604 Medical Adviser jobs in the United States
Clinical Advisor Product Trainer

Posted 13 days ago
Job Viewed
Job Description
The Clinical Advisor is primarily responsible for developing and nurturing long-term relationships with healthcare system clients in addition to creating and maintaining digital products program content to meet the ever-changing needs of the healthcare environment. Plans, develops, implements, and evaluates sustainable solutions for client education and product implementation. Applies project management skills for both internal and external projects. By leveraging the individual's clinical, leadership, quality, consulting and training expertise, the Clinical Advisor plays a senior, trusted, advisory role in building and sustaining leadership rapport with key clients. Assists organizations and healthcare systems to optimize the value of the digital product landscape while achieving and sustaining high-quality, safe, and compliant processes which are aligned with organization- and/or system-specific goals and objectives.
**Responsibilities**
+ Manages assigned key healthcare system clients and develops leadership rapport with each key client at the corporate level and at the highest organization level
+ Uses a consultative approach and performance improvement methodology to understand the client's business circumstance, organization culture, leadership maturity, accreditation challenges, business goals and objectives for purchasing digital products; drives change, success criteria and change management processes
+ Develops a customized training and implementation project plan and timeline in partnership with assigned clients. Assists with strategic planning and project deployment. Provides continuous support during the project planning, training, implementation, adoption, and improvement cycle. Content and customized training is aligned with strategic initiatives of the Joint Commission Enterprise.
+ Maintains current knowledge of Joint Commission and CMS requirements in addition to healthcare trends. Leverages Joint Commission and CMS expertise and internal resources to assist clients to identify and quantify actual and potential risks and develop customized tools and processes to assess and reduce risk
+ Assists healthcare systems and organizations to standardize accreditation preparation processes and collect, aggregate, and analyze meaningful business data across the enterprise to achieve optimal results, improve efficiencies, and generate cost savings
+ Collaborates with internal stakeholders Joint Commission including product management, product development and technical support to analyze gaps between current products and the desired state while strategically positioning product enhancements and innovations as solutions to client challenges
+ Provides clinical guidance for the Customer Technical Support team for clinical content concerns identified by clients. Communicates with users relative to subject matter
+ Provides clinical expertise in creating, reviewing, updating and augmenting clinical content for documentation libraries (hospital accreditation, non-hospital accreditation, certification and CMS) and other resources. Delivers content according to time-sensitive deadlines that correlate with requirements, regulations, and trending topics.
+ Collaborates to build training content with state-of-the-art online platform, standardized on-demand resources, and innovative solutions to engage clients, improve accessibility, and promote knowledge retention. Participates in re-platforming solutions, enhancement and any work that drives improvement within the technology.
+ Challenges status quo. Motivates Implementation Specialists leading to effective team work.
+ Supports key sales, marketing, and product management opportunities when requested. Also may support the development of proposals for work in support of Enterprise strategic initiatives.
+ Actively participates and completes any required training associated with standards changes, survey process updates and technology related training opportunities that are applicable to the role. Actively engages with cross divisional staff to ensure that information between areas supporting survey process are integrated into content and training plans for organizations.
**Qualifications**
+ Bachelor's Degree in nursing or related healthcare field required. Graduate degree preferred.
+ 10+ years of experience in healthcare industry in leadership, quality, safety, and accreditation initiatives
+ Demonstrated proficiency in software and web-based technology. Experience with technology development and implementation for the healthcare market preferred
+ Ability to analyze business systems to identify user needs, address operational or process issues, and implement improvements to accomplish business objectives
+ Strong knowledge of Joint Commission current standards and survey process. Knowledge of both accreditation and certification programs, including non-hospital programs
+ Strong knowledge of CMS requirements and survey process is preferred.
+ Exhibits strong problem-solving and facilitation skills. Strong customer service orientation for both internal and external customers. Excellent influencing and consultative skills. Uses business knowledge and field experience to identify and analyze actual or potential problems with the ability to communicate with digital product and IT team members to correct issues and/or improve products in a timely manner
+ Excellent listening, verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts. Exercises superior interviewing and presentation skills.
+ Outstanding decision-making and critical thinking skills
+ High energy, strong work ethic, quick learner and team player
+ Proficient in Microsoft Word, Excel and PowerPoint
+ 15-25% travel may be necessary to support customer engagements and may include international travel if required.
**We offer a comprehensive benefit package. For a complete overview of our benefits package, please visit ourJoint Commission Career Page ( job description is intended to describe the general nature and level of work performed by an employee assigned to this position. The description is not an exhaustive list of all duties, responsibilities, knowledge, skills, and abilities, and working conditions associated with this position. All requirements are subject to possible modification and reasonably accommodate individuals with disabilities.
**Min**
USD $90,000.00/year
**Max**
USD $124,000.00/year
**Job Locations** _US-IL-Oakbrook Terrace_
**Job ID** _ _
**# of Openings** _2_
**Category** _Professional_
+ Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
+ Please view Equal Employment Opportunity Posters provided by OFCCP here.
+ The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
+ This Organization Participates in E-Verify. Click here for more information.
Registered Nurse Clinical Advisor - Emergency Department
Posted 16 days ago
Job Viewed
Job Description
Overview
SHIFT OPEN: PT NIGHT
This position is referral eligible.
Part and Full-time roles are eligible for a $30,000 sign-on bonus - apply today to learn more!
Indiana University Health is looking for passionate, experienced nurses and upcoming/recent RN graduates to join our team and collaborate with top medical professionals.
At IU Health, you will learn and develop your career in significant ways, advancing healthcare and delivering the highest level of patient care. Being an IU Health nurse means building a professional nursing career designed by a culture that accepts your outstanding strengths and supports your personal and professional goals. If you are seeking an organization where you can develop clinical expertise, explore diverse career opportunities, embrace learning, cultivate new relationships, and fuel your spirit of inquiry, apply today.
Are you an upcoming nurse graduate or recent nurse graduate? Please apply through our pipeline requisition here: This pipeline requisition allows the IU Health Talent Acquisition team to pair upcoming & recent nurse graduates with the best opportunities available to them based on their unique skillset and interests. Thanks for your interest in joining the team!
Clinical Advisor, RN - Flexible hours
The clinical advisor assists in planning, implementing, and evaluating clinical skills for bedside team members. Ensures clinical instructions regarding medical and technical instruction is coordinated, clear, and received providing real time intervention and feedback. Manages clinical outcomes, patient satisfaction, and daily care needs of the team members and unit.
Preferences:
* 5 years of relevant experience
* Cerner documentation experience
* BLS certification (ACLS preferred), TNCC,PALS,ENPC
* Eagerness to provide education and real time feedback to team members
* Expected to be and stay up to date to current clinical standards. Will assist at bedside and ensure standards of care are being met
Expectations:
* Demonstrates commitment to all of IU Health's values: Purpose, Compassion, Excellence, and TEAM.
* Remain professionally engaged, eager to learn and grow, committed to creating a positive and safe work environment.
* Support bedside team members while maintaining boundaries of a clinical advisor.
* Planning, implementing, and evaluating clinical skills to build foundation of clinical knowledge and confidence of new bedside nurses.
* Works alongside the bedside team members to promote critical thinking and explore rationales for decision making.
* Exhibits sound professional judgment and able to handle unexpected needs and frequent interruptions requiring immediate attention.
* Provide real time feedback for implementation of new policies and procedures as well as standard work.
* Ensure compliance of HARM bundles for patients at risk.
* Performs unit and system leadership activities as necessary. Creates an engaged environment suitable for growth and development of a well-informed team.
* Expert at clear, concise, and complete communication.
* Role model positive leadership, attitudes, teamwork, practices, and conflict resolution.
* Round with interdisciplinary team. Determine gaps and developments to improve on.
Qualifications
* Requires an Associates of Nursing (ASN); Bachelor of Nursing (BSN) preferred.
* Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
* Requires that the RN has graduated from a nationally accredited nursing program.
* Requires Basic Life Support certification through the AHA.
* Other advanced Life Support certifications may be required per unit/department specialty according to patient care policies.
Why Join IU Health?
As Indiana's largest and most comprehensive healthcare system, and the number 1 ranked healthcare system in Indiana, we offer:
* Increased pay scale for bedside nurses
* A supportive and collaborative work environment that is patient centered.
* Competitive benefits.
* 401(K) retirement savings with employer match.
* Employer paid medical leave.
* Tuition reimbursement.
* Student loan forgiveness - IU Health qualifies under the public service loan forgiveness program.
* Employee Assistance Program - Counseling at no cost to you
* Healthy Results - Participation in our team member wellness programs award points that contribute toward a biweekly financial incentive in your paycheck. The more you participate, the more you earn.
Our culture of compassion allows for a holistic delivery of care that is individualized based on our patients' and their families' needs. At IU Health, every team member is a caregiver. This care does not stop with our patients, it also extends to one another and our community through service projects, health initiatives and wellness education.
Translational & Clinical Advisor – Autoimmune/Rheumatoid Arthritis
Posted today
Job Viewed
Job Description
Key Responsibilities:
- Advise on IND preparation, FDA interactions, trial design, and dose selection
- Support indication prioritization and differentiation from current standards of care
- Help connect with investigators, KOLs, and patient advocacy groups
- Translate preclinical data into a robust clinical and regulatory strategy
- Direct experience in autoimmune drug development, ideally RA
- Strong knowledge of translational science and clinical trial strategy
- Established network in the autoimmune research and clinical community
Estimated Min Rate : $50.00
Estimated Max Rate : $55.00
What’s In It for You?
We welcome you to be a part of the largest and legendary global staffing companies to meet your career aspirations. Yoh’s network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities and gain access to this exclusive opportunity available to you. Benefit eligibility is in accordance with applicable laws and client requirements. Benefits include:
- Medical, Prescription, Dental & Vision Benefits (for employees working 20+ hours per week)
- Health Savings Account (HSA) (for employees working 20+ hours per week)
- Life & Disability Insurance (for employees working 20+ hours per week)
- MetLife Voluntary Benefits
- Employee Assistance Program (EAP)
- 401K Retirement Savings Plan
- Direct Deposit & weekly epayroll
- Referral Bonus Programs
- Certification and training opportunities
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Visit to contact us if you are an individual with a disability and require accommodation in the application process.
For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.
Behavioral Health Clinical Advisor - LCSW, Santa Monica

Posted 7 days ago
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Job Description
In this role, you will provide a range of services to multidisciplinary teams with emphasis on outpatient practices of the UCLA Health-Behavioral Health Associates serving adult, geriatric populations, child and adolescents. Duties may include psychosocial assessment; care coordination, consultation to the team, individual, family or group psychotherapeutic treatment; liaison with community agencies; treatment plan documentation; and disposition planning and advocacy. The clinical advisor is a resource to providers, patients, care coordinators, and performs complex care coordination for high risk patients to improve access to psychiatric care and to prevent unnecessary ED admissions and hospitalizations. The clinical advisor has three main functions: 1. Resource and complex care coordination, 2. Project coordination/management for innovative approaches to deliver behavioral health services to enhance/improve access to care and 3. Direct clinical services, the clinical advisor may provide direct mental health services including urgent assessments, interventions, and recommendations to individual patients and their families and recruitment for and coordination of group therapy sessions.
The clinical advisor serves as a patient advocate, demonstrates problem solving skills to resolve conflict and to assist patients/families/caregivers to identify their past and present coping skills. Works collaboratively with the patient, community resources, other providers, managed care operations, the UCLA Health System, and health plans to implement, identify, coordinate, and monitor options and services to meet at-risk patients' healthcare needs. The clinical advisor aims to foster continuity of care and reduce unnecessary utilization of healthcare services by coordinating and providing health services that meet individuals' health needs. By connecting key individuals involved in the care of the patient and decreasing fragmentation and duplication of care, the clinical advisor is able to enhance the quality and cost effectiveness of the care that is delivered in the outpatient setting. The clinical advisor keeps current with the professional mental healthcare knowledge and pursues further enhancement of job-related knowledge.
LCSW Salary Range: $108,451 - $29,623 Annual
LMFT Salary Range: 71,500 - 154,900 Annual
Qualifications
+ Master's degree in Social Work (MSW) or Psychology/Marriage and Family Therapy
+ California Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT)
+ Experience and skill interacting with health care providers in a multidisciplinary setting
+ 2-3 years of relevant experience
+ Working knowledge of general theoretical and clinical models
+ Ability to develop effective rapport and working therapeutic alliances with patients
+ Skill in writing clear and complete clinical notes and summaries of clinical evaluations
+ Skills and experiences in documenting/charting to ensure current and accurate medical records are entered and documented in patient files in accordance with established Medical Records policies and procedures
+ Knowledge of LCSW/LMFT ethics and scope of practice
+ Ability to perform a complete mental status exam and recognize changes in mental status
+ Ability to establish and maintain effective and mutually respectful relationships with professionals and support staff
+ Knowledge of pertinent current community resources, including income maintenance, mental health treatment, special education, residential and vocational supports
+ Ability to provide and maintain appropriate coordination of care with existing providers and/or variety of community agencies and demonstrate assertiveness, persistence, and diplomacy as an advocate for the patient
+ Ability to triage high risk behavior of patients
+ Knowledge of community resources for higher level of care or specialty care
+ Knowledge of psychosocial factors related to all life stages; expertise in at least one stage
+ Ability to communicate clearly and therapeutically with patients and families regarding diagnosis, progress, treatment plan recommendations
+ Ability to establish and maintain effective and mutually respectful relationships with professionals and support staff
+ Ability to assess and respond appropriately in a timely fashion to the safety needs of patients, family and staff
+ Knowledge of child and adult abuse and neglect reporting laws and procedures
+ Knowledge of scope of practice of relevant other disciplines including psychiatry, psychology, and psychiatric nurse Practitioners.
+ Ability to recognize complex clinical situations and seek and apply consultation of supervision when needed
+ Ability to respond calmly and effectively in crisis situations
+ Demonstrated resourcefulness, effective written and verbal communications and diplomacy
+ Demonstrated leadership and organizational abilities with previous demonstration of consistency, independence, flexibility, initiative and creativity
+ Skill at writing documentation that is timely, meaningful, complete, legible, grammatically correct, concise and consistent with legal and administrative standards
+ Ability to use a computer for electronic mail and word processing, internet access to University policies and procedures, and community resources for patients/families
UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.
Clinical Physician Advisor
Posted 1 day ago
Job Viewed
Job Description
Cone Health, a not-for-profit health system, in Greensboro, North Carolina, is seeking an experienced FM/IM physician to serve as its Clinical Physician Advisor.
General Requirements:
- M-F, 8am-5pm
- Potential for remote work. Must reside in AL, FL, GA, KY, NC, SC, TN, VA, or WV.
- Ensure appropriate denials management and utilization of health system resources.
- Serve as a thought partner and resource to members of the medical staff, clinical staff, utilization management team members, CDI team members, Transitions of Care team members, case managers, and senior leadership.
- Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay, and potential quality issues.
- Provide guidance on individual cases and aggregate level to cultivate efficiency related to patient care delivery providing medical case review, utilization and quality review and submit recommendations, advice and liaison services concerning quality and cost-effective patient care.
- Review cases that indicate a need for issuance of a hospital notice of non-coverage (HINN)/Important Message from Medicare (IM).
- Effectively present information, both formally and informally
- Strong analytic skills, written and verbal communication skills, organizational skills
Qualifications:
Educational/Licensure Requirements: Doctor of Medicine (MD), Doctor of Osteopathy (DO) or equivalent degree and board certified in area(s) of specialty, NC medical license, full unrestricted DEA, Cone Health medical staff membership, and other employment requirements. Required: Physician Advisor Certification, Graduate of Physician Leadership Academy (Cone Health) or equivalent degree with education/preparation in healthcare administration and/or leadership development.
Experience Requirements: Five (5) years of progressive clinical demonstrating clinical skills, quality improvement, utilization management experience and team development. Required: 1-3 years in Quality Improvement; 1-3 years in Utilization Management.
World Class Care :
Cone Health is a not-for-profit 5 hospital system with 1100+ beds. We achieve top decile performance and quality through our Physician Engagement.
A Place to Call Home:
Greensboro and the surrounding North Carolina communities are centrally located in what’s known as the “Triad of NC”. Greensboro is one of the best places to live and play in NC… where you can get to know your neighbors and a place to call home. There are outstanding schools, wonderful cultural events, great sports, golf, eclectic dining, and more. The 4-season climate will inspire you to enjoy the outdoors year-round! For great travel, we have 3 airports (2 have international flights) that service our areas and for weekend getaways, it is an easy drive to the Blue Ridge Mountains and the Carolina coast. For more community information, please visit: Greensboro Life / Greensboro Professionals / Greensboro
Responsibilities: ? Reviews medical records of identified patients to assist with the level of care and length of stay determination.---
? Interacts with medical staff members and medical directors of third-party payers to discuss the patient needs and alternative levels of care.
---
? Provides education to physicians and other clinicians on regulatory requirements, appropriate utilization of alternate levels of care, community resources and end of life care.
---
? Develops strategy and processes to reduce denials and audits. Assists with appeals. Reviews and offers suggestions related to resources and service management.
---
? Utilizes hospital data sources to identify and analyze patterns of over or under-utilization of services, quality metrics and makes recommendations towards achievement of those goals.
---
? Suggests recommendations of treatment of specific cases and discusses about the same to the health care team.
---
? Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
---
? Reviews cases retroactively to determine appropriateness of Part B billing versus appeal.
--- Qualifications:
Clinical Physician Advisor
Posted today
Job Viewed
Job Description
Cone Health , a not-for-profit health system, in Greensboro, North Carolina, is seeking an experienced FM/IM physician to serve as its Clinical Physician Advisor. General Requirements:
Qualifications: Educational/Licensure Requirements: Doctor of Medicine (MD), Doctor of Osteopathy (DO) or equivalent degree and board certified in area(s) of specialty, NC medical license, full unrestricted DEA, Cone Health medical staff membership, and other employment requirements. Required: Physician Advisor Certification, Graduate of Physician Leadership Academy (Cone Health) or equivalent degree with education/preparation in healthcare administration and/or leadership development. Experience Requirements: Five (5) years of progressive clinical demonstrating clinical skills, quality improvement, utilization management experience and team development. Required: 1-3 years in Quality Improvement; 1-3 years in Utilization Management. World Class Care : Cone Health is a not-for-profit 5 hospital system with 1100+ beds. We achieve top decile performance and quality through our Physician Engagement . A Place to Call Home: Greensboro and the surrounding North Carolina communities are centrally located in what’s known as the “Triad of NC”. Greensboro is one of the best places to live and play in NC… where you can get to know your neighbors and a place to call home. There are outstanding schools, wonderful cultural events, great sports, golf, eclectic dining, and more. The 4-season climate will inspire you to enjoy the outdoors year-round! For great travel, we have 3 airports (2 have international flights) that service our areas and for weekend getaways, it is an easy drive to the Blue Ridge Mountains and the Carolina coast. For more community information, please visit: Greensboro Life / Greensboro Professionals / Greensboro |
? Reviews medical records of identified patients to assist with the level of care and length of stay determination. --- ? Interacts with medical staff members and medical directors of third-party payers to discuss the patient needs and alternative levels of care. --- ? Provides education to physicians and other clinicians on regulatory requirements, appropriate utilization of alternate levels of care, community resources and end of life care. --- ? Develops strategy and processes to reduce denials and audits. Assists with appeals. Reviews and offers suggestions related to resources and service management. --- ? Utilizes hospital data sources to identify and analyze patterns of over or under-utilization of services, quality metrics and makes recommendations towards achievement of those goals. --- ? Suggests recommendations of treatment of specific cases and discusses about the same to the health care team. --- ? Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. --- ? Reviews cases retroactively to determine appropriateness of Part B billing versus appeal. --- |
Clinical Physician Advisor
Posted 1 day ago
Job Viewed
Job Description
Cone Health , a not-for-profit health system, in Greensboro, North Carolina, is seeking an experienced FM/IM physician to serve as its Clinical Physician Advisor. General Requirements:
Qualifications: Educational/Licensure Requirements: Doctor of Medicine (MD), Doctor of Osteopathy (DO) or equivalent degree and board certified in area(s) of specialty, NC medical license, full unrestricted DEA, Cone Health medical staff membership, and other employment requirements. Required: Physician Advisor Certification, Graduate of Physician Leadership Academy (Cone Health) or equivalent degree with education/preparation in healthcare administration and/or leadership development. Experience Requirements: Five (5) years of progressive clinical demonstrating clinical skills, quality improvement, utilization management experience and team development. Required: 1-3 years in Quality Improvement; 1-3 years in Utilization Management. World Class Care : Cone Health is a not-for-profit 5 hospital system with 1100+ beds. We achieve top decile performance and quality through our Physician Engagement . A Place to Call Home: Greensboro and the surrounding North Carolina communities are centrally located in what’s known as the “Triad of NC”. Greensboro is one of the best places to live and play in NC… where you can get to know your neighbors and a place to call home. There are outstanding schools, wonderful cultural events, great sports, golf, eclectic dining, and more. The 4-season climate will inspire you to enjoy the outdoors year-round! For great travel, we have 3 airports (2 have international flights) that service our areas and for weekend getaways, it is an easy drive to the Blue Ridge Mountains and the Carolina coast. For more community information, please visit: Greensboro Life / Greensboro Professionals / Greensboro |
? Reviews medical records of identified patients to assist with the level of care and length of stay determination. --- ? Interacts with medical staff members and medical directors of third-party payers to discuss the patient needs and alternative levels of care. --- ? Provides education to physicians and other clinicians on regulatory requirements, appropriate utilization of alternate levels of care, community resources and end of life care. --- ? Develops strategy and processes to reduce denials and audits. Assists with appeals. Reviews and offers suggestions related to resources and service management. --- ? Utilizes hospital data sources to identify and analyze patterns of over or under-utilization of services, quality metrics and makes recommendations towards achievement of those goals. --- ? Suggests recommendations of treatment of specific cases and discusses about the same to the health care team. --- ? Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. --- ? Reviews cases retroactively to determine appropriateness of Part B billing versus appeal. --- |
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Clinical Pharmacist Advisor

Posted 7 days ago
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Job Description
+ As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
**Responsibilities:**
+ Collaborates with multiple groups within CD&A, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
+ Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (20%)
+ Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests (50%)
+ 6. Performs other related projects and duties as assigned including on call and after-hours pharmacist availability could be required. (10%)
**Experience:**
+ Minimum 1 year of experience in Prior Authorization & Medicare Part D although 2-5 years is preferred
**Skills:**
+ Prior Authorization
+ Medicare Part D
**Education:**
+ Bachelor's Degree Required, Pharm D Preferred
**About US Tech Solutions:**
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ( .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Senior Clinical Advisor (Assistant Nurse Manager) Intermediate Care

Posted 13 days ago
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Job Description
Full time
**Shift:**
Day Shift
**Description:**
At **Saint Mary's Hospital** the Intermediate Care Unit is a 20-bed unit providing care to high-acuity medical and surgical patients that require continuous cardiac monitoring and various interventions, supporting respiratory and hemodynamic stability.
+ The Senior Clinical Advisor (SCA), under the general supervision of the Nurse Manager collaborates to provide continuity of care by ensuring adequate resources are available on a shift to shift basis.
+ The SCA collaborates with the healthcare team to plan and coordinate timely admission, transfer and discharge of patients.
+ Creates an environment that ensures the delivery of safe and high quality patient care , high patient satisfaction, positive patient outcomes.
+ The ideal candidate will display a drive to provide patient-centered experiences through scholarly scientific inquiry, compassion for the human spirit and mind, advocacy and education for the patient and families, and collaboration with all those who touch our patients.
+ This critical role collaborates with other members of nursing leadership to create an environment that promotes excellence in clinical practice.
+ The SCA contributes to the effective management of the Department and Hospital.
**Minimum Qualifications**
+ **Education** : Graduate of an accredited college or university affiliated nursing program. BSN graduate preferred.
+ **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts.
+ **Certification** : BLS (AHA/ARC). ACLS required within 6 months of hire.
+ **Experience:** ICU/Critical Care, Telemetry, or Intermediate/Step Down nursing experience from an Acute Care Hospital. Progressive intermediate/step-down or critical care nursing experience including charge nurse experience and supervision. Knowledge of national standards, i.e. DPH, JC, CMS. Knowledge of current nursing, medical and health trends/practices.
**Work Schedule** : Full time, 40 hours/week Days
+ Great benefits
+ Patient-centric environment
+ Career growth and advancement potential
+ Diverse and inclusive culture
+ Engaged leadership
**Ministry/Facility Information**
**Mercy Medical Center** has established itself as one of the leading providers of health care services in Western Massachusetts. Mercy Medical Center is a 182-bed acute care hospital in Springfield. Other facilities include Mercy's Rehabilitation Hospital, a comprehensive hospital-based rehabilitation center on the campus of Mercy Medical Center and Brightside for Families and Children, an outpatient service offering counseling and family support programs.
**Our Commitment**
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran
Clinical Assessment Advisor, Home Health

Posted 13 days ago
Job Viewed
Job Description
Make a meaningful impact every day as a CenterWell Home Health nurse. You'll provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working closely with a dedicated team of physicians and clinicians, you'll develop and manage care plans that support recovery and help patients get back to the life they love.
The **Clinical Assessment Advisor** directly completes and oversees development/ of the plan of treatment as approved by physician, performs ongoing evaluation of patient needs and coordinates team of professionals and other licensed clinicians and home health aides to ensure optimal clinical outcomes. Works with physician and/or referral source to obtain all pertinent clinical information for optimal assessment generation. Ensures consistent team care scheduling and dissemination of updated clinical information. Coordinates assigned care team members and resources. Maintains focus on all healthcare quality and affordability initiatives (HCQAI's). Established productivity standards and performance will be monitored and measured under general supervision of the Clinical Field Staff Supervisor (CFSS) or above.
**Essential Functions** :
+ Performs or delegates the initial and ongoing evaluation of patient needs within their scope of practice
+ Routinely complete Start of Care/Resumption of Care/Recertification/Discharge of OASIS visits and may occasionally need to provide routine visits based on individual patient needs and branch expectations
+ Ensures plan of care incorporates and guides appropriate teaching related to health maintenance, prevention and safety
+ Coordinates available resources to manage care plan and ensures stated outcomes are achieved
+ Periodically reassesses or delegates the reassessment of patient needs and revises care plan as necessary
+ Assures appropriate care of patient is met through the start of care assessment completion.
+ Promotes/coordinates communication between team members, attending physicians, appropriate administrative staff, referral sources and external case managers to ensure appropriateness of care
+ coordination and communicates any necessary changes to the plan of care
+ Ensures patient needs are identified and qualified caregivers are assigned to all cases within their scope of practice
+ Participates in special projects and performs other duties as assigned
**Use your skills to make an impact**
**Required Experience/Skills:**
+ Bachelor of Science degree in Nursing (BSN) preferred
+ At least 2 years clinical home care experience with minimum one year experience in a clinical management role is preferred
+ Current CPR certification
+ Excellent verbal and written communication skills
+ Excellent interpersonal skills
+ Knowledge of state and federal home health agency regulations and compliance standards and regulations
+ Knowledge of clinical policies and procedures and ability to implement
+ Knowledge of clinical structure of PDGM
+ Must read, write and speak fluent English.
+ Must have good and regular attendance.
+ Approximate percent of time required to travel: 60%
+ Performs other related duties as assigned.
+ A valid driver's license, auto insurance, and reliable transportation are required.
Pay Range
- $45.00 - $3.00 - pay per visit/unit
- 70,500 - 96,900 per year base pay
**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.
70,500 - 96,900 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 Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
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