TriWest Healthcare Alliance jobs

Patient First is the leading urgent care and primary care provider in the mid-Atlantic region. Because Patient First was founded by a physician, we understand the flexibility and freedom you want in both your professional and personal life. If you are ready for a fulfilling career providing exceptional care, you'll find it at Patient First. With over 75 locations throughout greater Washington D.C., Maryland, Virginia, Pennsylvania, and New Jersey, Patient First physicians have been providing urgent and primary care for our patients since 1981. In addition to flexible schedules and career advancement opportunities, we offer a comprehensive compensation package that includes: * Excellent salary * Licensure and certificate assistance and reimbursement * Outstanding malpractice insurance * Health, dental, vision, life, and disability insurance, plus more. We're actively recruiting for board-certified Physician Assistants to join our team. We offer 3 full-time employment statuses that all include Health Insurance, Vacation, and CME benefits. Our full-time position offerings are as follows: * Full-Time 40: Average 40 hours a week * Full-Time 36: Average 36 hours a week * Weekend Special: 108 hours during a four-week period, 60 of which must be weekend hours Board Certified required. To learn more, you can visit our website at ******************** Work Remotely * No Job Types: Full-time, Contract Pay: $186,000.00 - $235,000.00 per year Benefits: * 401(k) * 401(k) matching * Dental insurance * Employee assistance program * Employee discount * Flexible schedule * Flexible spending account * Health insurance * Health savings account * Life insurance * Paid time off * Referral program * Retirement plan * Vision insurance Medical Specialty: * Emergency Medicine * Internal Medicine * Primary Care * Urgent Care License/Certification: * Medical License (Required) * Board Certification (Required) Work Location: In person

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned Complies with all policies and standards This is a remote position. Candidates must be licensed and located in Florida. Ideal candidates will have an LCSW, LMFT or LMHC licensure. Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 - 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Job Description Centene is hiring a Remote Psychologist - Join Our Kentucky Medicaid Team! Are you a licensed Psychologist with a Kentucky license with a passion for improving access to behavioral health care? Centene is looking for a Remote Psychologist to support our Kentucky Medicaid plan. In this role, you'll play a key part in outpatient and psych/neuro psych testing note reviews, appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds. We're seeking candidates who: Hold an active Kentucky Psychologist license Are familiar with Medicaid guidelines, prior authorization, and telehealth practices Thrive in a collaborative, remote work environment This is a great opportunity to apply your clinical expertise in a non-direct care role, supporting quality care and outcomes for the Medicaid population. Position Purpose: Authorize, direct and monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care Conduct peer reviews with psychologist and licensed therapist/certified Behavior Analyst for outpatient and/or psychological testing requests Interact with network practitioners to provide education on best practice models and utilization management processes Interact with the Medical Director, or designee, to discuss clinical authorization questions and concerns regarding specific cases Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD Facilitate outpatient rounds offering clinical input and oversight related to outpatient services Performs other duties as assigned Complies with all policies and standards Education/Experience: PhD Clinical Psychology, Counseling, Behavior Analysis, or related field required: 2+ years Behavioral Health required Working Knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence based practices. required PSY - Psychologist Unrestricted License (PhD or PsyD) Upon Hire required or: Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire required: Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together. As part of a corporate legal team, this attorney will be expected to independently drive sophisticated projects to completion while operating within a team-oriented, results-driven practice group which works collaboratively with its clients on complex legal matters. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Provide transactional and strategic legal support for UnitedHealth Group's Enterprise Procurement team in a wide range of categories, including international services, human resources, clinical, healthcare / regulatory, advertising, marketing, transactional intellectual property and business process outsourcing Negotiate and draft complex and sophisticated agreements, including master services agreement, business process outsourcing agreements, pilot agreements, equipment purchase and lease agreements, software license agreements, software as a service / cloud computing agreements, data licenses and other similar complex commercial agreements Interpret vendor agreements and advise business leaders and other stakeholders on associated rights, risks, remedies and obligations Provide intellectual property and information technology diligence support and deal document negotiation for mergers & acquisitions transactions Create and maintain template agreements and related negotiation support tools, such as playbooks and checklists Develop and deliver training and support on current legal issues and developments Manage and resolve pre-litigation disputes with vendors You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Juris Doctorate degree 5+ years of sophisticated commercial / transactional legal experience 5+ years of relevant experience including: negotiation and drafting of sophisticated vendor / supplier contracts, clinical procurement, pilot / proof of concept agreements, business process outsourcing agreements, information technology / licensing negotiations, advertising, marketing, human resources, and other commercial ad hoc agreements as the need arises Current admission to a U.S. state bar, and admission to the Minnesota bar within one year of accepting offer of employment if located in Minnesota Preferred Qualification: Major law firm experience Experience managing and prioritizing multiple projects in a fast-paced environment while driving same to successful resolution in a timely and effective manner Experience meeting client needs and building trust and confidence across broad client base including senior executives Experience advocating / problem-solving in real time while negotiating with sophisticated Vendors / opposing counsel as necessary to obtain desired outcomes and meet regulatory requirements Experience working independently yet collaboratively in a team setting with other attorneys, subject matter experts and business partners of all levels Experience working in a matrixed environment Experience working in the healthcare or other highly regulated industry Proficiency with Word, PowerPoint, Excel, and other standard tools Minnesota location *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr

You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: This role will support the Threat Infrastructure Security tools in the Centene environment. This role's focus will be Data engineering/science for a Security Data Lake and automation projects. This role includes: develop strategy, execute design and implement efficient data pipelines to ensure a smooth flow of information into the Security Data Lake. Data Storage and Management: Store and manage the data the ingested data. This involves optimizing data schemas and ensuring data quality and integrity. ETL (Extract, Transform, Load) Processes: Design ETL pipelines to transform raw data into a format suitable for analysis. This involves data cleansing, aggregation, and enrichment, ensuring the data is usable for data scientists and analysts. Code Review and Mentorship: Spend time reviewing code submissions from team members, providing feedback, and mentoring junior developers or team members on best practices and design patterns. Operational support: Perform operational work including troubleshooting and On-call rotation. Data Collection and Cleaning: Acquiring data from various sources and ensuring it is accurate, complete, and ready for analysis. Data Analysis and Interpretation: Analyzing large datasets using statistical and machine learning techniques to identify trends, patterns, and insights. Model Building and Evaluation: Developing predictive models using machine learning algorithms to solve business problems. This includes selecting the right algorithms, training models, and evaluating their performance. Data Visualization: Creating clear and impactful visualizations (charts, dashboards, reports) to present data findings to stakeholders. Collaboration: Working closely with cross-functional teams, including business analysts, engineers, and other stakeholders, to understand their needs and deliver data-driven insights. Testing: Designing and conducting A/B tests to validate hypotheses or test the effectiveness of various strategies. Data Strategy: Providing strategic advice on how to leverage data for business growth and decision-making, including identifying new data opportunities. Automation and Optimization: Streamlining data processes and automating repetitive tasks, ensuring efficiency in data pipelines and analytics workflows. Continuous Learning: Stay updated with the latest trends in software architecture, AI technologies, and development tools. Problem-Solving: Be available to troubleshoot and solve complex technical problems as they arise, offering expertise to resolve issues efficiently. Professional Development and Training: Participate in or conduct training sessions to enhance the team's skills and knowledge in specific areas related to application architecture and AI technologies. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science). Requires 5 - 7 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Technical Skills: Proficiency in Databricks platform Advanced data pipeline design and development Data quality and governance Machine learning model development and maintenance Data integration processes Data security and privacy regulations Data visualization tools development Data warehouse and data mart design and development ETL (Extract, Transform, Load) processes. Data governance and compliance Proficiency in SQL and Python Knowledge of Big Data technologies (Hadoop, Spark) Cloud computing (AWS, Azure, GCP) Data modeling and architecture Advanced analytics and predictive modeling Knowledge of data privacy laws and regulations Proficiency in BI tools (Tableau, PowerBI) Strong problem-solving skills Excellent communication and presentation skills Project management and team leadership. Soft Skills: Intermediate - Seeks to acquire knowledge in area of specialty Intermediate - Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate - Ability to work independently Intermediate - Demonstrated analytical skills Intermediate - Demonstrated project management skills Intermediate - Demonstrates a high level of accuracy, even under pressure Intermediate - Demonstrates excellent judgment and decision making skills Intermediate - Ability to communicate and make recommendations to upper management Intermediate - Ability to drive multiple projects to successful completion Intermediate - Possesses technical aptitude License/Certification: CompTIA Security+ Certification, CISSP Certified Information Systems Security Professional, and/or Splunk Certifications preferred Databrick Certification, or Python Certifications (such as from Python Institute or Microsoft), or Professional Data Engineer (Google Cloud) or AWS Certified Big Data preferred Pay Range: $100,900.00 - $186,800.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Coordinates and supports the billing functions for assigned clinicians, across multiple practices and specialties. Works with the RCM vendor partner on daily revenue specific job functions, budget targets and all other responsibilities as assigned job functions/responsibilities; and reporting compliance issues/concerns in a timely and appropriate manner. **********

Patient First is accepting applications for AHA Education and Certification Trainer (Lead Trainer) in the Fairfax, VA and Anne Arundel, MD areas. Patient First provides a friendly work environment that promotes a team-oriented philosophy. Sign-on Bonus! The responsibilities of this job include, but are not limited to, the following: Implementing Patient First's policies and procedures; Offering quality nursing care and generating a genuinely warm and friendly atmosphere for patients and employees; Teaching ACLS, PALS, BLS Serving as Training Center Faculty Serving on the Continuing Education Committee Providing nursing care in the ambulatory setting to individual patients and families; Using sound judgment when administering medical care and screening patients; Administering medications and knowing correct dosage, actions, and side effects of each medication administered; Assisting the physician in all emergency cases; Providing positive, warm and friendly customer service in all interactions; Fostering teamwork and a positive, professional atmosphere; Completing other duties as directed. Minimum education and professional requirements include, but are not limited to, the following: Employee must be at least 18 years of age; High school graduate or equivalent; Previous PALS and ACLS experience a plus; BSN Preferred; ED, ICU or Step down experience preferred; Travel required; Teaching experience a plus; Ability to interpret and teach cardiac rhythms; Keyboarding experience required; Excellent verbal and written communication skills; One year of clerical experience preferred; One year of clinical experience with administration of medications preferred; Licensed to practice as a Registered Nurse in the state of Virginia or Maryland.

Patient First is accepting applications for X-ray Technologist in the Leesburg, Virginia area. Patient First provides a friendly work environment that promotes a team-oriented philosophy.

The responsibilities of this job include, but are not limited to the following: Following the laboratory's procedure for specimen collection, handling, and processing, as well as test analyses, reporting, and maintaining records of test results; Following the laboratory's quality control policies; Documenting all quality controls activities, instrument and procedural calibrations, and maintenance; Identifying indicators that may impact test performance or reporting of test results and either making corrections or notifying Lab Supervisor; Ordering, receiving, and distributing laboratory stock as needed in laboratory and treatment area; Understanding all checklists and being able to perform all duties on the checklists associated with the position; Adhering to safety policies as defined by Patient First and OSHA; Providing positive, warm and friendly customer service in all interactions; Fostering teamwork and a positive, professional atmosphere; Completing other duties as directed. Minimum education and professional requirements include, but are not limited to, the following: Employee must be at least 18 years of age; High school graduate or equivalent; Keyboarding experience required; Excellent verbal and written communication skills; One year of clerical experience preferred; One year of clinical experience preferred; Minimum 60 semester hours from a regionally accredited college, including chemistry, biology, and medical laboratory techniques, or an Associate degree in chemistry, biology or related science. Completion of clinical rotations in the areas of microbiology, urinalysis, chemistry and hematology; or Fifty week military Medical Laboratory Procedures course and meet qualifications for military enlisted occupational specialty of “Medical Laboratory Specialist”; Registered Medical Technologists (M.T.) or Medical Laboratory Technicians (M.L.T.) by the American Society for Clinical Pathology (ASCP) or other recognized certification agency of medical laboratory professionals preferred; Registry-eligible technologists are encouraged to apply. Salary Range: $31.50 - $35.50, depending on experience. Benefits and Other Compensation: • Health, Dental and Vision insurance for employees and dependents • Disability, Life and Long Term care insurance • Employee Assistance Program, Flexible Spending accounts, 401(k) Retirement Plan (with employer match) • Paid Annual Leave, Volunteer Time Off Pay, Bereavement Leave, Emergency Leave Bank • Overtime Pay, Holiday Pay, Double time compensation for all holidays worked • Discounted medical treatment at any Patient First location for employees and immediate family • Bonuses include: - Recruitment bonus - Patient Care Performance bonus (center employees only) - Weekend bonus (center employees only)

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned Complies with all policies and standards This is a remote position. Candidates must be licensed and located in Florida. Ideal candidates will have an LCSW, LMFT or LMHC licensure. Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 - 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Job Description Centene is hiring a Remote Psychologist - Join Our Kentucky Medicaid Team! Are you a licensed Psychologist with a Kentucky license with a passion for improving access to behavioral health care? Centene is looking for a Remote Psychologist to support our Kentucky Medicaid plan. In this role, you'll play a key part in outpatient and psych/neuro psych testing note reviews, appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds. We're seeking candidates who: Hold an active Kentucky Psychologist license Are familiar with Medicaid guidelines, prior authorization, and telehealth practices Thrive in a collaborative, remote work environment This is a great opportunity to apply your clinical expertise in a non-direct care role, supporting quality care and outcomes for the Medicaid population. Position Purpose: Authorize, direct and monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care Conduct peer reviews with psychologist and licensed therapist/certified Behavior Analyst for outpatient and/or psychological testing requests Interact with network practitioners to provide education on best practice models and utilization management processes Interact with the Medical Director, or designee, to discuss clinical authorization questions and concerns regarding specific cases Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD Facilitate outpatient rounds offering clinical input and oversight related to outpatient services Performs other duties as assigned Complies with all policies and standards Education/Experience: PhD Clinical Psychology, Counseling, Behavior Analysis, or related field required: 2+ years Behavioral Health required Working Knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence based practices. required PSY - Psychologist Unrestricted License (PhD or PsyD) Upon Hire required or: Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire required: Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

This internship offers a unique opportunity for students to gain hands\-on experience in Pharmacy Technology Management \(Clinical\)\. Interns will assist with managing processes such as user ID management, system setup, and handling eligibility issues\. They will also be involved in issue resolution by submitting tickets to vendors and internal teams, and learning system fundamentals to aid in problem\-solving\. Additionally, interns will maintain tracking logs, advocate for internal customers, and manage technology\-focused support tasks\. This role requires the ability to work independently, remotely, and without direct supervision, making it ideal for rising seniors or graduate\-level students with a background in business, technology or project management\. Interns will work closely with technology managers and project managers, gaining valuable insights into production support, project lifecycle and pharmacy technology management\. If this role interests you, please apply\! **Job Qualifications** _Education_ + Active college student \(in an accredited college or university\) who has completed a minimum of two years of college are eligible\. + Recent college graduates and students enrolled in a Masters or Doctoral program \(in an accredited college or university\) are also eligible\. + Must provide transcripts\. + Active full\-time BCBST employees are not eligible to participate in the program\. _Experience_ + Varies based on line of business\. Please see **Job Specific Requirements** section below for this internship's specific responsibilities and preferred qualifications\. _Skills/Certifications_ + Able to prioritize, work independently, and effectively manage time and resources\. + Effective communication skills: written and verbal\. + Proficient computer skills and Microsoft Office experience \(Outlook, Word, Excel and PowerPoint\) + Appropriate decision making skills required\. **GPA requirement** + Must have a 2\.75 GPA or higher **Number of Openings Available:** 1 **Worker Type:** Intern \(Trainee\) **Company:** BCBST BlueCross BlueShield of Tennessee, Inc\. **Applying for this job indicates your acknowledgement and understanding of the following statements:** BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law\. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices \(****************************************************************** **BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity\. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via\-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered\. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means\.** **Tobacco\-Free Hiring Statement** To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products \(including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes\) in any form in Tennessee and where state law permits\. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community\. **All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test\.** An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotineand/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six \(6\) months from the date of the post offer screening results\. Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree\.gov or 1\-800\-QUIT\-NOW\. About Us As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945\. More than that, we're your neighbors and friends - fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow\. BCBST is a remote\-first organization with many employees working primarily from their homes\. Each position within the company is classified as either fully remote, partially remote, or office based\. BCBST hires employees for remote positions from across the U\.S\. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York\. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense\. If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits\.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States Position Purpose: Supports the Medicare Sales Compliance team in the management of regulatory requirements associated with the Medicare sales compliance and third-party marketing materials. Consults on sales compliance topics, audits of Medicare sales activities and participates in the oversight, analysis, review, and approval of all third-party beneficiary-facing Medicare materials. Performs comprehensive, complex regulatory analyses, including the review, summarization and dissemination of key regulatory updates and changes. Performs routine audits of various sales activities, including sales events, third-party websites, and telephonic recordings. Provides regulatory support and advice to business owners as new regulations emerge. Partners with business areas to help ensure processes and policies are implemented to comply with CMS regulatory and contractual requirements. Analyzes audit data for trends, outliers, and spikes. Transforms data into presentations and recommendations for improved compliance Reviews all third-party marketing materials. Develops and hosts training sessions for business partners. Monitors and reports on the status of assigned projects, anticipating and identifying issues that could inhibit achieving the project goals and objectives, and implementing corrective actions and mitigation strategies. Provides project leadership, including the review of documents, summarizing results and implementing recommendations. Coordinates the filing of regulatory forms, reports, marketing materials, etc. May also assist other departments in understanding and complying with regulatory requirements and data entry of submission and preparation of regulatory forms, reports, and data. Tracks all sales issues referred to the Medicare Compliance Department up to and including resolution. Performs special projects as assigned. Education/Experience: Bachelor's degree in Health Administration, related field, or equivalent experience required. 3+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required. Some experience in State or Federal managed care compliance required. Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Patient First is accepting applications for X-ray Technologist (Float) in the Columbia, MD area. Patient First provides a friendly work environment that promotes a team oriented philosophy. The responsibilities of this job include, but are not limited to, the following: Obtaining quality x-rays using correct position and radiation exposure; Implementing safety procedures for patients, self, and staff to avoid unnecessary exposure to radiation; Creating and documenting x-ray CD copies correctly according to Patient First guidelines. Labeling images and sleeves correctly when making these copies; Understanding the x-ray and processing equipment so that it will be used correctly; Using and understanding the bell system; Filing and maintaining all x-ray paperwork; Ensuring the safety of patients when using wheelchairs, stools, and other equipment; Understanding and using the following: Daily Log, X-Ray Listing, Copy Listing, and X-Ray Status Screen; Understanding and using the automated medical records system; Cleaning work area, biological cleanup in accordance with OSHA guidelines and other maintenance assignments as directed; Receiving, moving, and restocking ordered supplies; Adhering to established Patient First policies and procedures; Addressing physician and nurse requests with respect and in a timely manner; Completing the tasks listed on the checklists for the x-ray area and treatment area; Attending training classes and staff meetings as scheduled; Being available as needed, breaks and mealtimes may be interrupted at any time for patient care and to maintain center operations; Responsible for the operating, using and maintaining medical and office equipment as trained. Minimum education and professional requirements include, but are not limited to, the following: Employee must be at least 18 years of age; High school graduate or equivalent; Keyboarding experience required; Excellent verbal and written communication skills; One year of clerical experience preferred; One year of clinical experience preferred; Registered with the American Registry of Radiologic Technologists (ARRT) Licensed to practice as Radiologic Technologist or a Limited Radiologic Technologist by the Virginia Board of Health Professions Limited Radiologic Technologist must be licensed to practice in the following anatomical areas: chest/thorax, extremities, skull/sinuses, spine and abdomen/pelvis. (VA only) ORLicensed to practice as a Radiographer by the Maryland Board of Physicians.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned Complies with all policies and standards This is a remote position. Candidates must be licensed and located in Florida. Ideal candidates will have an LCSW, LMFT or LMHC licensure. Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 - 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Job Description Centene is hiring a Remote Psychologist - Join Our Kentucky Medicaid Team! Are you a licensed Psychologist with a Kentucky license with a passion for improving access to behavioral health care? Centene is looking for a Remote Psychologist to support our Kentucky Medicaid plan. In this role, you'll play a key part in outpatient and psych/neuro psych testing note reviews, appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds. We're seeking candidates who: Hold an active Kentucky Psychologist license Are familiar with Medicaid guidelines, prior authorization, and telehealth practices Thrive in a collaborative, remote work environment This is a great opportunity to apply your clinical expertise in a non-direct care role, supporting quality care and outcomes for the Medicaid population. Position Purpose: Authorize, direct and monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care Conduct peer reviews with psychologist and licensed therapist/certified Behavior Analyst for outpatient and/or psychological testing requests Interact with network practitioners to provide education on best practice models and utilization management processes Interact with the Medical Director, or designee, to discuss clinical authorization questions and concerns regarding specific cases Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD Facilitate outpatient rounds offering clinical input and oversight related to outpatient services Performs other duties as assigned Complies with all policies and standards Education/Experience: PhD Clinical Psychology, Counseling, Behavior Analysis, or related field required: 2+ years Behavioral Health required Working Knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence based practices. required PSY - Psychologist Unrestricted License (PhD or PsyD) Upon Hire required or: Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire required: Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States Position Purpose: Supports the Medicare Sales Compliance team in the management of regulatory requirements associated with the Medicare sales compliance and third-party marketing materials. Consults on sales compliance topics, audits of Medicare sales activities and participates in the oversight, analysis, review, and approval of all third-party beneficiary-facing Medicare materials. Performs comprehensive, complex regulatory analyses, including the review, summarization and dissemination of key regulatory updates and changes. Performs routine audits of various sales activities, including sales events, third-party websites, and telephonic recordings. Provides regulatory support and advice to business owners as new regulations emerge. Partners with business areas to help ensure processes and policies are implemented to comply with CMS regulatory and contractual requirements. Analyzes audit data for trends, outliers, and spikes. Transforms data into presentations and recommendations for improved compliance Reviews all third-party marketing materials. Develops and hosts training sessions for business partners. Monitors and reports on the status of assigned projects, anticipating and identifying issues that could inhibit achieving the project goals and objectives, and implementing corrective actions and mitigation strategies. Provides project leadership, including the review of documents, summarizing results and implementing recommendations. Coordinates the filing of regulatory forms, reports, marketing materials, etc. May also assist other departments in understanding and complying with regulatory requirements and data entry of submission and preparation of regulatory forms, reports, and data. Tracks all sales issues referred to the Medicare Compliance Department up to and including resolution. Performs special projects as assigned. Education/Experience: Bachelor's degree in Health Administration, related field, or equivalent experience required. 3+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required. Some experience in State or Federal managed care compliance required. Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

This internship offers a unique opportunity for students to gain hands-on experience in Pharmacy Technology Management (Clinical). Interns will assist with managing processes such as user ID management, system setup, and handling eligibility issues. They will also be involved in issue resolution by submitting tickets to vendors and internal teams, and learning system fundamentals to aid in problem-solving. Additionally, interns will maintain tracking logs, advocate for internal customers, and manage technology-focused support tasks. This role requires the ability to work independently, remotely, and without direct supervision, making it ideal for rising seniors or graduate-level students with a background in business, technology or project management. Interns will work closely with technology managers and project managers, gaining valuable insights into production support, project lifecycle and pharmacy technology management. If this role interests you, please apply! Job Qualifications Education Active college student (in an accredited college or university) who has completed a minimum of two years of college are eligible. Recent college graduates and students enrolled in a Masters or Doctoral program (in an accredited college or university) are also eligible. Must provide transcripts. Active full-time BCBST employees are not eligible to participate in the program. Experience Varies based on line of business. Please see Job Specific Requirements section below for this internship's specific responsibilities and preferred qualifications. Skills/Certifications Able to prioritize, work independently, and effectively manage time and resources. Effective communication skills: written and verbal. Proficient computer skills and Microsoft Office experience (Outlook, Word, Excel and PowerPoint) Appropriate decision making skills required. GPA requirement Must have a 2.75 GPA or higher Number of Openings Available: 1 Worker Type: Intern (Trainee) Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means. Tobacco-Free Hiring Statement To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results. Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

Patient First is accepting applications for X-ray Technologist in the Capitol Heights, MD area. Patient First provides a friendly work environment that promotes a team-oriented philosophy. The responsibilities of this job include, but are not limited to, the following: Obtaining quality x-rays using correct position and radiation exposure; Implementing safety procedures for patients, self, and staff to avoid unnecessary exposure to radiation; Creating and documenting x-ray CD copies correctly according to Patient First guidelines. Labeling images and sleeves correctly when making these copies; Understanding the x-ray and processing equipment so that it will be used correctly; Using and understanding the bell system; Filing and maintaining all x-ray paperwork; Ensuring the safety of patients when using wheelchairs, stools, and other equipment; Understanding and using the following: Daily Log, X-Ray Listing, Copy Listing, and X-Ray Status Screen; Understanding and using the automated medical records system; Cleaning work area, biological cleanup in accordance with OSHA guidelines and other maintenance assignments as directed; Receiving, moving, and restocking ordered supplies; Adhering to established Patient First policies and procedures; Addressing physician and nurse requests with respect and in a timely manner; Completing the tasks listed on the checklists for the x-ray area and treatment area; Attending training classes and staff meetings as scheduled; Being available as needed, breaks and mealtimes may be interrupted at any time for patient care and to maintain center operations; Responsible for the operating, using and maintaining medical and office equipment as trained. Minimum education and professional requirements include, but are not limited to, the following: Employee must be at least 18 years of age; High school graduate or equivalent; Keyboarding experience required; Excellent verbal and written communication skills; One year of clerical experience preferred; One year of clinical experience preferred; Registered with the American Registry of Radiologic Technologists (ARRT); Licensed to practice as a Radiographer by the Maryland Board of Physicians.