The Bilingual Lead Care Manager partners with Care Team Operations, Clinical Operations, Compliance, Community Health Workers, Behavioral Health staff, and external providers (medical, housing, and social services) to ensure seamless, culturally responsive, member-centered care coordination. The bilingual LCM additionally supports members with limited English proficiency by facilitating communication, translation, and cultural interpretation as needed.
Responsibilities
Serve as the primary point of contact for assigned members, building trust and maintaining active engagement through consistent outreach, relationship-based strategies, and a trauma-informed approach. Provide all communication in the member's preferred language.
Conduct comprehensive assessments (physical, behavioral, functional, social) and develop person-centered care plans that reflect the member's goals, risks, preferences, cultural needs, and social determinants of health.
Implement, monitor, and update care plans following transitions of care, significant changes in condition, or required reassessments; ensure timely and compliant submission of all care plans.
Coordinate services across the continuum-including medical, behavioral health, housing, transportation, social services, and community programs-to reduce fragmentation and remove barriers to care.
Conduct required in-person home or community visits based on member need and risk stratification and maintain a compliant monthly visit structure.
Utilize motivational interviewing, coaching, and health education to promote behavioral change, self-management, and long-term member stability.
Identify gaps in care, service delays, lapses in benefits, unmet needs, and environmental risks; collaborate with internal and external partners to resolve issues quickly and effectively.
Maintain accurate, timely, audit-ready documentation of all interactions, assessments, and interventions using required HHN platforms, including eClinicalWorks (ECW), Google Suite, RingCentral, PowerBI dashboards, and payer portals.
Meet or exceed HHN and payer productivity standards, including encounter metrics, outreach requirements, documentation timelines, and quality measures.
Actively participate in multidisciplinary case reviews, team huddles, care conferences, and escalations with nurses, behavioral health staff, CHWs, care operations, and compliance.
Coordinate and schedule appointments with primary care, specialists, behavioral health providers, and community partners; manage referrals, transportation, and follow-ups to ensure continuity of care.
Support hospital discharge (TOC) planning through follow-up scheduling, care transitions, medication reconciliation support, and education on discharge instructions.
Assist members in navigating plan eligibility, redeterminations, documentation, social service applications, housing resources, and crisis interventions.
Maintain active and professional communication with members and care partners through HHN-approved channels, including RingCentral, secure messaging, SMS workflows, and phone.
Participate in HHN's continuous quality improvement efforts, identifying workflow gaps, documenting barriers, sharing insights, and contributing to best-practice development.
Uphold confidentiality and adhere to all HIPAA and payer regulatory requirements across all areas of care delivery.
Open to seeing patients in their home or their location of preference.
Provide real-time interpretation and translation support (verbal and written) for members and families with limited English proficiency.
Help bridge cultural gaps that may impact communication, trust, adherence, or engagement.
Skills Required
Fluency in English and another language (Spanish preferred); ability to read, write, and speak at a professional level.
Strong ability to build rapport and trust with diverse, high-need member populations.
Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools.
Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals.
Demonstrated skill in conducting holistic assessments and developing person-centered care plans.
Experience with motivational interviewing, trauma-informed care, or health coaching.
Strong organizational and time-management skills, with the ability to manage a complex caseload.
Excellent written and verbal communication skills across in-person, telephonic, and digital channels.
Ability to work independently, make sound decisions, and escalate appropriately.
Knowledge of Medi-Cal, SDOH, community resources, and social service navigation.
High attention to detail and commitment to accurate, audit-ready documentation.
Ability to remain calm, patient, and professional while supporting members facing instability or crisis.
Comfortable with field-based work, home visits, and interacting in diverse community environments.
Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences.
Competencies
Member Advocacy: Champions member needs with urgency and integrity.
Operational Effectiveness: Executes workflows consistently and flags process gaps.
Interpersonal Effectiveness: Builds rapport with diverse populations.
Collaboration: Works effectively within an interdisciplinary care model.
Decision Making: Uses judgment to escalate or intervene appropriately.
Problem Solving: Identifies issues and creates practical, timely solutions.
Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes.
Cultural Competence: Engages members with respect for their lived experiences.
Documentation Excellence: Produces accurate, timely, audit-ready notes every time.
Strong empathy, cultural competence, and commitment to providing individualized care.
Ability to work effectively within a multidisciplinary team environment.
Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Bilingual Communication (interpretation + translation)
Job Requirements
Education:
Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field preferred; equivalent experience considered.
Licensure:
Not required; certification in care coordination or CHW training is a plus.
Experience:
1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations.
Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred.
Familiarity with Medi-Cal, ECM, and community resource navigation.
Travel Requirements:
Regular travel for in-person home or community visits (up to 45%).
Physical Requirements:
Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.
$36k-47k yearly est. 5d ago
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Clinical Program Manager RN * Hybrid*
Providence Health and Services 4.2
Remote job
Clinical Program Manager RN
Hybrid.
Candidates residing in the areas of Portland, OR, Spokane, WA or Lubbock, TX are encouraged to apply.
In collaboration with the Division Director, the Clinical Practice Manager RN supports nursing practice, quality initiatives, and clinical improvement efforts across the division. This role is responsible for leading teams in developing and implementing evidence-based nursing and clinical practices, utilizing established standards, research findings, and quality improvement principles.
Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Strategic And Management Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
Bachelor's Degree: Nursing
Master's Degree: Nursing (Practice or Education)
5 years - Nursing experience in an acute care setting.
3 years - Clinical practice development, quality, or education experience.
active RN License for WA, OR or TX
Preferred Qualifications:
Ph.D.: Nursing or DNP (Doctor of Nursing Practice)
Salary Range by Location:
Oregon: Portland Service Area: Min: $59.39, Max: $93.75
Texas: Min: $45.30, Max: $71.51
Washington: Eastern: Min: $52.85, Max: $83.42
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Requsition ID: 403508
Company: Providence Jobs
Job Category: Clinical Administration
Job Function: Clinical Support
Job Schedule: Full time
Job Shift: Day
Career Track: Nursing
Department: 4007 SS CNTRL DIV EDU ADMIN
Address: OR Portland 4400 NE Halsey St
Work Location: Providence Health Plaza (HR) Bldg 1-Portland
Workplace Type: Hybrid
Pay Range: $see posting - $see posting
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
PandoLogic. Category:Healthcare, Keywords:Healthcare Program Manager, Location:Ransom Canyon, TX-79366
$46k-76k yearly est. 5d ago
Medical Field Case Manager
Enlyte
Remote job
At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.
Be part of a team that makes a real difference.
This is a full-time, work-from-home position. The candidate must be located in the Plant City, Florida area due to regular local travel for in-person patient appointments.
Perks: Full and comprehensive benefits program, 24 days of paid vacation/holidays in your first year plus sick days, home office equipment including laptop and desktop monitor, mileage and travel reimbursement, Employee Assistance and Referral Program, and hands-on workers' compensation case management training.
Join our compassionate team and help make a positive difference in an injured person's life. As a Field Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning. In this role, you will:
* Demonstrate knowledge, skills, and competency in the application of case management standards of practice.
* Use advanced knowledge of types of injury, medications, comorbidities, treatment options, treatment alternatives, and knowledge of job duties to advise on a treatment plan.
* Interview disabled persons to assess overall recovery, including whether injuries or conditions are occupational or non-occupational.
* Collaborate with treating physicians/providers and utilize available resources to help create and implement treatment plans tailored to an individual patient.
* Work with employers and physicians to modify job duties where practical to facilitate early return to work.
* Evaluate and modify case goals based on injured/disabled person's improvement and treatment effectiveness.
* Independently manage workload, including prioritizing cases and deciding how best to manage cases effectively.
* Complete other duties, such as attend injured worker's appointments when appropriate, prepare status updates for submittal to customers, and other duties as assigned.
Qualifications
* Education: Associates Degree or Bachelor's Degree in Nursing or related field.
* Experience: 2+ years clinical practice preferred. Workers' compensation-related experience preferred.
* Skills: Ability to advocate recommendations effectively with physicians/providers, employers, and customers. Ability to work independently. Knowledge of basic computer skills including Excel, Word, and Outlook Email. Proficient grammar, sentence structure, and written communication skills.
* Certifications, Licenses, Registrations:
* Active Registered Nurse (RN) license required. Must be in good standing.
* URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC).
* Travel: Must have reliable transportation and be able to travel to and attend in-person appointments with injured workers in assigned geography.
* Internet: Must have reliable internet.
* Transportation: Must have reliable transportation and be able to travel to and attend in-person appointments with injured workers in assigned geography.
Benefits
We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $63,000 - $85,000 annually. In addition to the base salary, you will be eligible to participate in our productivity-based bonus program. Your total compensation, including base pay and potential bonus, will be based on a number of factors including skills, experience, education, and performance metrics.
The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.
#LI-VH1
#FCM
Registered Nurse (RN), Nursing, Home Care Registered Nurse, Emergency Room Registered Nurse, Clinical Nurse, Nurse Case Manager, Field Case Manager, Medical Nurse Case Manager, Workers' Compensation Nurse Case Manager, Critical Care Registered Nurse, Advanced Practice Registered Nurse (APRN), Nurse Practitioner, Case Management, Case Manager, Home Healthcare, Clinical Case Management, Hospital Case Management, Occupational Health, Patient Care, Utilization Management, Acute Care, Orthopedics, Rehabilitation, Rehab, CCM, Certified Case Manager, CDMS, Certified Disability Management Specialist, CRC, Certified Rehab Certificate, CRRN, Certified Rehab Registered Nurse, COHN, Certified Occupational Health Nurse, CMC, Cardiac Medicine Certification, CMAC, Case Management Administrator Certification, ACM, Accredited Case Manager, MSW, Masters in Social Work, URAC, Vocational Case Manager
$63k-85k yearly 8d ago
Medical Case Manager - Temporary
UNC-Chapel Hill
Remote job
This position provides medical case management referral services, crisis intervention and eligibility determination services to adults with HIV infection receiving medical services in the outpatient Infectious Diseases Clinic. A very small percentage of time may include services to patients with other infectious diseases. The employee will complete assessments and identify service needs, facilitate linkage to services and coordinate with community agencies. They may assist with transportation and housing needs. Responsibilities may include assisting clients in accessing financial benefit programs. The employee will work closely with the existing licensed social work team, medical providers, nursing staff, and benefits coordinators as part of an interdisciplinary team. Requires timely data entry and data management in an electronic medical record ( EPIC ), electronic databases and tracking systems. Successful employees possess a strong ability to multi-task in a fast-paced environment. Employees are required to attend meetings as directed.
Required Qualifications, Competencies, And Experience
Bachelor's degree in a Human Service field with clinical experience.
Preferred Qualifications, Competencies, And Experience
Experience with clinic population, electronic medical records, and data management preferred. Course work in Social Work.
Work Schedule
Monday - Friday, 8:00 AM - 5:00 PM; fully remote position
$33k-55k yearly est. 9d ago
Clinical Monitoring Manager
Apogee Therapeutics
Remote job
About Apogee Therapeutics Founded in 2022, Apogee Therapeutics, Inc. (Ticker: APGE) is a well-funded, Nasdaq listed company that offers the opportunity to work in a fast-paced, highly dynamic environment. At Apogee, you can actively contribute to shaping the company culture, take on various roles and responsibilities, and grow professionally. Apogee Therapeutics, Inc. is a biotechnology company seeking to develop differentiated biologics for the treatment of atopic dermatitis, chronic obstructive pulmonary disease and other inflammatory and immunology indications with high unmet need. Our antibody programs are designed to potentially overcome limitations of existing therapies by targeting well-established mechanisms of action and incorporating advanced antibody engineering to optimize half-life and other properties. We seek to reshape the current standard of care for inflammatory and immune diseases because we believe people living with these diseases deserve the best possible treatment, and we refuse to stop at “good enough.” We are a fast-paced company committed to building an exceptional company culture, founded on our C.O.R.E. values: Caring, Original, Resilient and Egoless. If this sounds like you, keep reading! Role Summary
We are seeking a Clinical Monitoring Manager to oversee in-house Oversight CRAs that will oversee CRO CRA's management of clinical study site activities for Apogee sponsored clinical trials. This role will also support the study team in various trial related activities. In this role, you will serve as Apogee's primary liaison with the in-house CRAs and CRO clinical monitoring team and liaise with clinical study sites and contribute to building a culture of team, site and patient centricity. Helping Apogee become “Sponsor of Choice” with both our CRO partners and sites will be critical. This role is accountable for oversight of clinical monitoring activities from site identification through close out of the study site. The Clinical Monitoring Manager has ‘in-house' responsibilities (e.g., oversight CRAs), and as required by project scope, sponsor monitoring or co-monitoring visits at the clinical study sites.
The Clinical Monitoring Manager collaborates closely with the Apogee Executive Director, Clinical Operations and the Clinical Study Lead, assists in the planning/management/execution of Apogee sponsored clinical trials, and contributes to the overall success of the clinical study according to company and department objectives.
Key Responsibilities
In-house responsibilities
The Clinical Monitoring Manager is responsible for the study deliverables of in-house CRAs on a given study(s), ensuring study deliverables are met with efficiency and quality and in accordance with applicable standard operating procedures (SOPs), regulations, good clinical practices (GCP), Key Performance Indicators (KPs), and study-specific requirements
May be responsible for the hiring of in-house CRAs
Input into and assist with the development of study documents (e.g., protocols, case report forms, informed consent forms)
Oversee development and implementation of project specific processes, tools, and documents (e.g., monitoring oversight plans, site visit report templates, monitoring tools)
Support the training and development of in-house CRAs and ensuring study training compliance is maintained
Works with the study team on developing and updating best practices and processes, with input on discussions around quality by design and operational delivery
Oversight of review of monitoring visit reports and metrics, including protocol deviations and follow-up items, to evaluate for compliance and trends, summarizing for the study team, escalating issues, and involved in the development of corrective and preventative actions, as needed
Responsible for oversight of CRA review of clinical data (e.g., electronic case report forms, eCOA data, central laboratory data, risk-based monitoring outputs, etc.) to ensure the CRAs are informed and managing their site's data with quality and integrity
Responsible for ensuring CRAs maintain their sites as inspection ready, including the Trial Master File (TMF), for health authority inspections at all times
Responsible for compiling and providing clinical monitoring metrics per KPIs to ensure adequate oversight of clinical monitoring activities
Lead, conduct, and document regular meetings with their in-house and CRO CRA team and with individual CRAs to disseminate timely and relevant updates and best practices for consistency and efficiency
Oversee the study specific performance of the CRA team(s) and implement plans of action as needed; escalate performance issues to the Executive Director, Clinical Operations
Support and liaise with clinical site personnel, as needed
Review and approve time sheets and expense reports
Assist with review and revision of departmental SOPs and policies
Assist with creation and delivery of new department initiatives, improvement plans or training
May assist with the identification and selection of appropriate clinical trial sites and investigators
Field monitoring responsibilities
Conduct CRO co-monitoring visits or other monitoring visits (site qualification visit, site initiation visit, interim monitoring visit, or close-out visit) as required by study needs
Oversee CRO site visits to qualify, initiate, and close-out study sites, and perform site monitoring to ensure study sites' compliance with study timelines, protocol requirements, and applicable regulatory guidelines
Review and ensure data integrity, accuracy, and completeness at the clinical study sites
Escalate site related issues to the study team
Oversee the coordination for study site audit and ensure assigned study sites are inspection-ready, as needed
Ideal Candidate
Bachelor's degree in a scientific or healthcare-related field
Minimum of 8 years of experience as a CRA or related role within the pharmaceutical, biotechnology, or medical device industry
Minimum 2 years of experience leading a team of CRAs
Recent experience working on respiratory, dermatology and / or gastrointestinal clinical trials a plus
Certification as a Clinical Research Associate (CCRA) or equivalent preferred
Recent experience working on trials utilizing risk-based monitoring models
Strong knowledge of International Council for Harmonization (ICH) guidelines, Good Clinical Practice (GCP), and FDA regulations
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and Smartsheet
Experience with EDC systems, electronic trial master files (eTMFs) and other clinical trial databases and systems
Strong understanding of clinical trial processes and study conduct
Excellent organizational and time management skills
Effective communication and interpersonal skills, with the ability to work collaboratively in a team environment, but can also work independently without significant oversight
Experience working in a fast-paced and dynamic environment
Successfully exhibit Apogee's C.O.R.E. values: Caring, Original, Resilient and Egoless
Position requires up to 35% travel, including mandatory in-person attendance at Apogee All Hands meetings typically held twice per year. Travel is also required to attend key Phase 3 meetings, typically held at the Apogee San Francisco office. This position may also require US and international travel to clinical sites and/or medical conferences.
Position requires up to 35% travel, including mandatory in-person attendance at Apogee All Hands meetings typically held twice per year, and a clinical operations meeting held once per year. Travel is also required to attend key Phase 3 meetings, typically held at the Apogee San Francisco office. This position may also require US and international travel to clinical sites and/or medical conferences.
The anticipated salary range for candidates for this role will be $150,000 - $170,000. per year. The final salary offered will depend on several factors, which may include, but is not limited to relevant years of experience, educational background, and geography.
What We Offer
A great culture, grounded in our C.O.R.E. values: Caring, Original, Resilient and Egoless
Opportunity to work in a fast-paced, highly dynamic environment where you help shape the culture and company, wear multiple hats, and learn quickly
Market competitive compensation and benefits package, including base salary, performance bonus, equity grant opportunities, health, welfare & retirement benefits
We provide competitive time off, including three weeks PTO, two one-week company-wide shutdowns a year and dedicated paid sick leave
Commitment to growing you professionally and providing access to resources to further your development
Apogee offers regular all team, in-person meetings to build relationships and problem solve
E-Verify Participation: As part of the I9 verification of authorization to work in the US, Apogee participates in E-Verify. To learn more about E-Verify please review this poster. A
pogee Therapeutics is proud to be an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
To review our privacy policy, click here
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
$150k-170k yearly Auto-Apply 14d ago
Clinical, Manager, Prior Authorization Technician
Capital Rx 4.1
Remote job
About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:
Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
Judi , the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit ****************
Location: Remote (For Non-Local) or Hybrid (Local to NYC area)
Position Responsibilities:
Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process.
Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance.
Actively participate in the prior authorization technician metric and quality goal setting process.
Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders.
Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees.
Investigate/resolve escalated issues or problems from team members, clients, and other internal teams.
Key stakeholder in ensuring the prior authorization review platform is optimized for technician functions.
Maintain relationships with external Independent Review Organizations and clinical resource vendors.
Support the training and growth of both new and existing staff members in adherence to proper procedures.
Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties.
Assists with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department.
Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
Maintain compliance with local, state, and federal laws, in addition to established organizational standards.
Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
Required Qualifications:
Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required
Bachelor's or Associate's degree is preferred
4+ years of PBM or Managed Care pharmacy experience required
Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
Strong clinical background required
Excellent communication, writing, and organizational skills
Ability to multi-task and collaborate in a team with shifting priorities
Preferred Qualifications:
2+ years of regulated market prior authorization operations experience or knowledge of how to operationalize regulated market requirements
Previous prior authorization operations leadership experience
Salary Range$80,000-$90,000 USD
All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at *********************************************
Click here to view our 2026 Benefits Guide
Serves as the clinical expert in key healthcare domains, including infection control, wound care, surgical procedures, vascular access, LVAD (Left Ventricular Assist Device), Durable Medical Equipment (DME), Remote Patient Monitoring (RPM), and related product categories.
Leads expert clinical support for field sales teams to help achieve strategic business objectives and drive revenue growth.
Leads the planning and execution of product evaluations, customer training sessions, and implementation initiatives for both internal stakeholders and external healthcare professionals.
Develops and delivers professional education programs, including the creation of training materials and presentations, often acting as lead presenter and project manager.
Plays a critical role in shaping the customer experience across the sales lifecycle-from initial engagement and product adoption to long-term satisfaction-impacting training outcomes, product utilization, purchasing decisions, and overall customer retention.
Essential Functions (ACCOUNTABILITIES/RESPONSIBILITIES):
Serves as a clinical and education expert, providing training and support to internal teams, customers, distributors, and white-label partners across the full Bravida product portfolio.
Leads field-based product evaluations, implementations, and maintenance activities, including account setup and tailored training plans that directly support sales success.
Leads training for field sales representatives (direct and 1099), and for the training, supervision, and mentorship of per diem clinical staff and clinical education specialists ensuring clinical competence, brand consistency, and measurable ROI from training investments.
Drives the development and execution of Bravida Academy offerings, taking the lead in multiple education programs with significant influence on customer success and learning outcomes. Contributes to CE accreditation processes as needed.
Conducts customer needs assessments in response to field complaints, identifying trends, ensuring compliance with internal processes in partnership with RAQA, and recommends targeted training and troubleshooting strategies to field sales and clinical teams.
Leads and executes training programs for all internal colleagues and external customers, fostering long-term clinical skill development and amplifying the voice of the customer across Bravida teams.
Develops and maintains strategic relationships with KOLs (Key Opinion Leaders), overseeing consultant-led educational content, poster presentations, speaking engagements, and related projects.
Represents Bravida as an active member of professional organizations, delivering presentations, authoring content, and coordinating outreach and training at local, regional, and national events, conferences, and trade shows.
Maintains current expertise in clinical practice guidelines, FDA and regulatory standards, market trends, and competitor products; contributes to content and document review in QT9 quality management system.
Provides clinical input to New Product Development (NPD) and R&D teams, shaping portfolio innovation and supporting training strategy for product launches.
Leads clinical research activities, including Bravida-sponsored trials, ensuring alignment with FDA requirements and Good Clinical Practice (GCP) standards from initiation to completion.
Collaborates cross-functionally with the CCLO, Marketing, and Sales teams to develop and deliver clinical messaging, sales tools, and customer-centric educational content; drives continuous improvement through feedback integration.
Delivers clinical education using a variety of digital platforms (e.g., On24, eLearning tools, websites) and stays current with best practices in remote and virtual training technologies.
Utilzes Bravida business systems (e.g., SFDC, Fast Field, Monday.com, IntelAgree) for planning, communication, project tracking, and deliverable management.
Sets an example and ensures full compliance with Bravida policies, procedures, Code of Conduct, and the organization's mission and values.
Qualifications:
Experience
5+ years of clinical nursing experience in one or more of the following areas: Operating Room, Wound Care, Infection Control, Vascular Access, and/or Critical Care, with a strong foundation in patient care and clinical protocols.
3-5 years of experience in a nursingmanager and/or educator role, demonstrating leadership in staff development, training programs, and clinical oversight.
3-5 years of experience in the medical device industry preferred, with a focus on direct customer engagement, clinical field support, educational content development, and training delivery.
Education
Bachelor's Degree in Nursing (BSN) preferred.
Master's Degree in Nursing (MSN) or Business Administration (MBA) preferred.
Credentials
Registered Nurse (RN), licensed and in good standing, required.
Accredited Nursing Certifications (e.g., Wound Care Certification [WCC], Perioperative Nurse [CNOR], Infection Control [CIC], Critical Care Registered Nurse [CCRN]) preferred.
General Skills/Competencies/Specialized Knowledge
Strong clinical competencies in areas such as Operating Room, Wound Care, Infection Control, Vascular Access, and Critical Care.
In-depth understanding of the healthcare industry, market trends, and the evolving role of medical devices in clinical practice.
Proficient expertise in clinical program design for the medical device industry, with the ability to link clinical needs to business outcomes.
Proven effectiveness in supporting sales teams through customer training, product utilization, and decision-making support to drive business objectives.
Competent leadership and project management skills, including the ability to collaborate across departments and lead processes effectively to meet or exceed deadlines.
Training content development and strong presentation skills with a proven track record of success in educational settings.
Exceptional communication, interpersonal, and negotiation skills, with a focus on building long-term professional relationships.
Strong problem-solving abilities in complex clinical and business environments.
Competence in digital tools and platforms, including PPT, Excel, Power BI, eLearning, digital conference and webinar platforms with high-quality content delivery.
Desirable Job Competencies
Ambition and drive to grow within the company and the industry.
Ability to juggle multiple tasks simultaneously with a sense of urgency, prioritizing competing priorities in a fast-paced environment, ensuring timely delivery without compromising quality.
Ability to build strong relationships with internal teams, customers, and professional organizations.
Leadership potential with the ability to manage projects and initiatives to completion.
Innovative, creative thinker with a focus on customer experience and high-quality outcomes.
High clinical confidence with the ability to navigate and influence complex healthcare systems.
Expertise in networking and driving sales, contributing to customer conversion and retention.
TRAVEL REQUIREMENTS/WORK ENVIRONMENT and PHYSICAL DEMANDS:
Travel Requirements
Willing and able to travel up to 80% for customer-facing activities, including product evaluations, conversions, ongoing support, and educational training sessions in the field.
Work Environment & Physical Demands
Must be able to lift and carry items up to 30 lbs. as needed for demonstrations and training setups.
Requires frequent walking and standing in various settings, including acute care hospitals, conference centers, airports, and other customer locations.
$62k-97k yearly est. Auto-Apply 60d+ ago
Clinical Manager - Seating and Positioning
Ki Mobility 4.2
Remote job
The Clinical Manager is responsible for developing and implementing clinical training curricula detailing the application and fitting of the designated Etac product area to achieve positive functional outcomes. This position trains providers, therapists, and sales associates in the form, fit, and function of Etac products and their clinical applications. This is a traveling position providing product presentations, clinical in-services, and product/client fittings with providers and/or clinicians and provides one-on-one training with sales associates with the goal of supporting efforts to increase sales of all designated Etac products. The role also supports and leads larger in-person clinical product education and training engagements with key customers.
Product Areas:
Seating & Positioning: all Etac North America Mobility custom and “packaged” seating products, including Axiom, Axiom Kids, Axiom Custom Back, Axiom Custom Seating, Star Cushions, secondary positioning supports, and other products and accessories as they may be designated in the future.
Mobility: all Etac North America Mobility manual wheelchairs and related accessories or components, including power assist. This includes manual wheelchair in the folding, rigid, tilt-in-space, pediatric and adolescent categories, as well as, any products and accessories as they may be designated in the future.
Pediatrics: all Etac North America Mobility products intended for use by the pediatric population. This includes all products, accessories, or components from R82, Convaid, Ki Mobility, including power assist. This will also include any products and accessories as they may be designated in the future.
Essential FunctionsJob Responsibilities
Assist in the development of clinical training curricula relating to relevant Etac products.
Create and deploy training materials that will be used by sales associates, export partners, and other clinical education team members.
Establish and maintain a travel schedule with Etac sales associates centered around in-field customer and clinician engagements.
Attend trade shows, customer events, and sales meetings as necessary.
Contribute to the development of the company's strategic plan to drive future growth and profitability for relevant Etac products.
Present professional continuing education content (CEUs) as needed, either through coordination with sales associates and managers, or at key business partner education events.
Manage sales expenses within the guidelines of the Company expense policy.
Work closely with the sales team, specifically Territory Sales Managers, to align training initiatives with sales strategies and customer needs.
Collaborate with cross-functional teams to align and deliver product education and training programs.
Uphold Company values and ethical business conduct, as well as, maintain confidentiality of sensitive information.
Utilize sales and order analysis tools, including Qlik, to strategically plan and prioritize travel to optimize effectiveness.
Utilize sales and order analysis tools, including Qlik, post-travel to analyze effectiveness of travel and/or training curricula.
Be a key contributor to product development requirements around competitive opportunity, clinical requirements and efficacy that deliver strong new product enhancements that meet market needs.
Ensure and follow safety, quality, and other company requirements and standards.
Keep the work area clean and orderly.
Perform all duties in a manner that follows, demonstrates, and promotes Company's values.
Report to work as scheduled, on time, and able to work entire work schedule.
Perform additional duties as assigned.
Knowledge, Skills, and Ability
Excellent presentation skills and confidence in front of small and large groups.
Strong organizational skills.
Strong Microsoft PowerPoint skills.
Knowledge and proficiency with Microsoft Office Suite products, including Excel and Outlook, and other enterprise software.
In depth knowledge of clinical issues relating to disabled populations.
Knowledge of manual mobility and seating products than span adult and pediatric solutions within the complex rehabilitation industry.
Ability to establish and maintain professional communications both inside and outside the company.
Funding knowledge within complex rehab technology.
Ability to network with providers, ATP's, clinicians, and caregivers.
A high level of interactive communication is required to service our customers and clinicians; must be able to respond quickly and effectively to satisfy customer and clinician inquiries.
Possess a strong business acumen with an understanding of market potential and contract development.
Analytical skills in order to solve complex problems and make informed decisions.
Possess excellent written and oral communication and interpersonal skills to collaborate effectively with cross-functional teams.
Proactive and self-motivated with the ability to work independently and in a team environment.
Ability to lift and handle wheelchairs.
Ability to observe and identify details.
Ability to work extended hours as scheduled, including weekends.
Physical Demands
Frequent sitting, wrist manipulation, walking, and standing.
Frequent bending, pushing, pulling, and twisting.
Occasional to frequent driving in a vehicle.
Frequent light/medium work with lifting up to 30 pounds.
Occasional medium work with lifting up to 50 pounds.
Must be able to lift, handle, load, and unload all products.
Manual dexterity to type and operate office equipment frequently.
Must be able to complete all physical requirements to perform essential functions.
QualificationsEducation/Experience
Degree in a clinical discipline (Occupational or Physical Therapy, Kinesiology) or a related field or 3-5 years of experience in the complex rehab industry.
ATP certification is beneficial.
Must possess and maintain a valid driver's license.
Intermediate level experience with computer applications.
Working Environment
Remote position with an expectation of up to 75% travel focusing on specific key referral sources, their clinicians, providers, and ATP's.
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the associate for this position. Duties, activities, and responsibilities may change, or new ones may be assigned at any time with or without notice. Associate must be able to satisfactorily perform the essential functions of the position with or without reasonable accommodations.
Ki Mobility is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
$52k-70k yearly est. Auto-Apply 60d+ ago
Manager Clinical Affairs
Dexcom 4.7
Remote job
The Company
Dexcom Corporation (NASDAQ DXCM) is a pioneer and global leader in continuous glucose monitoring (CGM). Dexcom began as a small company with a big dream: To forever change how diabetes is managed. To unlock information and insights that drive better health outcomes. Here we are 25 years later, having pioneered an industry. And we're just getting started. We are broadening our vision beyond diabetes to empower people to take control of health. That means personalized, actionable insights aimed at solving important health challenges. To continue what we've started: Improving human health.
We are driven by thousands of ambitious, passionate people worldwide who are willing to fight like warriors to earn the trust of our customers by listening, serving with integrity, thinking big, and being dependable. We've already changed millions of lives and we're ready to change millions more. Our future ambition is to become a leading consumer health technology company while continuing to develop solutions for serious health conditions. We'll get there by constantly reinventing unique biosensing-technology experiences. Though we've come a long way from our small company days, our dreams are bigger than ever. The opportunity to improve health on a global scale stands before us.
Meet the team:
As a Manager in Clinical Affairs at Dexcom, you'll be an integral part of our mission to empower people to take control of their health. In this position, you'll lead a team of global direct reports responsible for comprehensive site management activities. This includes site selection, qualifications, activation, training, proctoring, communications, and closeout for all clinical studies sponsored by Dexcom. You will be responsible for the direct management and development of personnel. Additionally, you will drive the development and improvement of clinical procedures, processes, and templates in support of Dexcom's continuous quality improvement efforts. If you thrive in a fast-paced, evolving environment and are committed to building a world-class Clinical Affairs organization, we'd love to have you on our team.
Where you come in:
Perform line management for a team, including hiring, training/mentoring, resource allocation/assignments, performance and compliance assessments/reviews, recommending salaries and promotions, and implementing performance improvement plans and remedial actions as needed.
Lead the team to ensure high-quality site management, regulatory compliance, and timely delivery of study site milestones, including, but not limited to:
Accountable for global or regional operational leadership on one or more clinical trials, depending on program's priority and breadth.
Oversee site identification, qualification, and selection processes.
Ensure timely completion of Site Qualification Visits (SQVs) and approvals.
Confirm site activation readiness, including supply and equipment receipt.
Supervise Site Initiation Visits (SIVs) and Close-Out Visits (COVs).
Ensure ongoing site support and clear communication.
Provide support and allocate resources for internal or external audits/inspections and ensure resolution of audit/inspection findings.
Ensure maintenance of site-level Trial Master File (TMF) and sponsor TMF for archiving.
Oversee development and distribution of Investigator Site Files and study manuals.
Facilitate IRB/EC submissions and end-of-study notifications.
Lead the development and implementation of improved systems, frameworks, policies, and tools to support a culture of data use for decision-making across programs.
Provide strategic direction as a subject matter expert in site management.
Develop and oversee key performance metrics for the team and provide regular and ad hoc reporting of metrics to Clinical Affairs leadership.
Lead a team of Site Managers who will facilitate training on the use of study-specific equipment during the conduct of clinical study visits to ensure proper use of the equipment and adherence to the Clinical Investigation Plan. In support of this, the team will be responsible for:
Educating site staff on use of the study-specific equipment, including calibration, use, and troubleshooting.
Communicating technical information clearly and effectively.
Developing effective working relationships with site staff, with whom you will interact on a regular basis.
Ensure that staff meet or exceed project and functional timelines and deliverables (e.g., site start-up, enrollment targets, database lock, close-out, etc.). Partner with leadership to ensure shared study timelines are met or exceeded.
Proactively identify issues and create mitigation strategies in collaboration with leadership.
What makes you successful:
You must be open to a dynamic work environment which includes regular interaction with several different physicians and site staff across a variety of locations.
You have extensive prior experience in a similar role with a proven track record of successful clinical study completion with adherence to timelines and milestones.
You bring knowledge and experience with GCP and global medical device regulations and have experience leading complex medical device studies.
You have strong experience of managing individuals.
You are proficient at utilizing clinical management systems and electronic data capture systems.
You have experience in global Contract Research Organization (CRO)/vendor management.
You bring an operational-excellence mindset, critical thinking, and make data-driven decisions.
You are a detail-oriented, critical thinking, independent problem-solver.
You are proficient at working in an extremely fast-paced environment while maintaining high attention to detail, quality, and accuracy.
You have excellent communication (written and verbal) and proven ability to influence outcomes.
What you'll get:
A front row seat to life changing CGM technology. Learn about our brave #dexcomwarriors community.
A full and comprehensive benefits program.
Growth opportunities on a global scale.
Access to career development through in-house learning programs and/or qualified tuition reimbursement.
An exciting and innovative, industry-leading organization committed to our employees, customers, and the communities we serve.
Travel Required:
5-15%
Experience and Education Requirements:
Typically requires a Bachelor's degree with 8 - 12 years of industry experience.
Requires a degree in technical discipline.
2 -5 years of previous management of lead experience.
Remote Workplace: Your location will be a home office; you are not required to live within commuting distance of your assigned Dexcom site (typically 75 miles/120km).
If you reside within commuting distance of a Dexcom site (typically 75 miles/120km) a hybrid working environment may be available. Ask about our Flex workplace option.
Please note: The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor are they intended to be an all-inclusive list of the skills and abilities required to do the job. Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time. The duties and responsibilities in this job description may be subject to change at any time due to reasonable accommodation or other reasons. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, or protected veteran status and will not be discriminated against on the basis of disability. Dexcom's AAP may be viewed upon request by contacting Talent Acquisition at ****************************.
If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact Dexcom Talent Acquisition at ****************************.
Meritain, an Aetna Company, creates and publishes the Machine-Readable Files on behalf of Dexcom. To link to the Machine-Readable Files, please click on the URL provided: ***************************************************** Code=MERITAIN_I&brand Code=MERITAINOVER/machine-readable-transparency-in-coverage?reporting EntityType=TPA_19874&lock=true
To all Staffing and Recruiting Agencies: Our Careers Site is only for individuals seeking a job at Dexcom. Only authorized staffing and recruiting agencies may use this site or to submit profiles, applications or resumes on specific requisitions. Dexcom does not accept unsolicited resumes or applications from agencies. Please do not forward resumes to the Talent Acquisition team, Dexcom employees or any other company location. Dexcom is not responsible for any fees related to unsolicited resumes/applications.
Salary:
$116,600.00 - $194,400.00
$116.6k-194.4k yearly Auto-Apply 13d ago
Clinical Staff Manager, Cardiac Rehab
Recora, Inc.
Remote job
Job Title: Clinical Staff Program Manager
Classification: Full Time
Work Structure: Fully Remote
Schedule/Shift: Standard Business Hours
Team: Clinical Operations
Reporting to: Senior Manager, Cardiac Rehab
Location: United States
Compensation: $65,000-$75,000 annually
About Us:
Recora was founded in 2020 by seasoned digital health entrepreneurs. In past roles, we've founded and scaled high-growth startups, run large health systems, advised government programs, built technology you use every day, and provided healthcare for millions of lives.
We're backed by leading VCs including SignalFire, Pear, GFC , 2048, Great Oaks, MGV and more. Over the last year, we've built the leading virtual cardiac recovery and management platform for members with cardiac conditions. For every member we serve, we add an average of five years to their lifespan.
We're growing - fast. Our member base is doubling every month and we're looking to 3x our team size quickly. This will allow us to scale nationally and accelerate product development across the continuum of heart health.
Position Overview
Recora Health is seeking a dedicated and experienced Clinical Staff Program Manager to lead our virtual cardiac rehabilitation program. This role involves managing a team of care providers, ensuring high-quality patient care, and driving program success through strategic planning and execution. The ideal candidate will have a strong background in exercise physiology and a passion for improving patient outcomes in a virtual setting.
Key Responsibilities
Care Provider Management
Develop and manage care provider schedules to ensure adequate coverage and optimal patient care.
Conduct performance reviews to support professional development, uphold program standards, and address underperformance by implementing targeted improvement plans for care providers to include contract termination.
Ensure care providers meet performance targets and work with them to create plans for achieving those goals.
Provide guidance and support to the Lead Exercise Physiologist and Lead Intake Specialist, ensuring alignment with program goals, effective onboarding and training, session shadowing, and completion of other assigned responsibilities.
Hiring, Onboarding, and Training
Lead the recruitment process for new care providers, ensuring the selection of qualified candidates.
Oversee onboarding and training programs to equip new hires with necessary skills and knowledge.
Operational Oversight
Review and approve invoices related to program operations, ensuring accuracy and compliance with budgetary constraints.
Develop and update standard operating procedures (SOPs) to reflect workflow changes and ensure program efficiency.
Data and Metrics Tracking
Monitor and analyze program data and metrics to assess performance and identify areas for improvement.
Use data-driven insights to inform decision-making and strategic planning.
Communication and Meetings
Facilitate regular meetings with care providers to discuss program updates, share best practices, and collaborate on projects.
Prepare agendas and lead monthly huddles to ensure team alignment and effective communication.
Monitor care team slack channels and respond to escalations from care providers.
Qualifications
Proven experience in managing virtual care programs.
Proven experience managing a staff of 50+ 1099 contractors.
Strong leadership and communication skills.
Ability to analyze data and metrics to drive program improvements.
Experience in patient care and retention strategies.
Familiarity with virtual health platforms and technologies.
We are an equal opportunity employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected veteran status, or any other characteristic protected by federal, state, or local law.
$65k-75k yearly Auto-Apply 41d ago
Clinical Growth Manager - All Locations
Fay 4.2
Remote job
Fay is a 3-sided AI platform redefining preventative care with a b2b2c business in a box. We're one of the fastest growing companies in tech and the fastest growing company in wellness history. We combine clinical expertise with smart systems. The result? More affordable, effective care for the people who need it most.
Behind the platform is a Marvel team of builders deeply connected to the problem we're solving. We pride ourselves on attracting superstar talent - the kind that's driven the best growth-to-burn metrics since early Airbnb, Stripe, and WhatsApp. Those aren't our words, though. That's straight from our investors at General Catalyst, Forerunner, 1984, and Goldman Sachs.
If you're excited to build at the intersection of AI, healthcare, and real-world impact - we'd love to meet you.
As a Clinical Growth Manager, you'll lead efforts to grow our referral network of healthcare providers-from primary care to specialists-ensuring more patients access high-quality nutrition care. You'll build and nurture strong partnerships with referring clinicians, host in-person meetings and events, and develop local go-to-market strategies in key markets. Your work will directly help people access life-changing care, while amplifying the reach of Fay's mission in the broader healthcare ecosystem.
You'll be a great fit if you:
Are energized by connecting with physicians, care teams, and provider organizations
Have 2+ years of experience in sales, partnerships, account management, or clinical outreach (especially in healthcare or digital health)
Are an excellent communicator who can build trust quickly
Feel confident leading in-person meetings and events to represent Fay in the field
Are highly organized and comfortable managing multiple partnerships across different markets
Are curious, resilient, and eager to grow with a fast-paced startup
Are deeply aligned with Fay's mission to make nutrition care more accessible
In this role, you'll:
Identify and develop referral relationships with clinicians and healthcare orgs
Educate providers about Fay's services and how we support their patients
Coordinate and attend in-person visits, events, and presentations in local markets
Act as the voice of referring providers internally, sharing insights with product and growth teams
Help shape the strategy, tools, and materials that support clinical outreach at scale
Why this role matters:
Fay is pioneering a new model for nutrition care-and referral partnerships are key to unlocking access for millions. You'll be joining a mission-driven team that values heart, hustle, and humility. Together, we're transforming healthcare, one meal at a time.
The best companies are made of the best people. There's no shortage of work ahead, but we stay balanced and look forward to celebrating our wins as a team.
See our careers page here to learn more about working on our team.
If you don't meet every single requirement, but are still interested in the job, we hope you still apply! We know that the perfect candidate is more than just a resume.
Fay is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
$65k-99k yearly est. Auto-Apply 60d+ ago
Home Infusion Nurse - Accredo - Columbus, IN
Carepathrx
Remote job
Home Infusion Registered Nurse - Accredo Specialty Pharmacy Take your nursing skills to the next level by helping to improve lives with Accredo Specialty Pharmacy, a division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes.
As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team.
For more than 30 years, Accredo has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others.
How you'll make a difference and improve lives:
* Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health.
* Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes.
* Provide follow-up care and manage responses to ensure their well-being.
* Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey.
Requirements:
* Active RN license in the state where you'll be working and living
* 2+ years of RN experience
* 1+ year of experience in critical care, acute care, or home healthcare
* Strong skills in IV insertion
* Valid driver's license
* Willingness to travel to patients' homes within a large geographic region
* Ability to work 40 hours a week (can include days, evenings, and weekends, per business need)
* Flexibility to work different shifts on short notice and be available for on-call visits as needed
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$51k-74k yearly est. Auto-Apply 14d ago
Clinical Manager - Seating and Positioning
Etac Ab
Remote job
The Clinical Manager is responsible for developing and implementing clinical training curricula detailing the application and fitting of the designated Etac product area to achieve positive functional outcomes. This position trains providers, therapists, and sales associates in the form, fit, and function of Etac products and their clinical applications. This is a traveling position providing product presentations, clinical in-services, and product/client fittings with providers and/or clinicians and provides one-on-one training with sales associates with the goal of supporting efforts to increase sales of all designated Etac products. The role also supports and leads larger in-person clinical product education and training engagements with key customers.
Product Areas:
Seating & Positioning: all Etac North America Mobility custom and “packaged” seating products, including Axiom, Axiom Kids, Axiom Custom Back, Axiom Custom Seating, Star Cushions, secondary positioning supports, and other products and accessories as they may be designated in the future.
Mobility: all Etac North America Mobility manual wheelchairs and related accessories or components, including power assist. This includes manual wheelchair in the folding, rigid, tilt-in-space, pediatric and adolescent categories, as well as, any products and accessories as they may be designated in the future.
Pediatrics: all Etac North America Mobility products intended for use by the pediatric population. This includes all products, accessories, or components from R82, Convaid, Ki Mobility, including power assist. This will also include any products and accessories as they may be designated in the future.
Essential FunctionsJob Responsibilities
Assist in the development of clinical training curricula relating to relevant Etac products.
Create and deploy training materials that will be used by sales associates, export partners, and other clinical education team members.
Establish and maintain a travel schedule with Etac sales associates centered around in-field customer and clinician engagements.
Attend trade shows, customer events, and sales meetings as necessary.
Contribute to the development of the company's strategic plan to drive future growth and profitability for relevant Etac products.
Present professional continuing education content (CEUs) as needed, either through coordination with sales associates and managers, or at key business partner education events.
Manage sales expenses within the guidelines of the Company expense policy.
Work closely with the sales team, specifically Territory Sales Managers, to align training initiatives with sales strategies and customer needs.
Collaborate with cross-functional teams to align and deliver product education and training programs.
Uphold Company values and ethical business conduct, as well as, maintain confidentiality of sensitive information.
Utilize sales and order analysis tools, including Qlik, to strategically plan and prioritize travel to optimize effectiveness.
Utilize sales and order analysis tools, including Qlik, post-travel to analyze effectiveness of travel and/or training curricula.
Be a key contributor to product development requirements around competitive opportunity, clinical requirements and efficacy that deliver strong new product enhancements that meet market needs.
Ensure and follow safety, quality, and other company requirements and standards.
Keep the work area clean and orderly.
Perform all duties in a manner that follows, demonstrates, and promotes Company's values.
Report to work as scheduled, on time, and able to work entire work schedule.
Perform additional duties as assigned.
Knowledge, Skills, and Ability
Excellent presentation skills and confidence in front of small and large groups.
Strong organizational skills.
Strong Microsoft PowerPoint skills.
Knowledge and proficiency with Microsoft Office Suite products, including Excel and Outlook, and other enterprise software.
In depth knowledge of clinical issues relating to disabled populations.
Knowledge of manual mobility and seating products than span adult and pediatric solutions within the complex rehabilitation industry.
Ability to establish and maintain professional communications both inside and outside the company.
Funding knowledge within complex rehab technology.
Ability to network with providers, ATP's, clinicians, and caregivers.
A high level of interactive communication is required to service our customers and clinicians; must be able to respond quickly and effectively to satisfy customer and clinician inquiries.
Possess a strong business acumen with an understanding of market potential and contract development.
Analytical skills in order to solve complex problems and make informed decisions.
Possess excellent written and oral communication and interpersonal skills to collaborate effectively with cross-functional teams.
Proactive and self-motivated with the ability to work independently and in a team environment.
Ability to lift and handle wheelchairs.
Ability to observe and identify details.
Ability to work extended hours as scheduled, including weekends.
Physical Demands
Frequent sitting, wrist manipulation, walking, and standing.
Frequent bending, pushing, pulling, and twisting.
Occasional to frequent driving in a vehicle.
Frequent light/medium work with lifting up to 30 pounds.
Occasional medium work with lifting up to 50 pounds.
Must be able to lift, handle, load, and unload all products.
Manual dexterity to type and operate office equipment frequently.
Must be able to complete all physical requirements to perform essential functions.
QualificationsEducation/Experience
Degree in a clinical discipline (Occupational or Physical Therapy, Kinesiology) or a related field or 3-5 years of experience in the complex rehab industry.
ATP certification is beneficial.
Must possess and maintain a valid driver's license.
Intermediate level experience with computer applications.
Working Environment
Remote position with an expectation of up to 75% travel focusing on specific key referral sources, their clinicians, providers, and ATP's.
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the associate for this position. Duties, activities, and responsibilities may change, or new ones may be assigned at any time with or without notice. Associate must be able to satisfactorily perform the essential functions of the position with or without reasonable accommodations.
Ki Mobility is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
$53k-86k yearly est. Auto-Apply 60d+ ago
Telehealth Clinical Manager - Remote
Gateway Rehabilitation Center 3.6
Remote job
Ready to Elevate Addiction Recovery? If you're looking to redefine the way care is delivered and be at the forefront of addiction recovery, we have the career for you! Your expertise and compassion can change lives-one virtual session at a time
Gateway Rehab Center (GRC) is seeking a passionate and skilled Clinical Manager to revolutionize the way we deliver care. This management position allows you to bring compassion, innovation, and expertise to individuals on their journey to recovery-all from the comfort of your home with occasional travel to a GRC location. If you're driven by the mission of making high-quality, accessible care a reality for all, we want to hear from you!
Please Note: This is a remote position with occasional travel to a GRC facility in Robinson, PA. Ideal candidate should live in the Pittsburgh area or surrounding counties.
Why Choose Gateway Rehab?
Make an impact through Gateway's mission
“to help all affected by addictive disease to be healthy in body, mind, and spirit.”
Be a part of an organization that has been leading the way in addiction treatment for over 50 years.
Leverage cutting-edge telehealth technology to bridge gaps in care and transform lives.
Enjoy the flexibility of a remote role while maintaining meaningful client
Why This Role is the Future of Addiction Treatment?
GRC's Telehealth Services team is changing lives, and as a Clinical Manager you'll be at the forefront of this movement. Your work will expand access to critical services, empower clients, and shape the future of addiction recovery. This is more than just a job-it's a mission-driven career where you can make a lasting impact every single day.
Your Role in Transforming Recovery
Conduct authorization audits to ensure timely completion, avoiding any disruption in payments.
Develops a training curriculum for Aura/m.care, tailored for new hires in all Telehealth positions.
Performs chart audits for compliance of all new admissions, ensuring deadlines are met and sending reminders to staff with outstanding documentation.
Maintains staff training records and identify training opportunities based on areas of need, as recommended by the Director or Executive Director.
Oversees patient program attendance, ensuring compliance with policies and licensure requirements, particularly for psych services and IOP.
Conducts documentation audits across different levels of care to ensure timely completion of all required items.
Attends mandatory GRC trainings and in-services.
Requirements
What We're Looking For
Master's degree in field that meets Pennsylvania Department of Health staffing qualification regulations required.
License or certification from the Pennsylvania Certification Board eligible.
Two years' clinical experience in a health or human service agency, including one year working directly with chemically dependent persons.
Supervisory experience preferred.
Knowledge of Substance Use Disorders and Evidence-based treatment methods.
Strong leadership skills.
Ability to manage crisis, make decisions, and make sound clinical judgements.
Excellent written and verbal communication skills.
Additional Requirements
Pass PA Criminal Background Check.
Obtain PA Child Abuse and FBI Fingerprinting Clearances.
Pass Drug Screen.
TB Test.
Work Conditions
Remote with travel into a GRC facility.
Favorable working conditions.
Minimal physical demands.
GRC is an Equal Opportunity Employer committed to diversity, equity, inclusion, and belonging. We value diverse voices and lived experiences that strengthen our mission and impact.
$31k-38k yearly est. 23d ago
Clinical Manager, Care Management Services (Remote)
Author Health
Remote job
At Author Health, we're revolutionizing how mental health care is delivered, and we want you to be part of it! Our mission is to bring compassionate, high-quality care to people with serious mental illness, substance use disorders, and dementia, including older adults.
We don't just treat symptoms. We treat people - fully, holistically, and with heart! Through our virtual-first, innovative care model, we deliver community-based wrap-around outpatient mental health care inclusive of psychiatric, psychotherapeutic and care management services. We partner with primary care providers, hospitals, families, and caregivers to keep patients out of the hospital and empower them to live healthier, more connected lives.
At Author, inclusivity isn't a checkbox. It's how we build trust and drive better outcomes! We honor the unique cultures, identities, and stories that shape every patient's experience, and we're creating a workplace where team members can show up as their full selves, too.
If you're driven by purpose, ready to shake up the status quo, and eager to make a real impact in people's lives, we'd love to meet you. Let's build the future of mental health care together!
We are seeking a dynamic and experienced Clinical Manager of Care Management Services to oversee,coordinate, and deliver comprehensive care management services across both behavioral health and medical care settings. This clinical leadership role is critical in ensuring the seamless delivery of integrated care, optimizing patient outcomes, and promoting the efficient and effective utilization of resources within our organization. This Clinical Manager is expected to split his or her time between administrative / managerial responsibilities (typically ~60% of the time) and time serving patients directly (typically ~40% of the time).
WHAT IS YOUR SUPERPOWER?
Administrative & Managerial Responsibilities
* Develop, implement, and oversee care management policies, procedures, and protocols for behavioral health and medical care.
* Lead and supervise a multidisciplinary Care Management team organized in a "pod" model where:
* Care Managers (Registered Nurses and Behavioral Health Care Managers) are responsible for comprehensive care planning and clinical coordination,
* Licensed Practical Nurses (LPNs) focus on post-discharge outreach, coordination, and Transitional Care Management (TCM), while
* Patient Resource Specialists (PRSs) support our patients by addressing health-related social needs and social determinants of health.
* Manage care coordination processes across multiple payor environments, ensuring consistent standards of care, regulatory alignment, and effective operational workflows.
* Ensure compliance with regulatory requirements related to care management and patient care.
* Support the design and implementation of strategic initiatives that enable Author Health to innovate by piloting modifications or new builds in our care delivery model.
* Participate in interdisciplinary meetings and committees to enhance coordination and communication across departments.
* Coach members of the Care Management team to enhance performance on both clinical quality and overall efficiency - do so while using a data-driven approach, and by regularly shadowing and auditing individual team members (e.g., auditing calls and documentation).
* Monitor and analyze data related to care management outcomes, utilization, and quality improvement initiatives.
* Promote a culture of excellence, professionalism, and continuous improvement within the Care Management team.
* Perform other duties as assigned to support departmental and organizational needs.
Patient Care Delivery Responsibilities
* Conduct regular assessments of patient needs, develop individualized care plans, and monitor progress towards goals.
* Coordinate transitions of care and ensure continuity across different levels of care and health care settings.
* Collaborate closely with interdisciplinary teams of health care providers both within and outside of Author Health, including physicians, nurses, therapists, and social workers, to ensure integrated care planning and delivery.
* Serve as a resource for staff, patients, and families regarding care management services, resources, and community referrals.
WHAT WE ARE SEEKING:
* Bachelor's degree in Nursing; Master's degree preferred.
* Experience building and leading teams
* Minimum of 5 years of Nursing experience in care management, preferably in behavioral health or medical care settings.
* Proven leadership and supervisory experience with strong team-building skills.
* Excellent interpersonal and communication skills, with the ability to collaborate effectively with diverse stakeholders.
* Solid understanding of health care regulations, policies, and reimbursement practices.
* Strong analytical skills and the ability to use data for decision-making and quality improvement.
* Certification in Case Management (CCM, ACM, or similar) preferred
WHAT WE OFFER:
* Retirement savings plan (401k) Plan up to 3.5% company match
* Low cost benefits package for employee and dependents ( medical/ dental/ vision/ STD/ Life Insurance)
* Paid vacation
* Paid sick leave
* 9 paid holidays throughout the year with (2) additional flex holidays .. 11 in total!
* Performance-based bonuses
* and more!
NEXT STEPS:
* Submit an application
* Upload an updated resume
* Share LinkedIn profile and/or cover letter
Author Health is committed to a diverse and inclusive workplace. It is the company's policy to comply with all applicable equal employment opportunity laws by making all employment decisions without unlawful regard or consideration of any individual's race, religion, ethnicity, color, sex, sexual orientation, gender identity or expressions, transgender status, sexual and other reproductive health decisions, marital status, age, national origin, genetic information, ancestry, citizenship, physical or mental disability, veteran or family status or any other basis protected by applicable national, federal, state, provincial or local law. The company's policy prohibits unlawful discrimination based on any of these impermissible bases, as well as any bases or grounds protected by applicable law in each jurisdiction.
We are committed to providing an inclusive and accessible experience for all applicants. If you require any accommodations at any stage of the process, please let us know.
The company is pleased to provide such assistance and no applicant will be penalized as a result of such a request. In accordance with applicable legal requirements such as the San Francisco Fair Chance Ordinance Author Health will consider for employment qualified applicants with arrest and conviction records.
Monday through Friday, 8am-5pm EST
$42k-71k yearly est. Auto-Apply 41d ago
Remote HEDIS Nurse Consultant
Actalent
Remote job
HEDIS work typically includes requesting records, abstracting/overreading medical records, performing claims research, preparing medical records for the NCQA HEDIS Auditor, etc. Abstracts medical record data from practitioner's files to support annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting for company's accredited products
Conducts medical record reviews to support the annual reporting and responds to inquiries from provider, and their office staff, regarding the HEDIS initiative
Review and abstract 40-50 medical records per day, based on NCQA and HEDIS technical specifications
Document information clearly and concisely from patient record to paper document abstraction tool, or into company's electronic HEDIS application
Ensure Health & Care Management are in compliance with HEDIS audit and technical specification standards
Participate in the training of NCQA (national committee quality assurance) requirements with completion of Inter-Rater Reliability compliance
Communicate with internal and external stakeholders by making appropriate follow-up phone calls for additional medical information to complete reviews
Comply with regulatory standards, accreditation standards and internal guidelines
Remain current and consistent with the standards pertinent to the Quality Management team
Qualifications
* Active and Unrestricted RN License with 4+ years of experience.
(Need to have the license in the state in which they live but does not need to be compact since they are not working directly with members in Iowa.)
* Strong clinical background and understanding of medical terminology, healthcare practices and electronic medical record systems. Ability to review medical records and technical specifications and draw defensible conclusions from available information.
* Experience In health insurance, health care, managed care, or a related setting. A strong clinical background could also be considered - e.g., hospital medical records or research.
* Excellent attention to detail and ability to analyze complex medical records, identify relevant data and abstract HEDIS measures accurately.
* Strong written and verbal communication skills with ability to communicate and/or present complex information to team members and stakeholders.
* Demonstrated success in roles that require strong time management and work-flow management skills. Ability to prioritize work independently, manage multiple assignments simultaneously, and meet deadlines.
* Flexibility to adapt to changing requirements, regulations, and technology platforms related to HEDIS reporting.
* Proficiency with Microsoft Office and Microsoft Teams. Technical aptitude to learn new systems quickly.
Preferred Qualifications:
* 2 years of experience in HEDIS abstraction and familiarity with HEDIS measure specifications.
* Prior work in utilization management, quality management/review, accreditation, outpatient clinic setting or related area.
Job Type & Location
This is a Contract position based out of Des Moines, IA.
Pay and Benefits
The pay range for this position is $40.00 - $41.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Jan 7, 2026.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
$40-41 hourly 6d ago
Clinical Review Nurse - Remote
Arc Group 4.3
Remote job
Job DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
May develop recommendations for further corrective action based on medical review findings.
May refer for review, or implement, corrective action related to medical review activities.
May process claims and complete project work in the appropriate computer system(s).
The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
This may involve discussion with CMS leaders and leaders in the provider community.
Participate in special projects as assigned.
REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.
$52k-76k yearly est. 15d ago
Nurse Case Manager (Western Time Zone)
Argenx
Remote job
Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases.
We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.
The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx's products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers.
Roles and Responsibilities:
Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products
Communicate insurance coverage updates and findings to the patient and/or caregiver
Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease
Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues
Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis
Provide patient-focused education to empower patients to advocate on their behalf
Develop relationships and manage multiple and complex challenges that patient and caregivers are facing
Ensure compliance with relevant industry laws and argenx's policies
Aligned regional travel will be required for patient education to support patient programs
Must be an excellent communicator and problem-solver
Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines
Skills and Competencies:
Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills - with demonstrated effectiveness to work cross-functional and independently
Demonstrated ability to develop, follow and execute plans in an independent environment
Demonstrated ability to effectively build positive relationships both internally & externally
Demonstrated ability to be adaptable to changing work environments and responsibilities
Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude
Fully competent in MS Office (Word, Excel, PowerPoint)
Flexibility to work weekends and evenings, as needed
Participate in and complete required pharmacovigilance training
Comply with all relevant industry laws and argenx's policies
Travel requirements less than 50% of the time
Education, Experience and Qualifications:
Applicants must live in the desired Time Zone
Current RN License in good standing
Bachelor's degree preferred
5+ years of clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech
2-5+ years of case management
2+ years of experience in pharmaceutical/biotech industry a must
Reimbursement experience a plus
Must live in geographically assigned territory
Bilingual or multilingual a plus
#LI-Remote
For applicants in the United States: The annual base salary hiring range for this position is $136,000.00 - $204,000.00 USD. This range reflects our good faith estimate at the time of posting. Individual compensation is determined using objective, inclusive, and job-related criteria such as relevant experience, skills, demonstrated competencies and internal equity. This means actual pay may differ from the posted range when justified by these factors. Because market conditions evolve, pay ranges are reviewed regularly and may be adjusted to remain aligned with external benchmarks.
This job is eligible to participate in our short-term and long-term incentive programs, subject to the terms and conditions of those plans and applicable policies. It also includes a comprehensive benefits package, including but not limited to retirement savings plans, health benefits and other benefits subject to the terms of the applicable plans and program guidelines.
At argenx, all applicants are welcomed in an inclusive environment. They will receive equal consideration for employment without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other applicable legally protected characteristics. argenx is proud to be an equal opportunity employer.
Before you submit your application, CV or any other personal details to us, please review our
argenx Privacy Notice for Job Applicants
to learn more about how argenx B.V. and its affiliates (“argenx”) will handle and protect your personal data. If you have any questions or you wish to exercise your privacy rights, please contact our Global Privacy Office by email at
privacy@argenx.com
.
If you require reasonable accommodation in completing your application, interviewing, or otherwise participating in the candidate selection process please contact us at
****************
. Only inquiries related to an accommodation request will receive a response.
$56k-82k yearly est. Auto-Apply 12d ago
50% Field and 50% Remote Opening as a Nurse Case Manager II - (Wayne, Macomb, Barry, Van Buren, Kalamazoo, Calhoun, Branch, St Joseph, Cass, and Berrien Counties ): MI
Lancesoft 4.5
Remote job
Job Title: Nurse Case Manager II Estimated Length of Assignment: 03+ Months with Possible Extension (The dates provided are only an estimate and not a guarantee) Negotiable Estd. Pay Range - $40.00/Hour to $45.00/Hour on W2 (USD) -All Inclusive
Work Type: Wayne, Macomb, Barry, Van Buren, Kalamazoo, Calhoun, Branch, St Joseph, Cass, and Berrien Counties ): MI
Schedule -Monday-Friday 8am-5pm EST
Description:
Field and Telephonic
Add city/state, zip and county at the top of the resume
Candidates should be either in one of these counties or very close to it. They will be traveling to this region. Sourcing for Wayne, Macomb, Barry, Van Buren, Kalamazoo, Calhoun, Branch, St Joseph, Cass, and Berrien Counties ): MI.
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Experience
3 years Clinical practice experience, e.G., hospital setting, alternative care setting such as home health or ambulatory care required.
Healthcare and/or managed care industry experience.
Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations?
Position Summary
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Requires an RN with unrestricted active license for MI.
Education
RN with current unrestricted state licensure for MI.
Case Management Certification CCM preferred
What days & hours will the person work in this position? List training hours, if different.
Monday-Friday 8am-5pm EST
$40-45 hourly 8d ago
Telephonic Nurse Case Manager (Remote)
Berkley 4.3
Remote job
Company Details
Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker's successful and speedy return to work is good for people and good for Berkley's insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley's operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers' compensation cases.
To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley's operating units with reliable results, and reduced time and expenses associated with case management.
Responsibilities
As a Telephonic Nurse Case Manager, you will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers.
Coordinate and implement medical case management to facilitate case closure
Timely and comprehensive communication with with employers, adjusters and the injured workers.
Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care
Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure
Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction
Acquire and maintain nursing licensure for all jurisdictions as business needs require
Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services
Document activities and case progress using appropriate methods and tools following best practices for quality improvement
Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work.
Engage and participate in special projects as assigned by case management leadership team
Occasionally attend on site meetings and professional programs
Foster a teamwork environment
Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status.
Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed.
Obtain case management professional certification (CCM) within 2 years of hire
Qualifications
Minimum 2 years of experience in workers compensation insurance and medical case management preferred
Minimum of 4 years medical/surgical clinical experience required
Exhibit strong communication skills, professionalism, flexibility and adaptability
Possess working knowledge of medical and vocational resources available to the Workers' Compensation industry
Demonstrate evidence of self-motivation and the ability to perform case management duties independently
Demonstrate evidence of computer and technology skills
Oral and written fluency in both Spanish and English a plus
Education
Graduate of an accredited school of nursing and possess a current RN license.
RN compact license preferred, CCM preferred, Bachelor of Nursing preferred
Additional Company Details ******************
The Company is an equal employment opportunity employer
We do not accept any unsolicited resumes from external recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees
• Base Salary Range: $80,000 - $88,000
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.