Managed Care Coordinator Jobs Near Me

City/State Chesapeake, VA Work Shift First (Days) (United States of America) Sentara Home Care is looking for an Episode Care Coordinator to join the team. The ideal candidate will have 2 years of home care case management experience Episode Care Coordinator responsible and accountable for developing, overseeing and managing patient care according to the physician approved Plan of Treatment (POT). Responsible for obtaining and communicating physician's interim order (PIO) and EMR approval and oversight as it relates to the patients overall POT. Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of patient's needs, including physical and behavioral health, social services and long-term services Assures the provision of high-quality cost efficient and effective care to home health patients within the geographic area assigned. Will work closely with patients, providers and other healthcare professionals to provide support around treatment adherence and self-management identifying and addressing needs in care as appropriate and serves as a resource for clinical staff. Ensures compliance with regulatory, accrediting and company policies and procedures. Requirements: Registered Nurse associates or BSN preferred 2 years' experience in Home Health, Hospice or Infusion Case Management certification based on specialty area required within one year of eligibility. Keywords: Nursing, Talroo-Nursing, Monster, RN, Registered Nurse, nurse, remote nurse, sign on, sign-on, , Home Care, Case Management, homecare, Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met. For applicants within Washington and Maryland State, the following hiring range will be applied: $37.49 hourly to 51.71 hourly. Candidates must have a current residence in one of the following states or be willing to relocate: Al, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, NC, SD, TN, TX, UT, WA, VA, WV, WI, WY. All RNs who do not have their BSN will be required to sign a BSN Agreement committing to successfully obtaining their BSN within 5 years of hire. Job Summary RN Clinician responsible and accountable for developing, overseeing and managing patient care according to the physician approved Plan of Treatment (POT). Responsible for obtaining and communicating physician's interim order (PIO) and EMR approval and oversight as it relates to the patients overall POT. Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of patient's needs, including physical and behavioral health, social services and long-term services Assures the provision of high-quality cost efficient and effective care to home health patients within the geographic area assigned. Will work closely with patients, providers and other healthcare professionals to provide support around treatment adherence and self-management identifying and addressing needs in care as appropriate and serves as a resource for clinical staff. Ensures compliance with regulatory, accrediting and company policies and procedures. Requires an RN; BSN preferred. 2 years HH/HO/IV Case Management certification based on specialty area required within one year of eligibility. Qualifications: N-2YR - RN-Associate's Degree (Required), N-3YR - RN-Diploma (Non-degree) (Required), N-4YR - RN-Bachelor's Level Degree, N-6YR - RN-Master's Level Degree, N-DN - RN-Doctorate Level Degree Basic Life Support (BLS) - Certification - American Heart Association (AHA) RQI, Registered Nurse (RN) Single State - Nursing License - North Carolina, Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP), Registered Nurse License (RN) - Nursing License - Compact/Multi-State License Home Health or Hospice, Home Infusion, Nursing Skills Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission “to improve health every day,” this is a tobacco-free environment.

The RN Residency is an evidence based transition to practice program designed for the recent graduate of an RN program or an RN with less than one year of experience. We know the transition from a nursing student to professional nurse is challenging and the Residency program is designed to facilitate the transition from the classroom to the clinical environment. Our program includes collaboration with a unit specific preceptor and clinical nurse educators, and provides support and resources to facilitate educational and professional growth. Placement in each unit will be determined based upon the hospital's current needs and assessed monthly. Possible placement opportunities include: Float Pool, Medical, Progressive Care Unit, Inpatient Surgical, Behavioral Health, Maternal/Child, Perioperative, Post-Anesthesia Care, Intensive Care Unit, Home Health, Hospice, Skilled Nursing/Rehab, Emergency Department, and Outpatient Clinics/Urgent Care. The staff Registered Nurse (RN) is a vital part of an interdisciplinary team assessing, planning, implementing, evaluating, and documenting in efforts to deliver the highest levels of care to the patient and family. This position requires a full understanding and active participation in fulfilling the Mission of Augusta Health, and demonstrating behavior consistent with the Core Values. Winter 2025 cohort: December 2024 graduates For an application to be considered complete applicants must provide their current resume, cover letter and unofficial transcripts. Please attach this information to your active application. Interviews for the Winter 2025 Nurse Residency Program will begin following receipt of application and will continue until all positions are filled. If you are selected for an interview you will be contacted by a Human Resource representative. Job Requirements: Must be a graduate of an accredited RN Program or an RN with less than one year of full time acute care experience. Must be licensed or eligible to be licensed as an RN in the Commonwealth of Virginia. Premium Incentives: $5,000.00 Sign-On Bonus (24-month commitment, Paid in 1st Check) Reimbursable Relocation Assistance up to $5,000.00 Student Loan Repayment Assistance ($350.00/month, up to 5 years) Newly increased base rates! Some benefits of working at Augusta Health include: • Insurance package including health, dental, and vision • Retirement savings helping you to plan for your future • Generous paid time off to promote work life balance • Free onsite parking • 24/7 armed security to ensure your safety • Shift and weekend differentials • Flexible scheduling • Clinical ladder career path program • Shared governance • Tuition reimbursement • Onsite child care • Augusta Health Fitness Reimbursement Program • Individualized orientation with dedicated preceptor • Onsite credit union • Employee discounts including the cafeteria, gift shop, pharmacy, and movie tickets Company Information Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations. Equal Opportunity Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

Start the day excited to make a difference…end the day knowing you did. Come join our team. The Unit Clinical Care Coordinator - Emergency Department (Unit C3-ED) is responsible for the management of emergency department admission flow, patient progression, care coordination, and discharge planning to achieve system efficiency. This position is a spoke of the MWHC Hub serving as the primary liaison between the Emergency and the Hub, clinical and ancillary teams, and service departments to ensure patient care needs are met and treatment plans are executed timely. The Unit C3-ED leads and collaborates with members of the healthcare team to improve patient throughput, resulting in effective patient-focused outcomes and length of stay performance of the organization. Essential Functions & Responsibilities: Assesses ED patients' clinical presentation to identify admission appropriateness, working DRG and target length of stay; proactively communicates bed need to the Hub to facilitate admission flow. Communicates and coordinates patient admission and care activities with the Hub to facilitate system-wide planning; ensures timely patient placement, patient progression, and patient flow. Proactively identifies patients with repeated ED visits, 30-day readmissions, or unmet social/community needs; partners with physician and ancillary services (i.e., Social Work, Rehab) to determine admission appropriateness; assists in developing an alternative level of care for patients not requiring acute hospital level of care. Leads clinical care team (RN, physician, ancillary staff, and social worker) in SNAP huddles (for ED holds) to identify patient progression and discharge barriers; assigns barriers to appropriate team member for resolution; identifies and escalates unresolved barriers to senior leadership; aligns care team toward discharge goals. Assesses patient's discharge needs; develops and arranges for a comprehensive discharge plan that addresses patient needs, barriers, and readmission risk factors. Communicates plan of care and discharge plan to patient and/or their family in coordination with the patient's care team (RN, physician). Manages all aspects of admission/patient progression/discharge in hospital's bed management / discharge planning system (i.e., bed requests, patient attributes/alerts, DRG/TLOS, barriers, escalations, etc.); communicates timely updates of patient clinical status and level of care needs to the Hub to facilitate unit and bed assignment for admitted patients. Oversees and ensures timely compliance with preprocedural requirements for service department diagnostics and procedures; ensures communication of service event issues with care team. Proactively identifies and resolves barriers that may impede department or system-wide patient flow; escalates barriers to senior leadership when unable to resolve. Coordinates with Utilization Review (UR) Nurse to align payor and status requirements with patient's clinical progression; verifies appropriate regulatory letters are delivered to patient and family when indicated. Serves as a resource and educates medical and nursing staff on admission appropriateness, patient progression, utilization of resources, and care coordination. Performs other duties as assigned Qualifications: Required: Minimum of three (3) years recent acute care nursing experience Able to work independently, managing time, multiple priorities, and resources to achieve goals. Able to maintain a calm demeanor and command during times of crisis management. Able to assimilate information quickly to produce sound decisions and recognize situations that require immediate intervention. Able to articulate information and ideas clearly through both written and verbal communication. Preferred: Bachelor of Science in Nursing is preferred Emergency Department acute care nursing or case management is preferred One (1) year supervisory experience strongly preferred License and/or Certification Required: Valid RN License from Virginia or reciprocal compact state required. Preferred: Certification in nursing or case management As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.

Job Title: Sports Field Job Planner/Coordinator The Sports Field Job Planner/Coordinator is responsible for organizing the planning, and execution of sports field projects and maintenance services ensuring operational efficiency. This role includes managing schedules, planning job tasks, and coordinating the project timeline to ensure timely and successful project completion. As a hands-on position, this role is not remote and involves a combination of outdoor site work and office-based responsibilities. Key Responsibilities: 1. Project Planning: o Communicate with customers to understand goals for improvements and inspect facilities. Coordinate with Service Managers to plan work. 2. Scheduling & Job Planning: o Create and manage project/service schedules, ensuring tasks are prioritized and deadlines are met. o Plan, assign, and track job tasks for teams, ensuring optimal use of time and resources across all project stages. 3. Team Supervision & Leadership: o Assist Sports Field Managers to assign clear responsibilities and set expectations for performance and safety. o Foster teamwork and manage team dynamics to ensure smooth operations. 4. Timeline & Milestone Management: o Establish project/service timelines with clear milestones and ensure projects are completed on time. o Regularly update customers on progress, highlighting key achievements and upcoming tasks. 5. Site Inspections: o Oversee project quality, inspecting completed areas to ensure they meet design, safety, and regulatory standards. o Conduct regular site visits to ensure proper execution and adherence to project plans. 6. Client Communication & Satisfaction: o Serve as the primary point of contact for customers, providing regular updates and addressing any concerns or changes. o Ensure client expectations are met and exceed service standards. 7. Vendor & Supplier Coordination: o Manage relationships with vendors and suppliers, coordinating material orders, deliveries, and schedules. o Ensure timely delivery of materials and services, maintaining strong partnerships with suppliers. 8. Compliance & Safety: o Ensure all work is compliant with local regulations, zoning laws, and safety standards. o Uphold safety protocols on-site, promoting a culture of safety among team members. Qualifications: 1. Education: o High School Education required. College degree preferred. Candidates with equivalent professional experience in lieu of a formal degree will be considered. 2. Experience: o 3-5 years of experience in planning and scheduling or similar. o Skills: • Planning & Scheduling: o Strong proficiency in managing project/service schedules, budgets, and teams to ensure efficient operations and timely delivery. o Proven experience in creating detailed project plans, creating realistic schedules, and allocating tasks to ensure successful completion. o Ability to manage multiple projects simultaneously, prioritizing tasks and meeting deadlines in a fast-paced environment • Budget Management & Cost Control: o Experience in creating and managing project budgets, tracking expenses, and ensuring financial goals are met while maintaining quality and safety standards. • Technical Knowledge: o Working knowledge of Microsoft Office Suite (Work, Excel, PowerPoint & Outlook). • Communication: o Exceptional communication skills for client interactions, team management, and vendor coordination. • Problem-Solving: o Ability to address and resolve issues swiftly on-site, ensuring minimal disruption to project timelines. • Attention to Detail: o High standards for quality and operational efficiency. Additional Information: This is a non-remote, full-time position that involves both fieldwork and office-based responsibilities. This position will be expected to oversee day-to-day project tasks, work with Field Managers on team schedules, and ensure that all aspects of the project are running smoothly from start to finish.

Job Opening: Telecommunications Tower Permit Specialist Hybrid - 3 days a week in office - work from home Monday and Friday 12 month contract up to $41.14 an hour for the contract Downers Grove, IL , Canonsburg, PA OR Houston, TX Will be working CST hours Position Overview: We are seeking a dedicated Permitting Specialist to oversee and facilitate the preparation and submission of entitlement applications, permits, and agreements for the installation of communications infrastructure. This includes poles, towers, fiber, and ground equipment. The ideal candidate will have a strong understanding of municipal zoning and permitting processes, excellent communication skills, and the ability to collaborate with various stakeholders. Primary Responsibilities: Prepare and submit zoning and permitting applications in compliance with municipal regulations. Track progress of applications and address jurisdictional inquiries or requests for additional information. Collaborate with design teams to create permit drawings and construction documentation. Review, negotiate, and integrate jurisdictional requirements into project deliverables. Serve as a subject matter expert on federal telecommunications codes, including Section 6409(a) and related FCC regulations. Lead entitlement discussions during internal team meetings and manage document uploads per established workflows. Represent the company at municipal meetings and maintain relationships with city officials, planning departments, and neighborhood groups. Coordinate with external vendors, handle permitting fee payments, and provide detailed project updates to stakeholders. Research zoning and permitting risks, offering creative solutions for complex challenges. Qualifications: Education & Certifications: Bachelor's degree in business, urban planning, or a related field (or equivalent professional experience). Experience in zoning and permitting is required. Experience: At least 2 years of experience in planning, zoning, land use, or a telecommunications-related role, or relevant military experience. Strong track record of working within cross-functional teams and navigating regulatory environments.

Join Our Impactful Team at Health Connect America! Before you get started on your journey, take some time to learn more about us. Health Connect America and its brands are leaders in providing mental and behavioral health services to children, families, and adults across the nation. We provide our services directly to those in need whether that be within a person's home, their community, or in one of our office settings. HCA is honored to be a part of the communities we serve and the clients we walk alongside as they embark on a journey to self-improvement and more fulfilling lives. At Health Connect America, we are dedicated to making meaningful connections every day through creating quality, affordable opportunities for individuals and families to achieve their greatest potential in a safe, positive living environment. Our Brands Responsibilities: The IOP Coordinator assists in the management, oversight, and provision of services in the Outpatient Substance Abuse Programs. The IOP Coordinator is ideally responsible for the facilitation of only one Intensive Outpatient Group. The IOP Coordinator is responsible for assisting with marketing and coordination of transportation of the IOP program; and assisting Program Director in the training and mentorship of IOP staff. Communicate with customers, employees, and other individuals to answer questions, disseminate or explain information, and address complaints. Communicate with referral sources, clients and families. Coordinate day to day operations of the IOP programs. Coordination of treatment with clients to include assessments, admissions, authorizations, treatment planning, progress notes, discharge planning, random drug screening, linking client/family with appropriate resources and maintaining client records. Facilitate one (1) weekly group, and complete of required documentation related to group service(s). Submit all clinical documentation within specified time frames. Develop and ensure census of IOP programs are consistently met and/or exceeded in conjunction with the annual regional budget and strategic plan. Assist Program Director in recruitment and supervision of IOP staff. Assist with orientation, training, and mentoring of IOP staff. Assist in establishing and consistently maintaining relationships with new and existing community partners, and the ongoing development of regional territory in conjunction with the regional budget and strategic plan. Ensure compliance with all state regulatory bodies, payer sources, and accreditation organizations. Participate in Performance Quality Improvement (PQI) and strategic planning processes to assist Program Director in the identification and development of quality measures and solutions for improvement within IOP programs. Participate in treatment team meetings and the review and/or audit of ongoing treatment-related documentation. Maintain CPR certification and complete required Tuberculosis (TB) testing on a yearly basis. Qualifications: Master's degree in human services discipline, including, but not limited to: Social Work, Psychology, Sociology, Counseling, etc.; 2 years' experience working with children (experience can include internships, volunteer work, etc.) and 5 years' experience in working with substance abuse/ co-occurring disorder clients. Prefer licensed eligible or fully licensed (LPC, LCSW, LICSW, etc.) Be Well with HCA: We recognize the importance of self-care and work/life balance. We offer flexibility in scheduling and provide all employees access to our Employee Assistance Program (EAP), which includes 8 mental health counseling sessions annually. Full-time HCA employees enjoy paid time off, paid holidays, and a comprehensive benefits package that includes medical, dental, vision, and other voluntary insurance products. Additional benefits include: Access to a Health Navigator Health Savings Account with company contribution Dependent Daycare Flexible Spending Account Health Reimbursement Account 401(k) Retirement Plan Benefits Hub Tickets at Work Join a team where your contributions truly make a difference in the lives of others. Apply now to be part of our dynamic and supportive community at Health Connect America! Employment at Health Connect America and it's companies is contingent upon meeting the requirements of a comprehensive background investigation prior to joining our team. Health Connect America and its companies are an Equal Opportunity Employer and consider applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics, or any other basis forbidden under federal, state, or local law. For more information on Equal Opportunity, please click here Equal Employment Opportunity Posters

Provide evidence handling support to Project Management team. This person will be responsible for executing standard operating procedures that align with company as well as industry guidelines and best practices pertaining to evidence handling. To provide the highest level of client service to both external and internal contacts, said procedures will include, but are not limited to receiving and maintaining an inventory of client media, providing status updates, generating reports, documentation, metrics gathering and data analysis. Description: ·Receive all incoming physical evidence from clients or third parties and initiate chain of custody and evidence tracking records using company's proprietary software. ·Upload data from physical evidence to company networks following established protocols. · Manage onsite storage of all evidence. · Maintain highly organized and secure evidence room. ·Coordinate return of stored evidence to clients. ·Assist with downloading client deliverables and coordinate shipping to clients or third parties. ·Participate in evidence destruction requests in accordance with company policies, ensuring destruction documentation and authorizations are complete and accurate. · Prepare reporting and data analysis on stored evidence. · Work closely with internal teams to complete assignments. · Ability to handle multiple requests at once to ensure deadlines are met. ·Perform any additional duties as assigned by supervisors or senior leadership. ·Follow the TLS information security policies and procedures and ensure that all data in and out complies to these standards. · Work with and be part of the TLS global information security team (GIST) to ensure all aspects of the ISMS are followed, where applicable. ·Be the local point of contact for the TLS GIST and conduct annual security training / onboarding. ·Be part of the annual external audit, update relevant documentation, and participate in ISO27001 and other certification expansion efforts where needed. Required Skills: ·Bachelor's Degree in related field, such as computer sciences or information management-technology, a strong technical background is helpful. ·Knowledge of MS Office applications required. ·Ability to learn new technologies through training and use effectively as needed for position. · Exposure to information security policies such as ISO27001 / NIST 800171 a definite benefit. ·Strong organizational skills and attention to detail. ·Excellent customer service skills. · Strong written and oral communication skills. ·Available to work overtime, including evenings and weekends as needed. ·Available by phone or email when out of the office as needed. · Ability to work well under pressure and meet tight deadlines. · Positive attitude and ability to develop and implement new ideas to create customized solutions on a client by client basis. · May be required to lift and transport boxes weighing approximately 30 to 50 pounds each. About TransPerfect: TransPerfect Legal Solutions is the industry leader in multilingual legal support services. Since 1992, wehave been providing a comprehensive suite of solutions that facilitates every aspect of our clients' legal matters. From court reporting and e-discovery for litigation to virtual data rooms for M&A and bankruptcy cases, TLS is a one-stop-shop for the global legal industry. As a specialized division of TransPerfect Inc., the world's largest privately owned language services provider, we are the only legal support services provider that also offers a full array of translation, interpretation, and other multilingual solutions. For more than 20 years, TransPerfect has provided comprehensive language and technology solutions to help our clients communicate and conduct business more effectively in a global marketplace. Equipped with a quality management system certified to both the ISO 9001:2008 and EN 15038:2006 standards, TransPerfect provides a full array of language and business support services, including translation, interpretation, multicultural marketing, website globalization, subtitling, voiceovers, staffing services, e-learning and training, and legal support services. TransPerfect also offers a suite of next-generation technologies that significantly reduce costs and improve consistency throughout the translation process, making TransPerfect the vendor of choice for the world's leading multinationals. With annual revenues of over $500million, TransPerfect is the world's largest privately held provider oflanguage services and technology solutions. From offices in more than 90 cities on six continents, TransPerfect offers a full range of services in 170+ languages to clients worldwide. With an unparalleled commitment to quality and client service, TransPerfect is fully ISO 9001 and EN 15038 certified. TransPerfect has global headquarters in New York, with regional headquarters in London and Hong Kong. TransPerfect offers a comprehensive benefits package including: medical, dental, vision, 401k, paid time-off, company sponsored life insurance, short term and long term disability, flexible spending account options, and a pro-active and accessible HR department that focuses on the staff's health and happiness

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: ************************** How YOU will make a Difference: The Care Management Coordinator demonstrates the ability to independently assess and synthesize work inputs to determine the scope and function of the work to achieve the desired goal; works directly with project team leads to implement new functions; provides input for coordinating member support functions across the Care Team; assesses the needs of the business and forms recommendations in response to business growth. Care Management Coordinator provides ongoing operational support across the organization as needed. What you will do: Consult and work with healthcare providers throughout the RGA network to coordinate care and review service denials Work independently to create provider and member-facing denial letters by crafting clear and concise sentences using medical director denial information, personal expertise, medical criteria, and nurse input and plan language Use autonomy to triage and analyze requests for Peer to Peer calls, disabled dependent determinations, medical travel benefit work and other member and provider needs to determine next steps and actions Provide direct member contact and coordination for care needs not limited to disabled dependents, medical travel, continuity of care, denials, P2P and appeals Work across departments and with external partners to coordinate care not limited to customer care, Care navigators, intake, utilization review, case management, medical claim review, appeals, COB, enrollment and compliance Assess barriers to a positive member experience and strive to bridge gaps Support and fill-in non-clinical duties as needed to support the function of the Care Team Track and ensure regulatory functions and tasks are completed Analyze data and create work queues (PowerBI, Excel expertise) participate in the writing and updating of PWIs to keep team function documentation updated Knowledge, Experience, and Key Attributes needed for Success: Minimum of Associate's degree or equivalent experience required 4-7 years of minimum health plan, clinical or community health experience Ability to communicate complex ideas Ability to interpret reporting and set a plan of action Ability triage and prioritize work The ability to problem-solve and use critical thinking skills Excellent, internal and external client-facing verbal and written communication skills Proficiency with Microsoft Office applications (Outlook, Word, DOSS) Self-motivated and self-directed Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skill sets Compensation: The base salary range for this position in the greater Seattle area is $29/hr - $37/hr and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. In addition, HMA provides a generous total rewards package for full-time employees that includes: seventeen (IC) days paid time off; eleven paid holidays, one paid personal and one paid volunteer day; company-subsidized medical, dental, vision, and prescription insurance; company-paid disability, life, and AD&D insurances; voluntary life insurances; HSA and FSA pre-tax programs; 401(k)-retirement plan with company match; wellness incentive and reimbursement; remote work and continuing education reimbursements; discount program; parental leave; and a charitable giving match. For more information about HMA, visit ****************** Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. How we Support your Work, Life, and Wellness Goals We offer a comprehensive total rewards package including: competitive pay; annual incentive; wellness programs; medical, dental, and vision insurance; 401K retirement plan with match; generous PTO and holidays; an onsite gym; life, AD&D, short and long-term disability insurances; an Employee Assistance Plan with additional mental health support; free parking and easy freeway access to I-405 and I-520; a stocked kitchen on-site with subsidized snacks and refreshments; year-round wellness activities; monthly events; paid volunteer hours and more! HMA is primarily a remote workforce, requires a reliable internet connection, and provides all hardware. Some roles are required onsite 1-3 days per week/month while other roles are 100% remote. A background screen prior to employment is required. Protected Health Information (PHI) Access Healthcare Management Administrators (HMA) employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures. HMA is an Equal Opportunity Employer

About SonderMind At SonderMind, we know that therapy works. SonderMind provides accessible, personalized mental healthcare that produces high-quality outcomes for patients. SonderMind's individualized approach to care starts with using innovative technology to help people not just find a therapist, but find the right, in-network therapist for them, should they choose to use their insurance. From there, SonderMind's clinicians are committed to delivering best-in-class care to all patients by focusing on high-quality clinical outcomes. To enable our clinicians to thrive, SonderMind defines care expectations while providing tools such as clinical note-taking, secure telehealth capabilities, outcome measurement, messaging, and direct booking. To follow the latest SonderMind news, get to know our clients, and learn about what it's like to work at SonderMind, you can follow us on Instagram, Linkedin, and Twitter. About the Role As a Care Coordinator, you will be at the forefront of our mission to make therapy accessible for all. You will be our customer's initial contact and provide primary support for clients seeking care. In this role, you will also work with external partners and healthcare systems and utilize various technologies to ensure the client is connected and maintains the required support through an episode of care. Successful candidates will be able to communicate effectively, think critically to resolve issues, be willing to learn, be open to feedback, and be champions of the SonderMind brand while working in a fully remote environment. This is an excellent opportunity for those with experience in care coordination and/or recent college graduates or people looking for a career pivot and want to join a high-growth organization where they can advance their careers. Your journey at SonderMind will be about more than just a job; it will be about personal fulfillment, professional growth, and the chance to leave a lasting legacy in the world of mental health. What you'll do Provide primary support for clients seeking care to manage their mental and behavioral health wellness. Utilize a variety of technologies to ensure the client is connected with the appropriate therapist and maintains the required support through an episode of care. Utilize a consultative approach to assist with identifying the correct provider for care. Manage inbound and outbound calls and other forms of communication while applying standard guidelines to address or route messages to the appropriate care team member for follow-up when necessary. Interact with external partners and healthcare systems to ensure access to care. Conduct outreach to referred clients and provide personalized onboarding services and assistance with all aspects of getting into care. Assist with care coordination tasks such as appointment scheduling and facilitating communication with providers and other care team members. And other responsibilities and ad-hoc projects from time to time based on business needs. What does success look like? Within two weeks, fully understand our client journey and be able to support the client onboarding experience and share the benefits of choosing SonderMind to achieve their mental health goals. Within three weeks, understand SonderMind's technology platform and how to provide support for SonderMind clients. Within one month, fully support new client requests and inquiries via phone, email, and form submissions. Ongoing ability to effectively answer questions and requests from our new clients and effectively hit defined goals and targets. Ongoing ability to adapt to the change in workflow and job tasks. Ongoing proactive identification of problems and asking questions to clarify and help solve problems. Ongoing communication, both written and verbal, to engage, learn, and take action Who You Are Strong desire to assist clients and provide support to those seeking mental health care Ability to work with people in vulnerable situations Strong communication skills, both written and verbal Motivated and eager to learn, ability to adapt to new technologies, processes, and workflows Strong problem-solving skills and attention to detail Flexibility to work in a fast-paced, dynamic environment Goal-oriented with a strong drive to achieve results Openness to feedback and a commitment to personal and professional development Our Benefits The pay rate for this role is $21.64 per hour. As a leader in redesigning behavioral health, we are walking the walk with our employee benefits. We want the experience of working at SonderMind to accelerate people's careers and enrich their lives, so we focus on meeting SonderMinders wherever they are and supporting them in all facets of their life and work. Our benefits include: A commitment to fostering flexible hybrid work A generous PTO policy with a minimum of three weeks off per year Free therapy coverage benefits to ensure our employees have access to the care they need (must be enrolled in our medical plans to participate) Competitive Medical, Dental, and Vision coverage with plans to meet every need, including HSA ($1,100 company contribution) and FSA options Employer-paid short-term, long-term disability, life & AD&D to cover life's unexpected events. Not only that, we also cover the difference in salary for up to seven (7) weeks of short-term disability leave (after the required waiting period) should you need to use it. Eight weeks of paid Parental Leave (if the parent also qualifies for STD, this benefit is in addition which allows between 8-16 weeks of paid leave) 401K retirement plan with 100% matching which immediately vests on up to 4% of base salary Travel to Denver 1x a year for annual Shift gathering Fourteen (14) company holidays Supplemental life insurance, pet insurance coverage, commuter benefits and more! Equal Opportunity SonderMind does not discriminate in employment opportunities or practices based on race, color, creed, sex, gender, gender identity or expression, pregnancy, childbirth or related medical conditions, religion, veteran and military status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition (including genetic information or characteristics), sexual orientation, or any other characteristic protected by applicable federal, state, or local laws.

This Opportunity Versar Global Solutions is seeking a full-time Incident Management Coordinator to assist in delivering interstate asset maintenance services to the Virginia Department of Transportation (VDOT). The Incident Management Coordinator leads incident management of the project and must be knowledgeable in incident management, severe weather management, and response to major/minor crashes, hazardous and non-hazardous material spills, and other types of incidents, including workplace/public safety, incident response management, contract compliance, and reporting. Responsible for ensuring that all health and safety requirements are met at all times & be available to manage all types of incidents and serve as the Department's representative. Your Impact Lead, exemplify, and empower the safety culture at the project level, focusing on Zero Harm. Knowledgeable of Occupational Safety and Health Administration (OSHA) regulations. Experienced in incident management, severe weather management and response, major and minor crashes, hazardous and nonhazardous materials spills, and other related activities. Required to provide effective verbal and written communication. Available to respond to accident/Incident scenes at a Level (3) three event or higher. Assist project personnel with developing and implementing Job Hazard Analyses (JHA) and job-specific training related to incident response/scene protection. Risk Management: Identify potential risks in advance, analyze them, and take steps necessary to mitigate adverse impacts by reducing/managing the risk. Assist with project-level incident investigations as needed. Coordinates with corporate safety resources on policy, investigations, and best practices. Able to respond to emergencies (e.g., roadway incidents, inclement weather, etc.) twenty-four hours a day. Abides by and ensures compliance with company processes, policies, and procedures. Performs all other duties as prescribed by management. Who You Are Required Qualifications 18+ years of age High School Diploma or GED required, associate or bachelor's degree beneficial Minimum of two (2) years in documented experience as an Incident Management Coordinator or a similar position, five (5) years preferred Knowledge of highway maintenance equipment, materials, field operations, and records. Working knowledge of Microsoft Office Suite software Ability to walk, stand, or sit for extended periods of time Fluent English reading and writing skills to read and understand government guidance for day-to-day work requirements; bilingual in Spanish a plus. Must be able to effectively communicate with managers and coworkers in English Must maintain a valid United States driver's license. Ability to stand, bend, and reach for extended periods, bend or stoop, walk, work under stressful conditions, and assist crew members with moving heavy objects. Willingness to work multiple shifts and varying hours, including nights, weekends, and overtime Ability to work outdoors in a variety of weather conditions Ability to work along local roadways, interstates, and or/highways with commuter traffic passing by at varying rates of speed Must maintain an appearance appropriate to assigned duties and responsibilities. Successful results of pre-employment federal background check, motor vehicle report check, and drug screen Comply with Company's Drug and Alcohol Policy Must be authorized to work in the US or will be authorized by the successful candidate's start date Location Requirements The position will primarily work onsite in South Prince George, VA. This position is available to applicants in the Petersburg, Richmond, Templeton, South Hill, Alberta, Emporia, and Lawrenceville areas of VA, extending into Roanoke Rapids, NC. Compensation Expected Salary: $62,400 to $68,640 (USD) Annually Versar Global Solutions is providing the compensation range and general description of other compensation and benefits that the Company in good faith believes it might pay and/or offer for this position based on the successful applicant's education, experience, knowledge, skills, and abilities in addition to internal equity and geographic location. The Company reserves the right to ultimately pay more or less than the posted range and offer additional benefits and other compensation, depending on circumstances not related to an applicant's status protected by local, state, or federal law. EEO Commitment Versar Global Solutions is committed to providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state, and local laws. Versar Global Solutions complies with applicable state and local laws governing non-discrimination in employment in every location in which the company operates. This policy applies to all terms and conditions of employment, including hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Versar Global Solutions expressly prohibits any form of unlawful employee harassment based on race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity, marital status, amnesty, or status as a covered veteran. Improper interference with the ability of Versar Global Solutions employees to perform their job duties is not tolerated. About Versar Global Solutions Headquartered in Washington, DC, Versar Global Solutions provides full mission lifecycle solutions for challenges faced by our government and commercial customers in the natural, built, and digital environments. With nearly 2,000 team members around the world and a rich legacy spanning more than 70 years, Versar Global Solutions delivers a broad array of planning, analysis, and risk management solutions, project and program management, operations and maintenance services, and information technology applications for environmental management and remediation projects, mission-critical facilities and installations, and in support of readiness and contingency operations. Versar Global Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

**Managed Care Coordinator** Location: Candidate must reside in Northern Virginia. While primarily remote, occasional travel is required to meet with members face to face. The **Managed Care Coordinator** , as required by applicable state law and contract, contributes to the care coordination process by performing activities within the scope of licensure including telephonic or face-to-face assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and community services and supports. Position primarily serves individuals with intellectual and/or developmental disabilities. **How you will make an impact:** + Assists in identifying members for high risk complications. Obtains clinical data as directed. + Assists in identifying members that would benefit from an alternative level of care or other waiver programs. + Conducts clinical assessments, as necessary, and develops, monitors, evaluates, and revises the member's care plan to meet the member's needs. + Participates in coordinating care for members with chronic illnesses, co-morbidities, and/or disabilities, member and the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current needs of the member and require an understanding of disease processes and terminology and the application of clinical guidelines but do not require nursing judgment. **Minimum Requirements:** + Requires an LPN/LVN, LSW, LCSW, or LMSW or license other than RN in accordance with applicable state law and Nursing Diploma or AS in Nursing or a related field and minimum of 2 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator or similar role; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted LPN/LVN, LSW, LCSW, LMSW or license other than RN (as allowed by state law) in Virginia required. + Position is primarily telephonic/telehealth but very limited travel or in person work may be required. **Preferred skills, capabilities, and experiences:** + Experience with behavioral health and/or working with individuals with intellectual/developmental disabilities strongly preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

- Physician Peer Review Coordinator (2400056Z) **Job Description** Physician Peer Review Coordinator - ( 2400056Z ) **Description** The Peer Review Coordinator is responsible for managing the coordination of internal and external provider peer review. Duties include comprehensive quality review of the medical record, abstraction, appropriate and accurate documentation of findings and review and analysis of clinical indicators related to practitioner medical management and practice patterns. Ensures the Program meets Joint Commission, CMS, Medical Staff Bylaws and other regulatory requirements. Ensures the availability of data to evaluate the initial and ongoing quality of care and competency of the Medical Staff. Aggregates and reports clinical competency and other data to medical staff leadership and hospital leadership. This position supports the medical staff chair of the peer review committee including agendas, documenting minutes for various meetings, coordination of provider reviews, compose and send correspondence related to practitioner outcomes and medical audits. The coordinator must possess excellent communication skills for data presentation and reporting to various medical staff and hospital committees. The coordinator must have superior communication skills to provide data and education to medical staff chiefs and providers based upon peer review findings and audit results. Must possess critical thinking skills. **Qualifications** **QUALIFICATIONS:** * Bachelor's degree in Health Sciences, Medical Informatics, Health Administration, Management Information Systems, Science in Nursing or related healthcare field. * Minimum of five (5) years' experience in data/statistical analysis. Certified Professional in Healthcare Quality (CPHQ) preferred, new hires must pass within 1 year of hire. Proficient computer skills with extensive experience using various software applications such as MS Excel, Word, Access, Powerpoint; Experience with clinical/healthcare software applications preferred; demonstrated knowledge and skills in statistical presentations. * EPIC and RL6 experience preferred. **Primary Location** : Tampa **Work Locations** : TGH Main Campus 1 Tampa General Circle Tampa 33601 Eligible for Remote Work : Hybrid Remote **Job** : Quality/Utilization Management **Organization** : Florida Health Sciences Center Tampa General Hospital **Schedule** : Full-time Scheduled Days : Monday, Tuesday, Wednesday, Thursday, Friday **Shift** : Day Job **Job Type** : Hybrid Remote **Minimum Salary** : 69,305.60 **Job Posting** : Dec 13, 2024, 5:47:47 AM

Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare Advantage members who may have complex healthcare needs, authorizing medically necessary services at the right level of care to promote optimal health. This position is self-directed and works independently and collaboratively to facilitate care using clinical skills, principles of managed care, nationally recognized medical necessity criteria, and company medical policies to conduct reviews that promote efficient and medically appropriate use of the member's benefit to provide the best quality care. This role is eligible for our eWorker, Mobile, and Resident personas. This position can be fully remote, with a 1x/month staff meeting in our Hingham, MA office. Hours of work: 8:30a - 4:30p EST. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist, clinicians, medical directors and more, who collaborate to facilitate care.Key Responsibilities: + Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of service. + Evaluate members' clinical status, benefits, and appropriateness for programs and sites of service to develop a cost-effective, medically necessary plan of care. + Pass annual InterQual Interrater Reliability Test. + Interact with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care. + Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality of care issues. + Understand member insurance products and benefits, as well as regulatory and NCQA requirements. Key Qualifications: + Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team. + Ability to assess, analyze, draw conclusions, and construct effective solutions. + Proficient with multiple IT systems. + Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population. Education and Experience: + 3-5 years relevant experience in a variety of appropriate clinical health care settings (Inpatient, outpatient, or differing levels of care). + Utilization Management experience, preferred + Experience with Medicare Advantage, preferred + Active licensure in Massachusetts is required, appropriate to position (RN) + Licensure in additional states a plus. + Note: Any restrictions against a license must be disclosed and reviewed. + For Registered Nurses Only: A Bachelor's degree in nursing (BSN) is preferred Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above LocationHinghamTime TypeFull time Hourly Range: $38.22 - $46.71 The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability. This job is also eligible for variable pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. WHY Blue Cross Blue Shield of MA? We understand that the confidence gap (******************************************************************************** and imposter syndrome (********************************************************************* can prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL. As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture (************************************************** page. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join our Talent Community (*************************************************************** Type=JTC) to stay "in the know" on all things Blue. At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work (************************************************** " Page. Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates. Our Commitment to You We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance. Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law. Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Utilization Clinical Reviewer to join our growing and dynamic team! Job Summary As a Utilization Clinical Reviewer, you'll harness your expertise to meticulously evaluate medical records against precise criteria, wielding critical thinking and decisive skills to appraise the medical necessity of psychiatric inpatient care. With a focus on meeting production targets and maintaining top-tier quality assurance standards, this role serves as the linchpin for ensuring the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process. This full-time Clinical Reviewer Remote position based in the state of Maine. This provides an opportunity for impactful work without requiring direct patient interaction or communication. * A Maine LCSW or LCPC License is Required. The selected candidate must reside and work in Maine * Job Responsibilities: * Analyze and interpret patient records based on established criteria to determine medical necessity and care appropriateness, ensuring all documentation complies with service requirements. * Approve services or refer cases to a physician consultant as needed, providing detailed explanations for denials and ensuring timely and accurate processing of decisions. * Accurately abstract and record review-related data using the appropriate review tools, and submit all required administrative documents to relevant parties promptly. * Continuously reassess review processes to identify opportunities for improvement, recommending and facilitating necessary changes to enhance efficiency. * Build and maintain positive relationships with internal and external stakeholders, acting as a professional liaison to support the review process. * Participate in training sessions and meetings, staying informed and up to date on review processes and requirements. * Ensure strict adherence to HIPAA policies by maintaining medical record confidentiality and employing appropriate computer security measures. * Exhibit proper communication etiquette in verbal and written interactions, ensuring alignment with Acentra Health's policies and professional standards * The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. Qualifications Required Qualifications, Skills and Experience: * A minimum of 2 years of experience managing or working with Medicaid, government health plans, or hospital programs is required. * An active Maine license is required in one of the following fields: Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC). * Must have graduated from an accredited Master's Degree program. * Familiarity with psychiatric disorders, including standards of practice for determining levels of care and conducting mental health assessments. * Strong understanding of public sector services and supports. * Proficient in Microsoft Excel, Word, PowerPoint, Teams, and Outlook. * Ability to make clinical diagnoses while accounting for psychological and behavioral factors. * Proficient with computer equipment and web-based software to conduct work effectively. * Highly detail-oriented with strong prioritization and task execution skills. * Proficient in assessing and analyzing psychological, emotional, behavioral, and physical functions. * Comprehensive understanding of Medicaid programs with proven experience navigating similar projects. * Ability to develop accurate level-of-care recommendations based on clinical medical records and evaluations. Why us We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career. We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team EOE AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The compensation for this role is $32.00 to $35.00 per hour Based on our compensation program, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level. #LI-JS1

Care Coordinator - Martinsville, VA **CARE COORDINATOR** *Join BrightView as a Care Coordinator and play a vital role in providing coordination, assessment, and treatment planning services to patients with substance use disorder (SUD). In this pivotal position, you will support BrightView's patients by ensuring access to essential medical, social, educational, and community services necessary to meet their basic human needs. As a key member of our comprehensive care team, you will champion our patients' ability to achieve stability and productivity for lasting recovery. If you're passionate about making a difference in the lives of individuals struggling with SUD and thrive in a collaborative environment, we invite you to join us in our mission.* **RESPONSIBILITIES:** * **CLINICAL CARE** : + Responsible for assessing patient eligibility for specific service needs. + Assist patients in accessing appropriate medical, social, educational, and employment resources. + Evaluate effectiveness of recommended services and adjusts recommendations as needed. * **TREATMENT PLANNING AND PROGRESS MONITORING** : + Develop individualized integrated action plans for each patient. + Refer and connect patients and families with available resources, monitor adherence to recommendations, and follow up accordingly. + Monitor and ensure patients are seeing health care professionals outside of BrightView as outlined by the BrightView treatment plan. + Provide crisis and de-escalation techniques. * **COORDINATION AND COMMUNICATION** : + Ensure patients have reliable, consistent transportation to BrightView and other care providers. + Attend required meetings including individual and group supervision, treatment team meetings and quarterly in-service meetings. * **DOCUMENTATION AND COMPLIANCE** : + Complete detailed reports on needs assessments and care coordination activities. + Timely and comprehensively document all necessary care coordination data into the electronic patient health record, following adherence to all necessary regulatory and company compliance requirements. **KNOWLEDGE SKILLS, AND ABILITIES** * Excellent verbal and written communication skills * Highly empathetic and compassionate to effectively support the recovery journey of BrightView's patients * Competent at working with a diverse population of colleagues and patients * Natural problem solver, looks for solutions to best meet patient needs with a sense of urgency * Team-player, able to work collaboratively in a multidisciplinary healthcare environment * Adaptable and agile within a dynamic work environment * Technologically capable, comfortable operating in multiple systems for communication and documentation purposes. Familiarity with MS Office software (Outlook, Teams, Word, etc) preferred * Embraces BrightView's culture of compliance - operates with a high degree of integrity and compliance to work standards and regulatory requirements * Familiarity with HIPAA and 42-CFR Part 2 desired * Prior experience with harm reduction a plus **Why You'll Love This Job** **Skills & Qualifications** **QUALIFICATIONS:** * **EXPERIENCE** + Required: CSAC-S Licensure * **EDUCATION:** + Required: Bachelor Degree in one of the following fields (Social Work, Psychology, Psychiatric Rehabilitation, Sociology, Counseling, Vocational Rehabilitation, or Human Counseling) **BENEFITS AND PERKS:** * PTO (Paid Time Off) * Immediately vested and eligible in 401k program with employer match. * Company sponsored ongoing training and certification opportunities. * Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance. * Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) * Tuition Reimbursement after 1 year in related field We offer competitive compensation, comprehensive benefits, and a supportive work environment dedicated to your professional growth and development. #brightviewhealthjobs Job Number: 11497

We are currently hiring for a Managed Care Coordinator II/CM-DM to join BlueCross BlueShield of South Carolina. In this role Managed Care Coordinator II/CM-DM, you will review and evaluate medical and/or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests, or provide health management program interventions. You will also utilize clinical proficiency and claims knowledge/analysis; comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity options and services required to support members in managing their health, chronic illness, or acute illness. With this role, you will utilize available resources to promote quality, cost effective outcomes. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future. Description Logistics This position is full time (40 hours/week) Monday-Friday and will be fully remote (W@H). What You'll Do: Provides active care management, assesses service needs, develops, and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy OR other at-risk conditions that consist of intensive assessment/evaluation of condition, at-risk education based on members' identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. Performs medical OR behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized OR unauthorized services. To Qualify for This Position, You'll Need: Associates in a job-related field. Graduate of Accredited School of Nursing OR two years job related work experience. Four years recent clinical in defined specialty area. Specialty areas include oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery, OR four years utilization review/case management/clinical/OR combination; two of the four years must be clinical. Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, OR influence others. Analytical OR critical thinking skills. Ability to handle confidential OR sensitive information with discretion. Microsoft Office. An active, unrestricted RN license from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR active, unrestricted licensure as social worker from the United States and in the state of hire (in Div. 6B), OR active, unrestricted licensure as counselor, OR psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within four years of hire as a Case Manager. We Prefer That You Have the Following: Bachelor's degree - Nursing. Seven years of healthcare program management. Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Working knowledge of Microsoft Excel, Access, OR other spreadsheet/database software. Case Manager Certification, clinical certification in specialty area. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental, and vision coverage. 401K retirement savings plan with company match. Life Insurance. Paid Time Off (PTO). On-site cafeterias and fitness centers in major locations. Education Assistance. Service Recognition. National discounts to movies, theaters, zoos, theme parks and more. What We Can Do for You We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail ************************ or call **************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

**_What Individualized Care contributes to Cardinal Health_** Delivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Cardinal Health, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. Personalized service and creative solutions executed through a flexible technology platform means providers are more confident in prescribing drugs, patients can more quickly obtain and complete therapy, and manufacturers can directly access more actionable insight than ever before. With all services centralized in our custom-designed facility outside of Dallas, Texas, Sonexus Health helps manufacturers rethink how far their products can go. **_What is expected of you and others at this level_** + Applies acquired job skills and company policies and procedures to complete standard tasks + Works on routine assignments that require basic problem resolution + Refers to policies and past practices for guidance + Receives general direction on standard work; receives detailed instruction on new assignments + Refers to policies and past practices for guidance + Receives general direction on standard work; receives detailed instruction on new assignments + Consults with supervisor or senior peers on complex and unusual problems **Responsibilities** + Responsible for handling inbound calls, with ability to determine needs and provide one call resolution. + Manage workload of inbound faxes (if applicable) + Investigate and resolve patient/physician inquiries and concerns in a timely manner + Enter detailed information into company proprietary software while conversing via telephone + Place outbound phone calls for patient follow ups, confirmations or to obtain missing information + Interact with the patient referral sources to process new applicants + Follow up with other internal team members regarding next steps + Communicate with external constituents including physician offices and pharmacies + Ability to identify, document and submit Adverse Events during customer contact or via received documentation **Qualifications** + Minimum high school diploma or GED, preferred + Certified Pharmacy Technician, preferred + 1+ years' experience in fast paced call center environment preferred + Basic computer knowledge, Microsoft systems, telephony + Strong communication/customer service skills + Ability to be an independent worker and self-directed + Ability to sit for long periods of time in a cubicle setting + Demonstrate superior customer support talents + Ability to prioritize multiple, concurrent assignments and work with a sense of urgency + Ability to work any schedule between 7am-5pm M-F **TRAINING AND WORK SCHEDULES:** Your new hire training will take place 8:00am-5:00pm CST, mandatory on camera attendance is required. This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 5:00pm CST. **REMOTE DETAILS:** You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. + Download speed of 15Mbps (megabyte per second) + Upload speed of 5Mbps (megabyte per second) + Ping Rate Maximum of 30ms (milliseconds) + Hardwired to the router + Surge protector with Network Line Protection for CAH issued equipment **Anticipated hourly range:** $18.10 per hour - $25.80 per hour **Bonus eligible:** No **Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being. + Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings plan + Access to wages before pay day with my FlexPay + Flexible spending accounts (FSAs) + Short- and long-term disability coverage + Work-Life resources + Paid parental leave + Healthy lifestyle programs **Application window anticipated to close:** 03/06/2025 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. _Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._ _Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._ _To read and review this privacy notice click_ here (***************************************************************************************************************************

* Contract * Office Address: 20116 Ashbrook Pl #100 Ashburn, VA ** Better Morning emerged as an outpatient behavioral health practice in Ashburn, VA in the year of 2014. In addition to providing counseling from the Ashburn office, Better Morning started off as a certified provider for intensive in home and community-based services (IHCBS), for at risk youth in District of Columbia. In August of 2017, Better Morning was certified as a Core service agency (CSA) by DC Department of Behavioral Health. Better morning founder's passion for at risk youth and their family were the motivation to keep expanding the evidenced based programs to meet the need of the underserved population. **Job Description** Care Coordinator with some prior medical office experience needed to greet clients, schedule appointments, answer phones, check insurance benefits via phone or online, obtain prior-authorizations, collect payments (copays, coinsurance, etc.) and conduct office functions such as copying, filing, chart management, etc., for a behavioral health practice. These duties are not inclusive and will include other tasks as assigned. Must be very good at professional communication. Responsibilities: * Work closely with Psychiatrist * Attend staff meetings and other activities, which ensure the smooth functioning of clinical operations. * Run the case load report * Complete consumer surveys * Make reminder calls for assessors, psychiatrist, NP, therapists * Document the reminder calls * Schedule consumer for intake * Create consumers profile in credible * Prior medical billing experience required to perform obtain prior-authorizations * Check the voice messages, save or delete as needed * Review each clinician's availability for the week for D&A and tele counseling and keep a note of these availability to serve the consumers * Review the no show report, call and reschedule * Other related duties as assigned **Qualifications** Education: BS/BA in Social Science Field or related fields Experience: Customer service: 1 year (Preferred) **Additional Information** Ability to commute/relocate: * Ashburn- Reliably commute or willing to relocate (Required) Job Type: Full-time Pay: $22.00 - $25.00 per hour Schedule: * 8 hour shift * Monday to Friday * Weekends as needed Work Location: In person **Job Location** Care Coordinator * 20116 Ashbrook Pl, Ashburn, VA 20147, USA * Contract

OrthoVirginia, Virginia's largest provider of expert orthopedic and therapy care, is currently seeking a full-time, experienced DME Coordinator to join our team! Along with a collaborative, team-oriented work environment, our outstanding employment package includes competitive salaries, excellent medical, dental, and vision benefits, paid time off (PTO), a generous 401k incentive plan, short-term and long-term disability insurance, life insurance, and a company-wide wellness program. Position Summary The DME Coordinator works in the clinical office(s) and consistently communicates with the Regional DME Manager, Clinical office managers, providers, and clinical teams to ensure patients receive outstanding care, understanding and proper use of their ordered orthosis. Primary Functions & Accountabilities Organizes and represents the assigned clinical component and location of OrthoVirginia's DME program Daily measurements and fittings following provider orders Collaborates with the Regional DME Manager, providers, and clinical staff to ensure patients are educated on proper use and fit of DME Educates patients as to the financial responsibility associated with their DME Communicates with providers when changes are made to DME Policies and Procedures Responsible for the DME inventory management at assigned clinical locations and daily duties within the DME program Works closely with DME Business Specialist and Preauth Specialist to ensure accurate and timely billing and that preauthorization requests are met. Serves as point of contact for Billing, Insurance Verification, and DME Surgery Coordinator at assigned clinics Communicates well with other DME team members, regional and state to ensure excellent outcomes regarding patient care and inventory management Assists in quarterly training of clinical staff of proper use and fitting of DME Takes ownership of their assigned location(s) and supports the overall mission of the practice Other duties and projects assigned Knowledge, Skills & Abilities Excellent customer service/patient care skills Exceptional organization and communication skills Ability to think on his/her feet and display strong emotional intelligence working with the public Ability to practice solid problem-solving techniques to ensure patients understand donning and doffing and are wearing their orthosis properly Knowledge of basic anatomy and medical terminology Must have the ability to multitask in a fast-paced environment Ability to contribute and work well with a team Ability to take on, organize and complete assigned department projects when requested by manager Position Requirements BA or BS preferred, HS Diploma or Equivalent General DME/Orthopaedic experience required. Certification as an Athletic Trainer, Orthotic Fitter, or Orthopaedic Tech preferred but not required Physical health sufficient to meet the ergonomic standards and demands of the position This organization participates in E-Verify. Esta organizacion participa en E-Verify