Managed Care Coordinator jobs at VIVA HEALTH - 17 jobs

Nurses and Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a Care Coordinator in Dothan, AL! The ideal candidate will be located in Pike or Bullock county. VIVA HEALTH knows that nursing and social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION REQUIRED: Licensed BSN/ADN Licensed BSW PREFERRED: Licensed MSW and/or Certified Case Manager (CCM) designation Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.

The Bilingual Lead Care Manager partners with Care Team Operations, Clinical Operations, Compliance, Community Health Workers, Behavioral Health staff, and external providers (medical, housing, and social services) to ensure seamless, culturally responsive, member-centered care coordination. The bilingual LCM additionally supports members with limited English proficiency by facilitating communication, translation, and cultural interpretation as needed. Responsibilities Serve as the primary point of contact for assigned members, building trust and maintaining active engagement through consistent outreach, relationship-based strategies, and a trauma-informed approach. Provide all communication in the member's preferred language. Conduct comprehensive assessments (physical, behavioral, functional, social) and develop person-centered care plans that reflect the member's goals, risks, preferences, cultural needs, and social determinants of health. Implement, monitor, and update care plans following transitions of care, significant changes in condition, or required reassessments; ensure timely and compliant submission of all care plans. Coordinate services across the continuum-including medical, behavioral health, housing, transportation, social services, and community programs-to reduce fragmentation and remove barriers to care. Conduct required in-person home or community visits based on member need and risk stratification and maintain a compliant monthly visit structure. Utilize motivational interviewing, coaching, and health education to promote behavioral change, self-management, and long-term member stability. Identify gaps in care, service delays, lapses in benefits, unmet needs, and environmental risks; collaborate with internal and external partners to resolve issues quickly and effectively. Maintain accurate, timely, audit-ready documentation of all interactions, assessments, and interventions using required HHN platforms, including eClinicalWorks (ECW), Google Suite, RingCentral, PowerBI dashboards, and payer portals. Meet or exceed HHN and payer productivity standards, including encounter metrics, outreach requirements, documentation timelines, and quality measures. Actively participate in multidisciplinary case reviews, team huddles, care conferences, and escalations with nurses, behavioral health staff, CHWs, care operations, and compliance. Coordinate and schedule appointments with primary care, specialists, behavioral health providers, and community partners; manage referrals, transportation, and follow-ups to ensure continuity of care. Support hospital discharge (TOC) planning through follow-up scheduling, care transitions, medication reconciliation support, and education on discharge instructions. Assist members in navigating plan eligibility, redeterminations, documentation, social service applications, housing resources, and crisis interventions. Maintain active and professional communication with members and care partners through HHN-approved channels, including RingCentral, secure messaging, SMS workflows, and phone. Participate in HHN's continuous quality improvement efforts, identifying workflow gaps, documenting barriers, sharing insights, and contributing to best-practice development. Uphold confidentiality and adhere to all HIPAA and payer regulatory requirements across all areas of care delivery. Open to seeing patients in their home or their location of preference. Provide real-time interpretation and translation support (verbal and written) for members and families with limited English proficiency. Help bridge cultural gaps that may impact communication, trust, adherence, or engagement. Skills Required Fluency in English and another language (Spanish preferred); ability to read, write, and speak at a professional level. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Bilingual Communication (interpretation + translation) Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field preferred; equivalent experience considered. Licensure: Not required; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

Join our Specialty Pharmacy team and play a vital role in supporting patients and healthcare providers. In this position, you will help coordinate medication deliveries, maintain accurate records, and ensure exceptional service-all under the supervision of a licensed pharmacist. Responsibilities Support specialty pharmacy operations, including onboarding new patients and coordinating medication deliveries. Maintain and update patient profiles, complete assessments, and document all activities accurately. Communicate with patients, caregivers, and medical staff via inbound and outbound calls to ensure timely service. Provide accurate copay information and process payments in compliance with standards. Ensure all required information for accreditation and pharmacist review is obtained and documented. Meet or exceed quality and productivity standards while delivering excellent customer service. Act as a liaison between pharmacy, operations, and healthcare professionals to resolve issues promptly. Perform additional tasks as assigned to support pharmacy operations and patient care. Qualifications Required: High School diploma or GED. Strong customer service and communication skills. Ability to manage time efficiently and work independently or as part of a team. Proficiency in Microsoft Suite and ability to maintain confidentiality of patient information. Preferred: Pharmacy technician certification. Previous experience in specialty healthcare or pharmacy operations. Familiarity with patient onboarding and medication delivery processes. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

is intended to start January 2026. The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in. Work Culture: GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together. GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer). GCHP's focuses on 5 Core Values in the workplace: • Integrity • Accountability • Collaboration • Trust • Respect Disclaimers: • Flexible work schedule is based on job duties, department, organization, or business need. • Gold Coast Health Plan will not sponsor applicants for work visas. POSITION SUMMARY The Gold Coast Health Plan (GCHP) RN, Clinical Care Manager I supports the GCHP mission to improve the health of the members through provision of the best possible quality care and services. As defined by the Case Management Society of America (CMSA): Care management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. The RN, Clinical Care Manager I works closely with other team members and is a role model and resource to colleagues. This position acts as a bridge by facilitating communication between the member, member's family and the providers. The RN, Clinical Care Manager I also provides member advocacy and education to maintain or improve clinical outcomes. Amount of Travel Required: 5-10% Work Schedule: Predominately remote work. Flexibility to work beyond normal business hours as needed. Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions. ESSENTIAL FUNCTIONS Job Function & Responsibilities • Assess and identify members who may benefit from additional education, clinical support, and connecting them with appropriate medical providers. • Promote the most cost-effective healthcare delivery by coordinating with the medical management team. • Engage members into care coordination activities to reduce care gaps. • Evaluate for and work toward elimination of barriers to care. • Formulation of a member-centric care plan in partnership with the member. • Collaborate with internal partners including but not limited to; social workers, health education, pharmacy staff and ECM/ Community Supports team, member services • Ensure confidentiality of utilization review, quality assurance information, and individual beneficiary identification • Assist with data collection for special member determination as required • Prepare written reports such as summaries of case management functions and updates of case status, use of covered services, supporting and reporting required metrics and other pertinent performance data, as directed • Provide accurate documentation to meet departmental policies, regulatory requirements and audits • Attend community meetings concerning health issues or provision of health-related services Establish and maintain effective working relationships with community resources and service agencies • Strong organizational, delegation and task prioritization skills • Member advocacy focus • Knowledge of required regulatory timelines to ensure department compliance with State contracts • Ability to convey empathy and is nonjudgmental of the member • Demonstrates team support by consistently seeking opportunities to recognize and promote colleagues • Ability to stay calm and professional when working with internal and external partners • Exhibits accountability by maintaining good attendance • Adhere to all GCHP Policies and Procedures and meet required performance standards • Review referral requests for Enhanced Care Management and Community Supports referral requests. • Authorize referral requests for various ECM and CS providers. • Serve as liaison for Justice Involved population. • Attend National Health Foundation meetings with Enhanced Care Management. • Attend CalAim meetings with Ventura County. • Educate members, staff and providers about policies for ECM and CS. MINIMUM QUALIFICATIONS Education: • Bachelor's Degree (four-year college or technical school) is preferred, Field of Study: in a health-related field and managed care experience is desired • Registered Nurse (RN) valid and current license. Experience: • 2 plus years of experience in the health care field. Required. • Care management, discharge planning, or equivalent combination of education and experience. • Managed care experience in a health plan, preferred. • Ability to evaluate clinical and other health data and to communicate effectively both orally and in writing. • Ability to synthesize thoughts and plans succinctly in writing. • Ability to balance multiple tasks. • Strong organizational skills. • Critical thinking skills. • Flexibility in role delineation and workload assignments. • Team player KNOWLEDGE, SKILLS & ABILITIES Preferred Qualifications: Technology & Software Skills: Strong background and knowledge of computer skills in MS Office products. Certifications & Licenses: • Active, valid and unrestricted license, California Registered Nurse CCM or other CM certification preferred. • A valid and current Driver's License, Auto Insurance, and professional licensure(s) Other: • Bilingual in English and Spanish preferred • An attitude to excel, a special empathy for working with multiple populations, an investigative personality and a willingness to mentor colleagues. • A working knowledge of Medi-Cal and related policy and regulations. Competency Statements • Management Skills - Ability to organize and direct oneself and effectively supervise others. • Business Acumen - Ability to grasp and understand business concepts and issues. • Customer Oriented - Ability to take care of the customers' needs while following company procedures. • Coaching and Development - Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas. • Communication, Oral - Ability to communicate effectively with others using the spoken word. • Team Builder - Ability to convince a group of people to work toward a goal. • Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

Now Hiring: Strategic Partnership Coordinator 🚀 Are you passionate about making a difference through sales? Do you thrive in a dynamic environment where your efforts directly impact success? If so, we're looking for a Strategic Partnership Coordinator to join our team! What We're Looking For: ✅ Licensed Life & Health Agents OR ✅ Motivated Individuals (We'll help you get licensed!) We need goal-oriented professionals who are ready to create impact-whether that means stepping into leadership or building a flexible, high-earning income stream. Are You a Good Fit? ✔ Excited about making a real impact through sales and client relationships? ✔ Ready to invest in yourself and take your career to new heights? ✔ Self-motivated and driven to succeed without constant supervision? ✔ Coachable and eager to learn from top sales professionals? ✔ Looking for a business that is recession- and pandemic-proof? If you answered YES, keep reading! What We Offer: 💼 Flexible Work Environment - Work remotely, full-time or part-time, on your own schedule. 💰 Unlimited Earning Potential - Part-time: $40,000-$60,000/month | Full-time: $70,000-$150,000+++/month. 📈 Warm Leads Provided - No cold calling, no chasing friends & family. ❌ No Sales Quotas, No High-Pressure Tactics, No Micromanagement. 🧑 🏫 Comprehensive Training & Mentorship - Learn from top-performing professionals. 🎯 Daily Pay - Earn directly from insurance carriers. 🎁 Bonuses & Performance Incentives - 80%+ commissions + salary 🏆 Leadership & Growth Opportunities - Build your own agency (optional). 🏥 Health Insurance Available for qualified agents. 🚀 Create real impact, grow your career, and unlock your potential. 👉 Apply today and start making a difference! ( Your success depends on effort, skill, and commitment to training and sales systems. )

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** The Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. **Primary Responsibilities:** + A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review + Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches + The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Registered Nurse with an active unrestricted United States license + Must be bilingual in Japanese and English, with strong verbal and written communication skills + 3+ years of experience in medical-surgical inpatient acute care + Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations + Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals + Proven communication skills at all levels + Proven ability to be flexible and display a positive attitude + Proven solid problem-solving, organizational and crisis management skills + Proven ability to function confidently and efficiently in fast paced work environment + Proven ability to foster team cohesion in an international virtual environment + Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations + Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members + Proven advanced software skills with ability to work in multiple platforms with clinical case reviews + Proven advanced skills with Microsoft Office - Excel, Word + Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs **Preferred Qualifications:** + Bachelor's degree + 2+ years of experience in utilization management or case management in a managed care or hospital environment + Experience in international healthcare and/or air medical transport + Experience in discharge planning and/or chart review + International travel experience + Demonstrated familiarity with InterQual criteria guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve. The Behavioral Health (BH) Autism Care Management Coordinator's primary responsibility is to evaluate a member's BH condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for Autism and Applied Behavioral Analysis services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria. If necessary, the BH Autism Care Management Coordinator directly interacts with providers to obtain additional BH information. The BH Autism Care Management Coordinator has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review. For those cases that do not meet established criteria, the BH Autism Care Management Coordinator provides relevant information regarding members BH condition to the Medical Director for their further review and evaluation. The BH Autism Care Management Coordinator has the authority to approve but cannot deny the care for patients. The BH Autism Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations. Additionally, the BH Autism Care Management Coordinator acts as a patient advocate and a resource for members when accessing and navigating the behavioral health care system. Key Responsibilities * Applies critical thinking and judgement based on advanced knowledge of Applied Behavioral Analysis (ABA) and other treatments for Autism Spectrum Disorder (ASD) to cases utilizing specified resources and guidelines to make approval determinations Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan. * Utilizes the behavioral health criteria of InterQual, and/or Medical Policy to establish the need for authorization, continued care, intensity/dosage of ABA services and, and ancillary services. InterQual - It is the policy of the Medical Affairs Utilization Management (UM) Department to use InterQual (IQ) criteria for the case review process when required. IQ criteria are objective clinical statements that assist in determining the medical appropriateness of a proposed intervention which is a combination of evidence-based standards of care, current practices, and consensus from licensed specialists and/or primary care physicians. IQ criteria are used as a screening tool to support a clinical rationale for decision making. * Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services. * Reviews Autism diagnostic evaluations, and requests for Applied Behavioral Analysis (ABA)services with providers to ensure valid diagnoses, and medically necessary services. Collaborates with providers to obtain and clarify required information for review. * Provides education and resources to caregivers/families and providers regarding autism benefits, Applied Behavior Analysis (ABA) treatment, company policy and procedures. Supports education of caregivers /families and providers on diagnostic, assessment and authorization processes and required documentation to facilitate efficient diagnosis, access to care and utilization management processes. § Assists providers with shaping of ABA services to ensure progress, proposes modifications to align with medical necessity criteria and supports alternative care planning when requests for services do not meet medical necessity criteria. § Identifies physical and BH conditions, family and social needs, barriers to progress and facilitates coordination with IBX Care Navigators and Case Management services as well as service providers (such as medical, speech, occupational therapy, physical therapy, IEP services) for comprehensive care coordination and services. * Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation and determination. * Performs early identification of members for discharge planning support to ensure appropriate transition to services including community based and other appropriate services. * Appropriately refers utilization, access issues, or trends to Autism Care Management leadership, Quality Management Department, Network staff to support continuous quality improvement activities. * Ensures requests are covered within the members' benefit plan. * Ensures utilization decisions are compliant with state, federal and accreditation regulations. * Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests. * Ensure that all key functions are documented in accordance with the Care Management Coordination Policy. * Maintains the integrity of the system information by timely, accurate data entry. * Performs additional duties assigned. Qualifications Education/License: * Active unrestricted independent clinical mental health license (LCSW, LSW, LMFT or LPC, Psychologist) * Board Certified Behavior Analyst Certification Experience * 3+ years post independent licensure with facility based and /or outpatient psychiatric and/or substance use disorder treatment. * 3+ years BCBA certification experience specifically providing ABA services including oversight of paraprofessionals performing ABA services. * Experience providing case management or utilization management of members with autism spectrum disorder or complex psychiatric/SUD cases preferred. Knowledge & Skills * Knowledge of DSM V or most current diagnostic edition. Ability to identify medically necessary Autism and ABA care and collaborate with providers to implement solutions that directly influence the quality of care. * Exceptional communication, interpersonal, problem solving, facilitation and analytical skills. * Action oriented with strong ability to set priorities and obtain results. * Collaborator - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy. * Open to change, comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable. * Embrace the diversity of our workforce and show respect for our colleagues internally and externally. * Excellent organizational planning and prioritizing skills. * Ability to effectively utilize time management. * Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances. Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Commercial Underwriting Assistant that is responsible for handling large volumes of files for NY & National Commercial transactions. Responsibilities: Extensive experience with National or NY commercial transactions Serve as the point of contact for all parties to the transaction including, underwriters, clients and their respective counsel, lenders, brokers and third-party vendors. Review title insurance products such as commitments, pro-formas, policies and endorsements with support of in-house legal team or agency counsel if necessary. Work with Buyer/Seller and Lenders to clear and close transactions. Assist Underwriter and Coordinators in preparing invoices on deals. Firm understanding of Title bills and Title policies. Analyze and review Purchase/Sale Agreements to ensure compliance with all terms and conditions of the same. Experience with national commercial transactions, firm understanding of compliance and settlement including disbursements and funding. Review Purchase/Sale Agreements to prepare closing statements Confirm financial figures with all parties involved in the closing transactions. Respond to and resolve all client and third-party inquiries in a timely manner. Requirements Candidates with experience and strong knowledge of Title Insurance are encouraged to apply. 5+ plus years of experience Knowledge of SoftPro Select a plus Great time management skills Outstanding work ethic with the ability to work in both team oriented and self-directed environments. Detail-oriented and professional; able to handle confidential information. High level of accountability Customer service oriented Creative problem-solving skills Ability to communicate effectively (written and verbal). Ability to work in a fast-paced environment and handle multiple tasks simultaneously About Kensington Vanguard National Land Kensington Vanguard National Land Services is one of the largest independent full-service national title insurance agencies in the country providing: • Commercial & Residential Title Insurance• Real Property & Cooperative Lien Searches• Settlement Services• Escrow Services• Recording Services• 1031 Exchange Services Kensington Vanguard National Land is an Equal Opportunity Employer. Job Type: Full-time Benefits: Health insurance Dental insurance Vision insurance Employer Paid Life insurance Employer Paid LTD Paid Time Off 401(k) 401(k) Employer Match Flexible Spending Account Health Savings Account Employee Assistance Program The annual base salary for this position is $85,000.00 - $105,000.00. General Description of Available Benefits for Eligible Employees of CRC Group: At CRC Group, we're committed to supporting every aspect of teammates' well-being - physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan. CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace. EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify

We're hiring a CGA Triage Coordinator to join our CG&A team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: (You will play a critical role in the initial management and routing of all member complaints, grievances and appeals. You will be responsible for the timely and accurate intake, categorization, and prioritization of incoming cases. By ensuring that each case is promptly triaged and assigned to the appropriate liaison, the Coordinator directly supports the team's ability to meet strict regulatory deadlines and maintain the highest standards of member and provider service. You will report into the CGA Team Lead. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $22.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year. Responsibilities: Receive, log, and process all incoming complaints, grievances, and appeals through various channels, including mail, fax, email, and internal systems. Monitor and manage case queues, proactively flagging urgent cases and assigning them to the appropriate liaison or team. Identify, investigate, and triage incoming documents within determined SLAs Collaborate with colleagues, specialists, and Leads to identify trends and roadblocks Utilize internal tools and resources seamlessly Escalate updates or incorrect information in the internal knowledge management system for Member and Provider Services Compliance with all applicable laws and regulations Other duties as assigned Requirements: 1+ years of customer support/service experience Excellent organizational and time management skills Foundational knowledge of escalations or complaints, grievances and appeals processes Bonus points: Experience in a Complaints, Grievances or Appeals department Experience using CRM and knowledge management tools to resolve issues Experience using ticket management and reporting tools Experience managing an assignment caseload Healthcare and/or SAAS experience This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** The Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. **Primary Responsibilities:** + A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review + Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches + The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Registered Nurse with an active unrestricted United States license + Must be bilingual in Japanese and English, with strong verbal and written communication skills + 3+ years of experience in medical-surgical inpatient acute care + Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations + Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals + Proven communication skills at all levels + Proven ability to be flexible and display a positive attitude + Proven solid problem-solving, organizational and crisis management skills + Proven ability to function confidently and efficiently in fast paced work environment + Proven ability to foster team cohesion in an international virtual environment + Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations + Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members + Proven advanced software skills with ability to work in multiple platforms with clinical case reviews + Proven advanced skills with Microsoft Office - Excel, Word + Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs **Preferred Qualifications:** + Bachelor's degree + 2+ years of experience in utilization management or case management in a managed care or hospital environment + Experience in international healthcare and/or air medical transport + Experience in discharge planning and/or chart review + International travel experience + Demonstrated familiarity with InterQual criteria guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Coordinates and tracks audit activities for the claims audit team. Ensures audit schedules, documentation, and reporting are completed accurately and on time. Your Impact Manage audit calendars and coordinate audit logistics. Collect, compile, and distribute audit results. Maintain audit records and track corrective actions. Support communication between auditors and claims departments. Successful Candidate Will Have High school diploma or Associate's degree; Bachelor's preferred. 2+ years of administrative or audit coordination experience. Strong organizational, communication, and time management skills. Proficiency in Microsoft Office, especially Excel and SharePoint. At Risk Strategies Company, base pay is one part of our total compensation package, which also includes a comprehensive suite of benefits, including medical, dental, vision, disability, and life insurance, retirement savings, and paid time off and paid holidays for eligible employees. The total compensation for a position may also include other elements dependent on the position offered. The expected base pay range for this position is between $32,200 - $50,000 annually. The actual base pay offered may vary depending on multiple individualized factors, including geographical location, education, job-related knowledge, skills, and experience. Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, Risk Strategies serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and over 5,000 employees across the US and Canada. Our industry recognition includes being named a Best Places to Work in Insurance for five years (2018-2022) and on the Inc. 5000 list as one of America's Fastest Growing Private Companies. We are committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues. Pay Range: 32200 - 50000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role. Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: ******************************** Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.

VIVA HEALTH ranked one of the Best Places to Work by Modern Healthcare has an opportunity for a Telephonic Care Coordinator (Social Worker) in Birmingham, AL! VIVA HEALTH knows that social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! The Telephonic Care Coordinator will work alongside the Alabama Coordinated Health Networks (ACHN) team to complete telephonic follow up calls to ensure that recipients have access to all covered services appropriate to the patient's condition or circumstance. This role will assist other ACHN team members in carrying out care management services by providing assistance with promoting disease self-management, utilizing approved education tools, providing information to the patient on medical and community services as directed, and assisting with carrying out established plan of care as directed. This individual may also assist with additional referral outreach or outreach related to Quality Improvement Projects. This individual must reside in Jefferson or Shelby County. REQUIRED: LBSW Two years of clinical experience Willing to submit to vaccine testing and screening Excellent interview and telephone skills, as well the ability to work with patients in a caring and helpful (confident and tactful) manner Working knowledge of health-related service delivery systems Excellent communication and relationship skills Ability to analyze varied environmental factors in relation to patient wellbeing and work independently in an autonomous setting Ability to locate, augment and develop resources, including information on services offered by other agencies Strong organizational and time management skills Ability to be flexible and adaptable Basic computer skills including use of Microsoft Word and Excel PREFERRED: LMSW CCM One year of assessing resources and coordinating care with low-income populations

Nurses and Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a Care Coordinator in Dothan, AL! VIVA HEALTH knows that nursing and social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION REQUIRED: Licensed BSN/ADN Licensed BSW PREFERRED: Licensed MSW and/or Certified Case Manager (CCM) designation Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. The Care Coordinator will coordinate the with the Care Team Lead and Care Team Member Services Manager to ensure the team has the resources required to satisfy member enrollment and maintenance in the IPC Copay Assistance Program. The Care Coordinator will respond accordingly to incoming and make external calls to client members to ensure appropriate processing of copay assistance. Essential Duties and Functions: Provide client support where needed Coordinate member implementation calls with Care Team Lead Provide adhoc claims review as required Identify utilizing patients, review history, determine next coverage date Assist patient with enrollment in the manufacturer's program Maintain patient database for follow-up, tracking and reporting Receive notification of new patient's prior authorization/or review daily rejected and paid claims This position will include job duties that require risk designations for access to Electronic Protected Health Information (PHI) in the course of their job responsibilities Other duties may be assigned Competencies: Planning/organizing-the individual prioritizes and plans work activities and uses time efficiently. Makes good and timely decisions that propels our company forward Interpersonal skills-the individual maintains confidentiality, remains open to others' ideas and exhibits willingness to try new things. Creates an environment where teammates feel connected and energized. Written and Oral communication-Communicate a concise message that resonates every time. The individual speaks clearly and persuasively in positive or negative situations and demonstrates group presentation skills. Problem solving-Create innovative ways for our customers and our company to be successful. The individual identifies and resolves problems in a timely manner, gathers and analyzes information skillfully and maintains confidentiality. Quality control-the individual demonstrates accuracy and thoroughness and monitors own work to ensure quality. Adaptability-the individual adapts to changes in the work environment, manages competing demands and is able to deal with frequent change, delays or unexpected vents. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Required Certified Pharmacy Technician (CPhT.) License or 2-5 years of experience in a retail pharmacy or pharmacy benefit management environment Excellent communication skills Proficient with MS Office Suite Professional telephone demeanor Ability to maintain a high level of confidentiality Pay Range 18.00 - 20.00 Hourly The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities. Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service May support performing service assessments/screenings for members and documenting the member's care needs Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager Provide education on benefits and resources available Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires a High School diploma or GED. Requires 1 - 2 years of related experience License/Certification: For Arkansas Total Care plan - Bachelor's degree in social science/health-related field or a high school diploma with at least one (1) year of experience coordinating care for developmentally or intellectually disabled clients or behavioral health clients. This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 30%. required Preferred Qualifications: Experience working with members with intellectual and developmental disabilities. This is a field-based role covering Pulaski and Lonoke counties in Arkansas. Pay Range: $17.50 - $27.50 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health. The Care Management Coordinator, Medical Review conducts post service reviews on medical claims and cases to ensure medical criteria has been met in accordance with current Company medical policies and medical management guidelines for inpatient, outpatient, surgical and diagnostic procedures including out of network services. This position is within the Claims Medical Review team. Responsibilities/Duties * Reviews provider submission of medical records for specific services that have been processed through system automation and require documentation to determine if additional payment is warranted. * Reviews specific medical services during the claims adjudication process against medical policies and medical management guidelines to ensure criteria has been met and provides direction to claims processing area. * Conducts analysis review of post payment claims against current medical policy and medical management guidelines * Identifies claims/services that require medical records review retrospectively * Works with Hospitals and Professional providers to obtain medical records to conduct retrospective reviews * Reviews medical records for identified claims/services to ensure medical criteria based on policies and guidelines have been met * Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Directors for further evaluation determination * Collaborates with appropriate areas of the Company including Care Management, Medical Policy, CFID, Appeals, Clinical Vendor Management and Claims Operations. * Summarizes and tracks all analyses performed and reports to Management * Identifies and suggests process improvements or potential process efficiencies based on reviews conducted * Participates in key business area projects * Assists with review and maintenance of the Claim Medical Review team's policies, procedures, checklists and documentation as required. * Performs other related duties as assigned Knowledge/Skills/Qualifications * RN license, BSN Preferred * Minimum 3-5 years' experience with medical criteria reviews * Strong knowledge of ICD-10, HCPCS and CPT coding/billing * Claims auditing experience a plus * Proficiency with Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances. * Self motivated, highly organized and detailed oriented as well as problem solving, analytical, verbal and written communication skills are required * Demonstrate the ability to work in a multi-tasking environment Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.