external payers. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.

Coordinate and collaborate with Prison Facilities via in person. Knowledge of community resources that help support incarcerated population. Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are typically performed during face-to-face home visits. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services). Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member`s care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan. Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary. Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases. Provides assistance to members with questions and concerns regarding care, providers or delivery system. Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources. Generates reports in accordance with care coordination goal. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities 3-5 years experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required. Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment. Knowledge of referral coordination to community and private/public resources. Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data. Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking. Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols. Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures. Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills. Ability to work well with clinicians, hospital officials and service agency contacts. General Job Information Title Care Coordinator - Transition of Care Grade 22 Work Experience - Required Clinical, Quality Work Experience - Preferred Education - Required GED, High School Education - Preferred Associate, Bachelor's License and Certifications - Required DL - Driver License, Valid In State - OtherOther License and Certifications - Preferred CCM - Certified Case Manager - Care MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt Salary Range Salary Minimum: $50,225 Salary Maximum: $75,335 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

This position works collaboratively with child serving state agencies (e.g., Children, Youth, and Families Department) ensuring members receive care coordination and appropriate access to eligible and necessary services. Provides training and technical assistance to both internal and external stakeholders in order to enhance communication and coordination within the juvenile systems of care. Acts as the single point of contact for information specific to member's entering and exiting the children's services system. Serves as the single point of contact to communicate and collaborate with children serving systems (e.g., CYFD, to include Child Protective Services, Juvenile Justice Services, etc.; child serving provider organizations, the Health Plan, and others). Acts as the interagency liaison between the Children, Youth, and Families Department (CYFD), the members, their families/caregivers, and other organizations. Ensures appropriate transitions both in and out of the State Custody, including care coordination and completing documentation within the member's record. Partner with clinical and quality teams to conduct outreach to child-serving higher levels of care, such as RTC and TFC, to support quality oversight of said organizations. Interfaces with the children's advocates, to include Court Appointed Special Advocates, legal guardians, etc. to support development of a care plan that takes the child's needs into consideration. Communicates with Medicaid as needed (e.g., reports, notifications, etc.). Shares information that assists the clinical team in developing treatment plans that incorporate children's and their caregivers needs. Coordinates with providers, including delegated providers to ensure appropriate access to care and follow-up. Develops and initiates collaborative interagency protocols and MOU agreements within the both community-based and congregate care providers. Provides coverage in the absence of the Care Coordinator, including attending and participating Individual Planning Meetings, and other meetings as appropriate. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities Bachelor's degree in Social Work, Nursing, Psychology, or related field required 5+ years of experience working within the children's behavioral health system or with child serving agencies (e.g., CYFD). May accept an equivalent combination of education and experience without the bachelor's degree. Strong verbal and written communication skills. Demonstrated problem solving skills. Organized with strong attention to detail. General Job Information Title Senior Children and Youth Services Liaison Grade 24 Work Experience - Required Social Work Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's - Social Work Education - Preferred Master's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $58,440 Salary Maximum: $93,500 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Shift: 7:00PM-7:00AM The Phlebotomist is responsible for the proper collection of blood specimens to support accurate laboratory testing for the diagnosis and treatment of diseases. This role ensures positive patient identification, timely specimen collection, and adherence to safety and regulatory standards. The Phlebotomist provides exceptional patient care by maintaining professionalism and demonstrating effective communication during interactions with patients, staff, and visitors. Essential Functions Performs venipuncture and capillary blood collection following laboratory policies and procedures to ensure accurate and timely specimen collection. Ensures positive patient identification by using two patient identifiers and labeling specimens at the patient's bedside to prevent errors. Prepares, packages, and transports specimens to the laboratory while maintaining sample integrity and adhering to safety protocols. Explains procedures to patients, providing reassurance and addressing concerns to ensure a positive patient experience. Cleans, sterilizes, and maintains phlebotomy equipment and workspace in compliance with safety and infection control standards. Accurately documents patient and specimen information in the laboratory system, ensuring compliance with regulatory requirements. Collects timed specimens as ordered, prioritizing and efficiently completing phlebotomy tasks to meet clinical needs. Identifies and resolves specimen issues, including addressing rejections and recollecting samples when necessary. Collaborates with healthcare team members to clarify orders, resolve collection challenges, and communicate specimen status. Adheres to all laboratory and hospital safety requirements and follows Laboratory procedures to ensure compliance with accreditation and regulatory standards. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications 0-2 years of phlebotomy experience required Phlebotomy Certification Required BLS Certification Required Knowledge, Skills and Abilities Knowledge of safety guidelines, sanitation, and infection control protocols. Ability to perform blood collection techniques successfully across all age groups (neonates to geriatrics). Understanding of standards for patient identification, specimen handling, and lab testing requirements. Strong communication skills, both written and verbal, with the ability to interact professionally with patients, staff, and physicians. Ability to multitask, remain calm in stressful situations, and adapt to a dynamic environment. Proficiency in distinguishing sample types and understanding order-of-draw requirements for lab testing. Demonstrates a high level of attention to detail and accuracy in specimen collection and documentation.

The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization review plans and works to optimize hospital resource utilization, reduce readmissions, and maintain compliance with payer requirements. Essential Functions Performs admission and continued stay reviews using evidence-based criteria, clinical expertise, and regulatory guidelines to ensure appropriate utilization of hospital services. Collaborates with physicians and clinical teams to obtain necessary documentation for medical necessity, discharge planning, and payer requirements. Documents all utilization review activities in the hospital's case management software, including clinical reviews, escalations, avoidable days, payer communications, and authorization details. Works with insurance companies to secure coverage approvals and mitigate concurrent denials by submitting reconsiderations or coordinating peer-to-peer reviews. Communicates effectively with utilization review coordinators, case managers, and discharge planners to ensure a collaborative approach to patient care. Analyzes trends in hospital admissions and extended stays, identifying opportunities for process improvements to enhance utilization management. Serves as a key contact for facility staff and insurance representatives regarding utilization review concerns. Supports training initiatives within the department and escalates complex issues to management as needed. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications Associate Degree in Nursing required Bachelor's Degree in Nursing preferred 2-4 years of clinical experience in utilization review, case management, or acute care nursing required 1-3 years work experience in care management preferred 1-2 years of experience in utilization management, payer relations, or hospital revenue cycle preferred Knowledge, Skills and Abilities Strong knowledge of utilization management principles, payer guidelines, and regulatory requirements. Proficiency in case management software and electronic health records (EHR). Excellent communication and collaboration skills to work effectively with interdisciplinary teams and external payers. Strong analytical and problem-solving skills to assess utilization trends and optimize hospital resource use. Ability to work in a fast-paced environment while maintaining attention to detail and accuracy. Knowledge of HIPAA regulations and patient confidentiality standards. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required CCM - Certified Case Manager preferred or Accredited Case Manager (ACM) preferred

Talent Acquisition Sourcing for Personal Financial Counseling Positions. Seeking someone with experience sourcing for CFP's, AFC's and CHFC's. Contract position up to 6 months. Fully Remote. What is Talent Acquisition at Magellan? It may not be what you think. We operate with one goal in mind, to share our unique brand far and wide. We are thought leaders in health care and masters of networking. This position is ideal for recruitment partners with exceptional ability to find and engage passive candidates, utilize market intelligence and influence key business leaders. In this position, you are a. . . . Digital Citizen You use digital technology purposefully and confidently to communicate, find information and come up with effective solutions. You are a Super User of our Candidate Relationship Management (CRM) technology and use it to automate the candidate communication process, encourage engagement and improve the candidate experience. You fully leverage our CRM methodology and technology to effectively manage talent pipelines, work efficiently and engage in new ways of finding candidates. You understand that technology will improve results and appreciate the way cutting edge systems can differentiate Magellan. Marketer You understand Magellan's vision, hiring goals and business needs. You live and give life to our brand and share it throughout our networks. You speak, write and listen combining empathy with business savvy. Career Coach You create authentic relationships with hiring managers, candidates and colleagues. You understand and balance the hiring need with the candidate's career goals. You manage conflicting situations, such as salary level vs. skill set, with professionalism and objectivity. Design Thinker You construct talent acquisition strategies infused with market, industry and labor intelligence in order to understand how best to personalize candidate engagement and attract the talent needed. Data-Based Decision Maker You use data to ask questions, seek answers and gain accurate insights. You use data to help candidates, managers and business leaders make better decisions. Why join Magellan? Working at Magellan is more than a job. It's a calling to make a difference for our most vulnerable populations - we're leading humanity to healthy, vibrant lives. You're a key part of our purpose, you're not just filling vacancies. Through best in class processes and technology solutions, and a commitment to what makes us uniquely Magellan, you'll find the talent we need to lead our organization into the future. Come join us! The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities To be successful in this role, you should have the following skills and experience: At a minimum, 3 years or more of recruitment/recruitment coordinator/HR experience and a bachelor's degree OR 5 years or more of recruitment/recruitment coordinator/HR experience and an associate's degree Demonstrated ability using CRM technology or sophisticated ATS technology. Understand and drive the full life cycle recruitment process. Strong understanding of marketing and branding principles and how to effectively use them to hire talent. Ability to manage high volume recruitment and meet deadlines for hiring. Ability to attend career fairs and other hiring events. Ability to establish relationships and partner effectively with candidates, HR business partners, managers and peers. Ability to be flexible and work in a sometimes ambiguous and changing environment and able to juggle shifting priorities and manage time effectively. General Job Information Title Financial Talent Acquisition Sourcer - Contract Position/Remote Grade 25 Work Experience - Required Talent Acquisition/Recruiting Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's Education - Preferred Master's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $64,285 Salary Maximum: $102,855 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Responsible for the development, strategy, and implementation of community outreach programs in conjunction with the Clinical and Administrative departments. Leads the development of strategic plans for engagement, within assigned territories, regions or communities, that nurture and retain positive relationships between the health plan, members and caregivers, the community, and provider organizations. Leads resource assessments within assigned region to identify potential partnerships to serve our members through enhanced access, improved community awareness of programs, and participation with established community advisory boards. Provides information about health care services, preventative care, as well as information related to health, welfare, and social services or social assistance programs offered by the state or local communities. Organizes and attends community events and health fairs. Serves as the liaison to community organizations. Conducts member, community, and organizational trainings. Completes face-to-face outreach. Ensures compliance with all state and federal marketing requirements. Drives engagement in care by facilitating a robust engagement strategy, which may include leveraging community relationships and developing opportunities to present and educate in front of members, caregivers, and other interested parties. Develops and implements promotional plans for new outreach opportunities. Distributes educational materials to community and provider organizations. Presents the program and offerings in group settings. Consistently achieves member engagement strategies while meeting quality performance standards. Attends provider and community meetings and participates in special projects. Conducts consumer and community surveys as needed. Provides training on programs to staff and agencies as necessary. Collaborates with multiple departments, including peers, business development, marketing, network contracting, and provider liaison teams. Participates as a member of the Clinical team in developing and implementing strategies to engage stakeholders. Develops and implements promotional plan for new outreach opportunities. Maintains thorough knowledge of healthcare programs and community resources. May act as a subject expert on Medicaid programs and benefits for internal and external stakeholders. Develops a resource guide for assigned territory (such as community-based organizations, service agencies, housing, food pantries, churches etc.), and cultivates relationships and identifies potential collaboration opportunities. Plans and implements territory monthly action plan and consistently meets and/or exceeds outreach targets. Produces summary reports on outreach activities. Participates in cross functional teams and quality improvement initiatives. Responsible for identifying, developing and maintaining strategic relationships with community contacts and organizations to pursue outreach engagements for multiple regions. Distributes written material to community and provider organizations. May schedule and facilitate marketing events, both formal and informal, with stakeholders that meets contract requirements. Identifies and attends community and health events. Identifies and coordinates outreach activities and necessary materials at community and health events. Organizes staff and other resources in the participation and the support of select community events and activities. Responsible for post-event follow up and maintenance of relationships for future and recurring events. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities 5+ years of community outreach and engagement experience with 1 year working with government-sponsored population, particularly Medicare and Medicaid. Self-starter with the ability to work with limited supervision. Excellent verbal and written communication skills. Must exhibit sensitivity towards the target population. 2+ years of experience working with individuals with adverse childhood experiences. General Job Information Title CISC Member, Caregiver and Stakeholder Engagement Manager Grade 23 Work Experience - Required Community Relations/Outreach Work Experience - Preferred Education - Required Associate Education - Preferred Bachelor's, Master's License and Certifications - Required DL - Driver License, Valid In State - OtherOther License and Certifications - Preferred CPRS/CPS/CPSS/CRPS/PRSS, Peer Specialist, State Requirements - Care MgmtCare Mgmt, LMSW - Licensed Master Social Worker - Care MgmtCare Mgmt Salary Range Salary Minimum: $53,125 Salary Maximum: $84,995 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

The Network Contract Specialist will be responsible for creating and maintaining behavioral health provider contracts across the New Mexico territory for Presbyterian Health Plan with Medicaid, Medicare, and Commercial lines of business. This role includes managing provider contracting activities in coordination with the Network team and processing all necessary contract-related updates. Key responsibilities include handling contract changes, Statements of Work, amendments, rate updates, Letters of Direction, and other required modifications. The specialist will also ensure all contract updates are compliant with internal policies and New Mexico-specific regulatory requirements. Strong collaboration with internal departments is essential to maintain network accuracy, provider data integrity, and overall operational efficiency. Detailed tracking and documentation of all contract activities and provider communications are critical components of this role. Support and maintain behavioral health provider contracts for Medicaid, Medicare, and Commercial lines of business across the New Mexico territory Perform provider contracting functions in collaboration with the Network team Process contract-related updates including: Exhibits Contract changes SOS Amendments Rate updates Letters of Direction (LODs) NCQA/CAQH Ensure compliance with internal standards and state-specific requirements Collaborate with internal departments to support network accuracy, provider data integrity, and operational efficiency Maintain thorough documentation and tracking of all contract activity and communications This position is responsible for the support of all activities related to developing and maintaining the physician, practitioner, group, and/or facility, MPPS and organization services delivery system in small to mid-size market defined by membership, number of providers in delivery system, number of business operating units and lines of business. Interacts with all areas of organization to coordinate network management and network administration responsibilities. Assesses network needs, analyzes network composition, and using organization databases, application of regulatory requirements, accreditation entities and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality network. Conducts and coordinates contracting and amendment initiatives. Provides issue resolution and complex trouble shooting for providers. Conducts provider education and provider relation activities, providing necessary written materials. Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests. Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers. Conducts and manages ongoing audits of provider compliance with Magellan policies and procedures as well as contractual obligations for multiple customers. Develops work plans to address audit requirements. Works with management to draft, clarify and recommend changes to policies which impact network management. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities Knowledge of National Committee for Quality Assurance (NCQA) requirements. Ability to work independently and prioritize activities. Intermediate knowledge of Microsoft Office Suite, specifically Excel. Strong presentations skills using PowerPoint. Minimum of 1 year experience in related position/field. General Job Information Title Network Management Specialist (Contract Specialist) Grade 21 Work Experience - Required Network Work Experience - Preferred Education - Required Education - Preferred Bachelor's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $45,655 Salary Maximum: $68,485 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

The Assignment Ready Counselor (ARC) will provide coverage in short-term, surge and on demand situations resulting from the Military needs such as a post-deployment event or to cover an existing assignment for counselors who are absent. The Summer ARC counselor position covers assignments during the May 15th through September 15th time period, coinciding with the school summer break. With minimal guidance and oversight, provides the full breadth of Adult or Child and Youth Behavioral (CYB) counseling services to military service members and their families at military installations. These services may include non- medical counseling, training/health and wellness presentations, consultation with parents, personnel at child daycare centers and schools, and consultation to installation command regarding behavioral health issues affecting military personnel and their family members. ARC CYB counselors may be assigned to DoDEA schools and community schools and will need to have experience working in a school setting to qualify for ARC role in backing up a school position. CYB counselors may also be assigned to youth programs, summer camps, and on demand assignments. ARC adult counselors may be assigned to support MFLC services in a variety of military community and readiness centers, as well as on-demand and surge assignments. The counselors work closely with the installation and military branch Points of Contact (POC) to assure that the program is provided within scope and meets the needs of the installation. Provides non-medical, short term, solution focused, counseling directly to adults, children, and youth of service members. Services include assessment, brief counseling and consultation, action planning, referral to resources (assuring linkage as appropriate), and follow-up as indicated. CYB counselors will also have a focus on supporting the staff and personnel of CDCs, DoDEA and community schools, youth programs and summer camps as well as providing parent training and guidance. Provides training and health and wellness presentations, participate in health fairs and other base/installation activities. Enters counselor activity data daily through smart phone or web application assure that reporting is accurate from assigned installation while maintaining confidentiality and anonymity of service / family member. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities Master's Degree from an accredited graduate program in a mental health related field, or social work. With short notice, willing to accept assignments of undefined periods to include weekends. Can cover, on a full-time basis, assignments of varying length from a weekend to two weeks. Quickly builds rapport with service personnel clients, family members, students, parents and co-workers. Adaptable to new working conditions, varying location rules, etc.; adjusts working style to align with each work environment. Able to work effectively with minimal instruction and guidance. Listens carefully to instructions provided. With minimal notice, participates in regular in-services/training, Quality Improvement committees or other contract activities as assigned. Requires ability to quickly engage and communicate with military members, spouses or children as assigned, in order to accomplish job functions, and to respond quickly to emergent situations in any physical location on a military installation and/or within a school setting, which includes the need to traverse short and/or long distances within the base to both indoor and outdoor locations, to maneuver through rugged, outdoor or uneven locations (e.g., steep inclines, stairs, grass), and work in outdoor weather and other military base conditions. Due to the nature of working on military installations or related worksites, counselors may need to comply with various site-specific requirements to work at designated locations. For example, for some assignments, counselors will need to have certain current immunizations or vaccinations and provide record of receipt. Ability to prove US Citizenship and must be fluent in English. Advanced knowledge of brief therapy and solution-focused counseling methods. Prior military service/military family member and/or strong familiarity with military culture desired. For CYB positions must meet the Magellan MFLC CYB criteria for experience with children and youth and specialty in child and adolescent development/psychology. Creates a presence on the installation in which the service and family members feel comfortable approaching the counselor and recognize the program to be confidential; for CYB counselors -- creates a presence in child and youth settings, is available to children, youth, and staff. When working with children, counselor must abide by line of site protocol. Establishes and maintains working relationships with community resources and provides appropriate linkages. Partners with POC to provide Adult and CYB services in a manner that addresses the needs of the installation/facility. Develops an excellent working relationship with the installation/facility POC. Manages duty to warn and restricted reporting situations according to DoD protocol and staffs the cases with Regional Supervisor/Regional Director. Communicates with Regional Supervisors and participate in regular individual and group supervision, sharing information regarding trends and issues on the installations and in facilities to which they are assigned for substitute or on call services. Responds to critical incidents and special requests as directed by the POC and approved by the OSD program manager. General Job Information Title Military and Family Life Counselor - Short Term Assignments or On Demand for On Site Grade MFLC ARC Work Experience - Required Clinical Work Experience - Preferred Education - Required Master's - Behavioral Health, Master's - Social Work Education - Preferred License and Certifications - Required Current licensure required for this position that meets State, Commonwealth or customer-specific requirements - Care MgmtCare Mgmt, DL - Driver License, Valid In State - OtherOther, LPC - Licensed Professional Counselor - Care MgmtCare Mgmt, Must be an independently licensed behavioral health clinician - Care MgmtCare Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $59,922 Salary Maximum: $100,280 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

The Collections Specialist II is responsible for managing outstanding patient accounts, ensuring accurate and timely collections from insurance companies, third-party payers, and self-pay patients. This role requires strong knowledge of insurance processes, medical billing, and collection regulations to maximize reimbursement and minimize bad debt. The Collections Specialist II works independently to research accounts, resolve payment discrepancies, and negotiate payment arrangements while maintaining compliance with federal, state, and organizational guidelines. **This position is REMOTE** **Essential Functions** + Manages assigned inventory of outstanding patient accounts, following up on insurance, third-party, and self-pay balances to ensure timely payment collection. + Reviews and analyzes patient accounts, identifying alternative payment options, including insurance coverage, financial assistance programs, or legal action when necessary. + Communicates with patients, guarantors, and insurance representatives via phone, email, and written correspondence to secure outstanding balances. + Understands and explains the litigation process and its requirements, providing guidance on legal collections procedures when applicable. + Resolves claim denials and payment discrepancies, working with payers and internal revenue cycle teams to ensure accurate reimbursement. + Demonstrates knowledge of third-party collections regulations, utilizing automated resources and payer collection guidelines. + Handles inbound and outbound collection calls professionally, ensuring courteous and compliant communication with all stakeholders. + Accurately updates and maintains patient account records, documenting all actions taken in the system for compliance and audit purposes. + Abides by all local, state, and federal collection laws, including HIPAA, FDCPA, TCPA, and CFPB regulations. + Performs other duties as assigned. + Maintains regular and reliable attendance. + Complies with all policies and standards. **Qualifications** + H.S. Diploma or GED required + 2-4 years of experience in medical billing, collections, accounts receivable, or insurance follow-up required + Experience in hospital revenue cycle, third-party collections, or litigation-related collections preferred **Knowledge, Skills and Abilities** + Strong knowledge of insurance billing, reimbursement processes, and collection regulations. + Familiarity with third-party payer requirements, claim denial management, and payment posting procedures. + Ability to interpret and explain patient financial responsibilities, payment options, and litigation processes. + Strong communication and negotiation skills, ensuring positive patient interactions and effective payer negotiations. + Proficiency in healthcare billing software, electronic health records (EHR), and collections management systems. + Knowledge of federal, state, and industry regulations related to collections, including HIPAA, FDCPA, and consumer protection laws. + Strong problem-solving skills, with the ability to analyze account details, resolve billing disputes, and secure payments. Equal Employment Opportunity This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.

This position provides non-clinical, evidence-based peer support services and serves as a member and family advocate. The FSN brings their life experiences and skills to deliver assistance to the family as they explore the goals they would like to achieve and offers interventions to the family to increase engagement and empowerment within a variety of service delivery systems. Provides peer support to family/caregivers of children with mental health and substance use conditions identified as requiring intensive wellness support and recovery-oriented interventions. Guides families in creating Wellness Recovery Action Plans (WRAP ) for themselves and their family to recognize strengths and identify wellness self-management and crisis prevention strategies. Utilizes the 8 dimensions of wellness to help parents/caregivers identify their social determinants of health needs, determine their whole health goals and objectives in order to address their own challenges and those of their child. Guides and empowers family members to understand and participate in all decisions related to the treatment process, the support plan, service choices, and transitions in care. Coaches and role-models regarding a parent's perspective and lessons learned from life experience. Facilitates support and education to families who have questions, concerns or specific needs related to mental health or substance use and their relationship to Magellan and child serving agencies. Strategically shares their lived experience to inspire hope, empowerment, and positive action. Performs ongoing interventions to engage families and members in traditional and nontraditional health services and supports, as well as community and social support networks including community-based peer, parent, and family support services. Facilitates a team approach to member care including with the Magellan care coordination team. Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Acts as an advocate for family and member`s needs by identifying and addressing gaps in services and supports. Educates providers, supporting staff, members, and families on resiliency and recovery-oriented principles, practices, strategies, and tools. Documents all interactions according to company standards. Maintains professional responsibility to maximize supervision, respond appropriately to personal stressors that impact ability to perform job duties, and recognize crisis situations or risks to the member's safety and respond appropriately. Travels to meet families within the community. Other duties as assigned. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities 2+ years' experience working as a family peer specialist. Peer Specialist certification as required by the state. CFPS/National Peer Support Credential required within one year of hire. Must be or have been a parent or caregiver of a child who is or who has in the past received services from a child-serving agency for mental health related issues. Applicants must be able to draw from their own personal experience of parenting or caregiving for a child or youth with significant mental health or substance use challenges; negotiating services and supports for their child and family; be familiar with key resources for children, youth and families in the community; be able to transcend personal events to provide unconditional support and assistance to families. Positive attitude that communicates hope and a recovery and resiliency orientation; approachable and empathetic; strong people skills. Must have a vehicle in good, working condition with the ability to travel within the community regularly. Working knowledge of Microsoft Office Product Suite. Ability to make decisions that require significant analysis of solutions, and quick, original, and independent thinking. Ability to determine appropriate courses of action in complex situations that may not be addressed by existing policies or protocols. Knowledge of local mental health, substance use, and community systems; wellness strategies, resiliency and recovery principles, practices, and tools, such as system of care, Wellness Recovery Action Plans (WRAP), wraparound process, and community-based peer, family and parent support organizations and services. Strong interpersonal and organizational skills and effective verbal and written communication skills. Ability to represent strengths and needs of families and members in clinical settings. Ability to summarize and document findings and maintain complete and accurate records. Must be able to work effectively, independently and in a team, and prioritize in a fast-paced environment to meet the demands of the organization. General Job Information Title Family Support Navigator Grade 19 Work Experience - Required Lived experience as parent/caregiver of a child with mental health challenges, Peer Specialist Work Experience - Preferred Education - Required Education - Preferred Associate License and Certifications - Required CPRS/CPS/CPSS/CRPS/PRSS, Peer Specialist, State Requirements - Care MgmtCare Mgmt, DL - Driver License, Valid In State - OtherOther License and Certifications - Preferred NCPS - National Certified Peer Specialist - Care MgmtCare Mgmt Salary Range Salary Minimum: $37,725 Salary Maximum: $56,595 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

This position will analyze, evaluate and design/redesign business, IT or operational processes using scientific approaches such as Critical Thinking, Lean Management, ITIL, Design Thinking and structured systems analysis and design. Provide leadership to more junior IT Analysts through all aspects of the software development cycles. Be a hands-on analyst who can define user stories and acceptance criteria, assist with problem solving, root cause analysis, trouble shooting and coaching of junior it analysts on the team and ensure that requirements and acceptance criteria satisfy business needs. Demonstrate a high level of expertise in the `IT Analyst` craft. Help the team work through impediments. Clear impediments and escalate issues when needed. Drive usability and quality of the software developed within the area. Help the team manage changes. Plan, prioritize and deliver the detail behind enhancements. Work on a variety of enterprise applications and problems. Develop relationships with senior stakeholders across partner teams, addressing concerns and removing roadblocks to drive projects forward. Ensure that requirements and acceptance criteria satisfy business needs. Deploy business requirements through reliable business system configuration updates to enterprise applications. Help the team work through impediments. Clear impediments and escalate issues when needed. Drive usability and quality of the software developed within the area. Helps the team manage changes. Plan, prioritize and deliver enhancements. Work on a variety of enterprise applications and problems. Develop relationships with senior stakeholders across partner teams, addressing concerns and removing roadblocks to drive projects forward. Analyze issues with focus on identifying root cause and prevention. Help the team arrive at innovative solutions. Other duties as assigned. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities - 6+ years related experience including a minimum of 3+ years of delivering requirements and testing in support of high quality, secure software in IT. - Good presentation and communication skills. - Highly collaborative. - Ability to execute on strategies to solve complex and open-ended business problems. - Lead prototyping of potential solutions. - Perform implementation reviews. - Lead support of resolution of technical challenges. - Proactive, can-do attitude. - Take responsibility for ensuring success of all implementation. - Technically proficient and hands-on. - Mastery of QA methodology and problem solving tools/techniques. - Experience with applying Design Thinking Techniques. - Critical Thinker. - Strong presentation skills. - Creativity and show initiative. General Job Information Title Principal IT Analyst Grade 29 Work Experience - Required IT Work Experience - Preferred Education - Required A Combination of Education and Work Experience May Be Considered., Bachelor's - Computer and Information Science Education - Preferred License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $93,955 Salary Maximum: $159,725 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

This is a remote position supporting New Mexico. Candidate needs to be licensed in the State where they reside. Maintains accountability for medical management functions to achieve the business and clinical outcomes for the health plan, meeting contract requirements, National Committee of Quality Assurance (NCQA) accreditation standards, and supporting initiatives with providers and members to manage cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management of crisis calls. Depending on SBU/product supported, supports goals, contracts, and accreditation requirements of health plan in conducting reviews of clinical interactions and clinical documentation including reviews of case management, utilization management, vendor, and provider records. Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting. Interacts with multiple stakeholders internally and externally. Conduct staff audits, process audits and pre-delegation and delegation activities. Reviews audit results with appropriate stakeholder and manages trainings in conjunction with the trainer for individual and/or for unit learning gaps. Directs, coordinates and evaluates efficiency and productivity of utilization management functions. Works closely with SBU and vendors to assure integration, oversight, and efficiency of utilization management and appeals processes and for delegated functions. In collaboration with the national clinical team, assures that all utilization management-related activities meet the standards required for the state contract and NCQA. Leads and organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks and targets. Identifies opportunities for improvement; organizes and manages cost of care initiatives. Collaborates with local and national leaders including Quality Improvement, Analytics, Finance, Network, and other areas to assure a comprehensive approach to managing quality of care, service, and cost of care. Provides expert input to Finance regarding patterns of utilization and cost and high cost cases. Assures staff selection, training, and evaluation to promote the development of a high quality team and effective transitions of care with the clinical care teams. Works closely with and provides input to national health plan clinical team on program design, policies, procedures, workflows, and correspondence. Collaborates with Network leaders to design and implement successful methods for working with hospitals, home health, and other services providers. Ensures integration and efficiency of Network strategy and vendor relationships with utilization management and claims processes. Works closely with network on the training and evaluation of providers as well in resolving provider related issues. Directs staff who assure quality, inter-rater reliability and standards are met in daily operations. Responsible for resolution and communication of utilization management issues and concerns and corrective action plan activities and reporting. Participates as a member of health plan Quality Insurance Committee and co-chair health plan Utilization Management Committee. Collects, analyzes and prepares record/documents information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. Prepares monthly performance reports with audit results. Presents findings at provider, customer, UM and CM meetings as needed. Audits and reviews case manager, Health guide, UM staff, vendor, and provider documentation and telephone interactions against health services quality monitoring standards, regulations, accreditation standards and contract requirements. Reviews vendor and/or provider records against clinical and procedural established standards and contract requirements. Leads and conducts ongoing activities which monitor established quality of care standards in the participating provider network, vendors, UM staff, Health Guides, and for case managers. Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for vendors, providers, UM staff, and case managers. Makes recommendations as to required training based upon audit results. Responsible for monitoring and validating internal audit results and/or corrective action plans. Other duties as assigned. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities 3+ years in utilization management operations. 5+ years in health care quality improvement. Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements. One or more of the following current, active licenses are required: BCBA, LCMFT, LCSW, LMHP, LPC, LPT, LOT or RN. Must have experience overseeing contractual performance standards. Experience with reporting and analyzing managed care utilization data. Strong verbal and written communications skills. General Job Information Title Director, Clinical Care Services - New Mexico, Remote Grade 30 Work Experience - Required Clinical, Management/Leadership, Quality, Utilization Management Work Experience - Preferred Education - Required Bachelor's - Nursing, Bachelor's - Occupational Therapy, Bachelor's - Physical Therapy, Master's - Behavioral Health Education - Preferred License and Certifications - Required BCBA - Board Certified Behavior Analyst - Care MgmtCare Mgmt, LCMFT - Licensed Clinical Marriage and Family Therapist - Care MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, LMFT - Licensed Marital and Family Therapist - Care MgmtCare Mgmt, LMHP - Licensed Mental Health Professional - Care MgmtCare Mgmt, LPC - Licensed Professional Counselor - Care MgmtCare Mgmt, OT - Occupational Therapist, State Licensure - Care MgmtCare Mgmt, PT - Physical Therapist, State Licensure - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $105,230 Salary Maximum: $178,890 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.