Utility accounts director jobs near me - 54 jobs

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Manager, Utilization Management (UM) Coordination, oversees non-clinical inpatient and pre-service operations under the direction of the Director of Utilization Management. This role provides leadership to UM Supervisors and their coordinator teams to ensure timely, accurate, and compliant processing of authorizations and referrals in accordance with CMS and organizational standards. The Manager drives operational efficiency, staff development, and process improvement while collaborating with internal departments to support continuity of care and overall service quality. Job Responsibilities: Provide operational leadership and direction to two Utilization Management Supervisors overseeing non-clinical coordinator teams supporting both Inpatient and Pre-Service workflows. Lead the teams meet established turnaround times (TATs), quality, and productivity standards for authorization processing, referral routing, and related UM functions. Oversee staffing allocation, scheduling, and workload balancing between inpatient and pre-service units to maintain consistent service levels. Conduct regular one-on-one meetings with supervisors to review performance metrics, workflow barriers, and staff development needs. Own the daily operations to ensure timely and accurate completion of authorizations, correspondence, and documentation in compliance with CMS, NCQA, and organizational standards. Identify process inefficiencies and implement corrective actions to improve turnaround, accuracy, and staff productivity. Lead root-cause analyses for escalated operational issues and coordinate corrective action plans. Responsible for all the accuracy of all UM workflows, systems, and reporting dashboards to support data-driven decision making. Oversee the development and delivery of training materials, competency assessments, and reference guides to promote consistent and compliant practices. Mentor Supervisors to build leadership capacity, coaching them on staff management, delegation, and performance improvement techniques. Drive onboarding, cross-training, and refresher sessions are regularly conducted to support staff versatility across inpatient and pre-service functions. Manage all team activities adhere to CMS and organizational policies related to Utilization Management, confidentiality, and member communication standards. Oversee internal audit reviews and collaborate with the Quality and Compliance teams to address findings and implement improvement plans. Direct that all letters and communications use approved templates and standardized language for UM determinations and continuity-of-care requirements. Participate in internal and external audits, Medical Services Committee meetings, and other regulatory reviews as required. Review and analyze key performance indicators (KPIs), including volume, turnaround time, accuracy, and productivity reports; present trends and improvement strategies to leadership. Support the preparation and submission of monthly UM reports, dashboard summaries, and Medical Services Committee deliverables. Leverage data to identify training needs, process gaps, and operational trends impacting service delivery or compliance. Serve as a liaison between UM, Case Management, Provider Relations, and Claims departments to streamline interdepartmental communication and issue resolution. Collaborate with network providers and internal teams to clarify authorization processes and ensure alignment with benefit and policy criteria. Participate in internal workgroups or initiatives to improve system functionality, workflow automation, and reporting enhancements. Assist with the development, implementation, and monitoring of UM-related initiatives and special projects (e.g., claims review process, continuity-of-care tracking, or performance optimization programs). Evaluate and revise UM policies and procedures to align with evolving regulatory standards and organizational goals. Support readiness activities for CMS audits and other accreditation requirements. Perform other related functions and special assignments as directed by senior leadership. Core Competencies: Leadership & Talent Development - Demonstrates the ability to lead through others by developing and empowering supervisors and staff. Fosters a culture of accountability, engagement, and continuous improvement within the UM department. Operational Management - Applies strong organizational and analytical skills to oversee workflow execution, resource allocation, and performance metrics across inpatient and pre-service teams. Regulatory & Compliance Expertise - Maintains in-depth knowledge of CMS regulatory standards, confidentiality requirements, and UM protocols to ensure full compliance and audit readiness. Analytical Thinking & Decision-Making - Uses data to identify trends, evaluate outcomes, and implement process improvements that enhance accuracy, turnaround times, and service quality. Communication & Collaboration - Communicates clearly across all organizational levels; partners effectively with Clinical Operations, Provider Relations, Case Management, and Claims to resolve issues and align priorities. Process Improvement & Innovation - Continuously evaluates operational workflows and implements efficiency strategies that support organizational goals and member satisfaction. Member & Service Orientation - Demonstrates commitment to delivering high-quality service, ensuring that UM processes support positive member experiences and continuity of care. Change Management - Adapts to evolving regulatory, system, and organizational needs while leading teams through process transitions and new initiatives effectively. Supervisory Responsibilities: Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management. Job Requirements: Experience Required: Minimum (4) years of related experience in a managed care setting and a minimum (3) years of recent and related supervisory experience Education Required: Highschool Diploma or GED Required Preferred: Bachelor's Degree or higher Other: Strong knowledge of Medicare Managed Care Plans Proficient in Microsoft Word, Excel, and Outlook; advanced Excel skills preferred (pivot tables, formulas, data visualization, and reporting functions for performance tracking and analysis). Experience leading and sustaining process improvement initiatives within healthcare operations to enhance efficiency, compliance, and service quality. Communication and Interpersonal Skills - Excellent written and verbal communication skills; able to build and maintain collaborative relationships with diverse teams, including leadership, staff, and external partners. Analytical and Reasoning Skills - Strong analytical thinking with the ability to define problems, collect and interpret data, establish facts, draw valid conclusions, and develop actionable solutions. Problem-Solving and Organizational Skills - Demonstrated ability to prioritize multiple tasks, manage time effectively, and maintain accuracy in a fast-paced, dynamic environment. Data and Report Analysis - Ability to interpret, analyze, and present statistical and operational reports to support decision-making and performance monitoring. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $70,823.00 - $106,234.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.

Role Description As the Manager, Account Management you bring a proven track record of leading high-performing sales teams, with at least two years of leadership experience across both transactional and enterprise customer lifecycles. The ideal candidate is a strategic thinker who's also willing to get hands-on-joining calls, partnering on deal strategy, and helping reps win. They lead with a people-first, coaching-oriented approach, setting a high bar while developing talent and fostering growth. In a fast-paced tech environment, this person is agile in the face of change and thrives amid ambiguity, guiding teams with clarity and resilience. This role requires a strong command of sales process and operational rigor, with the ability to drive team-wide consistency in pipeline management, activity, and revenue performance. The ideal candidate will be familiar with structured sales methodologies (such as MEDPPICC, Challenger or Winning by Design) and will use the methodology consistently to enable value-based, impact-driven selling. Success in this role requires a data-driven mindset-bringing precision to forecasting and balancing the dynamics of high-velocity sales with the complexities of enterprise engagement. Responsibilities Manage a team of account managers responsible for retention and growth targets across both transactional and enterprise motions. Lead with a people-first mindset, setting a high bar while developing talent through a coaching and growth-focused approach. Set team strategic direction while also engaging directly with reps-whether on calls or in deal strategy-to drive results. Champion leading through ambiguity, building alignment, and creating a shared sense of purpose during go-to-market transformation. Maintain a structured approach to managing team activity, pipeline health, and revenue outcomes, ensuring consistent execution and accountability. Display ability to incorporate and coach to sales methodologies to drive value-based selling over transactional approaches. Leverage data to forecast accurately and inform decisions, balancing high-velocity sales environments with complex enterprise deals. Requirements Minimum 2 years of experience managing a high-performing sales teams with an additional 5+ years of sales closing experience tied to strategic, value driven sales Previous exposure to navigating go-to-market transformation with a demonstrated ability to build commercial strategies that adapt to evolving product portfolios and buyer personas Proven ability to grow, coach, and lead high-performing sales teams with accountability to quota and KPIs Data-driven and highly analytical with strong command of Salesforce and modern sales tools including Gong, Outreach, Sales Navigator, etc. Exceptional communicator and cross-functional collaborator capable of aligning diverse stakeholders around new strategies Comfortable working in a virtual-first, fast-paced, and ambiguous environment Bachelors Degree or equivalent required Preferred Qualifications Background working in startup or scaling tech companies Demonstrated experience leveraging AI tools in the flow of work Experience working in several different size and stage of companies, from SMB to mid-market and enterprise level organizations. Compensation US Zone 1 This role is not available in Zone 1 US Zone 2$214,600-$290,400 USDUS Zone 3$190,700-$258,100 USD

ABOUT: The current accounting environment has seen a large takeover of private equity firms, which can impede an individual's ability to move up the career ladder; however, our Client is different. Our Client's flourishing, award-winning business seeks a growth-oriented individual to become its future Audit Director. This position will quickly become Partner-level and will have immense influence on the firm's development. If you're looking to advance your career and join a company that values its employees' well-being, please apply today! Requirements: CPA is required for this position Minimum of 8 years of public accounting experience, focusing on Audit functions. Diverse client industry/ sector experience, such as: nonprofits, construction, real estate, life sciences, energy/ oil, etc. Minimum Bachelor's degree in accounting or related field. Experience leading teams and mentoring junior staff. Interest/ experience in developing new business. Comfortable with client interface and ensuring client satisfaction. Salary: $150K-$220K/yr base salary DOE Benefits: Opportunity for flexible REMOTE work Health/ Dental/ Vision/ Life/ Disability/ AD&D Insurance HSA & FSA 401(k) Performance Bonuses Parental & Family Medical Leave PTO/ Vacation/ Sick/ Paid Holidays Professional Development Tuition Assistance Company events + Much More

Immunovant, Inc. is a clinical-stage immunology company dedicated to enabling normal lives for people with autoimmune diseases. As trailblazer in anti-FcRn technology, the Company is developing innovative, targeted therapies to meet the complex and variable needs of people with autoimmune diseases. The Role: Reporting to Sr. Director, Quality Audit Management, this position is vital for ensuring Immunovant's clinical studies and operations are compliant with internal and external regulatory and quality standards. The person in this role will plan, implement, execute and complete the GCP audit program using a risk -based approach for all Immunovant clinical trials, including audits of Clinical Investigator Sites, Clinical Research Organizations (CROs), Clinical Testing Laboratories, Clinical Data Systems and internal processes to ensure Sponsor oversight complies with Good Clinical Practice (GCP). They will also be responsible for tracking audit metrics /data and monitoring timelines to demonstrate effective execution of the GCP audit program and to support data-driven decision making. Key Responsibilities: Plan, organize, and conduct clinical audits as Lead Auditor to assess GCP compliance across various Clinical Investigator Sites and the company's network of Clinical Research Organizations, Clinical Testing Laboratories, and Clinical Data Management Systems; Conduct targeted /for-cause audits to support quality investigations, scientific misconduct and potential serious breach of GCP, supporting the functional teams with identifying root cause and possible corrective/preventative actions Collaborate with both internal and external parties to ensure audits are purpose-driven, refining audit scope as needed; Independently write-up audit reports, document and communicate findings across impacted functions within the organization; Collaborate with Clinical Quality on the preparation of study-specific risk profiles, evaluation of risks and controls related to GCP and study-specific requirements for various Clinical Investigator Sites; Maintain the Clinical Quality Audit Plan in collaboration with Clinical Quality to ensure GCP audits are effectively planned and executed in accordance with risk-based criteria; Manage and track audit and inspection observations; Track and maintain audit data /metrics using internal tools and systems; Support GCP inspection readiness activities; Serve as a resource for GCP compliance issues, offering guidance, identifying risks, and recommending mitigation strategies to stakeholders and functional teams; Escalate risks to senior management and suggest immediate and long-term solutions Requirements: Bachelor's degree (scientific or healthcare discipline preferred) 10+ years in a GxP pharmaceutical/biotech industry environment with strong practical application of GCP, solid knowledge of FDA, MHRA and EMA regulations and ICH requirements, experience with other GxP areas an advantage 8+ years of direct auditing experience as a Lead Auditor Experience with managing external Consultants Excellent communication skills, with the ability to remain objective and impartial throughout audits, findings presentations and implementation of CAPAs Ability to independently interpret and apply practical knowledge of regulations and guidelines for the immediate resolution of compliance and Culturally competent to communicate and effectively navigate cross-functional needs within multiple teams Ability to travel both domestically and internationally Lead Auditor Certification preferred Work Environment: Remote-based Dynamic, interactive, fast-paced, and entrepreneurial environment Domestic or international travel are required (10-30%) Salary range for posting$215,000-$225,000 USD Compensation is based on a number of factors, including market location, and may vary depending on job-related knowledge, skills, and experience. Equity and other forms of compensation may be provided as part of a total compensation package, in addition to a full range of medical, dental, vision, 401k, and other benefits, including unlimited paid time off and parental leave.

“Mineralys Therapeutics is a clinical-stage biopharmaceutical company focused on developing medicines to target hypertension and related comorbidities such as chronic kidney disease (CKD), obstructive sleep apnea (OSA) and other diseases driven by dysregulated aldosterone. Its initial product candidate, lorundrostat, is a proprietary, orally administered, highly selective aldosterone synthase inhibitor. Mineralys is headquartered in Radnor, Pennsylvania. For more information, please visit ************************ Follow Mineralys on LinkedIn, Twitter and Bluesky” Mineralys is a fully remote company. The Director of Internal Audit is the internal audit leader for the Company and is responsible for designing, building, and leading a risk-based internal audit function for a growing, publicly traded biopharmaceutical organization. This role provides independent and objective assurance and advisory services focused on governance, risk management, and internal control over financial reporting (ICFR), including Sarbanes-Oxley Section 404 compliance. The Director of Internal Audit will partner closely with executive leadership, the Audit Committee, and cross-functional stakeholders to evaluate and strengthen processes across R&D, G&A, commercial operations, supply chain, and manufacturing. This remote position is based in Colorado, with regular bi-monthly, in person meetings with the Finance team in the Boulder region. Principal Responsibilities Establish, lead, and continuously enhance the internal audit function, including strategy, organizational structure, methodology, and annual risk-based internal audit plan. Develop, present, and obtain approval of the annual internal audit and SOX compliance plan; provide regular updates on plan execution, key findings, and remediation status. Oversee the Company's SOX 404 program, including scoping, risk assessment, process documentation, control design and testing, deficiency evaluation, and reporting of internal control over financial reporting. Lead and execute (directly and through staff and co-sourced providers) financial, operational, IT, and compliance audits across clinical, commercial, manufacturing, and corporate functions in accordance with professional internal audit standards. Provide independent assurance over the design and operating effectiveness of controls in high-risk areas such as revenue recognition, gross-to-net, inventory and COGS, third-party relationships, treasury, payroll, and equity compensation. Partner with management to identify, assess, and prioritize key enterprise risks, and ensure the internal audit plan is aligned with the Company's risk profile and strategic objectives. Coordinate and oversee co-sourced or outsourced internal audit providers, ensuring quality, consistency, and value-added recommendations. Prepare clear, concise audit reports and presentations that communicate issues, root causes, and practical recommendations to management and the Audit Committee. Monitor and report on the status of management action plans to remediate identified control gaps, and validate closure of issues. Stay current on evolving regulatory expectations, internal audit and SOX best practices, and industry trends in biotech and life sciences; recommend enhancements to the Company's governance, risk, and compliance practices. Foster a culture of risk awareness, ethical conduct, and continuous improvement through training, communication, and partnership with business leaders. Build, lead, and develop a high-performing internal audit team; provide coaching, mentorship, performance feedback, and career development opportunities. Direct supervisory responsibility for internal audit staff and manages relationships with co-sourced or outsourced internal audit providers. Skills and Attributes 1. Deep knowledge of internal auditing standards, risk-based auditing, and internal control frameworks (e.g., COSO). 2. Strong expertise in Sarbanes-Oxley (SOX) 302/404 compliance, including ICFR design, testing, and remediation. 3. Significant experience in a publicly traded biopharmaceutical, biotech, or life sciences company, preferably with exposure to both clinical and commercial operations. 4. Proven ability to develop and execute a risk-based internal audit plan and to communicate results effectively to management and the Audit Committee. 5. Strong understanding of financial reporting processes, U.S. GAAP, and key areas of risk such as revenue recognition, inventory, COGS, and third-party programs. 6. Highly skilled in assessing processes, identifying control gaps, and developing pragmatic, value-added recommendations. 7. Exceptional communication, presentation, and influencing skills, with the ability to build trust and collaborate across all levels of the organization. 8. Demonstrated leadership in building, managing, and developing high-performing teams and effectively overseeing co-sourced audit partners. 9. High degree of integrity, objectivity, professional skepticism, and commitment to ethical business practices. 10. Proficiency with ERP and financial systems (e.g., NetSuite) and experience leveraging data analytics and automation tools to enhance audit coverage and insight. Travel This position requires up to 10 % travel. Frequently travel is outside the local area and overnight. Education and Experience Bachelor's degree in Accounting, Finance, Business Administration, or a related field is required; an advanced degree is a plus. Professional certification such as CPA, CIA, or CISA is strongly preferred. 12+ years of progressive experience in internal audit, risk management, and/or public accounting, with at least 5 years in a leadership role (Senior Manager level or above). Prior experience in a publicly traded biopharmaceutical, biotech, or life sciences company is strongly preferred. Demonstrated experience leading SOX 404 compliance programs and working closely with external auditors and Audit Committees. Background in a Big 4 or large public accounting firm and/or corporate internal audit leadership in a complex, global environment is highly desirable. Proven ability to build and scale internal audit functions, including implementing risk-based audit methodologies, technology enablement, and best practices. This position is eligible for standard Company benefits including medical, dental, vision, time off and 401K, as well as participating in Mineralys incentive plans are contingent on achievement of personal and company performance. Actual compensation may vary from posted hiring range based on geographic location, work experience, education, and/or skill level. US Salary Range: 180,000 - 198,000 #LI-Remote

Blockchain.com is connecting the world to the future of finance. As the most trusted and fastest-growing global crypto company, it helps millions of people worldwide safely access cryptocurrency. Since its inception in 2011, Blockchain.com has earned the trust of over 90 million wallet holders and more than 40 million verified users, facilitating over $1 trillion in crypto transactions. Blockchain.com is seeking an accomplished Director of SOX & Internal Controls to lead our global Sarbanes-Oxley (SOX) program. This is a high-impact leadership role responsible for designing, implementing, and maturing a scalable internal control framework to support our continued global growth and public company readiness. You will partner cross-functionally with leaders in Finance, IT, Engineering, and Product to build and maintain a best-in-class control environment, embed operational excellence, and foster a culture of accountability across the organization. WHAT YOU WILL DO Lead our end-to-end global SOX 404 compliance program, including annual risk assessments, scoping, control design, testing, and remediation under the COSO framework. Build, lead, and mentor a high-performing team of internal controls professionals, fostering a culture of accountability and continuous improvement. Partner with Engineering, Product, and IT to design, monitor, and document automated controls and system dependencies for our core financial and operational systems. Partner with our Global Risk & Compliance IT team in serving as a trusted advisor on IT general controls (ITGCs), including system access, change management, and data integrity for all in-scope systems. Prepare and present clear, actionable reports on SOX compliance, control deficiencies, and remediation progress to executive leadership and the Audit Committee. Manage the relationship with external auditors, coordinating annual testing, process walkthroughs, and timely resolution of any findings. Drive SOX readiness and integration for any future acquisitions, ensuring a seamless onboarding of new processes and controls. Champion the continuous improvement and automation of controls across key business cycles (e.g., Order-to-Cash, Digital Assets, Procure-to-Pay, Record-to-Report). WHAT YOU WILL NEED 12+ years of progressive experience in SOX compliance, internal audit, or risk management, with at least 5 years in a leadership role. Preference for prior experience in crypto, fintech, or start-up environments CPA, CIA, or CISA certification is required. Deep expertise in SOX 404 requirements, the COSO 2013 framework, and PCAOB auditing standards. Proven success building and scaling a SOX program in a high-growth, global technology company; prior public company experience is required. A combination of “Big 4” public accounting and corporate industry experience is strongly preferred. Strong understanding of IT general controls (ITGCs) and hands-on experience with complex financial systems Experience working with Google Workspace and Microsoft Office Suite; Experience with NetSuite preferred Exceptional leadership and communication skills, with a demonstrated ability to influence senior stakeholders and drive cross-functional initiatives. A proactive, self-starter mindset with strong project management skills and the ability to thrive in a fast-paced, evolving environment. COMPENSATION & PERKS Competitive full-time salary based on experience and meaningful equity in an industry-leading company This is a role based in our Dallas office, with a mandatory in-office presence four days per week. The opportunity to be a key player and build your career at a rapidly expanding, global technology company in an exciting, emerging industry. Performance-based bonuses Apple equipment provided by the company Work from Anywhere Policy: You can work remotely from anywhere in the world for up to 20 days per year. We also offer benefits that include medical and dental coverage, retirement benefits, paid parental leave, flexible paid time off. Additionally, this role might be eligible for discretionary bonuses, and full-time employees will receive equity as part of the compensation package. Note: Blockchain.com benefits programs are subject to eligibility requirements. Blockchain is committed to diversity and inclusion in the workplace and is proud to be an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, religion, color, national origin, gender, gender expression, sex, sexual orientation, age, marital status, veteran status, disability status or any other characteristic protected by law. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, and apprenticeship. Blockchain makes hiring decisions based solely on qualifications, merit, and business needs at the time. You may contact our Data Protection Officer by email at ******************. Your personal data will be processed for the purposes of managing Controller's recruitment related activities, which include setting up and conducting interviews and tests for applicants, evaluating and assessing the results thereto, and as is otherwise needed in the recruitment and hiring processes. Such processing is legally permissible under Art. 6(1)(f) of Regulation (EU) 2016/679 (General Data Protection Regulation) as necessary for the purposes of the legitimate interests pursued by the Controller, which are the solicitation, evaluation, and selection of applicants for employment. Your personal data will be shared with Greenhouse Software, Inc., a cloud services provider located in the United States of America and engaged by Controller to help manage its recruitment and hiring process on Controller's behalf. Accordingly, if you are located outside of the United States, your personal data will be transferred to the United States once you submit it through this site. Because the European Union Commission has determined that United States data privacy laws do not ensure an adequate level of protection for personal data collected from EU data subjects, the transfer will be subject to appropriate additional safeguards under the standard contractual clauses. Your personal data will be retained by Controller as long as Controller determines it is necessary to evaluate your application for employment. Under the GDPR, you have the right to request access to your personal data, to request that your personal data be rectified or erased, and to request that processing of your personal data be restricted. You also have the right to data portability. In addition, you may lodge a complaint with an EU supervisory authority.

Join us to shape the future of audit reporting at JPMorgan Chase! As the Product Director within the Strategy, Innovation, & Practices team, you will drive innovation and transformation, delivering impactful solutions that empower our audit teams and senior leaders. As the Product Director within the Strategy, Innovation, & Practices team, you will promote innovation and transformation by delivering impactful solutions that empower our audit teams and senior leaders. In this role, you will lead the Reporting Product within the Audit Workflow Tool, spearheading innovation, unifying reporting solutions, and championing the use of artificial intelligence to deliver actionable data, insights, and a compelling business case. You will foster a culture of continuous improvement, guide a high-performing team, and help set the strategic direction for the department. Your leadership will enable operational excellence and promote meaningful change across the organization. Job Responsibilities Oversee the end-to-end delivery, launch, and enhancement of the Audit Workflow Tool Reporting Product and modules, including intake, dependency management, release management, and testing. Direct the multi-step design and delivery of a critical business case creating a unified AI generative stakeholder insights engine. Unify and integrate reporting solutions to align with business objectives and deliver seamless user experiences. Build and maintain strong relationships across product, technology, and operational teams to enhance efficiency and coordination. Develop a deep understanding of technical specifications and database structures to influence strategic design and communicate benefits to stakeholders. Monitor product timelines, manage dependencies, address blockers, and ensure adequate resourcing. Ensure compliance with firmwide risk, control, and regulatory requirements. Deliver business updates to internal stakeholders, including product, technology, audit teams, and governing bodies. Manage talent processes, including recruitment and performance reviews, while fostering an inclusive and supportive team environment. Provide coaching, feedback, and development opportunities to help team members grow and achieve their potential. Required qualifications, capabilities, and skills 10+ years of experience delivering high-impact products, projects, or technology applications, or managing database architecture. Excellent verbal and written communication skills, with the ability to present complex issues to senior management and influence change. Strong team player with the ability to collaborate locally and globally, share information, and encourage participation. Self-motivated, enthusiastic, and effective under pressure, with a strong sense of accountability. Proven relationship-building skills, adaptability, and strategic thinking. Ability to multitask, prioritize, and deliver results in a fast-paced environment. Strong project management and problem-solving skills, with a focus on continuous improvement. Experience leading and managing large, complex technology builds. Preferred qualifications, capabilities, and skills Background in technology, internal audit, audit operations, or client success/enablement. Experience with Java-based applications and Oracle databases.

Education Postsecondary non-Degree (Cert/Diploma/Program Grad) of an Accredited School of Nursing required Associate's Degree in healthcare or related field required Bachelor's Degree in healthcare or related field preferred Equivalent combination of Education and/or Experience in lieu of education (3+ years in a related field) may be considered. Licenses/Certifications Healthcare professional licensure preferred. In lieu of licensure, 3+ years of experience in relevant field required. Some states may require licensure or certification. Experience 3+ years of experience in a healthcare strongly preferred. Experience in managed care, case management, utilization review, or discharge planning a plus. At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary The Utilization Management Manager plays a vital role in ensuring patients have timely access to care by managing both front-end prior authorizations and in-house concurrent review authorizations. This position blends strong relationship-building skills with clinical knowledge to navigate complex payer requirements, streamline the authorization process, and support seamless patient transitions. From start to finish, this role drives the authorization process-reviewing prospective, retrospective, and concurrent medical records; coordinating with referring hospitals to secure prior authorizations; and partnering with case management teams at ScionHealth facilities to complete concurrent review authorizations. Acting as a navigator and liaison between Business Development, facility administration, managed care organizations, and payors, the specialist ensures determinations are communicated promptly and accurately to all relevant stakeholders. By combining attention to detail with proactive collaboration, the Utilization Management Manager safeguards revenue integrity, reduces delays, and supports the organization's mission of delivering exceptional patient care. This role actively contributes to quality improvement, problem-solving, and productivity initiatives within an interdisciplinary model, demonstrating accountability and a commitment to operational excellence. Essential Functions Extrapolates and summarizes essential medical information to obtain authorization for admission and continued stay to/at ScionHealth Level of Care. Prepares recommendations to sumbit timely request for reconsideration of denial determination in attempt to have denied authorization requests overturned. Ensures authorization requests are processed timely to meet regulatory timeframes. Reviews medical necessity assessments completed by case management, evaluating documentation for specific criteria related to severity of illness, and level of care appropriateness. Generates written appeals to medical necessity-based payor denials for denials prior to admission and concurrent review authorizations. Appeal letters may be processed on behalf of the physician, combining clinical and regulatory knowledge in efforts to have consideration of authorization. Documents authorization information in relevant tracking systems. Effectively builds relationships with business development team, admissions team/clinical staff and managed care team, to coordinate the patient admission functions in keeping with the mission and vision of the hospital. Supports review of patient referral for clinical and financial approval and/or escalation to leadership for approval following the Care Considerations grid. Coordinates and facilitates pre-admission Prior Authorizations for patients from the referral sources: Identifies /reviews medical record information needed from referring facility. Applies appropriate clinical guidelines to pre-authorization determination process. Communicates specific patient needs for equipment, supplies, and consult services as related to prior authorization requirements. Acts as a liaison with the Business Development team through every stage of the authorization process through determination. Initiates appeals process as appropriate. Facilitates and coordinates physician-to-physician communication as appropriate to support the denial management process. Communicates to appropriate teams, including business development and facility administration when clinical authorization and financial approval is complete, following standard authorization process. Provides hospital team with needed prior authorization information on pending / new admissions. Coordinate with managed care payor on all coverage issues and supports the LOA process as requested. Coordinates and facilitates Concurrent Review Authorizations for patients actively in-house at a ScionHealth facility Identifies /reviews medical record information needed from facility. Applies appropriate clinical guidelines to concurrent review authorization process. Review medical necessity review information provided by the case management team and communicates any additinoal questions or information requests Acts as a liaison with the Case Management team through every stage of the concurrent review authorization process through determination. Initiates appeals process as appropriate. Communicates with Medical Advisors or case managers of managed care company as necessary; including during Care Coordination / Managed Care calls Maintains a knowledge of areas of responsibility and develops and follows a program of continuing education. Participates in continuing education/ professional development activities. Learns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve them. Knowledge/Skills/Abilities/Expectations Strong relationship building skills and a spirit to serve to ensure effective communication and service excellence. Knowledge of regulatory standards and compliance guidelines. Working knowledge of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare and Medicaid rules, regulations, coverage guidelines, NCDs and LCDs. Working knowledge of Medicare, Medicaid and Managed Care payment and methodology. Extensive knowledge of clinical symptomology, related treatments and hospital utilization management. Excellent interpersonal, verbal and written skills to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers. Critical thinking, problem solving, and decision-making capabilities with the ability to discern, collect, organize, evaluate, and communicate pertinent clinical information with effective verbal and written skills. Technical writing skills for appeal letters and reports. Effective time management and prioritization skills. Computer skills with working knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook), word-processing and spreadsheet software. Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members. Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and others. Adheres to policies and practices of ScionHealth. Must read, write, and speak fluent English Must have good and regular attendance. Approximate percent of time required to travel\: N/A

We're Proof, a high growth company in the legal tech industry founded in 2017. We've built a best-in-class legal services platform used by thousands of law firms with a sustained average growth rate of over 10%. Our marketplace platform helps law firms and pro se parties access more efficient, transparent, and accessible legal services that are not traditionally available to everyone. Our primary services are Service of Process and E-Filing. We currently support over 3,000 law firms throughout the US and countless pro se parties. We welcome people from all backgrounds who seek the opportunity to help build a future where access to legal services is readily available, affordable, and efficient. Work with us if you have the curiosity, passion, and collaborative spirit to achieve the fundamental change in an outdated industry. About the Role We are looking for a seasoned, relationship-oriented Account Manager who thrives in the field. This is a remote role with extensive travel. So it is ideal for someone who loves being on the road, meeting clients face-to-face, understanding their operations, and becoming a trusted strategic partner. You will own relationships across some of our biggest and most complex accounts in the Property Management vertical. Your primary responsibilities will be retention, expansion, and maximizing adoption across our suite of products. This is a pivotal role at Proof, you will help shape how we partner with the largest PM portfolios in the country and ensure we deliver world-class service. Responsibilities Account Ownership & Relationship Management Own and manage a portfolio of major Property Management clients across the U.S. Build deep, consultative relationships with executives, regional managers, and onsite staff. Become the go-to point of contact for all strategic and day-to-day needs. Conduct regular QBRs, onsite visits, and performance reviews. Retention & Growth Drive high retention and reduce churn through proactive, hands-on support. Identify and execute expansion, upsell, and cross-sell opportunities. Ensure clients are fully educated on our capabilities and new products. Build account plans that forecast risks, opportunities, and expansion paths. Operational Excellence Partner with Product, Ops, and Support to solve issues, streamline workflows, and implement improvements. Understand client operational processes deeply and serve as their internal advocate. Monitor usage metrics and proactively address adoption gaps. Provide feedback to leadership on trends, needs, and market opportunities. Travel & Onsite Engagement Travel frequently to meet with PM portfolios and regional teams. Host trainings, onsite workshops, and relationship-building sessions. Attend conferences, industry events, and customer summits as needed. Qualifications 4-6+ years of Account Management, Customer Success, or field-based client-facing experience Proven track record of managing large, complex accounts or multi-site clients Ability and willingness to travel extensively (“road warrior”) Strong communicator with high emotional intelligence Deeply customer-focused and comfortable handling escalations Ownership mindset- you treat your accounts like your own business Preferred Qualifications Experience in property management, proptech, legal tech, or operations-heavy customer portfolios Experience driving expansion, renewals, and cross-functional customer initiatives Ability to run structured QBRs and executive-level reviews Experience working in a fast-moving startup or scale-up environment Compensation Salary range $100,000 - $140,000 based on experience and location Eligible to participate in company bonus plan Benefits Full time, hybrid, salary position Medical, dental, vision, disability insurance, and 401k available Flexible time off (paid planned and sick time, and paid holidays) Equipment provided E-Verify This company participates in E-Verify, for more information view the Participation and Right to Work Posters.

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: The Behavioral Health Utilization Manager for Inpatient and 24-Hour Diversionary Services is responsible for overseeing the appropriate and effective utilization of mental health and substance use disorder services across inpatient and residential care settings. This role entails conducting concurrent reviews, facilitating discharge planning, ensuring smooth transitions of care, and collaborating with care managers and state agencies to support members in achieving optimal health outcomes. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Responsibilities: · Use advanced clinical judgment and critical thinking to evaluate inpatient and 24-hour behavioral health services, determining the appropriateness of care based on individual member needs, clinical presentations, and professional standards. · Coordinating comprehensive discharge plans in collaboration with care managers, providers, and state agencies to ensure timely access to community-based support. · Identify potential risks and barriers to recovery during transitions of care and proactively implement creative solutions to support continuity and member stabilization. · Develop and oversee individualized care plans in partnership with hospital treatment teams, ensuring alignment with clinical objectives and long-term recovery goals. · Evaluate and approve requested behavioral health services by integrating clinical expertise with benefit considerations, provider resources, and member-specific factors. · Monitor inpatient stays to ensure that clinical decision-making aligns with organizational values, contractual expectations, and overall quality of care goals. · Proactively identify members who would benefit from enhanced care coordination and initiate referrals to high-touch case management and wraparound services. · Maintain timely and accurate documentation of clinical assessments, interventions, and decisions, reflecting professional discretion and adherence to ethical and regulatory standards. · Participate in clinical rounds and interdisciplinary case discussions to support collaborative care planning and cross-functional learning. · Represent the organization with external partners, including providers and state agencies, to address systemic barriers and contractional expectations. · Assess cases for potential indicators of Fraud, Waste, or Abuse and report findings per organizational protocols. · Provide crisis intervention support using clinical judgment to de-escalate situations and assist members in stabilizing their conditions. · Collaborate with Medical Directors and clinical leadership on strategic initiatives aimed at improving access, reducing unnecessary hospitalizations, and enhancing member outcomes. · Uphold all organizational policies, professional standards, and compliance requirements. · Contribute to special projects and organizational initiatives as assigned by senior leadership, offering insight and subject matter expertise · In rotation with other BH UM clinicians, provide weekend and holiday support for members ED boarding and manage urgent authorization needs. Potential Additional Responsibilities · Management of members who are Boarding in Emergency Departments. · Including assessing for possible diversion to lower levels of care or providing placement advocacy Qualifications: Educational Requirements: · Master's degree in Social Work, Psychology, Counseling, or a related Behavioral Health field. Experience: · 5-7 years experience in behavioral health utilization management within inpatient and residential treatment settings. · Proven experience with discharge planning, concurrent review, and transition of care processes. Preferred Qualifications: · Experience collaborating with state agencies and community providers to support member recovery and reintegration. · Familiarity with behavioral health regulatory requirements and managed care principles. · Experience working with Child and Adolescent Behavioral Health Services and/or Substance Use Disorder Services. Licensure and Certification: · Active, unrestricted independent licensure in one of the following: LICSW, LMHC, or LMFT. Core Competencies: · Strong clinical judgment and critical thinking skills to assess complex cases and determine appropriate levels of care. · Excellent communication and interpersonal skills to engage effectively with internal and external stakeholders. · High level of organizational skills and attention to detail in managing concurrent responsibilities. · Ability to work independently in a remote environment while maintaining adherence to timelines and regulatory requirements. · Proficiency in Microsoft Office applications and data management systems. · Strong analytical and problem-solving abilities with a focus on quality improvement initiatives. Work Environment and Physical Demands: · Fully remote position with periodic travel to the Charlestown, MA office for team meetings and training sessions. · Fast-paced and dynamic work environment requiring adaptability and focus. · Minimal physical effort required; primarily desk-based tasks such as documentation and virtual meetings. · Regular and reliable attendance is essential. Compensation Range $69,500 - $100,500 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This range is based on Boston-area data, and is subject to modification based on geographic location. About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

At ABB, we help industries outrun - leaner and cleaner. Here, progress is an expectation - for you, your team, and the world. As a global market leader, we'll give you what you need to make it happen. It won't always be easy, growing takes grit. But at ABB, you'll never run alone. Run what runs the world. This Position reports to: Manufacturing Manager - NEMA Your role and responsibilities (Mandatory) In this role, you will have the opportunity to operate process equipment or machinery to convert raw materials or semi-finished parts into components or finished parts for a final product at the right time and with the required quality. Each day, you will execute the assigned tasks according to agreed workflows and in accordance with ABB standard processes and safety guidelines and reports any non-compliance. You will also showcase your expertise by operating machines in accordance with the operating manual, work schedule, and/or production order instructions. The work model for the role is: {onsite/hybrid/remote} {insert Linkedin #} This role is contributing to the {insert product group/business area/division/function} in {insert region}. Main stakeholders are {insert main stakeholder groups if available}. You will be mainly accountable for: Performing routine machinery set-up, adjustments, and repairing and fitting simple replacement parts. Ensuring regular standard maintenance of the equipment, tools set-up, programming activities, and troubleshooting and reporting issues, if any; and maintaining detailed records of machinery set-ups, repairs, and maintenance activities. Keeping track of approved, defective units, and final products. Our team dynamics (Optional) You will join a {insert adjectives - e.g. dynamic, talented, high performing} team, where you will be able to thrive. Qualifications for the role (Mandatory) You are immersed in / engaged in / absorbed in / highly skilled in/ you enjoy working with {relevant tools and methodologies} and the {insert relevant industry/sector} market Ability to demonstrate your experience in / Have established skills / advanced skills / You have {insert number of years} years of experience in {insert relevant field} (OPTIONAL: working as {insert relevant role} with {insert relevant products or technologies}) Possess an enhanced knowledge of / You are qualified in / Highly adept in {insert specialized software/platforms} You are passionate about / you are captivated by / you are innovative around {insert relevant soft skills} and {insert relevant soft skills} Degree in / Have a demonstrated track record in / Extensive knowledge of / Proven experience of {insert specific degree, qualification} in {insert subject} You are at ease communicating in {insert required language skill(s)} You hold current {insert required licenses} valid in {insert job location} and {insert country-specific VISA/work permit} {where required} What's in it for you? (Optional) Benefits (Optional) We also offer our employees the following benefits: Benefit 1 Benefit 2 Benefit 3 Benefit 4 Benefit 5 Local Specific Benefits (Open Field below - Optional) Locally, you can count on {Add local perks and benefits in text format} More about us (Mandatory) {Insert specific business area/division/service function or corporate function paragraph from common source material} {Insert country/location -specific boilerplate (1-2 sentences only)} {optional} {Insert country-specific legal statement e.g.: EEO/data privacy} {where required} {Insert PES (Pre-employment screening) sentence} {when required} {Insert local TP or hiring manager contacts if necessary} Guidelines: Please be aware: All fields in yellow should be populated with relevant information (based on Job description and the Kick-off form). All other text can also be modified if necessary, within the given guidelines. Text in bold is fixed and should not be edited or removed Reporting Manager section is mandatory both internally and externally, to be posted via eRec functionality “Your role and responsibilities” should be plain text followed by maximum 4 additional bullet points The “Qualifications for the role” section should include no less than five and no more than seven bullet points. These bullet points should be listed in order of importance for the success in the role Indicate the required language knowledge in the “Qualifications for the role” section whenever it is mandatory and/or applicable Information about “Licenses and visa/work permit” is optional, use this sentence wherever it is required In the “More about us” section you can add further legal statements/PES indications or Talent Partner contacts, for example Read more about the guidelines in the Guidelines doc available in the SharePoint We value people from different backgrounds. Could this be your story? Apply today or visit *********** to read more about us and learn about the impact of our solutions across the globe.

The once in a century transition to autonomous and electric vehicles is underway and will require a multi-trillion-dollar investment in energy and charging infrastructure, and the real estate to site it on. Terawatt is the leader in delivering large scale, turnkey charging solutions for companies rapidly deploying AV and EV fleets. Whether it's an urban mobility hub, or a carefully located multi-fleet hub for semi-trucks, Terawatt brings the talent, capabilities, and capital to create reliable, cost-effective solutions for customers on the leading edge of the transition to the next generation of transport. With a growing portfolio of sites across the US in urban hubs and along key logistics and transportation corridors and logistics hubs, Terawatt is building the permanent transportation and logistics infrastructure of tomorrow through a robust combination of capital, real estate, development, and site operations solutions. The company develops, finances, owns, and operates charging solutions that take the cost and complexity out of electrifying fleets. At Terawatt, we execute humbly and with urgency to provide tailored solutions for fleets that delight our clients and support the transition of transportation. Role Description Terawatt Infrastructure seeks an Energy and Utilities Manager for its Energy & Utility team. The Energy and Utilities Manager is a critical, independent contributor role responsible for developing and executing comprehensive utility engagement strategies throughout the entire development lifecycle of Terawatt Infrastructure projects. This individual will serve as the primary point of contact and subject-matter expert for all utility-related matters, ensuring seamless coordination and alignment among internal teams, including real estate, Development, Design-Construction, and Business Development. During the crucial site evaluation phase, the Energy and Utilities Manager will proactively engage with relevant utility providers to assess infrastructure availability, capacity, costs, and potential risks. This involves conducting thorough due diligence, analyzing utility maps and data, and collaborating with development teams to determine optimal site selection based on utility feasibility and economic considerations. The role extends to project engineering, where the Energy and Utilities Manager will actively contribute to the customer and utility design process, ensuring that utility requirements and specifications are integrated into project plans. This includes collaborating with teams to develop detailed utility layouts, load calculations, and energization designs. Furthermore, this individual will create realistic project schedules incorporating utility timelines for service connections, upgrades, and relocations, effectively mitigating potential delays. Budgeting is another key area of responsibility, requiring the Energy and Utilities Manager to develop and manage comprehensive utility budgets that cover connection fees, infrastructure upgrades, and ongoing service charges. This involves cost estimation, financial forecasting, and proactive identification of cost-saving opportunities. A significant aspect of this role involves skillfully negotiating and executing complex utility agreements and contracts, ensuring favorable terms and conditions for the organization. This includes managing relationships with utility providers, resolving disputes, and staying abreast of utility changes and industry best practices.Core Responsibilities Own key project milestones and deliverables, and manage delivery dates Collaborate closely and guide the Site Acquisition, Project Development, and Construction teams regarding preliminary utility-related engineering, design, and construction timelines. Understand and make critical recommendations regarding timing, cost, and economic trade-offs involved with site energization or interconnection for behind-the-meter generation. Be the owner of the dry utility space: interpret Utility Design Standards and draft dry utility space design via Bluebeam design tools. Be a problem solver when utility bottlenecks or failures are causing project delays. Inform the Company's energy and energization strategy through collaboration with the Real Estate, Project Development, Design & Construction, and Business Development teams. Identify, hire, and manage utility consultants as needed for projects. Preferred Qualifications Experience working with regulated and municipal electrical utilities in major US metro areas. A strong understanding of utility distribution/transmission planning and design, and electrical design standards. Electrical and site design experience Experience with the complete utility coordination process, from application to design to energization. Strategic thinking skills regarding business, operations, and technical challenges, coupled with the technical skills to execute project schedules, contracts, initiatives, and team objectives. Experience in estimating utility service costs. Experience with project development from greenfield or brownfield site acquisition to operational assets. We are building a team that represents a variety of backgrounds, perspectives, and skills. At Terawatt, we continuously strive to foster inclusion, humility, energizing relationships, and belonging, and welcome new ideas. We're growing and want you to grow with us. We encourage people from all backgrounds to apply. If a reasonable accommodation is required to fully participate in the job application or interview process, or to perform the essential functions of the position, please contact ********************************* . Terawatt Infrastructure is an equal-opportunity employer.

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Work Day(s) Monday-Friday Shift Start Time 8:00 AM Shift End Time 5:00 PM Worker Sub-Type Regular Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's. Job Description Provides audits and reviews patient charts, corresponding ICD-10 CM, CPT-4 codes, modifiers, HCPCS codes, and charges for appropriateness. Provides reports to management of findings and recommendations for solutions. Identifies areas of improvement which will enhance internal controls and performance throughout Children's Healthcare of Atlanta. Proactively supports the efforts that ensure safe patient care and services and promote a safe environment at Children's Healthcare of Atlanta. Works with management team to educate Coding staff on coding and documentation compliance. Experience Minimum of 5+ years professional auditing experience Preferred Qualifications Associates degree in Health Information Management or related field Education High school diploma or equivalent Certification Summary Minimum of one of the following: Certified Professional Coder (CPC) Certified Professional Medical Auditor (CPMA) Certified Coding Specialist - Physician-based (CCS-P) Knowledge, Skills, and Abilities Knowledge of diagnosis-related group and ambulatory payment classification regulations Demonstrated knowledge of InterQual Criteria and Medicaid and managed care rules and regulations Strong analytical, organizational, and communication skills Job Responsibilities Manage inventory levels in Operating Room (OR & CVOR), ensuring adequate supply availability and minimal supply disruption. Manage Cath Lab and Interventional Radiology (IR) inventory levels to ensuring supply availability and minimal disruption to procedure areas. Conducts chart audits for compliance assessment and establishes coding policy and procedure. Prepares a report of findings for each audit along with an action plan. Records and monitors corrections to the bill. Assists in designing continued education to address deficiencies. Plans and organizes work assignments to complete audits in an efficient manner. Identifies problem situations or inadequate charge reconciliation procedures. Clearly documents information to support findings and conclusions. Keeps appropriate management personnel informed of any problems or unusual circumstances on a timely basis. Facilitates improvement in the overall quality and completeness of medical records documentation. Provides documentation education. Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law. Primary Location Address Used for remote worker assignment Job Family Coding

What We Do Roo (************ has created the first B2B labor marketplace in animal healthcare that connects veterinary professionals with hospitals through innovative technology, with opportunities to expand and offer more opportunities for both our demand & supply of users. Our dynamic platform enables hospitals to fulfill personnel needs in real time, while allowing high-quality veterinary professionals to secure work at the click of a button. Beyond the platform, Roo represents a growing opportunity to help hospitals meet all-things staffing, and a growing community of resilient vet industry professionals who value flexibility and work-life balance, in addition to providing the best possible outcomes for clients and their pets. Our aim is to combine experienced healthcare expertise with Silicon Valley talent to shake up this industry and change the way veterinarians and hospitals work! Why Join Our Talent Pool? By joining our Account Management Talent Pool, you'll stay in the loop with upcoming roles, potentially becoming part of our dedicated team working to elevate the user experience for hospitals and veterinary professionals alike. Our Account Managers operate within a collaborative, fast-paced environment focused on proactive support and user satisfaction. Each Account Manager partners closely with Business Development, Finance, and Client Support teams to fulfill immediate needs, resolve user inquiries, and drive high retention numbers from our existing providers on the Roo platform. With an emphasis on responsiveness, problem-solving, and user engagement, our Account Managers help drive the growth of our community through continuous improvement and active, solutions-oriented support. If you're energized by relationship-building, thrive in a dynamic environment, and are passionate about making an impact in the animal health space by giving vets another path to support their mental health and ultimately provide the best care for our furry friends, Roo could be an ideal fit for you. When we're hiring we're looking for: Client-Centered Advocates: You're passionate about delivering exceptional experiences for hospitals and veterinary professionals, ensuring their needs are met and that they feel supported on the Roo platform. Relationship Builders: You excel at creating lasting, trust-based relationships and are dedicated to fostering a sense of community among our users. Proactive Problem-Solvers: With a solution-oriented mindset, you anticipate challenges and address issues swiftly, helping users navigate any situation with confidence and ease. Adaptable Team Players: You thrive in a collaborative, fast-paced environment, easily shifting between tasks and working across departments to meet the needs of our providers and hospitals. Growth-Oriented Professionals: You see each interaction as an opportunity to learn, improve, and contribute to Roo's mission. Typical Roles in the Account Management Team: Account Manager - Vet Focus Account Manager - Hospital Focus Enterprise Account Manager Why Roo? Roo is dedicated to creating an inclusive, mission-driven workplace. As part of the Engineering team, you'll experience: Career Development: Stipends for home office setup, continuing education, and monthly wellness. Health and Wellness: Comprehensive health benefits, including base medical plan covered at 100%, with options for premium buy-up plans. Financial Security: 401K plan to help secure your financial future. Celebrating You: Gifts on birthdays & work anniversaries, and opportunities for domestic travel and team-building events. Our team lives by core values that drive our growth and success: Bias to Urgency, Drive Measurable Impact, Seek Understanding, Solve Customer Problems, and Have Fun! What happens when I join the Talent Pool? Your resume will be stored in our ATS and as soon as a role opens up, you'll be the first to know! In the meantime, you may hear from us from time to time about exciting Roo news - if you don't wish to receive those updates you'll be given the option to unsubscribe. Salaries will vary depending on role, experience level and, location. Salary Range$65,000-$90,000 USD Core Values Our Core Values are what shape us as an organization and we're looking for people who exhibit the same values in their professional life; Bias to Urgency, Drive Measurable Impact, Seek Understanding, Solve Customer Problems and Have Fun! What to expect from working at Roo! For permanent, full time employees, we offer: Accelerated growth & learning potential. Stipends for home office setup, continuing education, and monthly wellness. Comprehensive health benefits to fit your needs with base medical plan covered at 100% with optional premium buy up plans. 401K Unlimited Paid Time Off. Paid Maternity/Paternity and reproductive care leave. Gifts on your birthday & anniversary. Opportunity for domestic travel, including for regional team building events. Overall, you would be part of a mission-driven company that will significantly empower the lives of all veterinary professionals and the health of the overall animal industry that seeks massive innovation. We have diverse, passionate & driven team members from a variety of backgrounds, and Roo 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 veteran status. We are committed to creating an inclusive environment for all employees and candidates. We understand that your individual experience may not check every box but we still encourage you to apply even if you are not confident in every expectation listed. Ready to join the Roo-volution?!

Job Description TITLE: Director Case Management / Utilization Management / CDI Now is your chance to join a Forbes magazine top 100 hospital where career growth and opportunity await you. They are committed to building healthcare teams whose care exceeds the expectations of their patients and community and are looking for quality talent who share the same values. They're nestled in a beautiful rural setting but close enough to the big city to enjoy that too! If that sounds like the change you are looking for, please read on… What you'll be doing: •Responsible for developing, planning, evaluating, and coordinating comprehensive patient care across the continuum, to enhance quality patient care while simultaneously promoting cost-effective resource utilization. Provides director-level oversight of Inpatient and ED Case Management, Utilization Management and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements. Monitors patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, and ensures that these functions are integrated into overall hospital operations. Coordinate and monitors activities with appropriate members of the health care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care, and reduce risk and liability. Collaborates closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives. •Responsible for identifying tracking mechanisms in order to evaluate and achieve optimal financial outcomes, to enhance quality patient care, and promote cost-effective resource utilization. •Uses data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity •Coordinates daily activities of the Case Management, UM, and CDI Department in order to promote quality patient care, efficient use of hospital resources, facilitate timely and adequate discharges, and reduce risk and liability. •Investigates and initiates follow-up on utilization denials, contract negotiations, and external regulatory agencies' requirements. •Directs operations of our Physician Advisor Program, including analysis of performance through reporting and committee involvement and oversight. •Actively serves on hospital committees and teams and facilitates opportunities for employees to do the same. •Develops, performs, and improves personal and departmental knowledge of computer software and reporting functions. •Organizes and oversees the maintenance of denial and appeal activity. Follows up with physicians and others when indicated. •Prepares or coordinates the preparation of periodic and special reports required by various agencies, insurance contracts, and for hospital committees. •Analyzes and trends data results in order to incorporate efforts and information results with existing systems to optimize the efficiency of operational systems through strategic quality leadership. •Facilitates growth and development of the case management program, utilization management ( including physician advisor program and clinical documentation integrity (CDI), in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities, as needed. •Develop new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and/or basic human needs for the community. •Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials, and physician reports cards, and collaboratively initiate improvements related to these areas. •Maintains hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines. •Maintains professional knowledge by participating in educational seminars and opportunities. •Participates in Population Health work at an organizational level, including active involvement with the System-Wide Care Management Team and Value-Based Care Delivery. Additional info: •Position will report to a Manager that is well respected in the organization. Position is open as the person is retiring. They use EPIC(EMR) and the facility has a lot of technology. Person would be over about 50-60 people between CM/UM/CDI. Great team to work with. •If you're a passionate Pharmacist and seeking a rewarding career in a collaborative healthcare setting, this is the opportunity you've been waiting for. Join us in east central Ohio, and become part of our exceptional team dedicated to delivering high-quality care to our community. Apply now and embark on a fulfilling career journey with us. Requirements What they're looking for: •Master's degree in nursing, Healthcare Administration, or Business Administration required. •Current Ohio RN licensure (or active multi-state licensure). •Certified Case Manager(CSM). •At least three (3) years of management or demonstrated leadership experience required. •Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning, and continuum of services offered within Genesis and externally. Knowledge of coding, mid-revenue cycle, CDI, physician advisor and payor relations. •Ability to perform data analysis and to utilize computer systems to record and communicate information to other services. •The ability to lead collaboration with other leaders in the organization, especially about the delivery of high-quality, timely, and right site of care. •Excellent leadership, verbal and organizational skills to order to steer the case management process. Benefits Hours and compensation potential: •The position is full time. •The range starts at $62.50hr($130K)-$75hr($156K) depends on years of experience. •Full benefits package being offered.

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Work Day(s) Monday-Friday Shift Start Time 8:00 AM Shift End Time 5:00 PM Worker Sub-Type Regular Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's. Job Description Provides audits and reviews patient charts, corresponding ICD-10 CM, CPT-4 codes, modifiers, HCPCS codes, and charges for appropriateness. Provides reports to management of findings and recommendations for solutions. Identifies areas of improvement which will enhance internal controls and performance throughout Children's Healthcare of Atlanta. Proactively supports the efforts that ensure safe patient care and services and promote a safe environment at Children's Healthcare of Atlanta. Works with management team to educate Coding staff on coding and documentation compliance. Experience Minimum of 5+ years professional auditing experience Preferred Qualifications Associates degree in Health Information Management or related field Education High school diploma or equivalent Certification Summary Minimum of one of the following: Certified Professional Coder (CPC) Certified Professional Medical Auditor (CPMA) Certified Coding Specialist - Physician-based (CCS-P) Knowledge, Skills, and Abilities Knowledge of diagnosis-related group and ambulatory payment classification regulations Demonstrated knowledge of InterQual Criteria and Medicaid and managed care rules and regulations Strong analytical, organizational, and communication skills Job Responsibilities Manage inventory levels in Operating Room (OR & CVOR), ensuring adequate supply availability and minimal supply disruption. Manage Cath Lab and Interventional Radiology (IR) inventory levels to ensuring supply availability and minimal disruption to procedure areas. Conducts chart audits for compliance assessment and establishes coding policy and procedure. Prepares a report of findings for each audit along with an action plan. Records and monitors corrections to the bill. Assists in designing continued education to address deficiencies. Plans and organizes work assignments to complete audits in an efficient manner. Identifies problem situations or inadequate charge reconciliation procedures. Clearly documents information to support findings and conclusions. Keeps appropriate management personnel informed of any problems or unusual circumstances on a timely basis. Facilitates improvement in the overall quality and completeness of medical records documentation. Provides documentation education. Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law. Primary Location Address Used for remote worker assignment Job Family Coding

Join a Team That's Elevating CDI Excellence! UASI is seeking an experienced CDI Auditor to join our Quality Management team providing internal quality reviews for our CDI Staff. The ideal candidate will have strong CDI expertise combined with an ability to mentor and educate the team. Responsibilities: Work with the Managers across CDI Services to coordinate and perform CDI quality audits on UASI CDI staff. Use audit tool to analyze quality results, track overall quality, and identify trends in order to create training to improve CDI quality. Perform necessary feedback and research to CDI staff in response to CDI questions. Collaborate with the education team to provide training/mentoring to CDI staff as needed based on audit findings. Work with Manager and Supervisors to identify performance needs of CDI staff and create training to increase performance levels. Comply with UASI's policies regarding the use and disclosure of protected health information which includes accessing and using protected health information only to the extent necessary to fulfill the above-mentioned responsibilities. Qualifications Bachelor's degree preferred Active CCDS credential, RN preferred Minimum of 2 years combined CDI auditing/education experience Subject matter expertise specifically with CDI in a consulting environment Exceptional communication skills including the ability to collaborate effectively with the Managers and Quality COE teams. UASI provides a supportive environment that encourages professional development and enables each employee to achieve their individual goals. We offer a competitive pay and excellent benefit package. Don't pass on this great career opportunity! Interested candidates can apply online at ******************************

Job Address: 10270 Blacklick - Eastern Road NW Pickerington, OH 43147 Role: Director of Clinical Services Job Post Title: Director of Clinical Services Solero Behavioral Transitions We provide a safe and supportive environment for individuals struggling with severe mental illness. Our program offers comprehensive care, including individual and group therapy sessions, case management services and life skills training. A mental health residential facility is a place where people receive intensive, specialized care for mental health and or substance abuse issues in a non-hospital setting. Residents receive 24-hour supervision, treatment, and support from mental health experts. The environment is homelike and supportive, and residents participate in therapeutic activities. Shift: M-F, with a weekend rotation Hours: 8-4:30 Perks at Work Healthcare: Medical Packages with Rx - 3 Choices Flexible Spending Accounts (FSA) Dependent Day Care Spending Accounts Health Spending Accounts (HSA) with a company match Dental Care Program - 2 choices Vision Plan Life Insurance Options Accidental Insurances Paid Time Off + Paid Holidays Employee Assistance Programs 401k with a Company Match Education + Leadership Development Up to $15,000 in Tuition Reimbursements Student Loan Forgiveness Programs Approved HRSA Site Approved STAR-LRP Site The Role Itself License/Education/Certification: Formal education program or training in Quality Improvement/Risk Management/Compliance for inpatient or behavioral health settings. Familiarity with healthcare laws, regulations, accreditation standards, state licensure or certification and Best Practices in healthcare compliance program implementation Knowledge of the principals of The Joint Commission and must be well versed in CMS guidelines Knowledge and understanding of the Regulatory Compliance Ohio Department of Mental Health and Addictions Serves as resource for faculty regarding medical record content and regulatory requirements Ability to adapt to change and work under stressful situation Education: Masters degree in social work with LSW and documented experience in group therapy setting. Counselor Degree Must be 21 yrs or older Top of Form License: LSW, LISW, LPC, LPCC, MFT, LMFT Current unencumbered clinical license per state of practice guidelines. Levels of Care Residential Mental Health Services A service activity which uses clinical and medical interventions, including the administration of physician prescribed medications and clinical monitoring, to help stabilize mental health symptoms to for individuals requiring a more structured and supervised environment. Partial Hospitalization Program Comprehensive Mental Health program with intensive treatment services to help individuals prepare for re-entry into all aspects of their lives including home, work, school and relationships. Program Purpose: We are committed to producing the highest level of clinical outcomes for clients and their families. Solero Behavioral Transitions is a trauma-informed, non-coercive treatment program designed to treat individuals struggling with Mental Health symptoms. The Solero's focused mental health rehabilitation includes; Building Resiliency Optimistic outlook Locus of control Sense of self Ability to bounce back Change management Practical Life Skills Problem-solving Money management Time management Personal change Self-awareness Communication Skills Active listening Nonverbal communication Communication skills Social Radar Negotiation skills These are the core concepts that extend into many areas of a client's life and help develop the foundations for recovery and recovery sustainability.

_Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them._ Providence Health Plan is calling a Coding Quality Auditor, HEDIS who will: + Be responsible for conducting clinical quality audits/overreads for the Quality Department + Identify and reports issues related to clinical audits to determine potential areas for quality improvement within the HEDIS project + Collect data by way of chart extraction, using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records + Be responsible for collecting data based on standardized methodologies + Organize the data to identify and address opportunities for improvement + Perform chart audits electronically during the audit season + Complete HEDIS training prior to performing chart abstractions + Be provided direction regarding charts requiring auditing + Maintain all collected records in a confidential manner + Performs all duties in a manner which promotes team concept and reflects the Sisters of Providence mission and philosophy + Communicate in a collaborative manner with clinic and other staff with whom they interact, in a manner that represents Sisters of Providence _Please note the following important detail regarding this HEDIS Seasonal Role:_ + This posting is for multiple openings of a Coding Quality Auditor, HEDIS + This position is affiliated with Providence Health Plan and will be tied to a location and compensation range in Beaverton, Oregon + Position Type: Temporary, Per Diem, Non Benefitted + Length of Program Anticipated to last between: January 2026 - May 2026 + Work Schedule: Monday - Friday + Work Hours Scheduled Weekly: 40 + Additional Info: + This position will require a full time commitment to the project, meaning no extended time off during the HEDIS Season (January 2026 - May 2026) + Positions specified as "on call/per diem" refer to employment consisting of shifts scheduled on an "as needed basis" to fill in for staff vacancies. Providence welcomes 100% remote work for applicants who reside in the following states: + Alaska + Washington + Montana + Oregon + California + Texas - Levelland, Lubbock or Plainview area + New Mexico + Alabama + Arizona + Delaware + Florida + Iowa + Idaho + Michigan + Minnesota + North Carolina + New Jersey + Utah Required Qualification: + Technical certification/licensure in the area of Medical Assistant, Certified Nurse Assistant, or Licensed Practical Nurse upon hire. + H.S. Diploma or GED. + 3 years - Medical record audit experience, experience with extraction of clinical data points from medical records, experience with electronic medical records (EMR), comfortable with use of technology. Ability to interpret and understand medical knowledge/terminology in a medical record. + 2 years - HEDIS, Quality management/quality improvement/utilization review auditing experience, including experience in auditing within electronic health records. + 1 year - Experience in the medical field as a Medical Assistant, Certified Nurse Assistant, or Licensed Practical Nurse (LPN). Preferred Qualifications: + Associate's Degree - Nursing or Healthcare related field, Health Information Management degree. + Experience with health plans, project management, data analysis, and/or case review. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 403837 Company: Providence Jobs Job Category: Coding Job Function: Revenue Cycle Job Schedule: Part time Job Shift: Multiple shifts available Career Track: Business Professional Department: 5018 HCS QUALITY MANAGEMENT OR REGION Address: OR Beaverton 3601 SW Murray Blvd Work Location: Murray Business Ctr Beaverton-Beaverton Workplace Type: Remote Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.