Intensive Community Manager
Chenmed
Columbus, OH
We're unique. You should be, too. We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great people to join our team. The Intensive Community Care Manager (ICCM) is a Registered Nurse (RN) who works with our highest complexity patients, their primary care physicians, and other members of the care team that provides hyperfocus case management and field nursing interventions to prevent unnecessary hospital arrivals, keep patients engaged in our intensive primary care model and maximize their healthy time at home. The Intensive Community Managers (ICCMs) will serve as a clinical lead for the Complex Care Team. They will assess, evaluate, and coordinate the team's efforts to stabilize our highest risk patients, with special areas of focus including safe transitions of care from facilities back to our primary care teams, stabilization of our highest risk ambulatory patients and outreach to patients who are assigned to us but are not engaged in care. This person will perform assessments and design comprehensive plans of care, and drive the actions needed to keep the most complex patients safely at home. This professional will also provide clinical supervision to other team members in delivering the plan of care and in other tasks necessary to meet their needs and engage them in care. As a clinical leader for the team, this person will also be deeply involved in prioritizing team efforts and may also become the direct supervisor for some team members. The Intensive Community Manager works in partnership with the PCPs to draft personalized care plans that address patient's immediate needs that cause a risk for unnecessary hospital arrivals. This position adheres to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance and policies and procedures. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: Provides in-house, at facility, and telephonic visits to patients at high-risk for hospital admission and re-admission (as identified by CM Plan) with the main goal of preventing unnecessary hospital arrivals for patients that have consented to the program and after successfully completed full course of program. Provides home visits to perform field nursing interventions, assess patient, and the development of care plan to identify the goals, barriers, and interventions that will be addressing during the follow up patient visits. Once a patient has completed their episode of care management the register nurse (RN) will review patient chart for discharge and conduct final discharge with patient. Discharge from program may require formal approval from Complex Care Leadership Team Conducts supervisory visits with License Practical Nurse (LPN) and patient to provide any additional education patient may need and to oversee appropriate patient discharge from case management. Performs clinical, fall prevention, and social determination of Heath screening (SdoH) assessments to include disease-oriented assessment and monitoring, medication monitoring, health education and self-care instructions in the outpatient in home setting. Performs home field nursing interventions that have been agreed by PCP, Center Leadership, and Complex Care Leadership that would prevent hospital arrival. Such intervention may include taking vital signs, weighing patient, appropriate one time visits ordered by PCP and reviewed by the Manager for approval, and others as determined in Standard Operation Procedures (SOP) Coordinate the Plan of Care: Conducts/coordinates initial case management assessment of patients to determine outpatient needs and obtains patients consent to program. Ensures individual plan of care reflects patient needs and services available in the community or review of their benefits. Completes individual plan of care intervention with patients, family/care giver and care team members with a focus of incremental actions that will prevent unnecessary hospitalizations. Assesses the environment of care, e.g., safety and security. Conduct fall risk assessment as needed. Assesses the caregiver's capacity and willingness to provide care. Assesses and educations patient and caregiver educational needs. Coordinates, reports, documents and follows-up on multidisciplinary team meetings serving as host or lead for those conversations as needed. Helps patients navigate health care systems, connecting them with community resources; orchestrates multiple facets of health care delivery and assists with administrative and logistical tasks. Coordinates the delivery of services to effectively address patient needs. Facilitates and coaches' patients in using natural support and mainstream community resources to address supportive needs. Maintains ongoing communication with families, community providers and others as needed to promote the health and well-being of patients. Establishes a supportive and motivational relationship with patients that support patient self-management Monitors the quality, frequency, and appropriateness of HHA visits and other outpatient services. Assists patients and family with access to community/financial resources and refer cases to social worker and other programs available as appropriate. Collaborates closely with other members of the Complex Care and Clinica Strategy Team such as Hospital Care Managers and Post Hospital Care Coordinators and Manages to ensure patients in their program receive holistic care approval. Home visit under the direction of the patient's primary care physician to meet urgent patient needed with the aim of preventing unnecessary hospital arrivals Performs other duties as assigned and modified at manager's discretion. KNOWLEDGE, SKILLS AND ABILITIES: Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community Critical thinking skills Ability to work autonomously Ability to monitor, assess and record patients' progress and adjust and plan accordingly Ability to plan, implement and evaluate individual patient care plans Knowledge of nursing and case management theory and practice Knowledge of patient care charts and patient histories Knowledge of clinical and social services documentation procedures and standards Knowledge of community health services and social services support agencies and networks Organizing and coordinating skills Ability to communicate technical information to non-technical personnel Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint, and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software Ability and willingness to travel locally, regionally, and nationwide up to 10% of the time Spoken and written fluency in English. Bilingual a plus This job requires use and exercise of independent judgment EDUCATION AND EXPERIENCE CRITERIA: Associate degree in Nursing required Bachelor's Degree in nursing (BSN) or RN with bachelor's degree in home in a related clinical field preferred A valid, active Registered Nurse (RN) license in State of employment required. Compact License preferred for states where compact license is available A minimum of 2 years' clinical work experience required A minimum of 1 year of case management experience in community case management experience highly desired Certified Case Manager certification is preferred. Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired This position requires possession and maintenance of a current, valid driver's license. Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required w/in first 90 days of employment PAY RANGE: $35.8 - $51.17 Hourly EMPLOYEE BENEFITS ****************************************************** We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day. Current Employee apply HERE Current Contingent Worker please see job aid HERE to apply #LI-Onsite$35.8-51.2 hourly 4d agoProgram Management Office Manager
Us Tech Solutions
Columbus, OH
Summary: As a PMO Manager, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve - a community's most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges. The PMO Manager integrates project management and aspects of DevOps practices to ensure the successful delivery of software development projects. This client-facing, strategic role combines organizational, technical, and leadership skills to oversee project teams, and drive continuous improvement. Roles & Responsibilities: • Team Leadership & Collaboration o Manages client relationship. o Oversee project management team (10+ members), fostering collaboration, mentorship, and a culture of continuous improvement. o Provide periodic performance feedback and mentorship to team members, ensuring alignment with organizational goals. • Project & Process Management o Coordinate status reporting for internal and external stakeholders, ensuring clarity and compliance with requirements. o Proactively identify, mitigate, and manage project risks and issues, including response strategies and status tracking. o Integrate and coordinate efforts with internal and external leadership, internal and external project managers, and system managers. o Develop, maintain, and enforce processes related to system implementation. o Enforce change management and governance policies for both the organization and clients. o Collaborate with software development, QA, and IT teams to align priorities, requirements, and improve overall delivery performance. Required Skills & Experience: • Project Management: Minimum 3 years (preferably 6+) in similar roles; PMI certification; knowledge of PMBOK and best practices. • 9+ years' experience in project management both waterfall and agile methodologies • 7+ years' experience with healthcare delivery, health insurance management, managed care management or pharmacy benefit management. • Demonstrates advanced knowledge of project management methodologies and tools, client relations, IT industry, accounting, risk management, change management, and effort tracking. • Healthcare/IT Experience: Experience supporting healthcare claims, financial processing, or pharmacy benefits manager projects for state governments, hospitals, or insurance companies. • Technical Proficiency: Skilled in using laptops, Microsoft products, and project scheduling tools (e.g., Microsoft Project). • Leadership & Communication: Excellent verbal and written communication; ability to train, guide, and mentor personnel; effective with technical and non-technical stakeholders. • Attention to Detail: Strong compliance orientation and ability to analyze data and processes. • Advanced Planning: Project management skills to keep deliverables on track during review cycles. • Bachelor's degree in a relevant field (e.g., Computer Science, Information Technology, Business Administration). • Project Management Professional (PMP) certification required. Skills: Project Management, Medicaid, PMBOK, PMP, PMO, MS Products Education: Bachelors' Degree About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ************************ US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Recruiter Details: Name: Akib Email: *************************** Internal Id: 25-52840$35k-45k yearly est. 2d agoMedical Director
Intepros
Remote job
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)$181k-282k yearly est. 1d agoLead Care Manager (LCM)
Heritage Health Network
Remote job
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. 4d agoMember Engagement Specialist
Community Care of North Carolina Inc.
Remote job
The Member Engagement Specialist is responsible for telephonic outreach and screening of identified members based on plan stratification for care management with a call center approach. An experienced and energetic communicator, the engagement specialist is focused on deepening program participation as well as making members aware of CCNC (Community Care of North Carolina) (plan) programs and offerings. The Member Engagement Specialist interacts with members, providers, and other staff to initiate program interventions, document activities, and refer risk appropriate members to professional staff according to protocols. The candidate for this position must have a disposition towards good customer service, be assertive without being aggressive, and always maintain a professional demeanor. The Member Engagement Specialist may work remotely within regions to cover the needs across the state. This is primarily a remote position. Occasional in-person training and travel may be required. Essential Functions Conduct continual telephonic outreach to identified and referred members focused on engaging members with care management services. Receive/retrieve and manage referrals from data reports; clinical care management team members, PCP (Primary Care Provider), or other service providers for efficient screening and linking members with care management. Complete and document member screenings tools and refer clinical needs to most appropriate clinical care management team member for assessment and follow up. Schedule members for face-to-face or telephonic encounters for care management follow up. Meet monthly productivity and role expectations. Complete all assignments within expected timeframes. Notify supervisor promptly of any issues with receiving or sending referrals, making timely care management assignments, or issues with carrying out any other duties assigned. Collaborate with the Care Team to address barriers and create efficiency with processes. Abide by department guidelines, company policies, and HIPAA regulations. Perform all other duties as requested. Attend departmental and corporate meetings. Understand and uphold CCNC goals, objectives, and standards. Qualifications High School/GED. Prior telephonic call center experience desired Minimum of two years previous work experience, preferably in a health care setting Healthcare experience and medical terminology knowledge highly preferred Bilingual preferred Managed care experience a plus Knowledge, Skills, and Abilities Computer skills required including various office software and the internet; experience with MS Office software preferred Strong Initiative Performance metric driven and productivity mindset Strong oral and written communication proficiency Attention to detail Organizational and Time Management Skills Strong Interpersonal Skills Critical Thinking Skills Resourceful - Able to shift strategy or approach in response to the demands of a situation Team-oriented Adaptable - Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives Motivational Interviewing Skills Knowledge of Care Management Principles Ability to work independently and to use sound judgment when needed Multi-tasking Abilities Outgoing and energetic attitude Respectful customer service skills Ability to provide information in a manner that is culturally and linguistically appropriate Knowledge of and experience working in member or clinical data systems Working Conditions Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time and repetitive wrist motion Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds The job environment is a home environment Travel using personal vehicle may be required within the region and/or the State The job environment can be intense as high volume, repetitive work is an expectation$30k-38k yearly est. 28d agoRemote - Inpatient Coder II
Mosaic Life Care
Remote job
Remote - Inpatient Coder II Inpatient Coding PRN Status Day Shift Pay: $24.74 - $37.11 / hour Candidates residing in the following states will be considered for remote employment: Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time. This position is responsible for assigning ICD-10-CM and ICD-10-PCS codes for inpatient and LTACH services. This assignment is based on evaluation of the documentation in the medical record and utilization of coding guidelines, Coding Clinic, anatomy and physiology. This position works under the supervision of the Manager and is employed by Mosaic Health System. Codes complex diseases, procedures and diagnoses using the ICD-10-CM/PCS classification systems, in accordance with Official Coding Guidelines, CMS guidelines, PPS guidelines and organizational compliance standards. Assumes responsibility for professional development by participating in workshops, conferences and/or in-services and maintains appropriate records of participation. Completes complex coding assignments for reimbursement, research and compliance with Federal and State regulations. Researches coding guidelines. Reviews and appeals coding denials. Educates/Communicates with providers, querying providers to ensure that optimal clinical documentation is provided to demonstrate the severity and details of the patient's illness in the medical record. Coordinates/Communicates with departments including clinical departments, Quality Improvement, Care Management, Patient Financial Services to ensure accuracy and timeliness of coding. Ensures data accuracy by responding to coding edits received. Cross-trained and able to complete one type of outpatient facility coding in addition to inpatient coding. Example: Emergency Department, Observation, Referral. Mentors and assists with training coders. Completes analysis by utilizing reports, record reviews, etc. Other duties as assigned. Must have coding education. Associate's Degree or higher in Health Information Management / Medical Records required. CCS - Certified Coding Specialist, RHIA - Registered Health Information Administrator, or RHIT - Registered Health Information Technician required. Three years experience in coding in an acute care setting required.$24.7-37.1 hourly 60d+ agoRN Client Success Manager
Thekey LLC
Upper Arlington, OH
For nearly 20 years, TheKey has helped clients achieve successful long-term aging at home with comprehensive, concierge-based care. Ensuring the dignity, safety, and independence of its clients, TheKey is committed to changing how the world lives and ages at home. Employee-teams get the training, resources, and support they need to deliver an exceptional care experience for clients and their families. Founded in Silicon Valley, TheKey has grown from a single location to service coverage throughout North America enabling clients to live life on their own terms, in their own homes. Essential Duties and Responsibilities: * Understanding the new client including proactively identifying areas of interest, reaching out immediately after the client has been assigned to you and calendaring a first meeting and, having a collaborative relationship with clients and family members. * Conducting in- person nursing initial and reassessments and quality assurance visits that include but are not limited to a view of Home safety assessments, the client's daily routines, the client's preferences and needs converting them into active service with a Care Plan tailored to their unique needs. The assessment includes the informal and formal support systems and caregiving needs. * Ensuring caregivers meet state requirements, are adequately trained to perform their responsibilities and receive RN instruction and/or supervision as required. * Continuously ensuring a good experience for our clients by building rapport to create engagement and being highly visible to the client and the client's support systems. * After receiving the assignment, ensuring that ClearCare is up to date with all relevant information. * Making regular home visits, reassessments as needed and when there is a change of condition, provide updates to the care plan and communication to the team. This will include recommendation of the ideal caregiver for the client needs and noting specialized training of caregivers as needed, quality assurance visits and regular review of care notes. * Reviewing of the client rates as the care progresses * Ensuring that all state regulations are considered and compliance with visits and documentation is met. * Looking for cross-referral opportunities and other means of increasing business from existing clients. * Providing extra support for new client cases, including home visits during the first caregiver schedule and within the first two weeks of service, to ensure complete client satisfaction. * Communicating effectively with team members to ensure the best possible match of caregivers to client needs, the accuracy of client billing, long- term care insurance communication or education * Supporting ongoing client retention through hands-on attention, client appreciation initiatives and relationships with the clients and their families. * Implementing TheKey operating model and following all company guidelines and applicable state regulations. * Exercising and applying home care knowledge, business goals and care management goals that meets state home care regulations. * On call and after hours support as needed * Additional duties as assigned. Required Skills, Education and Certifications: * Current Registered Nurse license in the state of employment; continued employment is contingent upon maintaining active license in good standing; BSN preferred * 5 years' experience in health care, elder care, social work or related industry preferred * Excellent customer service and conflict resolution skills * Computer proficiency and ability to document timely and accurately notes in system related to client visits * Current driver's license and proof of insurance Physical Requirements: * Ability to travel approximately up to 30% of the time * Ability to lift and carry up to 15-20 pounds * Ability to sit, stand and walk for prolonged period of time throughout the work day * Ability to use standard office equipment such as personal computer, laptop, telephone, photocopy machine, etc. Benefits for full time employees * Medical/Dental/Vision Insurance * TouchCare VirtualCare * Life Insurance * Health Savings Account * Flexible Spending Account * 401(k) Matching * Employee Assistance Program * PTO Plan for Non-Exempt Employees * Flexible PTO Plan for Exempt Employees * Holidays and Floating Holidays * Pet Insurance TheKey is an equal opportunity employer. TheKey prohibits discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion, sex, age, national origin, disability status, protected veteran status, or any other characteristic protected by law. California Residents Only: In accordance with Article 2 of the California Health and Safety Code - California Community Care Facilities Act, TheKey requires timely and accurate positive fingerprint identification of California based applicants as a condition of employment. If an applicant has been convicted of a non-exemptible crime, and in compliance with all applicable state and local laws, their conditional offer will be rescinded. #LI-TK$58k-90k yearly est. Auto-Apply 33d agoFull-Time Remote Licensed Marriage &
Redwoods Rural Health Center
Remote job
Family Therapist (LMFT) / Licensed Clinical Social Worker (LCSW) Redwoods Rural Health Center is seeking a LMFT/LCSW therapist who can work anywhere in the country if licensed in California to provide therapy to clients referred by health providers or self-referred in individual and group sessions. JOB DUTIES & RESPONSIBILITIES: * Carry out program enrollment, intake and care management * Assist with quality improvement, chemical dependency programs, and the integrated behavioral health program * Support and carry out crisis assessment as needed to assess a patient's danger to self, danger to others and/or grave disability * Serve as a consultant to primary care staff on mental health and behavioral issues * Provide in-service training to staff on mental health and care issues as directed * Accurately and appropriately complete medical record documentation * Accurately code all services for legal, clinical and payor compliance * Complete continuing education and other requirements and attend staff meetings, training, workshops, and conferences as needed * Assist with community outreach efforts * Adhere to professional and ethical standards of care and RRHC policies and procedures * Complete training and maintain proficiency in core functions of practice management and all core functionality of the Electronic Records system and other applications, as needed * Perform other duties as assigned EDUCATION AND OTHER REQUIREMENTS: * Master's Degree from an accredited graduate school of social work or a PhD in Psychology * Clinical license - LCSW/LMFT EXPERIENCE AND SKILLS REQUIRED OR PREFERRED: * Knowledge of public health principles and practices preferred * Excellent interpersonal and written communication skills required * Three years of experience in an outpatient/inpatient clinical setting preferred * Bilingual in Spanish preferred ANNUAL PAY AND BENEFITS * Annual compensation for LMFT $85,005-$119,130 or LCSW $87,555-$121,915 depending on license and qualifications. * Four-day, 10 hours per day work week (not all positions will qualify for 4 days a week benefit) * 4% retirement match (100% vested on day one) * CE leave, CE reimbursement and license reimbursement available * Paid holidays, paid vacation, paid sick time benefits as outlined in the Employee Handbook * Comprehensive health benefits for you and your family For more information about the position including detailed job description and benefits, please contact: *********** or submit a letter of interest & resume to PO Box 769, Redway, CA 95560$87.6k-121.9k yearly Easy Apply 53d agoTelephonic Nurse Case Manager II
Elevance Health
Columbus, OH
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST * This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum requirements: * Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state(s) required. * Multi-state licensure is required if this individual is providing services in multiple states. For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills, and Experiences: * Certification as a Case Manager preferred. * Ability to talk and type at the same time preferred. * Demonstrate critical thinking skills when interacting with members preferred. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred. * Ability to manage, review and respond to emails/instant messages in a timely fashion preferred. * Minimum 2 years' experience in acute care setting preferred. * Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred. * Managed Care experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $73,280 - $115,416 Locations: New York, Columbus, OH In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.$73.3k-115.4k yearly 2d agoScheduling Coordinator
Compassionate Caregivers Home Care
Dublin, OH
We are seeking a dedicated and detail-oriented Scheduling Coordinator to join our homecare team. This role is responsible for coordinating caregiver schedules, matching client needs with caregiver availability, and ensuring consistent, high-quality service delivery. The ideal candidate will have strong organizational skills, excellent communication, and the ability to work in a dynamic environment where timely response is critical. Key Responsibilities Develop and maintain schedules for caregivers, ensuring optimal coverage and continuity of care for all clients. Match caregivers to clients based on skill set, availability, and client preferences. Communicate schedule updates and changes promptly to both clients and caregivers. Respond quickly to last-minute changes, such as caregiver call-outs, and secure appropriate coverage. Maintain accurate and up-to-date records in the scheduling and care management system. Collaborate with the care management team to ensure clients' care plans are being followed and supported by appropriate staffing. Provide outstanding customer service to clients and caregivers, resolving any scheduling concerns professionally and efficiently. Monitor caregiver hours to ensure compliance with labor laws and agency policies. Assist with onboarding and orientation scheduling for new caregivers. Participate in on-call rotation as needed for after-hours scheduling support. Job Type: Full-time Qualifications (Required): 2 years scheduling experience Wellsky Experience Salary: $35,000-$50,000 per year Benefits: PTO 401K Medical/dental benefits available Referral Program Schedule: 8 hour shift Work Location: In person$35k-50k yearly 60d+ agoDirector, Partnership Operations
Thyme Care
Remote job
OUR MISSION We exist to create a more connected, compassionate, and confident experience for people with cancer and those who care for them. We make it easier to get answers, access high-quality care quickly, and feel supported throughout treatment and beyond. Today, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. Our model combines high-touch human support with powerful technology and AI to bring together everyone involved in a person's cancer journey: caregivers, oncologists, health plans, and employers. As a tech-native organization, we believe technology should strengthen the human connection at the center of care. Through data science, automation, and AI, we simplify complexity, improve collaboration, and help care teams focus on what matters most: supporting people through cancer. Looking ahead, our vision is bold: to become a household name in cancer care, where every person diagnosed asks for Thyme Care by name. If you're inspired to make cancer care more human and to help reimagine what's possible, we'd love to meet you. Together, we can build a future where every person with cancer feels truly cared for, in every moment that matters. WHAT YOU'LL DO As a Director, Partnership Operations at Thyme Care, you'll be responsible for driving business outcomes for partners by translating strategic goals into scalable operations that deliver measurable results, all while developing and managing relationships with health plans and risk-bearing entities. You will: Lead implementation and performance management for payer and risk-bearing partnerships from contract to maturity. Serve as a strategic advisor to internal and external stakeholders, ensuring alignment and visibility across partner-specific workstreams. Build data-backed insights and presentations for leadership and partner discussions, telling the story of partnership impact. Identify and operationalize process improvements that enhance contract performance and scalability. Collaborate with cross-functional teams - Product, Care Delivery, Data, Operations - to address challenges and deliver outcomes. Own joint operating committees and business reviews, communicating progress, insights, and opportunities for deeper collaboration and partner expansion. This role is ideal for a strategic operator - someone who can think big, move fast, and drive results with both structure and creativity. WHAT YOU'VE DONE You bring a mix of strategic thinking and operational execution, with experience managing complex partnerships and working cross-functionally to turn ideas into measurable outcomes. Qualifications 6-10+ years in management consulting, strategy, or healthcare operations, ideally with payer, provider, or care delivery exposure. Proven ability to analyze, structure, and execute high-impact projects in a fast-paced, matrixed environment. Strong communicator and presenter; skilled at synthesizing complex information into concise, executive-ready materials. Confident navigating ambiguity and influencing across teams. Hands-on leader who takes ownership from problem to implementation. Nice-to-Haves Background in healthcare, care management, or value-based care. Blend of consulting and in-house experience in high-growth or startup settings. Familiarity with performance metrics, financial modeling, or partner success management. WHAT LEADS TO SUCCESS Act with our members in mind. Thyme Care's mission matters deeply to you, particularly our member experience. Move with purpose. You're biased to action. You know how to identify and prioritize your initiative's needs and do what it takes to ensure that urgent and important needs are acted on immediately. Comfortable with ambiguity. You have a proven track record of success in scaling businesses, fast-paced environments, and startups. You understand that rapid changes to the business, strategy, organization, and priorities are par for the course. Expertise. You blend analytical thinking with practical execution and can pivot seamlessly between big-picture strategy and hands-on work. You bring structured problem-solving, executive presence, and a strong ability to communicate complex ideas simply and effectively. You can interpret metrics, connect them to outcomes, and use them to tell a compelling story. OUR VALUES At Thyme Care, our core values guide us in everything we do: Act with our members in mind, Move with purpose, and Seek diverse perspectives. They anchor our business decisions, including how we grow, the products we make, and the paths we choose-or don't choose. Our salary ranges are based on paying competitively for our size and industry, and are one part of the total compensation package that also includes equity, benefits, and other opportunities at Thyme Care. Individual pay decisions are based on several factors, including qualifications, experience level, skillset, and balancing internal equity relative to other Thyme Care employees. The base salary for this role is $165,000-$195,000. The salary range could be lower or higher than this if the role is hired at another level. This position is also bonus-eligible. We recognize a history of inequality in healthcare. We're here to challenge the status quo and create a culture of inclusion through the care we give and the company we build. We embrace and celebrate a diversity of perspectives in reflection of our members and the members we serve. We are an equal-opportunity employer. Be cautious of recruitment fraud , and always confirm that communications are coming from an official Thyme Care email.$165k-195k yearly Auto-Apply 8d agoLicensed Master Social Worker
Essenmed
Remote job
: At Essen Health Care, we care for that! As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women's health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today! Job Summary Position Title: Licensed Master Social Worker- Hybrid opportunities Reporting to: Office Division Job Summary: The Licensed Master Social Worker will be responsible to perform daily social work operations Responsibilities Assessment of patients referred by Primary Care Provider (PCP) using evidenced based assessment tools. Treatment of behavioral health conditions using evidenced based approaches (CBT, Motivational Interviewing, crisis intervention, Interpersonal Psychotherapy, and behavioral activation). Make treatment recommendations during collaborative care team meetings Monitor treatment through care planning and coordination of care with clinical team and health homes. Provide crisis intervention services and risk assessment of patients as needed. Engage clients with limited utilization of behavioral health service through outreach efforts. Document services in a timely fashion. Engage in weekly clinical supervision Engage in team meetings and case conferences as needed. Qualifications LMSW Licensure Master of Social Work Degree from accredited institution Ability to utilize behavioral health screening tools and perform biopsychosocial assessments Utilize DSM-V diagnostic criteria to diagnoses and treat behavioral health conditions Assess for risk and collaborate with psychiatric and clinical team around risk management Ability to utilize electronic health records for documentation of clinical services and review of relevant health data. Communicate clinical information in a succinct and comprehensive way to integrated care teams, inclusive of PCP, NP/MD, and Health Home Care Management staff. Bilingual Spanish strongly preferred Salary: $63,000-$65,000 Equal Opportunity Employer ESSEN HEALTH CARE IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.$63k-65k yearly Auto-Apply 2d agoClinical Pharmacist, Manager - Illinois
Waymark
Remote job
About Waymark Waymark is a mission-driven team of healthcare providers, technologists, and builders working to transform care for people with Medicaid benefits. We partner with communities to deliver technology-enabled, human-centered support that helps patients stay healthy and thrive. We're designing tools and systems that bring care directly to those who need it most-removing barriers and reimagining what's possible in Medicaid healthcare delivery. Our Values At Waymark, our values are the foundation of how we work, grow, and support one another: Bold Builders: We tackle the toughest challenges in care delivery by harnessing the power of community and technology. Humble Learners: We seek feedback, embrace diverse perspectives, and welcome challenges to our assumptions. Experiment to Improve: We use data to inform decisions and continuously assess our performance. Focused Urgency: Our mission drives us to act swiftly and relentlessly in pursuit of meaningful results. If this resonates with you, we invite you to bring your creativity, energy, and curiosity to Waymark. About this role As a Clinical Pharmacist Manager in Illinois, you will be key to our efforts to provide better care and support to vulnerable populations. We are looking for a Clinical Pharmacist Manager with experience working with vulnerable populations; collaborating with a multidisciplinary team including Community Health Workers, Care Coordinators, and Therapists; supporting patients through direct patient outreach, medication adherence and chronic disease education, and assistance in obtaining medications and durable medical equipment after initial rejection; and using analytics dashboards to proactively engage with patients who may be at high risk for adverse drug events and/or avertable acute care events. The Clinical Pharmacist Manager will supervise and support pharmacists and pharmacy technicians working to address patient barriers to medication access and identify patients who can benefit from Waymark's assistance. Key Responsibilities & Duties Provide telephonic and/or video and/or SMS-based outreach, engagement, and education of vulnerable patients in the Medicaid program in Illinois Work with a multidisciplinary team to provide care management services that ‘wrap around' primary care provider practices; team members include Community Health Workers, Care Coordinators, and Behavioral Health Therapists Support patients and providers around transitions of care Provide clinical services that support day-to-day operations and safe practices of the program Participate in QI activities to assure quality, cost-effectiveness, and ROI Utilize analytics dashboards that help you proactively outreach patients who receive medication and/or equipment rejections, admissions/readmissions, or who may benefit from medication adherence counseling Lead and mentor pharmacists and/or pharmacy technicians Minimum qualifications PharmD with advanced practice license in good standing in Illinois. Remote, located in Illinois. Chicago or central Illinois preferred Completion of accredited PGY1 residency training in related discipline 5+ years of experience in pharmacy practice including delivery of interventions/direct patient care in an ambulatory setting among vulnerable populations Experience in multi-disciplinary care management Positive referrals from prior colleagues Preferred qualifications Completion of PGY2 residency training in related discipline (ambulatory care, geriatrics, pharmacotherapy, internal medicine) Strong analytic skills and ability to navigate dashboards and registry data for proactive outreach campaigns including for HEDIS gaps in care History of experience with medication management through collaborative practice agreements with primary care providers BPS Board Certification Preferred (prefer BCPS and/or BCACP) Experience serving vulnerable populations with a skill set including motivational interviewing, harm reduction, and behavioral health Leadership experience supporting other pharmacists, pharmacy technicians and/or other care team members Salary Range US Employees in Chicago - $98,000 - $151,000 US employees outside of the above listed US City - $95,000 - $147,000 In addition to salary, we offer a comprehensive benefits package. Here's what you can expect: Stock Options: Opportunity to invest in the company's growth. Work-from-Home Stipend: A dedicated stipend for your first year to help set up your home office. Medical, Vision, and Dental Coverage: Comprehensive plans to keep you and your family healthy. Life Insurance: Basic life insurance to give you peace of mind. Paid Time Off: 20 vacation days, accrued over the year, plus 11 paid holidays. Parental Leave: 16 weeks of paid leave for birthing parents after six months of employment, and 8 weeks of bonding leave for non-birthing parents. Retirement Savings: Access to a 401(k) plan with a company contribution, subject to a vesting schedule. Commuter Benefits: Convenient options to support your commute needs. Professional Development Stipend: A dedicated stipend supports professional development and growth. Offer of employment is contingent upon successful completion of a background check. Don't check off every box in the requirements listed above? Please apply anyway! Studies have shown that some of us may be less likely to apply to jobs unless we meet every single qualification. Waymark is dedicated to building a supportive, equal opportunity, and accessible workplace that fosters a sense of belonging - so if you're excited about this role but your past experience doesn't align perfectly with every preferred qualification in the job description, we encourage you to still consider submitting an application. You may be just the right candidate for this role or another one of our openings!$98k-151k yearly Auto-Apply 2d agoCare Manager, fluent English//Bengali - 100% Remote
Healthfirst
Remote job
**Duties and Responsibilities:** + **Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.** + **Conducts assessments to identify barriers and opportunities for intervention.** + **Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals.** + **Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes.** + **Liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed.** + **Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes.** + **Assists in identifying opportunities for alternative care options based on member needs and assessments.** + **Evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan.** + **Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.** + **Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as** **appropriate.** + **Occasional overtime as necessary.** + **Additional duties as assigned.** **Minimum Qualifications:** + **For Medical Care Management:** + **NYS RN or** + **LCSW or LMSW (any state)** + **For PEDS positions only: 1 year of pediatric clinical field experience and//or experience with families and child serving systems, including child welfare and//or medically** **fragile//developmentally disabled populations** + **For Behavioral Health (BH) Care Management:** + **NYS RN or** + **LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)** + **3 years of work experience in a mental//behavioral health or addictions setting** + **For BH PEDS positions only: 1 year of pediatric clinical field experience and//or experience with families and child serving systems, including child welfare and//or medically fragile//developmentally disabled populations** **Preferred Qualifications:** + **Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing situations.** + **Fluency in Bengali** + **Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors.** + **Experience managing member information in a shared network environment using paperless database modules and archival systems.** + **Experience and knowledge of the relevant product line** + **Relevant work experience preferably as a Care Manager** + **Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment** + **Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems** + **Experience using Microsoft Excel with the ability to edit, search, sort//filter and other Microsoft and PHI systems** WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.$33k-45k yearly est. 60d+ agoVP, Operations
Pair
Remote job
Team Pair Team is a public benefit company reimagining care for the safety net. As an AI-enabled medical group for Medicaid and Medicare, we deliver medical, behavioral, and social care by integrating shelters, pantries and other community-based organizations into our whole-person model. As California's largest complex care provider, we've proven our impact to reduce avoidable emergency care, including a 52% and 26% reduction in ER visits and hospitalizations respectively. Once scaled nationally, our approach would save tax payers $150B per year. With our years of experience and vast data collected, we are now building an AI platform that embeds social work agents across the safety net to truly unify our fragmented healthcare and welfare system. By scaling our country's frontline medical and social services workforce, we aim to bring high-touch care to everyone. At Pair Team, we're not just delivering care-we're transforming it. We're building a future where high-touch, community-driven care is accessible to everyone, especially the most underserved. Forbes: For Pair Team, Accessibility Is About Delivering Healthcare To Those Who Need It The Most TechCrunch: Building for Medicaid's regulatory moment with Neil Batlivala from Pair Team Journal of General Internal Medicine: A Novel Intervention for Medicaid Beneficiaries with Complex Needs About the Opportunity As the VP, Operations at Pair Team, you will play a critical role in leading the day-to-day and growth of Pair Team's most prominent program. You'll ensure operational excellence, payer alignment, and scalable care delivery while working on mission-critical programs that help fuel the future direction of the company. This high-impact leadership role is at the center of our mission to transform care for underserved communities. This is a fully remote position reporting to the SVP of Field Operations. What You'll Do Oversee the day-to-day operations of our Enhanced Care Management (ECM) program to ensure delivery targets are consistently achieved Grow, manage, and scale a large, multi-disciplinary care operations team, which includes case managers, nurses and behavioral health providers Manage the P&L, including unit economics, for your service line Design and optimize workflows, processes, and staffing models to balance scalability, growth, and patient experience Collaborate with thought partners in product, clinical, finance and growth to ensure operational readiness for new initiatives Introduce and operationalize performance metrics to drive accountability in alignment with organizational priorities Lead change management efforts as they arise; which include but aren't limited to: reorganizations, KPI rollouts, growth initiatives, etc. What You'll Need 8+ years of experience in operations with at least 5+ years of experience developing and leading large field teams Experience with managing a P&L, including unit economics Well versed in driving key performance metrics, building a high-performing team, and change management Ownership mindset - own driving results for the mission, business, and customer experience Strong collaboration skills with thought partners from product, clinical and finance teams Proven ability to translate operational needs into clear product requirements and able to drive them from ideation to execution with technical leaders/functions Strong desire to work in an early stage startup environment that is fast paced, complex, and has minimal barriers to make decisions (no “red tape”), and requires a “roll up your sleeves” attitude Passion for helping individuals experiencing complex chronic needs such as homelessness, severe mental illness, and substance use disorder Bonus points for additional experience in healthcare, scaling field-based care delivery models, introducing new performance frameworks, and/or coaching managers through transitions Able to flex your schedule to support a California-based team in a fully remote environment Our Values Lead with integrity: We keep our commitments and take responsibility for our actions. We are dependable and choose authenticity over perfection. Embrace challenges: We leave our egos at the door and step forward into discomfort instead of back into safety. We help each other to learn and provide feedback using candor and kindness. Break through walls: We go the extra mile for our patients, partners and one another, and we run toward hard things. We are resilient in our push for consistent improvement and challenge the status quo. Act beyond yourself: We build each other up and respect boundaries. We seek first to understand and assume positive intent. Care comes first: We hold ourselves to the highest standards for our patients. We are relentless in the pursuit of our mission, and ensure that we are taking care of ourselves in order to care for others. Because We Value You Competitive salary: $215,000 - $230,000 Equity compensation package Flexible vacation policy - take the time you need to recharge Comprehensive medical, dental, and vision coverage 401(k) 100% company-sponsored short and long-term disability and life insurance Subsidized backup childcare and caregiver supports through Wellthy Work entirely from the comfort of your own home Monthly $100 work from home expense stipend We provide the equipment needed for the role Opportunity for rapid career progression with plenty of room for personal growth! Pair Team is an Equal Opportunity Employer. At Pair Team, we value diversity and strive to provide an inclusive environment for all applicants and employees. All applicants will be considered without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, marital status, age, disability, political affiliation, military service, genetic information, or any other characteristic covered by federal, state, or local law. Pair Team participates in E-Verify to verify employment eligibility for new hires. Any offer of employment at Pair Team is conditioned upon passing a pre-employment background check. Following a conditional job offer, candidates will undergo comprehensive employment background checks, including; criminal history, reference checks, and driving records if a role requires vehicle use. We do not conduct any TA business outside of ***************** emails. If you're ever concerned about spam or fraudulent activity, please reach out to ***********************. Note: Please be aware that while we sincerely appreciate your interest, due to the high volume of requests, we're unable to respond to general position inquiries via email. To apply for a position with us, please submit your application for the role you are interested in. Our team regularly reviews applications and will reach out to candidates whose qualifications align with our current openings listed below. Thank you!$215k-230k yearly Auto-Apply 30d agoWound Specialist - Virtual Wound Care (REMOTE)
Redesign Health
Remote job
The Wound Care Nurse provides quality, cost-effective management of a caseload of patients via telehealth and remote encounters for patients across multiple states who have complex wound care needs. Upon referral from StealthCo partner physicians, the wound care nurse provides comprehensive patient care (treating the whole patient). Leveraging our tech stack, they can assess, formulate, and execute plans of care, using image-based remote patient monitoring to regularly adjust care plans, triage, and coordinate care for accelerated healing. You will provide expert consultation, coordination of services and education for patients, families and the healthcare team to achieve optimal patient care.The major clinical focus of this position is providing wrap-around services and management of the treatment journey virtually. You will report to and work with the Chief Medical Officer. (Note: this position has the opportunity to become full-time.) What you'll do: Wound Care Collaborates with partner physicians, coordinates referrals, DME, and prescriptions to drive positive outcomes. Assesses, examines, counsels, and determines a plan of care for prevention and healing of wounds. Determines and orders appropriate topical products, compression therapy, sharp debridement, referrals to specialty providers, labs and x-rays and protocols based on established evidence-based guidelines and algorithms Organizes and forms the plan of care for patients and rehabilitation through assessment, examination, teaching, counseling and recommending treatment and product use. Leverages image-based remote patient monitoring to continually inform treatment and care management. Wound Education and Consultation Consults with contracted home health agencies, primary care clinicians, wound care clinics, and partner physicians regarding appropriate clinical wound care and utilization for home care and outpatient services. Informs treatment protocols and patient engagement plans Consults with DME, Materials Management regarding optimum use of supplies and equipment Quality Management/Utilization: Participates in quality management/improvement activities including occurrence reporting, focused studies, process and outcome measurement and continuous quality improvement projects. Performs other duties as assigned. What you'll need: Background Nursing Degree Minimum four (4) years of wocn or NP experience Minimum two (2) years of wound care experience. License, Certification, Registration: This job requires licensure and credentials in Colorado, with the capability to be licensed and credentialed in multiple states in the future (Support to be provided) National Provider Identifier/ WOCN certification Misc. Skills Current evidence-based knowledge of wound nursing practice. Experience with wound assessments, Experience working with multiple technology platforms Knowledge/experience with all kinds debridement including sharp wound debridement. Ability to complete concise, thorough clinical documentation of patient assessments and care. Working knowledge of quality management and resource utilization methodologies. Thorough knowledge of universal infection control Presents in-service training Strong verbal and communication skills. Problem-solving, organizational and time management skills. Ability to work in interdisciplinary team as a consultant and direct care provider. Able to provide continuous patient education in alliance with WOCN standards Demonstration of customer-focused service skills. Ability to proficiently operate personal computer, technology platforms, virtual conferencing, and remote image support$29k-42k yearly est. Auto-Apply 60d+ agoCustomer Service Representative (Remote)
Arsenault
Remote job
Are you an experienced Customer Service Representative looking for a new challenge? Do you value care management and quality improvement? Are you motivated, energetic, and excited to become part of the Arsenault team? If so, you might be our next new team member! Who We Need The Customer Service Representative is responsible for supporting the prior authorization process by answering incoming telephone calls, resolving customer questions, complaints and requests while adhering to internal policies and procedures and utilizing working knowledge of the organizations services to meet productivity and quality standards. Why us? Arsenault is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. People Focused. Mission Driven. Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise. We do this through our people. At Arsenault, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career. Benefits are a key component of your rewards package at Arsenault. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more. What Youll Do Develops and maintains working knowledge of internal policies, procedures and services (both departmental and operational). Utilizes automated systems to log and retrieve information. Performs accurate and timely data entry of electronic faxes. Receives inquiries from customers or providers by telephone, email, fax, or mail and communicates response within required turnaround times. Responds to telephone inquiries and complaints in a prompt, accurate, and courteous manner following standard operating procedures. Interacts with hospitals, physicians, beneficiaries, or other program recipients. Investigates and resolves or reports customer problems. Identifies and escalates difficult situations to the appropriate party. Meets or exceeds standards for call volume and service level per department guidelines. Initiates files by collecting and entering demographic, provider and procedure information into the system. Serves as liaison between the Review Supervisors and external providers. Maintains logs and documents disposition of incoming and outgoing calls. What Youll Need Required Qualifications High School diploma or equivalent. Medical terminology course(s) helpful. Knowledge, Skills, Abilities Knowledge of: Medical terminology Health insurance industry Ability to: Speak English fluently enough to be clearly understood over the telephone. Use phone system effectively. Research and investigate. Follow confidentiality policies and procedures. Navigate and use electronic equipment and systems easily and proficiently. Multitask on a personal computer while conducting telephone conversations. Work in a fast-paced call center environment Remain calm and courteous when handling difficult calls and request Skills: Bilingual Spanish-English a plus. Effective verbal and listening skills to provide courteous and professional customer service. Effective PC skills including, electronic mail, intranet and industry standard applications. Experience 2+ years customer service/telephone experience in a similar call center environment and/or industry. Thank You! Arsenault is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.$25k-33k yearly est. 60d+ agoPharmacy Care Coordinator - Engagement Specialist
Stellus Rx
Remote job
We're opening eyes, hearts, and minds to the impact that a pharmacy team can have in changing lives. As part of Catalyst Health Group, Stellus Rx improves ease and outcomes in every moment that matters, along every health journey. Join our group of talented, committed team members-pharmacists, pharmacy care coordinators, technologists, product strategists and more-to create and expand the delivery of personalized health support that people didn't even know could be possible. The Pharmacy Care Coordinator - Engagement Specialist help our communities thrive by helping connect newly-referred patients to our Stellus Engage pharmacy team. The Pharmacy Care Coordinator - Engagement Specialist assists the Account Management team under the direction and supervision of the Clinical Pharmacy Specialists and Clinical Client Liaisons by providing support in identifying, outreaching, and educating patients about Stellus engage services through various communication channels. You will work closely with Stellus Rx leaders and across the organization, as we work collaboratively to unlock the health of millions of Americans by turning "use as prescribed" into a guarantee, not a direction. We are a culture that is unabashedly driven by purpose. We are making a difference to our patients and team members while growing at an accelerated rate. If you love serving others and would like to make a material difference in an industry‐transforming organization, then we invite you to apply to this role. Learn more about us at stellusrx.com. Accountabilities: This individual will need a broad working knowledge of the Stellus Engage service model or similar pharmacy-support services to drive enrollment growth and stellar patient satisfaction. You will develop superior customer experience knowledge and effectively educate and engage patients about the positive clinical impact pharmacy services can provide for them. Roles and Responsibilities: Assumes responsibility for a broad range of activities in the patient engagement workflow from patient outreach through scheduling Acts as a liaison for the patient between the referring physician or employer group and Engage pharmacist team Complete patient outreach via phone call and text message (SMS) to connect with referred patients about Stellus Engage services Confidently educate patients on Stellus Engage services and connection back to the PCP referral or employer group benefits Coordinate scheduling of patients with respective Engage pharmacist for CMA/IMA Professionally interact with patients on phone calls and text messages (SMS) Monitor referral queue and workflow for new patient referral funnel and support in referral entry from Leading Reach or other defined referral channel into Engage platform Support in UAT for application needs related to Account Management team sign off Understand confidentiality with respect to patient/client care; complying with all federal and state laws applicable to the confidentiality of protected health information (PHI) and electronic protected health information (EPHI); and follow HIPAA guidelines regarding readily identifiable protected health information. Complete tasks as assigned, related to the referral workflow and Account Management in general Accessing, inputting, and retrieving information through the Pharmacy's computer network to maintain accurate records. Comply with established procedures, rules, and regulations. Completes clear and concise documentation in Care Management programs. Promoting teamwork, professional services and clear communication Minimum Qualifications and Requirements: High school diploma or equivalent. Pharmacy technician license or pharmacy technician trainee license from the Texas State Board. Strong communication and customer service skills. Ability to read and transcribe pharmaceutical information. Sit for long periods of time, stand for intermittent periods of time. Flexibility to work from home.. PC literate, including Microsoft Office products. Analytical and interpretive skills. Strong organizational skills. Excellent interpersonal skills. Ability to work in a team environment. In-depth knowledge of patient servicing. Ability to handle conflict and confront challenging issues in a fast work environment. Ability to meet or exceed Performance Competencies. Able to influence and motivate others through persuasive points-of-view.$34k-47k yearly est. 60d+ agoDirector, Consult Partner - Contact Center - Healthcare or SLED
Kyndryl
Columbus, OH
**Who We Are** At Kyndryl, we design, build, manage and modernize the mission-critical technology systems that the world depends on every day. So why work at Kyndryl? We are always moving forward - always pushing ourselves to go further in our efforts to build a more equitable, inclusive world for our employees, our customers and our communities. **The Role** **Who We Are** Kyndryl Consult is the fastest growing business within the organization and instrumental to the company's strategic growth objectives. You will play a key leadership role across multi-disciplinary teams, guiding them through complex consulting engagements and be responsible for creating and positioning strategic change agendas within Kyndryl's largest accounts across the C-suite, spanning the intersection between complex Business and IT customer solutions, transformations that impact across the entire customer Eco-system. **As a Consult Partner,** we are seeking a dynamic and experienced individual to lead strategic sales and consulting engagements focused on transforming Contact Center operations for enterprise organizations, particularly those in the Healthcare or State or Local Government and / or Educational (SLED) spaces. This role involves working with teams of subject matter experts (SMEs) to deliver innovative solutions that enhance customer journeys, improving customer technology operations, and integrate cutting-edge capabilities such as Agentic AI. The ideal candidate will have a strong background in Customer Experience, BPO models, and/or CCaaS transformation programs with a passion for driving measurable business outcomes. **Contribute to Profitable Growth:** + Drive significant financial outcomes through signings and revenue targets + Ensure sustained growth and profitability, managing margin expectations and backlog growth + Support the identification, pursuit and conversion of a pipeline of business development opportunities + Undertake scoping and fee negotiation on engagements, while enduring profitability and understanding and containing risk **Client Engagement:** + Lead C-level client engagements and consultative sales for large enterprise contact center transformations. + Guide cross-functional consultants to design and implement customer experience (CX) transformation strategies. + Drive modernization of contact center technology platforms, including cloud-based CCaaS adoption and AI/ML integration. + Collaborate with clients to redesign customer journeys and improve service delivery across all touchpoints. + Develop and execute transformation roadmaps aligned with client business models and strategic goals. + Integrate Agentic AI and machine learning technologies into contact center workflows (e.g., agent assist, conversational AI, predictive outreach). + Design omnichannel orchestration strategies (voice, chat, SMS, app) and workflow-driven architectures. + Deliver measurable outcomes such as improved first-call resolution, reduced handle time, and enhanced customer satisfaction. **Operational Excellence:** + Achieve individual and team utilization targets + Lead the design of complex engagements and take responsibility for oversight of delivery, ensuring high performance and customer satisfaction **Leadership, Management, People:** + Lead by example; Fostering a culture of continuous personal and professional development and challenging our people to be curious and innovative and supportive for each other. At the same time ensuring that all outcomes are commercially focused, value adding and effectively executed **Strategic Contribution:** + Utilize industry and technology expertise to shape and drive the company's strategic initiatives. + Align with Kyndryl's strategic vision and contribute to its execution. + Drive external eminence and innovation, establishing a strong personal and organizational brand in the industry. + Proactively develop thought leadership and intellectual capital Kyndryl currently does not require employees to be fully vaccinated against COVID-19, however, if you are hired to work at a client, customer, or partner location, you may be required to show proof of vaccination to align with their respective COVID-19 vaccination policies. Those who believe they are eligible may apply for a medical or religious accommodation prior to the start of employment. **Who You Are** **Required Skills and Experience** + 10+ years of experience in sales, consulting, services or transformation roles within CX, BPO, or CCaaS domains. + Proven track record of leading large-scale transformation programs for enterprises with 10,000+ contact center agents. + Strong leadership and transformation skills. + Deep understanding of contact center technologies and customer experience strategies. + Experience with AI/ML and Generative AI applications in contact center environments. + Excellent communication, presentation, and stakeholder management skills with C-Level. + Healthcare industry experience is a strong plus, especially in payer/provider operations and care management workflows. **Preferred Qualifications: ** + 15+ years' experience in contact center sales, consulting, services, or transformation initiatives. + Previous experience in leading healthcare-focused journey redesign from eligibility verification to care management. + Align contact center transformation with healthcare business models including value-based care, STAR ratings, and cost containment. + Embed intelligent workflows into real-time call flows to support care gap closure and faster resolution. + Partner with CCaaS architects to build future-proof architectures with EHR, CRM, and claims system integrations. The compensation range for the position in the U.S. is $159,240 to $286,560 based on a full-time schedule. Your actual compensation may vary depending on your geography, job-related skills and experience. For part time roles, the compensation will be adjusted appropriately. The pay or salary range will not be below any applicable state, city or local minimum wage requirement. There is a different applicable compensation range for the following work locations: California: $175,080 to $343,920 Colorado: $159,240 to $286,560 New York City: $191,040 to $343,920 Washington: $175,080 to $315,240 Washington DC: $175,080 to $315,240 This position will be eligible for Kyndryl's discretionary annual bonus program, based on performance and subject to the terms of Kyndryl's applicable plans. You may also receive a comprehensive benefits package which includes medical and dental coverage, disability, retirement benefits, paid leave, and paid time off. Note: If this is a sales commission eligible role, you will be eligible to participate in a sales commission plan in lieu of the annual discretionary bonus program. Applications will be accepted on a rolling basis. **Being You** Diversity is a whole lot more than what we look like or where we come from, it's how we think and who we are. We welcome people of all cultures, backgrounds, and experiences. But we're not doing it single-handily: Our Kyndryl Inclusion Networks are only one of many ways we create a workplace where all Kyndryls can find and provide support and advice. This dedication to welcoming everyone into our company means that Kyndryl gives you - and everyone next to you - the ability to bring your whole self to work, individually and collectively, and support the activation of our equitable culture. That's the Kyndryl Way. **What You Can Expect** With state-of-the-art resources and Fortune 100 clients, every day is an opportunity to innovate, build new capabilities, new relationships, new processes, and new value. Kyndryl cares about your well-being and prides itself on offering benefits that give you choice, reflect the diversity of our employees and support you and your family through the moments that matter - wherever you are in your life journey. Our employee learning programs give you access to the best learning in the industry to receive certifications, including Microsoft, Google, Amazon, Skillsoft, and many more. Through our company-wide volunteering and giving platform, you can donate, start fundraisers, volunteer, and search over 2 million non-profit organizations. At Kyndryl, we invest heavily in you, we want you to succeed so that together, we will all succeed. **Get Referred!** If you know someone that works at Kyndryl, when asked 'How Did You Hear About Us' during the application process, select 'Employee Referral' and enter your contact's Kyndryl email address. Kyndryl is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics. Kyndryl is also committed to compliance with all fair employment practices regarding citizenship and immigration status.$75k-128k yearly est. 60d+ agoClinical Supervisor - PRN
Abode
Remote job
Abode, one of the largest and effective nonprofits working to end homelessness in the Bay Area, is seeking a Clinical Supervisor for our Enhanced Care Management program in Santa Cruz County. About the role: The Clinical Supervisor (Licensed as LCSWs, LMFTs, LPNs, LVNs, RNs, PAs, NPs, and CNSs, ) will provide clinical leadership, support, and oversight to the Enhanced Care Management team. The team will engage, house, and provide wrap-around clinical services to the chronically homeless, vulnerable individuals who have Serious Mental Health Disorders, Substance Use Disorders, and/or Chronic Health Conditions.⯠Abode's Benefits and Perks: $50.48 - $64.90/hour DOE PRN role (5-20 hours per week depending on need). Fully Remote Position Professional Development Trainings and Opportunities, All Staff Events Dynamic, mission-drive culture and supportive leadership The Diverse Culture: We believe that we make better decisions and provide quality services when our workforce reflects the diversity of the communities in which we operate. People of color make up nearly 70% of our workforce and we strive to recruit and retain employees from all backgrounds. How You Make an Impact: Monthly review of care plans and regular check-ins with non-clinical staff. Co-signatures or case conference notes can demonstrate oversight. Documentation of interventions by licensed staff is expected. Clinical supervision of non-licensed staff should be documented. Documentation of oversight activities (e.g., meeting minutes, signoffs) Clinical interventions should be documented (emails, meeting notes, verbal summaries. Other duties as assigned. How You Meet the Qualifications: Licensed as LCSWs, LMFTs, LPNs, LVNs, RNs, PAs, NPs, and CNSs. Experience with Enhance Care Management clinical review preferred. Knowledge of Santa Cruz County Programs/Resources preferred. 2 years' experience post licensure providing clinical supervision to staff. 5 years supervisory experience in community mental health or co-occurring program. 2 years of field experience working with people with serious mental illness, individuals with co-occurring disorders. complex health issues and/or the chronically homeless population. Basic knowledge and understanding of applicable federal, state, and local laws. Ability to work flexible hours, including some weekends and evenings. COMPETENCIES: Excellent verbal & written communication, organizational, and time management skills. Strong analytical and problem-solving skills with meticulous attention to detail. Experience working within an Assertive Community Treatment program or similar. Understanding of the following evidence-based practices: Housing First, Motivational Interviewing, Harm Reduction, and Psychosocial Rehabilitation required. Experienced in effectively intervening and /or supporting staff in crisis situations, with de-escalation techniques. Experience, understanding and ability to implement theories of biological, psychological, and social development This includes, but is not limited to, an understanding of human behavior and psychopathology, human diversity, interpersonal relationships and family dynamics, mental disorders, stress, and chemical dependency. Mastery of Medi-Cal charting, strong skills completing assessments and treatment plans.⯠Experience with Utilization Reviews and overseeing Clinical Quality Reviews. Ability to work well independently and collaboratively with teams. Understand and practice cultural sensitivity through open dialogue and self-exploration with diverse groups, while providing direct services. Proficiency in Microsoft Office programs, systems, and platforms. Ability to learn and use required mobile devices and business-related applications. Outstanding communication skills and high degree of emotional intelligence, cultural humility, with a proven track record to build and maintain effective relationships with a wide variety of internal and external contacts. Notice: This description is to be used as a guide only. It does not constitute a contract, commitment or promise of any kind. Abode Services reserves the right to change, add, delete, upgrade, or downgrade the position as dictated by business necessity at any time with or without notice. Notice: Abode Services is an Equal Opportunity Employer/Drug Free Workplace$50.5-64.9 hourly 20d ago
