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You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes<ul> <li>Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem.</li> <li>Develop and maintain the audit schedule</li> <li>Audit staff as outlined in the system auditing policies</li> <li>Train audit staff at the health plan in the use of audit process and tool</li> <li>Facilitate compliance with the auditing process</li> <li>Act as a consultant related to system auditing to others in the unit, department and health plan</li> <li>Work with staff to identify and resolve authorization load error report system problems</li> <li>Coordinate auditing outcomes with the Trainer to identify, develop and publish corrective actions/educational material related to audit errors</li> <li>Coordinate auditing outcomes and system maintenance with the Sr.</li> <li>Clinical Systems Specialist to resolve or enhance clinical systems</li> <li>Ability to travel</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years of related experience. License/Certification: Current state nursing license. Pay Range: $55,100.00 - $99,000.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Oklahoma Complete Health

Medical Management Auditor

CompanyCox Automotive - USAJob Family GroupCustomer Care GroupJob ProfileSr Customer Care SpecialistManagement LevelIndividual Contributor Flexible Work Option Can work remotely anywhere in the specified countryTravel %NoWork ShiftDayCompensationHourly base pay rate is $21.49 - $32.26/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate’s knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program.Job DescriptionSince 1999, Central Dispatch has been the leader in safe and self-service auto transport. Originally built as a simple platform where shippers could securely contact carriers, we’ve now digitized every step of the process with tools and features that are now the industry standard. In 2015, we became part of Cox Automotive, giving our customers unmatched scale and resources to ship across the country with ease. Through it all, we’ve stayed true to our original mission — to help you move cars with convenience and confidence. What You'll Do: <ul> <li>Become proficient in all knowledge base requirements to resolve clients’ needs as efficiently as possible</li> <li>Become proficient in all platforms, systems, and tools used to maintain client records, transactions, documentation, and relevant data</li> <li>Maintain appropriate documentation of conversations in designated system to ensure handoff continuity and client profile accuracy</li> <li>Manage high volume of tasks in a timely and efficient manner</li> <li>Identify client needs, research issue and provide solutions and/or alternatives</li> <li>Build sustainable relationships and engage clients by providing best-in-class service</li> <li>Meet and/or exceed established inbound call quality guidelines and key performance criteria</li> <li>Provide excellent client service and advocacy</li> <li>Work across the organization as needed to resolve client requests</li> <li>Assist clients with the onboarding process by providing status of application and registration process, guidance of next steps, and answer any questions</li> <li>Dispatch available vehicles to clients across all regions on an inbound basis</li> <li>Effectively communicate to the client how to use any of our client facing tools</li> <li>Perform other duties as deemed necessary by management</li> </ul>Minimum Qualifications:<ul><li>High School Diploma/GED and 5 years’ experience in a related field; OR the right candidate could also have a different combination, such as any level degree/certification beyond a HS diploma/GED in a related discipline and 3 years’ experience; OR 7 years’ experience in a related field</li></ul>Preferred Qualifications:<ul> <li>Auction and/or logistics/transportation knowledge a strong plus</li> <li>Excellent oral and written communications skills, particularly in a phone or email context</li> <li>Attention to detail and follow-through</li> <li>Demonstrated ability to adapt in a changing environment,</li> <li>Ability to multi-task within a fast-paced, high energy, dynamic and demanding environment</li> <li>Demonstrated experience being a customer-focused, service-oriented professional</li> </ul>Drug TestingTo be employed in this role, you’ll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited.BenefitsEmployees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells – or simply uses – cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer – All qualified applicants/employees will receive consideration for employment without regard to that individual’s age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. <h3> </h3>

Cox Automotive Inc.

Senior Customer Care Specialist

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Position Purpose:This position will be responsible for stewarding the continuous evolution of strategy and driving data transformation initiatives and ensuring data is leveraged effectively and efficiently to enable Centene's business goals. This role helps oversee the successful development of the company's data strategy, the implementation through cross-functional and interdepartmental transformation at Centene. Achievement requires the individual to understand and drive adoption of emerging industry trends and stay agile in adopting market innovation. This leader will translate corporate strategies to data strategy and drive implementation through divisional and departmental adoption. This role will also identify thematic data problems and drive comprehensive solutions across the business to conclusion for an optimized data ecosystem that all stakeholders can trust, in addition to leading negotiations of prioritization and departmental strategies to ensure appropriate resource allocation and incentives aligned to mutually beneficial outcomes. Achievement requires a deep understanding of data management, analytics, and data governance, coupled with strong leadership and strategic thinking skills.<ul> <li>Partner with Data &amp; Analytics Leadership and Business Leadership to continue to develop and refresh the company’s data, analytics, and interoperability strategy that aligns with the company’s business objectives. Identify opportunities to leverage data for competitive advantage and operational efficiency. Partner across markets and product lines to ensure alignment and optimization of data assets.</li> <li>Lead data transformation initiatives to modernize and optimize the use of data enterprise wide. Drive adoption of insights in transformational activities to enhance data-driven decision making, embedded use of data, and interoperability optimization. Ensure innovation is a consistent and constant component of data transformation activities. Oversee the implementation of data quality improvement throughout transformational efforts.</li> <li>Collaborate with business leaders, IT, and market stakeholders to ensure alignment and prioritization of consistent data governance efforts. Provide transparency into data maturity and reporting to executive team across all business units. Foster a culture of data stewardship and accountability throughout the organization. Communicate and collaborate on data strategy and governance policies to senior leadership and other key stakeholders. Engage cross-functionally and understand corporate vision. Guiding to align individual and team level goals to organizational strategic direction.</li> <li>Build and lead a high-performing team of data professionals, including data governance, policy, and enablement experts. Provide mentorship and professional development opportunities to team members. Promote a culture of continuous improvement and innovation across the data organization and in the business units.</li> <li>Develop and monitor key performance indicators (KPIs) to measure success of data governance. Drive consistent incentives across the matrixed organization to ensure data stewards and executive data stewards are working towards common goals for the shared benefit of the company. Provide regular updates and reports to executive.</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience:<ul> <li>Bachelor's Degree in a related field required.Master's Degree preferred. </li> <li>10+ years in operations, project management, or related experience required</li> <li>Experience with leading data &amp; analytics teams required</li> <li>Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff required</li> <li>New business development and/or professional consulting experience preferred</li> <li>Strong understanding of data management, data governance, and advanced analytics required</li> </ul>Pay Range: $182,100.00 - $345,600.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Vice President, Data Strategy & Operations

<h2 id="who-we-are">Who we are</h2> <h3 id="about-stripe">About Stripe</h3> Stripe is a financial infrastructure platform for businesses. Millions of companies—from the world’s largest enterprises to the most ambitious startups—use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Our mission is to increase the GDP of the internet, and we have a staggering amount of work ahead. That means you have an unprecedented opportunity to put the global economy within everyone’s reach while doing the most important work of your career. <h3 id="about-the-team">About the team</h3> The Terminal Partnerships team sits within the Global Partnerships Expansion and Incubation Pillar; sourcing, developing and managing relationships and programs that enable and expand Stripe’s in-person payment products. Stripe’s in-person payment products provide Stripe users tools to extend their online presence into the physical world and help all merchants create a unified commerce experience. With Stripe Terminal, users can unlock the in-person payment experiences best suited for their business model—whether it’s creating a flagship retail experience, unifying online and offline commerce or enabling a consumer mobile device to accept payments. The Terminal Partnerships team is responsible for developing and managing relationships; executing on high-impact, cross-functional initiatives to launch new product experiences and drive growth for Stripe Terminal globally through with partners.. In 2024, we expanded our <a href="https://stripe.com/blog/stripe-terminals-expanding-ecosystem-new-partnerships-bring-flexibility-and-innovation-to-unified-commerce" target="_blank">Terminal partnership ecosystem</a> considerably; bringing flexibility and innovation to unified commerce through partnerships with market leading POS solutions, platforms such as FreedomPay and 3P hardware in support of expanding Tap to Pay on Android. Through these partnerships, we are able to better serve modernizing enterprises and platforms across the Retail, Hospitality and F&amp;B industries. This is only the beginning as we drive Stripe Terminal to new levels of usability and reach in 2025 and beyond. <h2 id="what-youll-do">What you’ll do</h2> We are looking for a Partner Development Manager who will be responsible for identifying new opportunities, driving recommendations for partnerships that create product differentiation, managing new and existing partner relationships and optimizing partnerships for growth. This role will collaborate closely with cross-functional teams including Product, Legal, Engineering, Finance, GTM and other teams to evaluate product and business initiatives and execute new partner agreements to accelerate Teminal’s growth and ecosystem expansion. We are looking for a strategic, entrepreneurial business development manager with strong product instincts, experience negotiating and formalizing partnership agreements, building partner programs and working with cross-functional teams. <h3 id="responsibilities">Responsibilities</h3> <ul> <li>Identify, develop and lead new partnerships that empower our users to build or launch point-of-sale experiences that will shape the future of in-person commerce e.g., new capabilities, software or hardware products and/or commercial models. </li> <li>Structure and negotiate first-of-kind deals for initial product enablement or go-to-market partnerships with large B2B technology companies, in existing and new geographies. </li> <li>Collaborate closely with Product, Engineering, Technical Project Managers, Legal, Marketing and other cross-functional partnership teams to develop and execute our Terminal strategy. </li> <li>Understand our partners’ key priorities, challenges, and internal roadmaps; regularly communicate insights and recommendations to the Terminal team. </li> <li>Develop strategic perspectives based on market and partner insights, actively contributing a POV to our product strategy. </li> <li>Work with partners to define, deliver and manage KPIs, joint roadmaps and success metrics to deliver impact and scale partnerships. </li> <li>Manage QBRs, account plans, account mapping and cross functional engagement. </li> </ul> <h2 id="who-you-are">Who you are</h2> We’re looking for someone who meets the minimum requirements to be considered for the role. If you meet these requirements, you are encouraged to apply. The preferred qualifications are a bonus, not a requirement. <h3 id="minimum-requirements">Minimum requirements</h3> <ul> <li>7+ years of experience in product partnerships, business development, partner management or corporate development, working closely with other technology or fintech companies on platform or new business development </li> <li>Domain expertise in Payments, Enterprise software, Commerce and/or Hardware </li> <li>Technical acumen, an ability to understand Stripe’s product portfolio and strategy and use this understanding to define requirements with partners and evaluate new partnership opportunities </li> <li>Strong agency, can handle ambiguity in a fast-moving organization, and thrives on a high level of autonomy and responsibility </li> <li>Exceptionally strong communication skills, in both verbal and written form, and ability to influence stakeholders across a wide variety of functions </li> <li>Experience managing partnerships with significant cross functional engagement models </li> <li>Humility and leads by example, setting the right context and helping teammates do their best work </li> </ul> <h3 id="preferred-qualifications">Preferred qualifications</h3> <ul> <li>2+ years of experience working with in-person payment acceptance, devices/hardware, payment orchestration or gateways. </li> <li>A track record of developing high-impact partnerships with significant internal and external dependencies </li> <li>Experience bringing new product to market with a partner </li> </ul> This role is available either in an office or a remote location (typically, 35+ miles or 56+ km from a Stripe office). Office-assigned Stripes spend at least 50% of the time in a given month in their local office or with users. This hits a balance between bringing people together for in-person collaboration and learning from each other, while supporting flexibility about how to do this in a way that makes sense for individuals and their teams. A remote location, in most cases, is defined as being 35 miles (56 kilometers) or more from one of our offices. While you would be welcome to come into the office for team/business meetings, on-sites, meet-ups, and events, our expectation is you would regularly work from home rather than a Stripe office. Stripe does not cover the cost of relocating to a remote location. We encourage you to apply for roles that match the location where you currently or plan to live. Stripe does not yet include pay ranges in job postings in every country. Stripe strongly values pay transparency and is working toward pay transparency globally. Office locations Toronto, or Mexico City Remote locations Remote in United States Team Global Partnerships Job type Full time <a href="#"> Apply for this role </a>

Stripe

Partner Development Manager, Terminal Product Partnerships

<h2 id="who-we-are">Who we are </h2> <h3 id="about-stripe">About Stripe </h3> Stripe is a financial infrastructure platform for businesses. Millions of companies—from the world’s largest enterprises to the most ambitious startups—use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Our mission is to increase the GDP of the internet, and we have a staggering amount of work ahead. That means you have an unprecedented opportunity to put the global economy within everyone’s reach while doing the most important work of your career. <h3 id="about-the-team">About the team </h3> The Infrastructure organization is dedicated to building and maintaining the foundational infrastructure that powers Stripe’s innovative products and services. This includes Core Infrastructure, which ensures the reliability, performance, and scalability of critical tier-0 systems; Data Platform, responsible for the architecture and optimization of data systems; and Developer Infrastructure, which enhances the productivity of engineering teams through efficient tools and workflows. Reliability Insights and Excellence focuses on maximizing service reliability through data-driven insights and best practices. Meanwhile, Admin Platform builds the internal tools that streamline operational processes, and Support Experience Engineering enhances customer interactions by providing effective support solutions. Together, these teams drive the efficiency, reliability, and scalability necessary to support Stripe’s mission of providing outstanding financial solutions. Each group plays a vital role in Stripe’s overall success, bringing unique expertise and focus to the table. Below are more detailed descriptions of the specific teams within these organizations that are currently hiring, highlighting their contributions, innovations, and the ways in which they collectively enhance Stripe's infrastructure and user experience. The Compute Organization is responsible for building and maintaining tier-0 systems used by Stripe teams for running, deploying, networking, monitoring, and configuring their services. We own a large number of critical services which support Stripe’s 5.5 (9s) of reliability. Our infrastructure team cares deeply about our people, collaboration and delivering impact for the company. The Document Databases org is responsible for providing a fully-managed, highly available, secure, performant, and efficient database-as-a-service (DBaaS) for all of Stripe. Document Databases is the de-facto storage solution for most of Stripe’s product surface area, processing all of Stripe’s payment volume. We run a massive fleet of databases, and our offering is one of the largest MongoDB deployments on the planet. Ruby is the most used language at Stripe and is used to create tier-0 services. Ruby Infrastructure ensures that Stripe engineers who work in Ruby are as effective as possible. We own build systems, IDE tools, code analysis, a gradual static type checker (<a href="https://sorbet.org/" target="_blank">https://sorbet.org/</a>), and a lot more. We are passionate about the user experience and productivity of Stripe engineers. ### What you’ll do In this role, you will play a key part in enhancing the reliability, performance, and scalability of Stripe’s essential infrastructure. You’ll work closely with many teams across Stripe to develop solutions that elevate our systems and enrich customer experiences. We’re seeking candidates who are enthusiastic about building robust infrastructure, committed to collaboration, and ready to tackle complex problems in an agile environment. You’ll have the chance to innovate, optimize processes, and establish strong partnerships across teams, ensuring we understand and meet the diverse needs of our engineering community. Responsibilities: <ul> <li>Collaborate with engineers and leaders across Stripe to identify and capture opportunities to enhance our infrastructure platform, ensuring effective fault isolation, resource utilization, data security, and operational efficiency. </li> <li>Support the engineering team in achieving a high level of technical quality, reliability, and ease-of-use. </li> <li>Manage processes to help the team do its best work and engage effectively with the rest of Stripe. </li> <li>Engage with teams to create team vision, business goals, and yearly roadmaps. </li> <li>Use best of breed agile methodologies to consistently deliver on team commitments. </li> <li>Recruit great engineers, in collaboration with Stripe’s recruiting team. </li> <li>Develop engineers on the team, helping them advance in their careers. </li> <li>Contribute to engineering-wide initiatives as a member of Stripe’s engineering management team. </li> <li>Collaborate with stakeholders across engineering to provide a wonderful user experience. </li> </ul> <h3 id="who-you-are">Who you are </h3> We’re looking for someone who meets the minimum requirements to be considered for the role. If you meet these requirements, you are encouraged to apply. Minimum requirements <ul> <li>10+ total years of engineering experience with a minimal 3 years of management experience. </li> <li>Experience in building and scaling distributed platforms with a focus on horizontal scaling and sharding, ensuring exceptional performance to meet the needs of diverse applications </li> <li>Proven track record in managing teams that successfully shipped and operated critical software services, fostering a collaborative environment that values continuous improvement. </li> <li>Strong quantitative and analytical skills that drive data-informed decision-making and foster a culture of excellence within the team. </li> <li>Demonstrated ability to work effectively with geographically distributed teams, promoting clear communication and collaboration across time zones to ensure alignment and shared goals. </li> <li>Successfully recruited, mentored, and built high-performing teams, creating an inclusive environment that attracts diverse talent and empowers individuals to thrive. </li> <li>Ability to operate with a high level of autonomy and responsibility, taking ownership of projects and driving initiatives that contribute to the overall success of the organization. </li> <li>Exceptional written and verbal communication skills, enabling clear and persuasive interactions with colleagues and stakeholders, ensuring understanding of technical concepts and fostering collaboration. </li> </ul> Preferred qualifications <ul> <li>Experience working with globally distributed systems and platforms. </li> <li>Proven track record of building and scaling infrastructure to support high availability and performance requirements, handling millions of requests per second. </li> </ul> Office-assigned Stripes spend at least 50% of the time in a given month in their local office or with users. This hits a balance between bringing people together for in-person collaboration and learning from each other, while supporting flexibility about how to do this in a way that makes sense for individuals and their teams. The annual US base salary range for this role is $224,300 - $354,000. For sales roles, the range provided is the role’s On Target Earnings ("OTE") range, meaning that the range includes both the sales commissions/sales bonuses target and annual base salary for the role. This salary range may be inclusive of several career levels at Stripe and will be narrowed during the interview process based on a number of factors, including the candidate’s experience, qualifications, and location. Applicants interested in this role and who are not located in the US may request the annual salary range for their location during the interview process. Additional benefits for this role may include: equity, company bonus or sales commissions/bonuses; 401(k) plan; medical, dental, and vision benefits; and wellness stipends. Office locations Seattle Team Infrastructure &amp; Corporate Tech Job type Full time <a href="#">Apply for this role </a>

Engineering Manager, Core Tech

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Oversee the overall client satisfaction for all accounts <ul> <li>Manage account renewal and retention processes and assist sales team in generating new client referrals</li> <li>Identify new services and profit enhancement opportunities within existing clients</li> <li>Collaborate with internal departments regarding client needs and requests, including understanding and interpreting contractual obligations to meet business needs</li> <li>Oversee the identification of client complaints and resolution of issues related to internal processes and systems</li> <li>Implement client specific corrective action plans and ensure timely submissions of complaints process</li> <li>Oversee the reporting and client documentation within Salesforce.com</li> <li>Research competitive intelligence and relevant market information to enhance client experience</li> <li>Facilitate development of custom proposals for new and existing clients</li> <li>Ability to travel</li> </ul>Education/Experience: Bachelor’s degree in Healthcare or Business Administration, Marketing, related field or equivalent experience. 7+ years of account management experience, preferably in specialty pharmacy, pharmacy benefit management, and/or a managed care environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.Pay Range: $110,900.00 - $205,000.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Director, Account Management

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.<ul><li>Job Description</li></ul>Primary Job Duties &amp; Responsibilities Follows management-established procedures to execute routine business support tasks for core Inbound and Outbound communications functions, under general supervision. Develops effective relationships with all team members to effectively progress daily communications to resolve issues and prevent delays in service or responses. Handles Inbound and Outbound tasks in a manner that operates in full compliance with patient confidentiality policies and regulations. Maintains accurate and complete documentation of member health information to minimize risk management, while adhering to all regulatory, and accreditation requirements. Reviews requests for appropriate referral to medical services staff and approves services that do not require a medical review. Escalates more complex customer/member inbound inquiries to management for more thorough follow-up and resolution. Takes management direction to properly execute techniques, processes, and responsibilities according to established work area policies and procedures. Documents all Inbound and Outbound phone details into the company database to ensure full collection of customer/patient needs and requirements. Demonstrates active listening skills while handling customer/patient calls, also exerting compassion and understanding to gain customer/patient trust and loyalty. Education High school diploma or up to 1 year equivalent experience. Prior Relevant Work Experience 0-1 year Essential Qualifications Working knowledge of problem solving and decision making skills*Shift Available: Tuesday-Saturday 1:00pm-9:30pm EST*Training: 10:00 AM - 6:30 PM ET, for first 8 weeks *Some Holidays required.Position SummaryInbound Queue Associate - Behavioral Health role is responsible for accepting inbound calls from facilities, providers, and members regarding pre-certification process within Medicare and Commercial Insurance.Responsibilities to include but limited to the following:<ul><li><ul> <li>Performs intake of calls from members or providers regarding services via telephone, fax, EDI.</li> <li>Screens requests for appropriate referral to medical services staff.</li> <li>Approve services that do not require a medical review in accordance with the benefit plan.</li> <li>Performs non-medical research including eligibility verification, COB, and benefits verification.</li> <li>Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.</li> <li>Protects the confidentiality of member information and adheres to company policies regarding confidentiality</li> <li>Communicate with Aetna Case Managers, when processing transactions for members active in this program</li> <li>Other duties and responsibilities as required.</li> </ul></li></ul> Required Qualifications<ul><li><ul> <li>2 plus years of Customer Service Background</li> <li>2 plus years of Call Center experience</li> </ul></li></ul> Preferred Qualifications<ul><li><ul> <li>Familiarity with basic medical terminology and concepts used in care management.</li> <li>2-4 years experience as a medical assistant, office assistant or other clinical experience.</li> <li>Effective communication, telephonic and organization skills.</li> <li>Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.</li> <li>Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.</li> <li>Ability to effectively participate in a multi-disciplinary team including internal and external participants</li> </ul></li></ul> EducationHigh School Diploma or equivalent GEDAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $25.65This 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 peopleWe 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:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>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.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 03/19/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Inbound/Outbound Queue Associate

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.<ul> <li>Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome</li> <li>Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs</li> <li>Identifies problems/barriers to care and provide appropriate care management interventions</li> <li>Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services</li> <li>Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs</li> <li>Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate</li> <li>Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services</li> <li>May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources</li> <li>Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators</li> <li>Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits</li> <li>Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner</li> <li>Other duties or responsibilities as assigned by people leader to meet business needs</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Position is open to candidates located in Macomb and Wayne County Michigan. Travel is 75% for member visits in those counties. Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience. License/Certification:<ul><li>RN - Registered Nurse - State Licensure and/or Compact State Licensure required</li></ul>Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Care Manager RN

We have an opening at our Tulsa location. The role of Assistant Controller requires a Bachelor's degree in a business discipline, preferably in accounting, or a minimum of 5 years' experience in accounting, finance, and financial reporting. The starting salary for Assistant Controller is $90,000.00 Do you enjoy making a difference in the lives of patients and your community? Come join our community here at Counseling &amp; Recovery Services of Oklahoma. Where building better lives happen daily! Counseling &amp; Recovery Services of Oklahoma provides mental health and substance abuse treatment, physical health care management and wellness services for over 5,000 children and adults annually. We are Oklahoma's only community mental health center certified in the Sanctuary model of care. Using this model, the agency provides trauma-informed care helping to create an environment of safety, identify and manage emotions, process loss and help clients create a future of growth and change. Due to tremendous growth, we are hiring an Assistant Controller at our Tulsa location. As a member of our CRS team, you will have the opportunity to improve the quality of life for our patients by delivering one-on-one clinical guidance and support. Benefits: <ul> <li>Competitive 2024 Market Value Salaries.</li> <li>4% 403B Employer "Gifted" Contribution.</li> <li>3% Merit and 4% Bonus Increase Potential.</li> <li>10 Paid Holidays, and 2 Floating Holidays.</li> <li>Up to 4 weeks Vacation time.</li> <li>Gym Membership Stipend.</li> <li>Affordable Medical, Dental &amp; Vision Plans.</li> <li>Employer-paid Life Insurance.</li> <li>Employer-paid Long-Term Disability.</li> <li>Continuing Education Stipend up to $500.</li> </ul> Special Knowledge, Skills and Abilities: <ul> <li>Comprehensive knowledge of nonprofit accounting principles, financial reporting, and compliance requirements.</li> <li>Excellent analytical and problem-solving, and strategic thinking skills.</li> <li>Proficiency in financial software, QuickBooks Online for Nonprofits and Microsoft Excel.</li> <li>Excellent leadership and team management abilities.</li> <li>Effective communication and interpersonal skills.</li> <li>Ability to work collaboratively in a team and lead financial initiatives.</li> <li>Ability to work remotely and in the office.</li> <li>Must be able to show initiative and be a self-starter.</li> </ul> Example of Position Responsibilities: <ul> <li>Prepare monthly financial statements, analyze results and report results to CFO and Executive Director.</li> <li>Analyze monthly cash flow needs to ensure adequate cash on hand for operating needs.</li> <li>Monitor and provide support for accounts payable and purchasing activities to ensure proper cash reserves are available, making adjustments as necessary to ensure cash levels are maintained.</li> <li>Oversee the RFP process to ensure agency obtains the best quality goods and services for the most equitable price.</li> <li>Work with other Leadership members to develop the annual Capital Expenditures Budget.</li> <li>Prepare for and attend Board Meetings to present and/or assist Finance Committee Chair and CFO with reporting to the Board.</li> <li>Serve as back up to the CFO to: Provide support/assistance to External Auditors, Develop agency annual revenue &amp; expense budget, Analyze general ledger activities and problem solve discrepancies.</li> <li>Partner with Community Support Program Director to address Transitional Housing Resident issues and concerns and to assure that all vacancies are filled in a timely manner and appropriate client issues are addressed.</li> <li>Facilitate all Housing site visits by governing regulatory agencies to ensure regulations are met.</li> <li>Conducts annual performance evaluations and addresses performance issues in a straight forward and timely manner.</li> <li>Supports and promotes a service environment for individuals in need of behavioral health and/or co-occurring services that is recovery focused, welcoming, and attentive to the needs of the individuals who may have experienced trauma in their lives.</li> <li>Practices and promotes the Sanctuary model seven commitments: nonviolence, emotional intelligence, social learning, open communications, social responsibility, democracy and growth and change.</li> <li>Must be able to travel and provide own transportation </li> </ul> Other Duties: Perform other duties as assigned by CFO. Physical Requirements: Must be able to move from location to location, bending, stooping, lifting 25 pounds, communicate clearly, prepare written communications, present information to other employees, process complex information within established procedures/programs, enter data to various programs. Must be able to climb stairs and access non-handicapped equipped residences/facilities. Drug Free Workplace Policy This job is classified as a “safety-sensitive” position as defined by the Oklahoma Medical Marijuana and Patient Protection Act. Possession of a medical marijuana license does not exclude any applicants; however all employees are subject to the Counseling &amp; Recovery Services of Oklahoma Drug Free Workplace Policy. EEO/AA Employer/Vet/Disabled Counseling &amp; Recovery Services of Oklahoma (CRS) is committed to the full inclusion of all qualified individuals. As part of this commitment, CRS will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Frank Jeffries, Human Resources Director by calling 918-392-5817

Counseling & Recovery Services of Oklahoma

Assistant Controller

We have an opening at our Tulsa location. The role of Payroll Analyst requires a Bachelor's degree in a business discipline, preferably in accounting, or a minimum of 5 years' experience in accounting and payroll. The starting salary for Payroll Analyst is $65,000.00 Do you enjoy making a difference in the lives of patients and your community? Come join our community here at Counseling &amp; Recovery Services of Oklahoma. Where building better lives happen daily! Counseling &amp; Recovery Services of Oklahoma provides mental health and substance abuse treatment, physical health care management and wellness services for over 5,000 children and adults annually. We are Oklahoma's only community mental health center certified in the Sanctuary model of care. Using this model, the agency provides trauma-informed care helping to create an environment of safety, identify and manage emotions, process loss and help clients create a future of growth and change. Due to tremendous growth, we are hiring a Payroll Analyst at our Tulsa location. As a member of our CRS team, you will have the opportunity to improve the quality of life for our patients by delivering one-on-one clinical guidance and support. Benefits: <ul> <li>Competitive 2024 Market Value Salaries.</li> <li>4% 403B Employer "Gifted" Contribution.</li> <li>3% Merit and 4% Bonus Increase Potential.</li> <li>10 Paid Holidays, and 2 Floating Holidays.</li> <li>Up to 4 weeks Vacation time.</li> <li>Gym Membership Stipend.</li> <li>Affordable Medical, Dental &amp; Vision Plans.</li> <li>Employer-paid Life Insurance.</li> <li>Employer-paid Long-Term Disability.</li> <li>Continuing Education Stipend up to $500.</li> </ul> Special Knowledge, Skills and Abilities: <ul> <li>Ability to use critical thinking skills to evaluate, analyze, and solve problems.</li> <li>Ability to analyze financial data and prepare necessary reports.</li> <li>Ability to work and make independent decisions that follow recognized and credible accounting practices that meet regulations and support the business when possible.</li> <li>Organizational skills necessary to achieve promptness in meeting deadlines.</li> <li>Ability to rank order numerous projects and deadlines.</li> <li>A thorough understanding of computerized accounting systems, subsidiary ledgers, and the relationship among the various components of the general ledger.</li> <li>Expertise with MS Office, to include advanced Excel skills.</li> <li>Ability to operate ten key-by-touch.</li> <li>Ability to flex schedule to accommodate an occasional need to work weekend or evening hours.</li> <li> Ability to communicate clearly to interact with staff, clients, administration, and the community in person and on the telephone.</li> </ul> Example of Position Responsibilities: <ul> <li>Overseeing all the company's payroll processes and transactions.</li> <li>Processing payroll calculations and managing payroll data entry.</li> <li>Ensuring compliance with employment laws and maintaining accurate financial records.</li> <li>Preparing payroll audits and advising on complex transactions.</li> <li>Facilitate audits by providing records and documentation to auditors.</li> <li>Conducts annual performance evaluations and addresses performance issues in a straight forward and timely manner.</li> <li>Supports and promotes a service environment for individuals in need of behavioral health and/or co-occurring services that is recovery focused, welcoming, and attentive to the needs of the individuals who may have experienced trauma in their lives.</li> <li>Practices and promotes the Sanctuary model seven commitments: nonviolence, emotional intelligence, social learning, open communication, social responsibility, democracy and growth and change.</li> <li>Must be able to travel and provide own transportation.</li> </ul> Other Duties: Perform other duties as assigned by the Sr. Accountant. Physical Requirements: Must be able to move from location to location, bending, stooping, lifting 25 pounds, communicate clearly, prepare written communications, present information to other employees, process complex information within established procedures/programs, enter data to various programs. Must be able to climb stairs and access non-handicapped equipped residences/facilities. Drug Free Workplace Policy This job is classified as a “safety-sensitive” position as defined by the Oklahoma Medical Marijuana and Patient Protection Act. Possession of a medical marijuana license does not exclude any applicants; however all employees are subject to the Counseling &amp; Recovery Services of Oklahoma Drug Free Workplace Policy. EEO/AA Employer/Vet/Disabled Counseling &amp; Recovery Services of Oklahoma (CRS) is committed to the full inclusion of all qualified individuals. As part of this commitment, CRS will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Frank Jeffries, Human Resources Director by calling 918-392-5817

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