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You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. <h1>***POSITION IS REMOTE***</h1>**THIS TEAM PROCESSES APPEALS ONLY****Appeals Experience HIGHLY Preferred**Position Purpose: Supervise nurses in a highly regulated department responsible for performing medical necessity case reviews for appropriateness of medical care and service. Supervise the day to day clinical operations and functions within the department, ensuring productivity and quality metrics are met.<ul> <li>Provide oversight and interpretation of state/federal regulations and NCQA standards impacting member appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with policies and procedures</li> <li>Utilize clinical expertise to serve as a resource to the team regarding escalated or complex clinical issues</li> <li>Monitor and distribute team’s caseload and ensure adequate coverage</li> <li>Monitor and evaluate performance standards and provide feedback and guidance or problem resolution.</li> <li>Identify and develop opportunities for process improvement and work with various leaders to ensure problems are corrected</li> <li>Train and onboard new team members</li> <li>Audit staff to standards and provide continuous feedback</li> <li>Assist management in committee work, regulatory audits and regulatory reporting.</li> <li>Analyze and interpret state and federal regulatory requirements and NCQA standards and provide guidance to team to ensure adherence</li> </ul>Education / Experience: Bachelor's degree in Nursing preferred. 3+ years of combined nursing and appeal and grievance, or utilization management or case management experience. Previous supervisory experience strongly preferred. Proficient with Microsoft Office applications. Knowledge of coding preferred. Previous Quality Improvement experience preferred. Knowledge of DHCS/DMHC regulations preferred. Licenses, Certifications: LPN Required (RN preferred)Pay Range: $68,700.00 - $123,700.00 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

Supervisor, Clinical Grievance and Appeals

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Hours are day shift Pacific Standard Time. Position Purpose: The Public Programs Coordinator is responsible for triaging and resolving member access to care issues and coordinating services with programs that are “carved out” of the health plan contract with the Department of Health Care Services, i.e. California Children’s Services and Regional Centers, as well as, promoting member access to Health Net’s Empower Living Program (H.E.L.P.) This position is also responsible for communicating and collaborating with internal and external customers to ensure access to care and services for Health Net members.<ul> <li>Researches, resolves, makes referrals and follows up with clients and agencies for access to care issues.</li> <li>Collaborates with multiple Health Net Departments including, but not limited to, Member Services, Provider Network Management, Medical Management, Medical Review Unit, Pharmacy and Claims to resolve member issues.</li> <li>Serves as Health Net’s liaison to public agency programs and assists with referrals from the Participating Physician Groups (PPG) to the H.E.L.P Program.</li> <li>Receives, researches and resolves coordination of care referrals from Customer Services.</li> <li>Conducts escalated service coordination on complex cases and monitors through resolution.</li> <li>Supports programs such as Regional Centers, School Health Integration and California Children’s Services with in-person meetings to better understand and promote available services.</li> <li>Researches and prepares conflict resolution documentation to support Appeals and Grievances.</li> <li>Prepares and submits monthly and quarterly COC reports to compliance.</li> <li>Performs other duties as assigned.</li> </ul>Education/Experience: Associate’s degree, completion of Vocational Nursing School, Medical Assisting or Pharmacy Technician Program. Minimum three years of combined clinical and healthcare experience License/Certification: Current, valid and unrestricted California Medical Assistant Certification, or current, valid and unrestricted Licensed Vocational Nurse (LVN) license or current, valid and unrestricted Pharmacy Technician Certification preferred Pay Range: $22.79 - $38.84 per hourCentene 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

Public  Programs  Specialist

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryFully remote position. Work from home anywhere in the U.S.A. Shift: Monday through Friday 11:30am to 8pm EST Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health.Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.<ul> <li>Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Provides triage and crisis support.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation.</li> <li>Coordinates with providers and other parties to facilitate optimal care/treatment.</li> <li>Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.</li> <li>Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.</li> </ul>Required Qualifications<ul> <li>Must have active current and unrestricted Independent clinical behavioral health license in the state of residence (LPC, LCSW, LMFT, LMHC, etc) </li> <li> 3+ years of behavioral health experience </li> <li>Must be able to talk on the telephone and type at the same time as this is a queue based position.</li> <li>Must be able to work Monday through Friday 11:30am to 8pm EST</li> </ul>​Preferred Qualifications<ul> <li>3+ years of direct clinical practice experience post master's degree, including hospital setting or alternative care setting such as ambulatory care or outpatient program</li> <li>Managed care and utilization review experience preferred.</li> <li>Crisis intervention skills preferred.</li> </ul>Education<ul><li>Master's degree required if social worker, LPC, LCSW, LMFT, LMHC, </li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$60,522.00 - $129,615.00This 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: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Utilization management Clinician Behavioral Health

<a href="#"> </a> <a href="#">About Us</a> <a href="#">Current Employee Job Search</a> <a href="#">Go to Hillcrest HealthCare System Careers</a> <ul> <li> <a href="#">Home</a> <a href="#">Home</a> </li> <li> <a href="#">Locations</a> <a href="#">Locations</a> </li> <li> <a href="#">Nursing Careers</a> <a href="#">Nursing Careers</a> </li> <li> <a href="#">Provider Careers</a> <a href="#">Provider Careers</a> </li> <li> <a href="#">Corporate Careers</a> <a href="#">Corporate Careers</a> </li> <li> <a href="#">Executive Careers</a> <a href="#">Executive Careers</a> </li> <li> <a href="#">Join Talent Community</a> <a href="#">Join Talent Community</a> </li> </ul> <ul> <li> <a href="#">Home</a> </li> <li> <a href="#">Locations</a> </li> <li> <a href="#">Nursing Careers</a> </li> <li> <a href="#">Provider Careers</a> </li> <li> <a href="#">Corporate Careers</a> </li> <li> <a href="#">Executive Careers</a> </li> <li> <a href="#">Join Talent Community</a> </li> <li> <ul> <li><a href="#">Careers Home</a></li> <li><a href="#">Search Jobs</a></li> </ul> </li> </ul> Candidates residing in the following states, CA, CO, CT, HI, IL, MA, MD, ME, MI, MN, NH, NV, NY, OR, RI, VT, WA, Washington DC and WV, must be willing to relocate if they are hired in a remote role. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. FOLLOW US <a href="https://www.linkedin.com/company/hillcrest-healthcare-system" target="_blank"> </a> <a href="https://www.youtube.com/user/HillcrestMedicalCtr" target="_blank"> </a> <a href="https://www.facebook.com/UticaPark" target="_blank"> </a> <h4>ARDENT HEALTH SERVICES</h4> Ardent Health Services invests in quality health care. In people, technology, facilities and communities, Ardent makes considerable investments – producing high quality care and extraordinary results. <h4>CONTACT US</h4> 340 Seven Springs Way Suite 100, Brentwood, TN 37027 (615) 296-3000 We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Copyright © Ardent Health Services. All rights reserved. <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a>

Utica Park Clinic

ENT Employment for 2025 Availability | Tulsa, OK | Residency Stipend/Sign-On Bonus

<h2>What's the role?</h2> The Hilti North America (HNA) Inside Sales Account Manager is the direct link between Hilti and the customer. This position is responsible for creating, maintaining, and growing the customer base for Hilti North America, specifically for our Western Market Organization. <h2>Who is Hilti?</h2> Hilti is making construction better by fulfilling our customers' promise as being the best partner for productivity, safety, and sustainability. We challenge norms to bring innovative, top-of-line solutions to the global construction industry, and beyond. Hilti is where people are exploring possibilities, leveraging their potential, owning their personal development and growing lasting careers. <h2>What does the role involve?</h2> • Make over the phone sales growing a loyal customer base within a designated trade &amp; geographical area while strengthening the company’s position or market share within the territory • Develop, analyze, and manage business plans related to the customer database to effectively maintain and grow sales • Using Time and Territory Management (TTM), zone territory by customer potential and previous sales, create/own daily schedule, and utilize sales productivity tools • Demonstrate consultative selling; convince customers that they have a need for a product or service • Discuss Hilti products and services over the phone with customers • Identify the key roles within target companies and understand their responsibilities and needs; obtain contacts with decision makers at construction/ industrial companies • Create business plans to identify customer potential and where product gaps exist in a customer’s current purchasing habits • Collaborate with a variety of departments to be a successful account manager (materials management, logistics, credit, marketing, technical services, and customer service) • Care for and maintain company assets, e.g. laptop, and smart phone to minimize loss due to damage or loss • Participate in construction industry trade organizations to build relationships and network of contacts • Additional duties as assigned <blockquote> Hilti North America has been consecutively recognized in Selling Power’s Top 50 Companies to Sell For in the past 19 years. </blockquote> <h2>What do we offer?</h2> In addition to a base + bonus structure, we offer: <ul> <li> Medical/Dental/Vision coverage effective on your first day of employment </li> <li> 401(k) plan with dollar-for-dollar matching, up to 6% matching, and fully vested after one year of employment </li> <li> Generous Paid Time Off policy and holidays including two days to give back to your local community </li> <li> Paid parental leave, sabbaticals, military leave </li> <li> Education reimbursement and student loan assistance </li> <li> Up to five days per year of back-up daycare </li> <li> Life, accident and disability insurance </li> <li> Employee Assistance Program (EAP), company-paid wellness screenings </li> <li> Opportunities for growth – shift careers, support your professional development, or get assigned to any of the 120+ countries in which we operate </li> </ul> <h2>What you need is:</h2> • High School Diploma or GED required; Bachelor’s Degree preferred or equivalent work experience • One (1) year prior experience in customer service and/or sales working directly with customers preferred (either over phone or face-to-face) • Some experience with reading and understanding construction documents preferred • Previous experience of preparing professional sales presentations and quotes for customers • Demonstrated aptitude of cold-calling skills over the phone to customers required • Ability to thrive both independently and in a team environment • Demonstrated ability to develop engaged customer relationships &amp; implement strategic concepts • Excellent time management skills • Must be persuasive, sales driven, customer focused, and a team player • Must be able to build prospects and business relationships • Proficient computer skills including MS Office Suite and smartphones • Proficiency in SAP, CRM, Microsoft Office/access preferred <h2>Why should you apply?</h2> We are committed to caring for our people, which is why our retention has been over 90% for the last five years. It’s why we haven’t gone through any waves of layoffs – even during the COVID-19 pandemic. We value development, which is why 80-90% of our roles are filled internally. It’s why most of our account managers come from a non-construction background. Success at Hilti comes down to teamwork and ability – the Hilti culture is contagious, and we have an excellent mix of people who are always looking to help one another. Hilti, Inc is committed to employing a diverse workforce. Qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity, gender expression, veteran status, or disability.

HILTI

Insides Sales Account Manager

Jenks Public Schools

AP Computer Science Teacher

Special Education Teacher, Social Studies

<h2>Ready to be a Titan?</h2>We’re looking for a Director of R&amp;D Operations to optimize operations for our software development teams at ServiceTitan. This role focuses on building and scaling best-in-class processes and automation to help our engineering and product teams deliver high-quality software faster and more efficiently. You will lead initiatives to improve release cycles, reduce manual workflows, and automate operational tasks across key areas like release management, Agile practices, PDLC, Bug SLAs, and release enablement (GTM).Additionally, you’ll own headcount planning and administration to ensure we hire the right roles at the right time, while managing pacing to our R&amp;D operating budget, ensuring effective resource allocation to achieve business outcomes.This role is ideal for a strategic operator and problem-solver who thrives in a fast-paced environment with a deep understanding of software development processes and a passion for optimizing how teams build and ship software.What You’ll Do:<ul> <li>Optimize Software Development Operations: Design and implement scalable processes that improve efficiency and quality for product and engineering teams.</li> <li>Lead Release Process Transformation: Drive continuous improvement of release practices for both monolithic and microservices-based systems, reducing cycle times and improving quality.</li> <li>Automate Operational Workflows: Identify and implement automation opportunities to reduce manual effort across release management, PDLC, Agile, Bug SLAs, and release enablement processes.</li> <li>Headcount Planning &amp; Resource Management: Own headcount administration to ensure we hire and deploy resources strategically. Partner with talent acquisition and finance to manage hiring forecasts and backfill reviews, ensuring expenses align with business goals and supporting leadership with accurate forecasting and reporting.</li> <li>Define and Track Key Metrics: Build dashboards and KPIs to measure release efficiency, automation impact, team productivity, and budget utilization. Use data-driven insights to drive improvements.</li> <li>Cross-Functional Collaboration: Partner closely with engineering, product management, DevOps, QA, and finance to ensure alignment on operational goals, automation initiatives, and resource planning.</li> <li>Team Leadership: Lead and develop a high-performing team of program managers and operators, fostering a culture of continuous improvement and operational excellence.</li> </ul>What You’ll Bring:<ul> <li>Extensive Experience in Software Development Operations: 10+ years in operations, program management, or release management for software development teams, with a focus on optimizing processes at scale.</li> <li>Deep Knowledge of Software Development Processes: Proven expertise in release processes, PDLC, CI/CD pipelines, and automation within product and engineering organizations.</li> <li>Automation Mindset: Hands-on experience identifying and implementing automation across manual processes in Agile, release management, and bug resolution workflows.</li> <li>Budget &amp; Resource Management Expertise: Prior experience managing large budgets ($10M+), with a focus on headcount planning, resource allocation, and financial reporting.</li> <li>Data-Driven Leadership: Strong ability to define and track success metrics, leveraging data to inform decisions and continuously improve operations.</li> <li>Cross-Functional Leadership: Demonstrated success partnering with product, engineering, DevOps, and business teams to align on strategic priorities and execute operational improvements.</li> <li>Hands-On, Strategic Problem Solver: Comfortable with both high-level strategy and tactical execution, driving operational excellence across complex teams.</li> </ul>Be Human With Us:Being human isn’t about checking every box on a list. It’s about the experiences we have, people we meet, and the perspectives we share. So, if you have the skills but are hesitant to apply because of your background, apply anyway. We need amazing people like you to help us challenge the conventional and think differently about the problems that we’re solving. We’re in this together. Come be human, with us. What We Offer:When you join our team, you’re not just accepting a job. You’re making a career move. Here’s how we’ll support you in doing some of the most impactful work of your career:<ul> <li>Flextime, recognition, and support for autonomous work: Flexible time off with ample learning and development opportunities to continue growing your career. We offer a comprehensive onboarding program, leadership training for Titans at all levels, and other programs and events. Great work is rewarded through Bonusly, peer-nominated awards, and more. </li> <li>Holistic health and wellness benefits: Company-paid medical, dental, and vision (with 100% employer paid options and 90% coverage for dependents), FSA and HSA, 401k match, and telehealth options including memberships to Headspace, Galileo, One Medical, Ginger and more. </li> <li>Support for Titans at all stages of life: Parental leave and support, up to $20k in adoption reimbursement, on demand maternity support through Maven Maternity, free breast milk shipping through Maven Milk, pet insurance, legal advisory services, financial planning tools, and more.</li> </ul>At ServiceTitan, we celebrate individuality and uniqueness. We believe that the convergence of fresh perspectives and experiences from all walks of life is what makes our product and culture so great. We strongly encourage people from underrepresented groups to apply. We do not discriminate against employees based on race, color, religion, sex, national origin, gender identity or expression, age, disability, pregnancy (including childbirth, breastfeeding, or related medical condition), genetic information, protected military or veteran status, sexual orientation, or any other characteristic protected by applicable federal, state or local laws.ServiceTitan is committed to fair and equitable compensation for all of our employees. We thoughtfully consider a wide range of factors when determining individual compensation. The expected salary range for this role for candidates residing in the United States is between $221,400 USD - $296,100 USD. Compensation for candidates residing outside the United States will vary by location and the specific salary range will be discussed during the hiring process. Actual compensation for an individual may vary depending on skills, performance over time, qualifications, experience, and location. In addition to the base salary, the total compensation package also includes an annual bonus, equity and a holistic suite of benefits.

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