303 Dignity Health jobs in Arizona
Medical Director, Clinical Services
85067 Phoenix, Arizona
Highmark Health
Posted 2 days ago
Job Viewed
Job Description
**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J
View Now
0
Manager Clinical Services
85286 Tempe, Arizona
CommonSpirit Health at Home
Posted 2 days ago
Job Viewed
Job Description
**Job Summary and Responsibilities**
At Dignity Health at Home, we strive to embody our mission of delivering hope and healing to those we serve. As a Manager, Clinical Services you will contribute to the delivery of high quality care by ensuring the coordination, continuity, and quality of clinical care follows a physician's approved plan of treatment. The Manager, Clinical Services facilitates the completion of documentation to comply with regulatory, operational and financial requirements and acts as a clinical resource to internal and external customers.
+ **Independent Work:** Operate with limited supervision, adhering to organizational guidelines and policies.
+ **Leadership Support:** Promote and support departmental and organizational decisions.
+ **Clinical Education:** Act as a Clinical Educator when needed.
+ **EMR Utilization:** Utilize EMR System to accurately document patient interactions, assessments, and care plans, ensuring compliance with organizational policies and regulatory standards. Train and mentor clinical staff in effective EMR documentation practices to optimize workflow efficiency and enhance patient care.
+ **Team Collaboration:** Participate in case conferences and in-service training.
+ **Quality Care Oversight:** Direct the delivery of accurate and timely client care in compliance with regulations.
+ **Staff Management:** Ensure appropriate staffing, participate in recruitment and retention, and manage employee performance.
+ **Performance Excellence:** Establish goals for staff while fostering continuous improvement through coaching and feedback.
+ **Documentation Compliance:** Ensure clinical documentation meets all standards and requirements.
+ **Referral Management:** Oversee referral intake and ensure timely assessment visits for patients.
+ **Physician Communication:** Contact physicians for service orders and manage documentation reviews.
+ **Patient Visits:** May perform patient visits as requested by management.
**Your benefits include:**
+ Generous annual bonus opportunity based on company performance
+ Excellent holiday and paid time off plans
+ Medical, dental, and vision plans
+ Tuition reimbursement for degree-seeking students
+ Employer contribution to your 401(k)
**Job Requirements**
+ Current RN license (BSN preferred) or Therapist in good standing.
+ CPR or BLS certification (current).
+ Two years of home care or hospice experience; one year in hospital nursing preferred.
+ Strong clinical skills and understanding of home care regulations.
+ Excellent written and verbal communication skills.
+ Ability to work collaboratively within a multidisciplinary team.
+ Demonstrated leadership and supervisory skills, with attention to detail and organizational abilities.
At CommonSpirit Health at Home, we are proud to be an Equal Opportunity Employer, promoting diversity, equity, and inclusion in every aspect of our organization. We value the unique contributions of all individuals, including minorities, protected veterans, and individuals with disabilities.
**Where You'll Work**
Dignity Health at Home is part of an expansive health care network that is committed to providing better patient care, with better outcomes, where it is best received, at home. As a faith-based organization, we are committed to finding new ways to improve the health of our patients and their families and the health of the communities we serve. Rooted in humankindness, our ministry is at the heart of everything we do and can be seen in every patient we touch.
**Pay Range**
$37.59 - $54.50 /hour
We are an equal opportunity/affirmative action employer.
At Dignity Health at Home, we strive to embody our mission of delivering hope and healing to those we serve. As a Manager, Clinical Services you will contribute to the delivery of high quality care by ensuring the coordination, continuity, and quality of clinical care follows a physician's approved plan of treatment. The Manager, Clinical Services facilitates the completion of documentation to comply with regulatory, operational and financial requirements and acts as a clinical resource to internal and external customers.
+ **Independent Work:** Operate with limited supervision, adhering to organizational guidelines and policies.
+ **Leadership Support:** Promote and support departmental and organizational decisions.
+ **Clinical Education:** Act as a Clinical Educator when needed.
+ **EMR Utilization:** Utilize EMR System to accurately document patient interactions, assessments, and care plans, ensuring compliance with organizational policies and regulatory standards. Train and mentor clinical staff in effective EMR documentation practices to optimize workflow efficiency and enhance patient care.
+ **Team Collaboration:** Participate in case conferences and in-service training.
+ **Quality Care Oversight:** Direct the delivery of accurate and timely client care in compliance with regulations.
+ **Staff Management:** Ensure appropriate staffing, participate in recruitment and retention, and manage employee performance.
+ **Performance Excellence:** Establish goals for staff while fostering continuous improvement through coaching and feedback.
+ **Documentation Compliance:** Ensure clinical documentation meets all standards and requirements.
+ **Referral Management:** Oversee referral intake and ensure timely assessment visits for patients.
+ **Physician Communication:** Contact physicians for service orders and manage documentation reviews.
+ **Patient Visits:** May perform patient visits as requested by management.
**Your benefits include:**
+ Generous annual bonus opportunity based on company performance
+ Excellent holiday and paid time off plans
+ Medical, dental, and vision plans
+ Tuition reimbursement for degree-seeking students
+ Employer contribution to your 401(k)
**Job Requirements**
+ Current RN license (BSN preferred) or Therapist in good standing.
+ CPR or BLS certification (current).
+ Two years of home care or hospice experience; one year in hospital nursing preferred.
+ Strong clinical skills and understanding of home care regulations.
+ Excellent written and verbal communication skills.
+ Ability to work collaboratively within a multidisciplinary team.
+ Demonstrated leadership and supervisory skills, with attention to detail and organizational abilities.
At CommonSpirit Health at Home, we are proud to be an Equal Opportunity Employer, promoting diversity, equity, and inclusion in every aspect of our organization. We value the unique contributions of all individuals, including minorities, protected veterans, and individuals with disabilities.
**Where You'll Work**
Dignity Health at Home is part of an expansive health care network that is committed to providing better patient care, with better outcomes, where it is best received, at home. As a faith-based organization, we are committed to finding new ways to improve the health of our patients and their families and the health of the communities we serve. Rooted in humankindness, our ministry is at the heart of everything we do and can be seen in every patient we touch.
**Pay Range**
$37.59 - $54.50 /hour
We are an equal opportunity/affirmative action employer.
View Now
1
VP- Clinical Services Practice
85067 Phoenix, Arizona
Concentrix
Posted 2 days ago
Job Viewed
Job Description
Job Title:
VP- Clinical Services Practice
Job Description
The VP of Clinical Services will be instrumental in designing and driving the go-to-market (GTM) strategy for our newly launched clinical services capability. This individual brings deep expertise in clinical services within the healthcare payer/provider landscape, focusing on GTM design, building strategic solutions, and establishing market credibility. They will work closely with sales, product development, and leadership to shape and execute strategies that position us competitively and ensure successful engagement with clients.
The VP of Clinical Services will be instrumental in designing and driving the go-to-market (GTM) strategy for our newly launched clinical services capability. This individual brings deep expertise in clinical services within the healthcare payer/provider landscape, focusing on GTM design, building strategic solutions, and establishing market credibility. They will work closely with sales, product development, and leadership to shape and execute strategies that position us competitively and ensure successful engagement with clients.
This is a strategic role to business development and solution leadership enabling account and dales teams to credibly approach clients and ensuring that our clinical offerings align with market needs. The ideal candidate will be measured on their ability to shape and activate a national go-to-market strategy, generate demand for clinical services, enhance market positioning, and contribute to building a scalable clinical practice, with particular emphasis on incorporating technology and innovation into our service design.
Key Responsibilities:
Clinical Go to Market Leadership:
· Design and execute the go-to-market strategy for clinical services, ensuring alignment with broader business objectives.
· Bring SME-level knowledge to clinical GTM design, helping develop scalable and competitive offerings tailored to client needs.
· Identify key industry trends, market dynamics, and competitor positioning to inform strategic decisions and refine clinical practice capabilities.
· Serve as a credible industry voice, participating in industry events, conferences, and webinars to enhance the visibility and credibility of our clinical solutions.
Sales Enablement and Market Engagement:
· Act as the solution lead for clinical services, equipping sales teams with tailored strategies, materials, and insights to engage prospective clients effectively.
· Support sales efforts by participating in client meetings and pitches, ensuring a credible and knowledgeable presence in clinical discussions.
· Focus on driving deal flow by helping secure meetings with key stakeholders in the healthcare payer/provider space.
· Collaborate with sales teams to develop strategies and messaging that resonate with target clients, emphasizing designing and building clinical solutions rather than simply selling.
Building and Enhancing Clinical Practice:
· Provide strategic input into the design and build of clinical services, ensuring offerings are innovative and aligned with market demands.
· Integrate technology and analytics into the design of clinical solutions to enhance scalability, efficiency, and competitiveness.
· Work cross-functionally with operational teams to ensure that client engagements are seamlessly transitioned from design to delivery, but with minimal direct operational involvement.
Market Credibility and Competitive Positioning:
· Develop and execute strategies to position our clinical services competitively, focusing on differentiation in the marketplace.
· Engage in thought leadership by contributing to whitepapers, panels, or industry discussions that highlight our expertise and solutions.
Performance Metrics and Impact:
· Define and track key metrics to measure success, including the number of industry events attended, the quality and quantity of client engagements, and the impact on deal flow.
· Collaborate with leadership to establish benchmarks for growth and market presence, providing regular updates on progress.
Qualifications:
· Bachelor's degree in Healthcare Administration, Business, or a related field; Master's degree preferred.
· Proven experience and deep understanding of the U.S. healthcare payer/provider landscape, preferably including experience designing, scaling, and operationalizing clinical engagements.
· Demonstrated expertise in GTM strategy design for clinical services, including solution leadership and market positioning.
· Strong understanding of the intersection of clinical services and technology, with experience incorporating tech solutions into clinical practice design.
· Excellent communication, presentation, and interpersonal skills, with the ability to engage credibly at all levels.
· Experience attending or presenting at industry events and engaging with key stakeholders.
· Ability to travel as needed to meet business objectives.
Performance Metrics:
· Number of industry events attended or thought leadership activities contributed.
· Metrics around deal flow and client engagements (e.g., number of meetings secured with key stakeholders).
· Contribution to designing and building scalable clinical solutions that meet market needs and drive differentiation.
The base salary range for this position is plus incentives that align with individual and company performance. Actual salaries will vary based on work location, qualifications, skills, education, experience, and competencies. Benefits available to eligible employees in this role include medical, dental, and vision insurance, comprehensive employee assistance program, 401(k) retirement plan, paid time off and holidays and paid learning days.
Location:
USA NV Work-at-Home
Language Requirements:
Time Type:
Full time
Physical & Mental Requirements: While performing the duties of this job, the employee is regularly required to operate a computer, keyboard, telephone, headset, and other office equipment. Work is generally sedentary in nature.
**If you are a California resident, by submitting your information, you acknowledge that you have read and have access to the** Job Applicant Privacy Notice for California Residents ( is an equal opportunity and affirmative action (EEO-AA) employer. We promote equal opportunity to all qualified individuals and do not discriminate in any phase of the employment process based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy or related condition, disability, status as a protected veteran, or any other basis protected by law.
For more information regarding your EEO rights as an applicant, please visit the following websites:
-English ( ( request a reasonable accommodation please click here ( .
If you wish to review the Affirmative Action Plan, please click here ( .
VP- Clinical Services Practice
Job Description
The VP of Clinical Services will be instrumental in designing and driving the go-to-market (GTM) strategy for our newly launched clinical services capability. This individual brings deep expertise in clinical services within the healthcare payer/provider landscape, focusing on GTM design, building strategic solutions, and establishing market credibility. They will work closely with sales, product development, and leadership to shape and execute strategies that position us competitively and ensure successful engagement with clients.
The VP of Clinical Services will be instrumental in designing and driving the go-to-market (GTM) strategy for our newly launched clinical services capability. This individual brings deep expertise in clinical services within the healthcare payer/provider landscape, focusing on GTM design, building strategic solutions, and establishing market credibility. They will work closely with sales, product development, and leadership to shape and execute strategies that position us competitively and ensure successful engagement with clients.
This is a strategic role to business development and solution leadership enabling account and dales teams to credibly approach clients and ensuring that our clinical offerings align with market needs. The ideal candidate will be measured on their ability to shape and activate a national go-to-market strategy, generate demand for clinical services, enhance market positioning, and contribute to building a scalable clinical practice, with particular emphasis on incorporating technology and innovation into our service design.
Key Responsibilities:
Clinical Go to Market Leadership:
· Design and execute the go-to-market strategy for clinical services, ensuring alignment with broader business objectives.
· Bring SME-level knowledge to clinical GTM design, helping develop scalable and competitive offerings tailored to client needs.
· Identify key industry trends, market dynamics, and competitor positioning to inform strategic decisions and refine clinical practice capabilities.
· Serve as a credible industry voice, participating in industry events, conferences, and webinars to enhance the visibility and credibility of our clinical solutions.
Sales Enablement and Market Engagement:
· Act as the solution lead for clinical services, equipping sales teams with tailored strategies, materials, and insights to engage prospective clients effectively.
· Support sales efforts by participating in client meetings and pitches, ensuring a credible and knowledgeable presence in clinical discussions.
· Focus on driving deal flow by helping secure meetings with key stakeholders in the healthcare payer/provider space.
· Collaborate with sales teams to develop strategies and messaging that resonate with target clients, emphasizing designing and building clinical solutions rather than simply selling.
Building and Enhancing Clinical Practice:
· Provide strategic input into the design and build of clinical services, ensuring offerings are innovative and aligned with market demands.
· Integrate technology and analytics into the design of clinical solutions to enhance scalability, efficiency, and competitiveness.
· Work cross-functionally with operational teams to ensure that client engagements are seamlessly transitioned from design to delivery, but with minimal direct operational involvement.
Market Credibility and Competitive Positioning:
· Develop and execute strategies to position our clinical services competitively, focusing on differentiation in the marketplace.
· Engage in thought leadership by contributing to whitepapers, panels, or industry discussions that highlight our expertise and solutions.
Performance Metrics and Impact:
· Define and track key metrics to measure success, including the number of industry events attended, the quality and quantity of client engagements, and the impact on deal flow.
· Collaborate with leadership to establish benchmarks for growth and market presence, providing regular updates on progress.
Qualifications:
· Bachelor's degree in Healthcare Administration, Business, or a related field; Master's degree preferred.
· Proven experience and deep understanding of the U.S. healthcare payer/provider landscape, preferably including experience designing, scaling, and operationalizing clinical engagements.
· Demonstrated expertise in GTM strategy design for clinical services, including solution leadership and market positioning.
· Strong understanding of the intersection of clinical services and technology, with experience incorporating tech solutions into clinical practice design.
· Excellent communication, presentation, and interpersonal skills, with the ability to engage credibly at all levels.
· Experience attending or presenting at industry events and engaging with key stakeholders.
· Ability to travel as needed to meet business objectives.
Performance Metrics:
· Number of industry events attended or thought leadership activities contributed.
· Metrics around deal flow and client engagements (e.g., number of meetings secured with key stakeholders).
· Contribution to designing and building scalable clinical solutions that meet market needs and drive differentiation.
The base salary range for this position is plus incentives that align with individual and company performance. Actual salaries will vary based on work location, qualifications, skills, education, experience, and competencies. Benefits available to eligible employees in this role include medical, dental, and vision insurance, comprehensive employee assistance program, 401(k) retirement plan, paid time off and holidays and paid learning days.
Location:
USA NV Work-at-Home
Language Requirements:
Time Type:
Full time
Physical & Mental Requirements: While performing the duties of this job, the employee is regularly required to operate a computer, keyboard, telephone, headset, and other office equipment. Work is generally sedentary in nature.
**If you are a California resident, by submitting your information, you acknowledge that you have read and have access to the** Job Applicant Privacy Notice for California Residents ( is an equal opportunity and affirmative action (EEO-AA) employer. We promote equal opportunity to all qualified individuals and do not discriminate in any phase of the employment process based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy or related condition, disability, status as a protected veteran, or any other basis protected by law.
For more information regarding your EEO rights as an applicant, please visit the following websites:
-English ( ( request a reasonable accommodation please click here ( .
If you wish to review the Affirmative Action Plan, please click here ( .
View Now
2
Clinical Services Pharmacy Technician
85067 Phoenix, Arizona
CenterWell
Posted 2 days ago
Job Viewed
Job Description
**Become a part of our caring community and help us put health first**
The Consultative Pharmacy Technician certified Pharmacy Technician who acts as an intake for all calls from patients, pharmacies and providers. The Consultative Pharmacy Technician performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.
The Consultative Pharmacy Technician addresses questions related to specific assigned area and assists with medication research. Triages calls that require consultation with a pharmacist. Makes outbound calls to patients to offer medication therapy management programs and schedules medication review sessions with consultative pharmacists. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.
**Use your skills to make an impact**
**Required Qualifications**
**Candidates** **MUST** **reside in one of the following states: Arizona, Ohio, or Florida.**
+ Must have an active Pharmacy Technician or Tech in Training license
+ Technical Mail Order Pharmacy or Manufacturing experience
+ Experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting
+ Excellent communication skills
+ Experience using multiple computer applications simultaneously and strong data entry skills
+ A positive, proactive attitude with a passion for customer service
**Required Work Schedule** **:**
+ 2:30pm - 11:00pm EST Monday-Friday.
+ You must also be available to work every 3rd Saturday 10:00am- 6:30pm EST with a day off during the week when it is your Saturday rotation.
+ **Shift Differential may apply for evenings and weekend work.**
**Preferred Qualifications**
+ PTCB or ExCPT Certified
+ High School Diploma or GED
+ Bilingual in English / Spanish with the ability to speak, read, and write in both languages without limitations or assistance.
**Additional Information**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**Interview Process**
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule
+ **Text Prescreen** : Shortly after submitting your application, you may receive both a text message and email requesting that you complete a few prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.
+ **Video Prescreen:** If you are successful with the text screen, you will receive another communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.
+ **Interviews** : Some candidates will be invited to a final virtual interview. If so, the recruiter will reach out to schedule.
+ **Offers:** Finalists from the interview will be contacted by a recruiter to discuss an offer for the job.
+ **Note:** Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$39,000 - $49,400 per year
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
The Consultative Pharmacy Technician certified Pharmacy Technician who acts as an intake for all calls from patients, pharmacies and providers. The Consultative Pharmacy Technician performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.
The Consultative Pharmacy Technician addresses questions related to specific assigned area and assists with medication research. Triages calls that require consultation with a pharmacist. Makes outbound calls to patients to offer medication therapy management programs and schedules medication review sessions with consultative pharmacists. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.
**Use your skills to make an impact**
**Required Qualifications**
**Candidates** **MUST** **reside in one of the following states: Arizona, Ohio, or Florida.**
+ Must have an active Pharmacy Technician or Tech in Training license
+ Technical Mail Order Pharmacy or Manufacturing experience
+ Experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting
+ Excellent communication skills
+ Experience using multiple computer applications simultaneously and strong data entry skills
+ A positive, proactive attitude with a passion for customer service
**Required Work Schedule** **:**
+ 2:30pm - 11:00pm EST Monday-Friday.
+ You must also be available to work every 3rd Saturday 10:00am- 6:30pm EST with a day off during the week when it is your Saturday rotation.
+ **Shift Differential may apply for evenings and weekend work.**
**Preferred Qualifications**
+ PTCB or ExCPT Certified
+ High School Diploma or GED
+ Bilingual in English / Spanish with the ability to speak, read, and write in both languages without limitations or assistance.
**Additional Information**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**Interview Process**
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule
+ **Text Prescreen** : Shortly after submitting your application, you may receive both a text message and email requesting that you complete a few prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.
+ **Video Prescreen:** If you are successful with the text screen, you will receive another communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.
+ **Interviews** : Some candidates will be invited to a final virtual interview. If so, the recruiter will reach out to schedule.
+ **Offers:** Finalists from the interview will be contacted by a recruiter to discuss an offer for the job.
+ **Note:** Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$39,000 - $49,400 per year
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**About us**
About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options
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3
Clinical Services Clerk I -CHS (Cottonwood)
86366 Cottonwood, Arizona
Yavapai County, AZ
Posted 4 days ago
Job Viewed
Job Description
Salary: $17.42 - $22.21 Hourly
Location : Cottonwood, AZ
Job Type: Full Time - Non Exempt
Job Number:
Department: Community Health Services - CHS
Opening Date: 09/19/2025
Closing Date: Continuous
Role
As a Clinical Services Clerk I, you will play a vital role in supporting the smooth operation of clinical services through a variety of responsibilities. These include patient registration, clerical and administrative support, front desk reception and communication management, and coordinating appointment scheduling. You will also assist with data entry and reporting to ensure accurate patient records and workflow efficiency. Additionally, you will support clinical staff in daily operations contributing to a collaborative and patient-focused care environment.
The ideal candidate will possess prior office experience in a medical environment with behavioral health and demonstrate familiarity with electronic health records systems. Additionally, proficiency in both English and Spanish is preferred.
Review class specification for
Major Duties, Responsibilities
Minimum Qualifications
Education:
High school diploma or equivalent.
Experience:
A minimum of one (1) year of general office experience, preferably in a medical office setting.
Additional Requirements:
Must possess a valid Arizona driver's license.
Must possess a current fingerprint clearance card Issued by the Arizona Department of Public Safety.
EMPLOYEE BENEFITS
Yavapai County Government offers a comprehensive employee benefits package to
Full-Time employees working 30 or more hours per week that includes but is not limited to:
• 10 Paid Holidays Per Year
• Annual Leave
• Employee Assistance Program (EAP)
• Health Care Insurance - Medical, Dental, Vision
• Life Insurance
• Long-Term & Short-Term Disability
• Retirement Plans
• Sick Leave
• Tuition Reimbursement Program
ELECTIVE COVERAGE
• 457 Deferred Compensation Program
• Dependent Health Care Insurance - Medical, Dental, Vision
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Short-Term Disability
• Supplemental Life (for employees & dependents)
PLEASE NOTE
• Part-Time, Temporary and Seasonal employees accrue Sick Leave based on hours worked.
• Part-Time employees have limited benefits available.
• Temporary and Seasonal employees are not eligible to accrue Annual Leave.
01
Do you have a high school diploma or equivalent?
02
Do you have a minimum of one (1) year experience of general office experience, preferable in a medical office setting?
03
Do you have any experience with Electronic Health Records Systems?
04
Are you bilingual in Spanish/English?
05
Do you have any experience working in the behavioral health field?
06
You must possess a current fingerprint clearance card Issued by the Arizona Department of Public Safety.
Required Question
Location : Cottonwood, AZ
Job Type: Full Time - Non Exempt
Job Number:
Department: Community Health Services - CHS
Opening Date: 09/19/2025
Closing Date: Continuous
Role
As a Clinical Services Clerk I, you will play a vital role in supporting the smooth operation of clinical services through a variety of responsibilities. These include patient registration, clerical and administrative support, front desk reception and communication management, and coordinating appointment scheduling. You will also assist with data entry and reporting to ensure accurate patient records and workflow efficiency. Additionally, you will support clinical staff in daily operations contributing to a collaborative and patient-focused care environment.
The ideal candidate will possess prior office experience in a medical environment with behavioral health and demonstrate familiarity with electronic health records systems. Additionally, proficiency in both English and Spanish is preferred.
Review class specification for
Major Duties, Responsibilities
- Checking patients in and out of the health center and collection of fees with reconciliation.
- Obtains eligibility, patient information, and insurance verification.
- Answers telephones, schedules appointments, and processes messages.
- Processing specialty referrals; and filing documents into the electronic health record.
- Performs other job-related duties as assigned.
Minimum Qualifications
Education:
High school diploma or equivalent.
Experience:
A minimum of one (1) year of general office experience, preferably in a medical office setting.
Additional Requirements:
Must possess a valid Arizona driver's license.
Must possess a current fingerprint clearance card Issued by the Arizona Department of Public Safety.
EMPLOYEE BENEFITS
Yavapai County Government offers a comprehensive employee benefits package to
Full-Time employees working 30 or more hours per week that includes but is not limited to:
• 10 Paid Holidays Per Year
• Annual Leave
• Employee Assistance Program (EAP)
• Health Care Insurance - Medical, Dental, Vision
• Life Insurance
• Long-Term & Short-Term Disability
• Retirement Plans
• Sick Leave
• Tuition Reimbursement Program
ELECTIVE COVERAGE
• 457 Deferred Compensation Program
• Dependent Health Care Insurance - Medical, Dental, Vision
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Short-Term Disability
• Supplemental Life (for employees & dependents)
PLEASE NOTE
• Part-Time, Temporary and Seasonal employees accrue Sick Leave based on hours worked.
• Part-Time employees have limited benefits available.
• Temporary and Seasonal employees are not eligible to accrue Annual Leave.
01
Do you have a high school diploma or equivalent?
- Yes
- No
02
Do you have a minimum of one (1) year experience of general office experience, preferable in a medical office setting?
- Yes
- No
03
Do you have any experience with Electronic Health Records Systems?
- Yes
- No
04
Are you bilingual in Spanish/English?
- Yes
- No
05
Do you have any experience working in the behavioral health field?
- Yes
- No
06
You must possess a current fingerprint clearance card Issued by the Arizona Department of Public Safety.
- Yes, I currently possess a current fingerprint clearance card issued by the Arizona Department of Public Safety.
- No, I do not currently possess a current fingerprint clearance card issued by the Arizona Department of Public Safety, but acknowledge i must obtain one upon hire.
Required Question
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4
Associate Manager, Clinical Health Services - Utilization Management (Remote)
Arizona, Arizona
CVS Health
Posted 2 days ago
Job Viewed
Job Description
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Information**
Schedule: Monday-Friday 8:00am-5:00pm EST Hours (Shift times may vary based on business needs)
Travel Required up to 5% for meetings/audits.
Location: 100% Remote (U.S. only)
**About Us**
American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.
**Position Summary**
The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and monitoring of high performing teams. Works closely with functional area leadership team (department Associate Managers, Manager, and other key stakeholders such as Medical Directors, account teams/clinical liaisons, etc.) to ensure consistency in clinical interventions supporting our members.
**Key Responsibilities**
+ Accountable for meeting the financial, operational and quality objectives of the unit.
+ Ensures team maintains compliance and privacy practices.
+ Oversees the implementation of utilization management services for assigned area
+ Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable)
+ Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
+ Ensure implementation and monitoring of best practice approaches and innovations to better address the member's and provider's needs across the continuum of care
+ May act as a liaison with other key business areas.
+ May develop/assist in development and/review new training content.
+ May collaborate/deliver inter and intra-departmental training sessions
+ Protects the confidentiality of member information and adheres to company policies regarding confidentiality
+ Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care
+ May collaborate with leadership for the development of, monitoring and communicating performance expectations
+ Ensures the team's understanding and use of information system capability and functionality
+ May act as a single point of contact for the customer and the Account Team including participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
+ Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
+ Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and on-purpose culture.
+ Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
+ Consistently demonstrates the ability to serve as a model change agent and lead change efforts
+ Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
+ Accountable for maintaining compliance with policies and procedures and implements them at the employee level
**Remote Work Expectations**
+ This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
+ Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
**Required Qualifications**
+ Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.
+ 5+ years of acute experience as a Registered Nurse
+ 3+ years of Utilization Management experience
+ 3+ year(s) of Appeals experience in Utilization Management
+ Must have experience using MS Office
+ Must be willing to work holiday rotation annually, up to 2 per year
+ Utilization Management work schedules will include weekends, holidays, and evening hours rotation.
**Preferred Qualifications**
+ Prior leadership experience
+ Ability to evaluate and interpret data, identifies areas of improvement
**Education**
+ Associate's degree in nursing (RN) required, BSN preferred.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$72,306.00 - $207,648.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/09/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Information**
Schedule: Monday-Friday 8:00am-5:00pm EST Hours (Shift times may vary based on business needs)
Travel Required up to 5% for meetings/audits.
Location: 100% Remote (U.S. only)
**About Us**
American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.
**Position Summary**
The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and monitoring of high performing teams. Works closely with functional area leadership team (department Associate Managers, Manager, and other key stakeholders such as Medical Directors, account teams/clinical liaisons, etc.) to ensure consistency in clinical interventions supporting our members.
**Key Responsibilities**
+ Accountable for meeting the financial, operational and quality objectives of the unit.
+ Ensures team maintains compliance and privacy practices.
+ Oversees the implementation of utilization management services for assigned area
+ Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable)
+ Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
+ Ensure implementation and monitoring of best practice approaches and innovations to better address the member's and provider's needs across the continuum of care
+ May act as a liaison with other key business areas.
+ May develop/assist in development and/review new training content.
+ May collaborate/deliver inter and intra-departmental training sessions
+ Protects the confidentiality of member information and adheres to company policies regarding confidentiality
+ Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care
+ May collaborate with leadership for the development of, monitoring and communicating performance expectations
+ Ensures the team's understanding and use of information system capability and functionality
+ May act as a single point of contact for the customer and the Account Team including participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
+ Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills
+ Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and on-purpose culture.
+ Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
+ Consistently demonstrates the ability to serve as a model change agent and lead change efforts
+ Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
+ Accountable for maintaining compliance with policies and procedures and implements them at the employee level
**Remote Work Expectations**
+ This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
+ Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
**Required Qualifications**
+ Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.
+ 5+ years of acute experience as a Registered Nurse
+ 3+ years of Utilization Management experience
+ 3+ year(s) of Appeals experience in Utilization Management
+ Must have experience using MS Office
+ Must be willing to work holiday rotation annually, up to 2 per year
+ Utilization Management work schedules will include weekends, holidays, and evening hours rotation.
**Preferred Qualifications**
+ Prior leadership experience
+ Ability to evaluate and interpret data, identifies areas of improvement
**Education**
+ Associate's degree in nursing (RN) required, BSN preferred.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$72,306.00 - $207,648.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit anticipate the application window for this opening will close on: 10/09/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
View Now
5
Program Manager, Healthcare Services - Clinical Systems
85258 Scottsdale, Arizona
Molina Healthcare
Posted today
Job Viewed
Job Description
**Job Summary**
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
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6
Program Manager, Healthcare Services - Clinical Systems
85702 Tucson, Arizona
Molina Healthcare
Posted today
Job Viewed
Job Description
**Job Summary**
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
7
Program Manager, Healthcare Services - Clinical Systems
85286 Tempe, Arizona
Molina Healthcare
Posted today
Job Viewed
Job Description
**Job Summary**
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
8
Program Manager, Healthcare Services - Clinical Systems
85067 Phoenix, Arizona
Molina Healthcare
Posted today
Job Viewed
Job Description
**Job Summary**
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential Job Duties**
+ Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
+ Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to business needs.
+ Serves as a subject matter expert and leads healthcare services programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. - Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents.
**Required Qualifications**
+ At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience.
+ Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
+ Strong analytical and problem-solving skills.
+ Strong organizational and time-management skills.
+ Ability to work in a cross-functional, professional environment.
+ Experience working within applicable state, federal, and third-party regulations.
+ Strong verbal and written communication skills.
+ Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
**Preferred Qualifications**
+ Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification.
+ Leadership experience.
+ Medicaid/Medicare population experience.
+ Six sigma certification
+ Experience with Agile Methodology
+ Experience with Epic
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
9