Nursing services manager work from home jobs

Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Reports Jointly To: Chief Executive Officer and Chief Medical Officer Clinical Specialty: MD, Board Certified in Sports Medicine (primary board specialty flexible) ViewFi is a nationwide virtual musculoskeletal (MSK) practice bringing high-quality orthopedic, sports-medicine, and physical-therapy care directly to patients in both traditional and non-traditional markets. We serve a diverse set of partners including personal injury/med-legal groups, self-insured employers, risk-based payers, and digital health collaborators in the sports and fitness markets through technology enabled, evidence-based clinical care. We are redefining what excellent MSK care looks like in a virtual environment. Position Summary The Medical Director will serve as the clinical leader of ViewFi's physician team and a core partner to our physical therapy, product, operations, and business teams. This role requires a practicing, board-certified Sports Medicine physician who can balance patient care with 30-40% administrative/leadership responsibilities. The Medical Director will ensure clinical excellence, maintain high-quality and consistent clinical pathways, represent ViewFi as the medical voice of the organization, and advance the science and evidence behind virtual MSK care. Key Responsibilities Clinical Leadership & Oversight Lead, oversee, and support the national team of physicians delivering virtual MSK care. Maintain and update clinical pathways, treatment standards, and practice guidelines across all ViewFi service lines. Partner closely with the Physical Therapy leadership team to ensure integrated, cohesive care between MDs and PTs. Ensure consistent, high-quality clinical documentation, coding accuracy, and compliance across markets. Oversee peer review, quality assurance activities, and clinical performance metrics. Participate in recruitment, onboarding, and ongoing development of new clinicians. Patient Care (70-80%) Actively see patients in a virtual setting, providing MSK consults and follow-ups. Model best-in-class virtual care workflows and contribute to continuous improvement of the patient experience. Support escalated or complex cases requiring senior clinical judgment. Strategic & Administrative Leadership (20-30%) Serve as the medical voice of ViewFi at conferences, webinars, panels, and partner meetings. Collaborate with executive leadership on product development, new service lines, geographic expansion and clinical innovation initiatives. Guide medical input for payers, partners, self-insured employers, and med-legal groups. Participate in strategic planning related to national expansion, licensure strategy, and resource allocation. Work cross-functionally with operations and technology teams to enhance clinical workflows. Provide medical insight and feedback on ViewFi's technology roadmap, including clinical decision support, AI integration, and general telehealth tools. Research, Publishing & Thought Leadership Lead or collaborate on clinical research demonstrating the efficacy of virtual MSK care, including both MSK MD consults and virtual PT. Publish and present outcomes, case series, and efficacy studies at relevant medical and industry conferences. Help build ViewFi's reputation as the leader in evidence-based virtual MSK care. Quality, Compliance & Risk Management Ensure the practice meets state and federal clinical guidelines, telehealth regulations, and licensure requirements. Maintain oversight of clinical incident review processes, risk-mitigation protocols, and outcome tracking. Drive continuous improvement in clinical quality, patient safety, and service reliability. Qualifications MD with Board Certification in Sports Medicine (primary board: FM, IM, EM, PM&R, etc. is flexible). Multi-state licensure required; willingness to pursue additional licensure required. Minimum 10 years of clinical experience; virtual care experience strongly preferred. Demonstrated leadership experience in a clinical or medical director role. Strong collaboration skills with PTs, operational teams, and cross-functional partners. Excellent communication and presentation skills; comfortable representing ViewFi publicly. Passion for virtual care, musculoskeletal medicine, and innovative delivery models. What We Offer Opportunity to lead a national MSK practice at the forefront of technology enabled virtual healthcare Collaborative environment with clinical and operational teams aligned around quality care and aggressive growth Competitive compensation with protected administrative time Support for conference travel, research, publishing, and clinical innovation Commitment to clinical excellence, patient outcomes, and provider support

Medical Director (Utilization Management) The Medical Director plays a key role in ensuring coverage and payment determinations are clinically appropriate, compliant, and aligned with plan benefits and contractual agreements with participating provider networks. This position requires sound clinical judgment, collaborative leadership, and a strong understanding of healthcare delivery, population health, and payer operations. Key Responsibilities Provide physician leadership and clinical guidance to Utilization Management and Care Management functions Render coverage and payment determinations in accordance with health plan benefits, medical policies, and provider contracts Apply evidence-based clinical guidelines and best practices to support consistent, high-quality decision-making Exercise informed medical judgment grounded in clinical medicine, patient safety, quality management, and population health principles Collaborate effectively with clinical teams, operational leaders, senior management, and external partners Promote efficient, cost-effective care delivery across all lines of business Support organizational initiatives related to quality improvement, compliance, and healthcare outcomes Required Qualifications & Experience Medical Doctor (MD) or Doctor of Osteopathy (DO) from an accredited medical or osteopathic medical school recognized by AAMC, AOA, or WHO Unrestricted and active Pennsylvania medical or osteopathic license Current board certification through ABMS or AOBMS (Family Medicine or Internal Medicine preferred) Ability to successfully complete organizational credentialing requirements Strong knowledge of Utilization Management, healthcare delivery systems, and payer-based medical decision-making Work Location Fully Remote: This position is designated as fully remote Work must be performed within the Tri-State Area (Pennsylvania, New Jersey, or Delaware)

Spectrum Healthcare Resources is excited to offer a potential career opportunity for a Behavioral Health Medical Director supporting the TriCare/Department of Defense and Community Care Network/Department of Veterans Affairs. This remote-based civilian position is an outstanding chance to make a meaningful contribution to the healthcare of veterans and military beneficiaries while benefiting from work-life flexibility, professional collaboration, and impactful leadership. Join us in leading high-quality care initiatives for those who have served our country, with a focus on system-wide clinical improvement, peer collaboration, and mission-driven support! Requirements: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited medical school. Active, unrestricted license to practice medicine in the United States. Board certification or board eligibility through a recognized specialty board. U.S. Citizenship. Favorable background investigation through the Department of Defense (DoD). Minimum of 5 years of medical practice experience. 3+ years of experience in managed care environments. Preferred: Experience working with TRICARE, Veterans Affairs, or other federal health plans. Advanced degree in management (MPA, MBA, MHA, MPH). Corporate-level leadership experience. Experience using InterQual and/or similar evidence-based criterial to assess medical interventions, procedures and treatments. Job Responsibilities: Provide program-wide clinical guidance across multiple medical management domains including Utilization Management, Case Management, Quality, and Public Health. Lead and participate in quality committees and collaborative safety initiatives. Review member cases for appropriateness and quality of care; document findings in CareRadius and other health systems. Conduct peer-to-peer discussions with network providers and internal stakeholders. Develop and implement corrective action plans related to clinical quality or provider performance. Collaborate closely with TriWest teams such as Clinical Operations, Data Analytics, and General Counsel. Support the Emergency Operations Center (EOC) in person or virtually during contingency operations, which may include 24/7 coverage. Provide clinical expertise on new technologies, treatment protocols, and population health initiatives. Interact with veterans and beneficiaries to support satisfaction and outcomes. Stay current with required licensure, board certification, and federal medical standards. Working Conditions: Remote position with standard weekday hours and occasional after-hours availability. Limited to moderate travel by air or ground as needed. May require short-notice deployment (24?48 hours) to austere environments in emergency events. Extensive computer-based work; prolonged periods of sitting may be necessary. Must obtain a Common Access Card (CAC); security clearance may be required. Company Overview: Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals. EOE/Disabled/Veterans

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally.

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Position Overview The Medical Review (MR) Manager is responsible for overseeing all medical review activities and quality assurance functions for the CMS Review and Validation Contractor (RVC) program. This role ensures accurate application of Medicare policy, directs daily workflow for medical review staff, and supports the validation of Recovery Audit Contractor (RAC) determinations. The MR Manager must be available Monday-Friday, 8:00 AM to 4:30 PM ET. Key Responsibilities Manage and oversee medical review operations, including accuracy reviews, disputes, RAC topic evaluations, and special studies. Lead and supervise medical review staff to ensure proper application of Medicare policies and procedures. Provide clinical expertise and guidance for complex or questionable claim review situations. Conduct quality assurance (QA) audits to verify compliance with contract and regulatory requirements. Brief, train, and educate review personnel on policy interpretation and validation processes. Stay current on medical practice, technology changes, billing trends, and potential areas of improper payments. Ensure medical review activities align with CMS FFS Recovery Audit Program requirements. Serve as the clinical resource for Medicare coverage, documentation, coding, and regulatory requirements. Maintain timely communication with CMS and internal leadership as required. Ensure that all duties requiring clinical expertise are performed directly by the MR Manager; non-medical staff may not substitute. Required Qualifications Minimum of 5 years of medical review experience. Minimum of 3 years of experience as a Medical Review Manager, including QA oversight. Extensive knowledge of the Medicare program, including coverage, payment, billing, and policy requirements. Working knowledge of the CMS Fee-for-Service (FFS) Recovery Audit Program. Strong analytical and decision-making skills with demonstrated clinical judgment. Education and Licensure Registered Nurse (RN), currently licensed in the United States or U.S. Territory (license verified annually). Bachelor's degree in Nursing (BSN) required. Core Competencies Medical review expertise Clinical judgment and decision-making Medicare coverage and policy knowledge Quality assurance and audit experience Leadership and staff management Policy interpretation and training Strong written and verbal communication Attention to detail and accuracy Work Schedule Monday through Friday 8:00 AM to 4:30 PM ET Availability required during these hours for CMS and operational needs What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Benefits: Job you will love Fulfilling work Rewarding Career Supportive Environment Make a difference for your clients In Demand The Care Manager is responsible for providing quality professional care management services to all clients and their responsible parties. Our objective is to assist our clients in managing and navigating challenges in aging as well as Adults with physical and mental disabilities and providing the highest quality of life. This includes: Care Coordination Managing home health aides Medical oversight Interfacing with medical personnel Advocacy, information and referrals Qualifications: Professional and positive approach, commitment to customer service Self-motivated and work with own initiative Strong in building relationships, team player and able to communicate at all levels Recognizes industry trends and problem solves Respectful of company and client confidentiality; any violation of company or client confidence is immediate grounds for dismissal. Personalized and compassionate service - focusing on the individual client's wants and needs. Ability to provide non-directive guidance and facilitate constructive relationships. Ability to ensure inappropriate placements, duplication of services, and unnecessary hospitalizations are avoided. Manage time efficiently. Ability to provide coordinated communication between family members, doctors and other professionals, and service providers. This is a remote position. Aging Life Care Professionals offer a holistic, client-centered approach to caring for older adults or others facing ongoing health challenges. Working with families, the expertise of Aging Life Care Professionals provides the answers at a time of uncertainty. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress and time off of work for family caregivers through: Assessment and monitoring Planning and problem-solving Education and advocacy Family caregiver coaching This business is independently owned and operated. Your application will go directly to the business, and all hiring decisions will be made by the management. All inquiries about employment at this business should be made directly and not to Aging Life Care Association.

Unless otherwise noted, all positions are fully remote with work permitted from the following states: CA, CO, HI, IL, MA, MD, NJ, NM, NY, OR, and WA. We are living through a pivotal moment for reproductive and sexual health-and Hey Jane is uniquely positioned to help. From day one, we've been committed to providing safe, discreet medication abortion treatment-and have helped more than 100,000 people get the care they need. Today, we offer a range of reproductive and sexual health care services from the comfort and convenience of your phone. Our in-house clinical care team, composed of board certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away. We're committed to helping our patients get safe, discreet, judgment-free virtual health care, from a team that truly cares. Role Overview We are seeking a compassionate, detail-oriented, and experienced APC Manager who thrives in a fast-paced clinical environment and is motivated by the opportunity to expand access to high-quality, patient-centered care. In this role, you will lead and manage a team of nurse practitioners and certified midwives, ensuring the delivery of safe, compliant, and compassionate care across all aspects of our services. You will oversee day-to-day clinical operations, drive performance management for your team, and serve as a critical bridge between the clinical team and organizational leadership-translating strategy into action through strong communication, sound judgment, and operational excellence. Working in a startup telehealth environment requires flexibility and adaptability, while offering the unique opportunity to shape and refine clinical workflows. The ideal candidate is both a skilled Nurse Practitioner and an empathetic leader-comfortable mentoring others, managing tough conversations, and steering the team through change with grace and accountability. You'll excel at building trust within your remote team, fostering a culture of continuous improvement, and ensuring that every patient receives timely, evidence-based care delivered with empathy and respect.Qualifications 5+ years of clinical experience as a NP or CNM with 1+ years in reproductive or sexual health 2+ years of experience managing clinical teams, preferably in telehealth, reproductive healthcare, or a startup environment Proven ability to motivate, mentor, and support clinical staff with a focus on team morale, development, and accountability Proven ability to foster collaboration, trust, and a supportive team culture Experience documenting protocols, implementing process updates, and training teams through changes in clinical or operational systems Strong interpersonal and communication skills, with the ability to collaborate effectively across clinical, operational, and leadership teams Knowledge of healthcare compliance, regulatory requirements, and quality assurance frameworks Ability to analyze clinical and performance data and translate insights into actionable improvements Deep understanding of trauma-informed care principles Comfortable working in a fast-paced, mission-driven startup environment Able to travel to on-site location at least once a quarter At Hey Jane, we work towards the vision of having equitable healthcare, changing the status quo, and rebuilding the way people experience healthcare-and bring that same vision to our workplace. We're an equal opportunity employer committed to building an inclusive environment, and encourage all applicants from every background and life experience.

Department Escalon Tax Practice Employment Type Full Time Location Remote Workplace type Fully remote What You'll Bring Why You'll Enjoy Working at Escalon: More about us: About Escalon Services, LLC.

Home Infusion Registered Nurse - Accredo Patient visits for this position will mostly be on the weekends, and possibly some evenings. However, some weekday availability will be required, especially during training. Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy 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 by Evernorth 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 do multiple patient visits per week (mostly weekends, but may also include weekday evenings, 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.For this position, we anticipate offering an hourly rate of 36 - 61 USD / hourly, depending on relevant factors, including experience and geographic location. 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.

Role Type and Location Work from home role - this role requires you to be based full time in the East Coast, USA. Eligibility to work Unfortunately, we cannot offer USA based Visa sponsorship for this full time USA BASED role. Role Summary We are seeking a proactive and detail-oriented Project Manager to support the delivery of pathology-focused clinical trial projects at Diagnexia Analytix. Sitting under the Clinical Trial Manager, this role will act as the operational driver of projects - ensuring that timelines, deliverables, and quality standards are met across complex, multi-stakeholder clinical studies. The Project Manager will not design the science, but will make sure the science happens: coordinating vendors, labs, pathologists, and internal teams, while keeping communication clear and projects audit-ready. Key Responsibilities Project Delivery & Coordination Translate Statements of Work (SoWs) into actionable project plans, timelines, and trackers. Manage day-to-day execution, logistics, and operational workflows. Oversee sample flow, staining, scanning, and digital pathology processes. Pathologist Management, training and communication Stakeholder Communication Serve as a central point of contact between sponsor, CRO, central labs, and internal teams. Organize and document sponsor calls, training sessions, consensus/adjudication meetings. Maintain action logs, decision records, and issue escalation pathways. Quality & Compliance Ensure all activities follow GCP/GCLP, ICH E6, and regulatory standards. Support preparation of validation reports, pathology manuals, final study reports, and archival outputs. Track QC metrics, deviations, CAPA actions, and maintain audit readiness. Risk & Change Management Maintain a risk register for timelines, logistics, and deliverables. Coordinate structured change control processes when scope or timelines shift. Required Skills & Experience (Must-Have) Degree in life sciences, biomedical sciences, or a related discipline. 3-5 years' experience in clinical trial project management, CRO operations, or translational/biomarker projects. Strong knowledge of GCP/GCLP and ICH E6 standards. Proven ability to deliver multi-stakeholder projects on time and within scope. Excellent organizational skills; able to manage multiple vendors, labs, and deliverables. Strong communication skills, with experience preparing reports, dashboards, and running status calls. Ability to anticipate issues, escalate appropriately, and drive solutions. Proficiency with project management tools (e.g., Smartsheet, MS Project, Asana) and shared document platforms. Preferred Skills & Experience (Nice-to-Have) Exposure to pathology, histology, or biomarker assay workflows. Experience coordinating pathologists and pathology vendors. Familiarity with digital pathology platforms (WSI, image hosting, secure data transfer). Therapeutic area experience in oncology, immunology, or liver disease trials. Formal PM certification (PMP, PRINCE2) or Lean/Agile training. Strong interpersonal skills: able to “manage up” to senior stakeholders while motivating delivery teams. Experience in a scale-up/fast-growing environment. Ideal Candidate Profile A “doer” who thrives on making things happen in complex clinical projects. Comfortable working alongside scientific leaders while taking responsibility for operations, timelines, and compliance. Highly organized, proactive, and able to bring structure and accountability to dynamic, multi-stakeholder studies. What are the benefits of working with Deciphex 💰 Competitive salary with annual performance-based increases. Rewarding your impact and growth 🩺 Healthcare benefits, giving you peace of mind to focus on what you do best 🌴 Annual leave with service increments - Means more time to recharge and enjoy life outside work 💡 Pension contributions, helping you build a secure future 🚀 Work with a world-class, high-performing team in a hyper-growth startup. You'll earn fast, make an impact, and shape the future 📈 Regular feedback and clear career growth opportunities. You keep developing and moving forward 🌍 A collaborative, supportive, multicultural team. Here you'll feel valued and inspired every day About the Company Through the work that we do, the team at Deciphex helps pharma to accelerate the process of essential drug development and helps patients to get timely and accurate diagnosis. Founded in Dublin in 2017, Deciphex has scaled rapidly to a team of over 180 people and counting who are providing software solutions to address the pathology gap in research pathology and clinical areas. We have offices in Dublin, Exeter, Oxford, Toronto and Chicago and are expanding our team throughout the world. We are software developers, clinical specialists, AI engineers, operations professionals and so much more, all working as one team to support our customers and patients. Our team culture is built on trust. We give our team the space they need to deliver results and the environment to ensure they can enjoy doing it. We are looking for highly motivated individuals who are excited to take on challenges and value making a difference in their day-to-day work. This is a unique opportunity to make a difference in the emerging Digital Pathology field. Read more about Deciphex here and more about our incredible team on our Careers Page here

Our Office, NRV Oral & Maxillofacial Surgery LTD - Blacksburg, a busy specialty practice in Blacksburg, VA, is looking for a talented and skilled Practice Manager to help us fulfill our mission of improving the lives of our patients by providing a world-class specialty experience at the Blacksburg and Radford locations. If you're passionate about delivering exceptional patient care and leading a dynamic team, we'd love to connect with you! At NRV Oral & Maxillofacial Surgery LTD - Blacksburg & Radford, we believe in the power of collaboration and continuous learning. Our diverse team includes Dental Assistants, Sterilization Technicians, Specialists, Office Managers, and Patient Care Coordinators who work together to ensure exceptional patient experience and outstanding clinical results. We're committed to fostering an environment where all employees are valued, respected, and given the opportunity to thrive-at work, at home, and everywhere in between. Your Role: Practice Manager As our Practice Manager, you will play a crucial role in ensuring our operations run smoothly, efficiently, and in compliance with all regulations. You'll be responsible for mentoring team members, enhancing patient experiences, and implementing best practices across all levels of our organization. Here's what you can expect in this role: Travel to the Radford location Overseeing daily operations to ensure they are carried out in a cost-effective manner. Managing budgets, financial data, and forecasts to improve profitability. Purchasing materials, planning inventory, and optimizing warehouse efficiency. Ensuring the practice remains compliant with all legal and healthcare regulations. Implementing quality controls and monitoring key performance indicators (KPIs). Training and supervising staff, while fostering a culture of continuous improvement. Enhancing the quality of patient care through innovative and compassionate leadership. Coordinating and facilitating additional office responsibilities as needed. Your Background: We're looking for a resourceful and compassionate Practice Manager who excels at leading teams and achieving financial goals. You thrive on seeing patients leave our office healthier and happier, and you're a problem-solver who can adapt to changing priorities. Here's what we're looking for: 3-5 years of experience managing a dental or OS practice. WinOMS experience a plus Expertise in insurance verification, claims, and resolution processes. Strong understanding of patient and insurance accounts receivable (AR) management. Proven ability to maintain positive employee relations and oversee payroll. Solid knowledge of profit and loss (P&L) management, with a focus on controlling expenses. Familiarity with standard OSHA and HIPAA practices and policies. If this describes you, you'll fit right in with our team! Your Benefits & Perks: We offer a comprehensive benefits package designed to support you in all aspects of your life, including: Sign on bonus offered! BCBS High Deductible & PPO Medical insurance Options VSP Vision Coverage Principal PPO Dental Insurance Complimentary Life Insurance Policy Short-term & Long-Term Disability Pet Insurance Coverage 401(k) HSA / FSA Account Access Identity Theft Protection Legal Services Package Hospital/Accident/Critical Care Coverage Paid Time Off Diverse and Inclusive Work Environment Strong culture of honesty and teamwork #priority We believe in transparency through the talent acquisition process; we support our team members, past, future, and present, to make the best decision for themselves and their families. Starting off on the right foot with pay transparency is just one way that we are supporting this mission. Position Base Pay Range$45,000-$55,000 USDSpecialty1 Partners is the direct employer of non-clinical employees only. For clinical employees, the applicable practice entity listed above in the job posting is the employer. Specialty1 Partners generates job postings and offer letters to assist with human resources and payroll support provided to the applicable practice. Clinical employees include dental assistants and staff assisting with actual direct treatment of patients. Non-clinical employees include the office manager, front desk staff, marketing staff, and any other staff providing administrative duties. Specialty1 Partners and its affiliates are equal-opportunity employers who recognize the value of a diverse workforce. All suitably qualified applicants will receive consideration for employment based on objective criteria and without regard to the following (which is a non-exhaustive list): race, color, age, religion, gender, national origin, disability, sexual orientation, gender identity, protected veteran status, or other characteristics in accordance with the relevant governing laws. Specialty1 Partners' Privacy Policy and CCPA statement are available for view and download at ************************************************** Specialty1 Partners and all its affiliates participate in the federal government's E-Verify program. Specialty1 further participates in the E-Verify Program on behalf of the clinical practice entities which are supported by Specialty1. E-Verify is used to confirm the employment authorization of all newly hired employees through an electronic database maintained by the Social Security Administration and Department of Homeland Security. The E-Verify process is completed in conjunction with a new hire's completion of Form I-9, Employment Eligibility Verification upon commencement of employment. E-Verify is not used as a tool to pre-screen candidates. For up-to-date information on E-Verify, go to **************** and click on the Employees Link to learn more. 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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.

Who we are: Access TeleCare is the largest national provider of telemedicine technology and solutions to hospitals and health systems. The Access TeleCare technology platform, Telemed IQ, enables life-saving patient care through telemedicine and empowers healthcare organizations to build telemedicine programs in any clinical specialty. We provide healthcare teams with industry-leading solutions that drive improved clinical care, patient outcomes, and organizational health. We are proud to be the first provider of acute clinical telemedicine services to earn The Joint Commission's Gold Seal of Approval and has maintained that accreditation every year since inception. We love what we do and if you want to know more about our vision, mission and values go to accesstelecare.com to check us out. What you'll be responsible for: The Clinical Service Excellence Manager will be responsible for overseeing all clinical processes and serving as the client champion for Access TeleCare's Neurology programs. In this role, you will have the opportunity to build effective relationships with client stakeholders, develop clinician workflows, support new program implementation, create action plans to support service performance, and interface with clinicians to facilitate clinical excellence. In addition, this you will serve as the clinical point of contact for practice issues for partner sites. What you'll work on: Participate in program launches and support with the development of clinical workflows Maintain working rapport with individual providers covering the service as needed to address clinical workflow or practice issues, and communicating recommended changes to medical director and hospital(s) affected Build and maintain positive working relationships with partner facility clinical staff; train partner staff on tasks that promote clinical workflow efficiency such as cart coordination, and address concerns in a timely manner Analyze and present reports on healthcare processes and patient outcomes to identify and prioritize areas for improvement Coordinate performance improvement activities focused on specific patient services or organizational quality initiatives through the use of specific benchmarks and evidence-based practices Participate in efforts to establish and maintain organizational readiness to meet regulatory requirements based on service line specialty Collaborate closely with Neurology Practice Administrator and Service Line Chief to work on team initiatives, develop and report KPIs, identify opportunities within programs to improve communication, efficiencies, and processes What you'll bring to Access TeleCare: Bachelor of Science in Nursing from an accredited school of nursing At least three years of experience in neurology service line, inpatient services preferred (required) Prior experience as a charge nurse or nurse supervisor (preferred) Ability to navigate multiple EMR systems required Excellent computer skills and familiarity with Microsoft Office programs including Excel for data manipulation Excellent interpersonal communication skills and the ability to exercise empathy when working with patients and their families Excellent organizational and time management skills Demonstrate an understanding of standard clinical procedures, laws, and regulations Thorough knowledge of medical terminology Ability to work independently, but function as part of a team Work Environment and Schedule: High growth fast paced organization Primarily remote based environment Not more than 20 days travel to select sites annually Travel quarterly to corporate office in Dallas, TX Must be able to remain in a stationary position 50% of the time. Company perks: Health Insurance (Medical, Dental, Vision) Health Savings Account Flexible Spending (Medical and Dependent Care) Employer Paid Life and AD&D (Supplemental available) Flexible Vacation, Wellness Days, and Paid Holidays About our recruitment process: We don't expect a perfect fit for every requirement we've outlined. If you can see yourself contributing to the team, we would like to speak with you. You can expect up to 4 interviews via Zoom. Access TeleCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, age, religion, color, marital status, national origin, gender, gender identity or expression, sexual orientation, disability, or veteran status.

**Home Infusion Registered Nurse - Accredo** **Patient visits for this position will mostly be on the weekends, and possibly some evenings. However, some weekday availability will be required, especially during training.** Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy 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 by Evernorth 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 do multiple patient visits per week (mostly weekends, but may also include weekday evenings, 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. For this position, we anticipate offering an hourly rate of 36 - 61 USD / hourly, depending on relevant factors, including experience and geographic location. **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._

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 *********************************************

Description - Behavioral Health Services Manager Original Board Approval Date 08/26/2020 Reports to Director of Behavioral Health Division Behavioral Health/Administrative Exempt/Non-Exempt Status Exempt Security Roles Clinical Administration; Clinical Care Specialist JOB SUMMARY: The Behavioral Health Services Manager plays a key role in supporting HOPE's integrated care model by helping oversee the day-to-day operations of the Behavioral Health (BH) department. This position provides direct supervision to BH nurses, medical assistants, and other support roles within the department, ensuring high-quality, patient-centered care. The Manager also serves as a vital administrative partner to the Director of Behavioral Health, offering clerical, programmatic, and operational support to help drive departmental goals, improve workflows, and maintain compliance with FQHC standards. Primary Duties & Responsibilities: Clinical Support: Demonstrates proficiency in all aspects of patient triage within the Behavioral Health department and completes competency assessments for both new and existing employees. Serves as a backup for the Behavioral Health medical assistant or nurse during periods of absence to ensure continuity of patient care and clinic operations. Human Resources & Staffing Support: Assists with the orientation and onboarding of new Behavioral Health staff, including interview coordination and preparation of new hire materials. Manages the department's weekly staffing schedule, including time-off approvals, timesheet submissions, missed punch corrections, and payroll approvals using ADP. Organizes and facilitates regular departmental meetings, including preparing agendas and documenting meeting minutes. Quality Improvement & Data Management: Supports departmental quality improvement efforts through data collection, analysis, and reporting. Tracks and reports on key indicators such as patient satisfaction, departmental expenses, and service utilization. Provides feedback and suggestions for process improvement based on insights from staff, patients, and community partners. Collaborates with the Director of Behavioral Health to develop and maintain spreadsheets and databases (e.g., Excel) to support budgeting and quality initiatives. Assists with the maintenance and updates of departmental forms and documentation. Community & Program Development: Educates patients, families, and community partners on available behavioral health services. Assists the Director of Behavioral Health in community outreach efforts to increase awareness and utilization of services. Represents the Behavioral Health department on internal committees, such as the Compliance/Risk Committee, Safety Committee, and Quality Assurance/Quality Improvement (QA/QI) Committee. Administrative & Operational Support: Provides general administrative support to the Director of Behavioral Health, including assistance with travel arrangements, training logistics, and expense reimbursements. Demonstrates adaptability and serves as a change agent to support ongoing departmental and organizational improvements. Supports teamwork and proactive communication among the Behavioral Health team and across departments. Intermittent Duties: Performs other duties as assigned by the Director of Behavioral Health to support departmental operations and organizational needs. Off-Site Work: Occasional off-site work is required for this position. With prior Team Leader approval, various job tasks may be completed remotely. These may include, but are not limited to: program development, policy and procedure updates, conference calls, grant writing, and similar administrative tasks. Employees approved for off-site work must have a confidential, designated workspace to ensure privacy and productivity. Off-site work classification and arrangements will be reviewed by the Team Leader at hire, during annual performance evaluations, and as needed throughout the year. Skills/Qualifications: Education & Experience: Some college coursework with 2-4 years of experience in a social or human services-related field, preferably with direct behavioral health experience. Bachelor's degree in a related field preferred. Specialized training or certifications (e.g., Non-Violent Crisis Intervention, Suicide Prevention/Intervention) are preferred. Technical & Professional Skills: Proficient in Microsoft Office Suite (Word, Excel, PowerPoint); ability to learn additional software and systems as needed. Strong organizational and time management skills, with the ability to prioritize tasks, meet deadlines, and manage multiple responsibilities. High-level problem-solving skills and sound judgment, with the ability to make independent decisions and consult with leadership when appropriate. Communication & Interpersonal Skills: Excellent verbal and written communication skills. Demonstrated cultural competency and the ability to engage effectively with individuals from diverse backgrounds. Strong interpersonal skills and a professional, customer-service-oriented demeanor. Other Key Competencies: Ability to take initiative and follow through on assignments with minimal supervision. Flexible, adaptable, and able to function effectively in a fast-paced, team-oriented environment. Personal Attributes: The Behavioral Health Services Manager must maintain strict confidentiality and consistently uphold HOPE's core values while performing all duties. The ideal candidate will demonstrate the following personal qualities: Trustworthiness and integrity Respectfulness toward patients, colleagues, and the community Cultural awareness and sensitivity to diverse backgrounds Flexibility and adaptability in a dynamic work environment Strong work ethic and commitment to excellence Working Conditions & Physical Demands: This position primarily functions in a professional office environment with periodic travel between HOPE sites. Occasional extended hours may be required based on organizational priorities. As a healthcare setting, employees may be exposed to body fluids and other potential health hazards. Requires sufficient visual acuity to read, write, and operate equipment commonly used in this role. Must be able to communicate effectively in English, both verbally and in writing; proficiency in a second language is helpful but not required. Requires adequate hearing ability to communicate effectively in person and by telephone. Occasionally required to lift items weighing up to 25 pounds. Note: This is intended to convey information essential to understanding the scope of the Behavioral Health Services Manager. It is not intended to be an exhaustive list of qualifications, duties, or responsibilities, as other duties may be assigned as needed. This job description follows the Americans with Disabilities Act (ADA) and the Fair Labor Standards Act (FLSA) (May 1995) HOPE Family Health Services is an equal opportunity employer who complies with applicable State and Federal civil rights laws and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran or disability status. Many positions at HOPE Family Health Services are funded in-part or in-whole by State or Federal Department of Health and Human Services funding and as such, our organization cannot employ individuals with certain criminal backgrounds or who are on State or Federal exclusion or debarment lists.

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

Join the BlueCare team at BCBST as a Clinical Review Manager! In this role, you will complete medical reviews for utilization management within the BlueCare member population. You'll have the opportunity to collaborate with the BlueCare Utilization Management team, Case Managers, and other departments. The ideal candidate for this role is a quick learner who thrives in a role that requires attention to detail and research skills. The role also requires the ability to navigate clinical information and disseminate it in a timely manner. Finally, we're looking for a candidate with strong communication skills to be able to work effectively across multiple teams. Key Schedule Details: Typical schedule is 8-5 pm EST or 9-6 pm EST. Fully remote, at home position. There is an option, upon management approval, for alternative workdays or a compressed work schedule. For example, the Clinical Review Manager may work five 8-hour shifts or four 10-hour shifts, which may include a combination of weekdays and weekends (e.g., Wednesday-Sunday or Thursday-Sunday)." Join our team and make a significant impact on the quality of care our members receive! Job Responsibilities Initiate referrals to ensure appropriate coordination of care. Seek the advice of the Medical Director when appropriate, according to policy. Assists non-clinical staff in performance of administrative reviews Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility. Occasional weekend work may be required. Must be able to pass Windows navigation test. Testing/Assessments will be required for Digital positions. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Job Qualifications License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical experience required Skills\Certifications Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Working knowledge of URAC, NCQA and CMS accreditations Must be able to work in an independent and creative manner. Excellent oral and written communication skills Strong interpersonal and organizational skills Ability to manage multiple projects and priorities Adaptive to high pace and changing environment Customer service oriented Superior interpersonal, client relations and problem-solving skills Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.