field_remote_option

job_industry

field_job_occupational_field_parents_all

job_organization_name

job_upgrade_is_featured

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 Summary:The Clinical Pharmacist is an operation-based role that conducts criteria based &amp; clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed.This position is responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education.Responsibilities:1.) Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval &amp; denial management processes. 2.) Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and 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. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.3.) Responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership.4.) Assist with standard or client specific oncology review process changes as needed. 5.) Assist with writing Work Instructions when needed.6.) Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.7.) Provide feedback of trends pertinent to oncology reviews.8.) Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.9.) Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.This is a remote role, open to qualified candidates within the United States.Essential Functions: 1. Regular and predictable attendance2. Colleague may be required to work mandatory overtime/extended work week when needed3. Colleague may be required to travel when needed4. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.5. Adhere to all policies and procedures6. Attend on going training and development meetingsPhysical Requirements:1. Sits at desk for long periods of time (up to 100%)2. Talking on phone for extended periods of time (up to 100%)3. Computer use for extended periods of time (100%)4. Reading a computer screen (up to 100%)5. Light lifting of less than 10 lbsWork EnvironmentColleague is responsible for maintaining a HIPAA-compliant remote workspace. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access. Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet)Education: BS in Pharmacy or PharmD requiredBoard Certified Oncology Pharmacist (BCOP) requiredActive, unrestricted pharmacist licensure in state of residence requiredRequired Skills &amp; Other Minimum Required Qualifications: <ul> <li>Licensed Registered Pharmacist</li> <li>Board Certified Oncology Pharmacist (BCOP) required</li> <li>2+ years clinical pharmacist experience, inclusive of prior authorization experience</li> <li>Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.</li> <li>Must be able to multitask and utilize multiple system applications simultaneously.</li> <li>Must be able to utilize available resources independently and provide high quality work.</li> <li>Must demonstrate problem solving ability and attention to detail.</li> <li>Ability to adapt and change with workflow and shifting priorities.</li> <li>Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the PA team.</li> <li>Must possess excellent written, verbal, grammar, and listening communication skills.</li> <li>Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.</li> <li>Ability to maintain confidentiality of PHI (Protected Healthcare Information).</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$45.43 - $101.54This 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: 05/12/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Clinical Pharmacist - Prior Authorization/Oncology (BCOP Required)

Global Master Black Belt<h2>Job Description</h2>As a person, you’re a problem-solver – a connector – someone who thrives on creating order from complexity and driving continuous improvement. You see the big picture while mastering the details, ensuring that every product, process, and partnership flows with precision and purpose. You live your life in alignment with the highest values of integrity, efficiency, and collaboration, always working to turn today’s challenges into tomorrow’s success stories. In this role, you’ll help us deliver better care for billions of people around the world.It starts with YOU.Summary of Position: Reporting to the Associate Director, Six Sigma Master Black Belt, this global role will engage and collaborate with regional Master Black Belts to lead the development and deployment of CI/OPEX/LSS global standards and capability frameworks. The Master Black Belt (MBB) will be responsible for creating advanced LSS training materials, combining interactive online learning and hands-on online workshops focused on practical, real-world problem-solving. The role requires strong coaching, mentoring, and influencing skills across all levels of the organization—from frontline associates to senior leaders—and will leverage Agile Sprint methodologies to accelerate execution and learning.Location: This role can be located anywhere globally and can sit at any KC site globally. In this role, you will:<ul> <li>Lead the development and deployment of CI/OPEX/LSS global standards and capability frameworks through collaboration with regional MBBs.</li> <li>Design and deliver innovative LSS capability programs using interactive online platforms and hands-on, online workshops focused on practical problem-solving.</li> <li>Coach and mentor belts and stakeholders across functions and organizational levels, from frontline employees to executive leadership.</li> <li>Drive continuous improvement using Lean Six Sigma and Agile Sprint methodologies, including planning, standups, reviews, and retrospectives.</li> <li>Apply structured change management approaches to ensure sustainable adoption of new ways of working across regions.</li> <li>Influence and align diverse stakeholders without formal authority, navigating complex matrixed and multicultural organizations.</li> <li>Integrate AI/GenAI tools into LSS programs to support on-demand learning, faster diagnostics, and scalable coaching.</li> <li>Present complex improvement concepts, analyses, and recommendations to executive stakeholders to inform strategic decisions.</li> </ul>About UsHuggies®. Kleenex®. Cottonelle®. Scott®. Kotex®. Poise®. Depend®. Kimberly-Clark Professional®. You already know our legendary brands—and so does the rest of the world. In fact, millions of people use Kimberly-Clark products every day. We know these amazing Kimberly-Clark products wouldn’t exist without talented professionals, like you.At Kimberly-Clark, you’ll be part of the best team committed to driving innovation, growth and impact. We’re founded on more than 150 years of market leadership, and we’re always looking for new and better ways to perform – so there’s your open door of opportunity. It’s all here for you at Kimberly-Clark.Led by Purpose. Driven by You.About YouYou perform at the highest level possible, and you appreciate a performance culture fueled by authentic caring. You want to be part of a company actively dedicated to sustainability, inclusion, wellbeing, and career development. You love what you do, especially when the work you do makes a difference. At Kimberly-Clark, we’re constantly exploring new ideas on how, when, and where we can best achieve results. When you join our team, you’ll experience Flex That Works: flexible (hybrid) work arrangements that empower you to have purposeful time in the office and partner with your leader to make flexibility work for both you and the business.In one of our Supply Chain, roles, you’ll focus on winning with consumers and the market, while putting safety, mutual respect, and human dignity at the center. To succeed in this role, you will need the following qualifications:<ul> <li>Bachelor’s degree in Business, Supply Chain, Engineering, or a related field.</li> <li>You must be able to read, write and communicate effectively in the English Language.</li> <li>Master Black Belt Certification from a recognized and reputable organization (e.g., ASQ or equivalent)</li> <li>7+ years of experience in Continuous Improvement, ideally in manufacturing and global supply chain environments.</li> <li>Proven experience engaging and collaborating with regional MBBs in the development and deployment of CI/OPEX/LSS global standards.</li> <li>Deep expertise in Lean Six Sigma tools and techniques, including SPC, MSA, Multivariate Analysis, hypothesis testing, regression, root cause analysis, DOE, pFMEA and control plan.</li> <li>Strong ability to influence across levels without authority—from frontline to executive leadership.</li> <li>Exceptional communication, coaching, and facilitation skills across a heavily matrixed organization, including experience with C-Suite stakeholders.</li> <li>Ability to work across global time zones with a flexible schedule to support distributed teams and international collaboration.</li> <li>Must be able to travel to meet business needs up to 20% of the time.</li> </ul>Total BenefitsHere are just a few of the benefits you’d enjoy working in this role for Kimberly-Clark. For a complete overview, see <a href="http://www.mykcbenefits.com/" target="_blank">www.mykcbenefits.com</a>. Great support for good health with medical, dental, and vision coverage options with no waiting periods or pre-existing condition restrictions. Access to an on-site fitness center, occupational health nurse, and allowances for high-quality safety equipment.Flexible Savings and spending accounts to maximize health care options and stretch dollars when caring for yourself or dependents.Diverse income protection insurance options to protect yourself and your family in case of illness, injury, or other unexpected events.Additional programs and support to continue your education, adopt a child, relocate, or even find temporary childcare.[Insert any uniquely positive benefits for the specific role and/or location]To Be Considered Click the Apply button and complete the online application process. A member of our recruiting team will review your application and follow up if you seem like a great fit for this role.In the meantime, please check out the <a href="https://www.careers.kimberly-clark.com/en/our-careers/career-areas" target="_blank">careers website</a>.And finally, the fine print….For Kimberly-Clark to grow and prosper, we must be an inclusive organization that applies the diverse experiences and passions of its team members to brands that make life better for people all around the world, which is why we seek to build a workforce that encompasses the experiences of our consumers. When you bring your original thinking to Kimberly-Clark, you fuel the continued success of our enterprise. We are a committed equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity, age, pregnancy, genetic information, citizenship status, or any other characteristic protected by law. The statements above are intended to describe the general nature and level of work performed by employees assigned to this classification. Statements are not intended to be construed as an exhaustive list of all duties, responsibilities and skills required for this position. Employment is subject to verification of pre-screening tests, which may include drug screening, background check, and DMV check. Veterans and members of the Reserve and Guard are highly encouraged to apply.This role is available for local candidates already authorized to work in the role’s country only. Kimberly-Clark will not provide relocation support for this role.This is a P4/Grade 08 and compensation may vary based on location. Salary Range: 127,600 – 157,600 USDAt Kimberly-Clark, pay is just one aspect of our total rewards package, which also includes a variety of benefits and opportunities to achieve, thrive and grow. Along with base pay, this position offers eligibility for a target bonus and a comprehensive benefits suite, including our 401(k) and Profit Sharing plan. The anticipated base pay range for this role is provided above for a fully qualified hire. Actual pay will depend on several factors, such as location, role, skills, performance, and experience. Please note that the stated pay range applies to US locations only.<h2>Primary Location</h2>Roswell Building 300<h2>Additional Locations</h2>Beech Island Mill, Beech Island Mill, Chester Mill, Corinth Mill KC Prof Products, Corinth Mill Nonwoven Products, Germany-Flexible Location, India - Mumbai, India - Pune, Jenks Mill, LaGrange Mill, Loudon Mill, Malaysia - Johor - Kluang, Malaysia - Petaling Jaya, Marinette Mill, Maumelle Facility, Mobile Mill, Neenah - Cold Spring Facility, Neenah - Experimental Mill, Neenah - KCPX, Neenah - West R&amp;E Office, New Milford Mill, Ogden, Owensboro Mill, Paris Plant, Philippines-Flexible Location {+ 2 more}<h2>Worker Type</h2>Employee<h2>Worker Sub-Type</h2>Regular<h2>Time Type</h2>Full time

Kimberly-Clark Corporation

Global Master Black Belt

Location: Hybrid, you will work up to one week within our office in Murray, UT per month. All other working days will be work from home. Shift: Flexible start time, 6:00AM-8:30AM, 8.5 hour shifts with a 30 minute lunch, Monday-Friday. R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1 is publicly-traded organization with employees throughout the US and international locations. The Patient Financial Counselor will be responsible for processing patient financial assistance applications, placing outbound phone calls and scanning financial assistance documents into system. The PFC is responsible for accurately and compassionately explaining to the patient their financial obligations during the financial counseling session. In this role, the successful candidate must display a strong sense of patient care and attention to detail. Here’s what you will experience working as a Financial Counselor: <ul> <li>Explain financial responsibilities for services received payment options and collection procedures to patients or parties responsible for payment</li> <li>Counsel patients regarding insurance benefits and recommend alternative sources of payment and financial assistance when appropriate</li> <li>Identify hospital, public and private financial assistance programs for patients unable to meet their financial obligations</li> <li>Work with Case Management, Clinical Staff, Medicaid Vendor, and Family Independence Agency to assist patients and families in completing assistance program applications and determine eligibility and coverage</li> <li>Maintain accurate documentation of pre-processing information</li> <li>Perform all other duties and projects as assigned</li> </ul> Required Skills: <ul><li>High school diploma or GED is required</li></ul> <ul> <li>Attention to detail</li> <li>Strong customer service experience</li> <li>Ability to multi-task and navigate between multiple systems simultaneously</li> <li>Comfortable with handling outbound calls</li> </ul> Desired Qualifications: <ul> <li>Previous experience as a financial counselor with background in medical terminology preferred</li> <li>Understanding of State and Federal assistance</li> <li>Fluency in Spanish is preferred</li> </ul> For this US-based position, the base pay range is $14.76 - $22.48 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>#tj2022 #healthcare #customerservice #financialcounseling #banking #LI-TJ2022 #remote #hybrid

R1 RCM

Financial Counseling Representative I (Hybrid remote)

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.As an R1 Financial Counseling Associate, you will be responsible for counseling uninsured and under-insured patients to attempt to obtain a paying funding source for their medical service(s). You will be expected to accurately and compassionately explain financial options and obligations during financial counseling sessions held directly with patients. In this role, a successful candidate must display excellent customer service, commitment to assisting patients, and attention to detail. The Financial Counselor will be responsible for counseling patients or parties responsible for payment. The Patient Financial Counselor will educate patients on their responsibilities and potential options. The PFC is responsible for accurately and compassionately explaining to the patient their financial obligations during the financial counseling session. In addition, the counselor must obtain any necessary pre-certifications or authorizations and assist with any financing or third-party applications. In this role, the successful candidate must display a strong sense of patient care and attention to detail.Responsibilities: Explain financial responsibilities for services received, payment options and collection procedures to patients or parties responsible for payment. Counsel patients regarding insurance benefits and recommend alternative sources of payment and financial assistance when appropriate. Contact insurance carriers or other sources and act as an advocate for the patient. Initiate process for collecting prepays due and perform follow up activity to insure maximum collection is achieved. Identify hospital, public and private financial assistance programs for patients unable to meet their financial obligations. Work with Case Management, Clinical Staff, Medicaid Vendor, and Family Independence Agency to assist patients and families in completing assistance program applications and determine eligibility and coverage. Notify manager, physician and servicing department of possible delay of service for any elective, urgent admissions, procedures and scheduled diagnostic testing which have not been approved prior to the date of service. Maintain accurate documentation of pre-processing information. Provide assistance to uninsured patients and families in completing and filing Medicaid or assistance program applications with the appropriate agency. Perform all other duties and projects as assigned. Required Qualifications: High school diploma is required At least one year of call center experience Attention to detail Strong customer service experience Ability to multi-task and navigate between multiple systems simultaneously Ability to handle a large volume of incoming calls Desired Qualifications: Previous experience as a financial counselor with background in medical terminology preferred Understanding of State and Federal assistanceFor this US-based position, the base pay range is $14.76 - $22.48 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

Financial Counseling Rep I

Job TitleSpatial Data StrategistJob Description SummaryThe Spatial Data Strategist on a Space Management team is to help solve business problems by building standard and ad hoc dashboards. Provide strategic space and occupancy planning expertise in support of long-term supply and demand planning, real estate strategy, workplace design, space analysis and space efficiency within a Client’s real estate portfolio data.Job DescriptionPrinciple Responsibilities<ul> <li>Building standard and ad hoc BI dashboards</li> <li>Utilization and allocation reporting analysis</li> <li>Work with Spatial data team to create scenarios and long-term strategic planning related to space</li> <li>Contribute to workplace trends/strategies and future ways of working.</li> <li>Work with various levels of the organization to capture project goals, objectives, and the associated requirements.</li> <li>Work with business key stakeholders to determine various KPIs and data reporting needs for various levels</li> <li>Gather requirements for building external and internal data dashboards. Work with vendors and customer to understand data needs</li> <li>Understand various roles and responsibilities in business group for better data governance and data security</li> <li>Cross functional collaboration with other service lines and SME Functions to ensure consistency of data across platforms and processes.</li> <li>Continual focus on innovation, constantly striving to improve delivery of services. This will include actively obtaining feedback from stakeholders and responding to the same, bringing in industry knowledge, innovation and best practice.</li> <li>Show strong verbal presentation skills and ability to communicate to executive level</li> <li>Process work quickly, accurately, and with changing priorities</li> </ul>Targeted Competencies<ul> <li>Advanced skills in Business Intelligence tools (i.e.: Tableau and Power BI)</li> <li>Advanced/Expert skills in Excel</li> <li>Advanced skills in Adobe and Microsoft application suites</li> <li>Strong written and verbal presentation skills, ability to communicate to executive level and internal teams</li> <li>Solid business acumen; ability to understand and anticipate business needs to provide appropriate solutions</li> <li>Strong team player who is adaptable and capable of driving change / change management</li> <li>Possess analytical, organizational and problem-solving skills with a focus on the long term, strategic vision.</li> <li>Advanced understanding of CAFM\IWMS (Serraview preferred) for Space Management preferred</li> <li>Basic understanding of Corporate Real Estate and Financial concepts</li> <li>Bachelor’s degree (BA/BS) in a related discipline or field of study (i.e. Data and Analytics, Computer Science, Information Systems, Architecture, Interior Design, Corporate Real Estate &amp; Facilities Management Planning/Coordination, Facilities, Project or Construction Management, etc.) preferred</li> <li>Seven+ year’s experience in a corporate real estate environment preferred</li> <li>Ability to process work quickly, accurately and with changing priorities</li> <li>Ability to effectively interpret and apply policy and procedure</li> </ul> Cushman &amp; Wakefield also provides eligible employees with an opportunity to enroll in a variety of benefit programs, generally including health, vision, and dental insurance, flexible spending accounts, health savings accounts, retirement savings plans, life, and disability insurance programs, and paid and unpaid time away from work. In addition to a comprehensive benefits package, Cushman and Wakefield provide eligible employees with competitive pay, which may vary depending on eligibility factors such as geographic location, date of hire, total hours worked, job type, business line, and applicability of collective bargaining agreements. The compensation that will be offered to the successful candidate will depend on factors such as whether the position is covered by a collective bargaining agreement, the geographic area in which the work will be performed, market pay rates in that area, and the candidate’s experience and qualifications. The company will not pay less than minimum wage for this role. The compensation for the position is: $84,915.00 - $99,900.00Cushman &amp; Wakefield is an Equal Opportunity employer to all protected groups, including protected veterans and individuals with disabilities. Discrimination of any type will not be tolerated.In compliance with the Americans with Disabilities Act Amendments Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a position at Cushman &amp; Wakefield, please call the ADA line at 1-888-365-5406 or email <a href="#">HRServices@cushwake.com</a>. Please refer to the job title and job location when you contact us.INCO: “Cushman &amp; Wakefield”

Cushman & Wakefield

Spatial Data Strategist

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 SummaryThe Behavioral Health Medical Director is responsible for behavioral health medical leadership providing their subject matter expertise to the health plan. They will have key roles in utilization management and case management programs for mental health and substance use disorder services. They will collaborate with health plan leadership to oversee the behavioral health benefit and work collaboratively with state agency leaders and other stakeholders as it relates to behavioral health needs. Responsibilities include ∙ Participation in the development of clinical practice standards, policies, and procedures ∙ Behavioral health care management performance and coordination with physical health care management ∙ Participation in state agency/stakeholder meetings when requested ∙ Oversight and implementation of the utilization management program for behavioral health services, including preventing contraindicated care ∙ Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities ∙ Overseeing the complaint and grievance process for behavioral health denials, ∙ Review and resolution of quality-of-care concerns ∙ Participation in clinical staff recruitment and ongoing performance improvement. ∙ Provide strategic oversight and leadership for all behavioral health activities within the health plan. ∙ Serve as the subject matter expert on behavioral health for ABHKY, ensuring compliance and alignment with state regulations and expectations. ∙ Lead and coordinate efforts with the state and other health plan colleagues to promote integrated care models. ∙ Oversee coordination activities with the state, ensuring effective collaboration and adherence to regulatory requirements. ∙ Work closely with health plan leadership, the Chief Medical Officer, other Medical Leadership, Pharmacy Director, clinical staff (including those in utilization management, care management, quality management), and colleagues within network and provider relations, to enhance the delivery of holistic and integrated care. ∙ Contribute to the development and implementation of policies and procedures that support the health plan's objectives and comply with state guidelines. ∙ Advocate for and implement innovative approaches to behavioral health care, promoting evidence-based practices that enhance patient outcomes. ∙ Support duties as required regarding utilization management of the service benefit and pharmacy benefit within the state health plan and additional duties as assigned. ∙ Actively participate in continuous improvement activities, development and monitoring of SAI initiatives, and other activities that support quality of care and total cost of care oversight. ∙ Serve as a key health plan external facing liaison, regarding behavioral health initiatives, programs, and projects with state regulators, providers, vendors, and community organizations. ∙ Provides guidance and/or represents the Health Plan in all state fair hearings for services that are behavioral health related. Required Qualifications ∙ Board-certified Psychiatrist licensed in the State of Kentucky. ∙ Clinical experience in the treatment of substance use disorders, including utilization of ASAM criteria, and an understanding of the Kentucky system of care. ∙ At least five years combined experience in mental health and substance use services and at least two (2) years of BH leadership experience in a government, health management, or managed care organization, and/or at least two (2) years of experience as a Medical Director in clinical practice, and/or at least three (3) years of clinical BH experience (excluding psychiatric residency). Preferred Qualifications ∙ Experience with KY Medicaid behavioral health benefits and service ∙ Ability to effectively interact with providers, advocacy groups and State partners ∙ Excellent organization and time management skills ∙ Experience navigating a matrixed organization. ∙ KY Medicaid regulatory experienceEducationMD or DOPay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. 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: 07/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Behavioral Health Medical Director - ABH KY

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. Medical Director - SIU (Special Investigations Unit) CVS Health - Special Investigations Unit (SIU) Join our mission to safeguard healthcare integrity and protect patient well-being. As the Medical Director of Healthcare Fraud Investigations, you'll lead our efforts to detect, prevent, and combat fraudulent activities in the healthcare system. **This is a remote based, work from home role.** Key Responsibilities: The Special Investigations Unit (SIU) Medical Director will be responsible for performing reviews of medical records in support of healthcare fraud investigations. Serving as a clinical liaison supporting SIU activities across all lines of business the SIU Medical Director will be responsible for making both pre and post-payment claim payment determinations based on Aetna Clinical Policy and/or state and federal regulations. Additional responsibilities include: <ul><li>Serves as a clinical liaison supporting SIU Investigators, Managers, and Directors in matters pertaining to the investigation of suspected healthcare fraud cases </li></ul> <ul><li>Develops and delivers presentations to internal and external customers regarding healthcare fraud matters and Aetna’s approach to fighting fraud. </li></ul> <ul><li>Provides clinical expertise and business direction in the creation of analytical solutions designed to identify potentially fraudulent scenarios </li></ul> <ul><li>Maintains open communication with constituents within and external to the organization </li></ul> <ul><li>Uses available resources and technology in developing evidence, supporting allegations of fraud, waste, or abuse </li></ul> <ul><li>Documents all appropriate information related to medical review determinations </li></ul> <ul><li>Proactively builds relationships with other internal MDs to obtain clinical guidance when required to ensure accurate decision making </li></ul> <ul><li>Represents Aetna as a witness in legal matters as required, and as approved by the Legal Department. Demonstrates high level of knowledge and acts confidently when providing testimony during civil or criminal proceedings. </li></ul> <ul><li>Responsible for peer to peer reviews of SIU related claims based on provider escalation or state/federal requirements </li></ul> <ul><li>Supports legal efforts by providing expert medical testimony and </li></ul> <ul><li>Conducts root cause analysis to identify potential control gaps in the organization’s existing clinical policy, procedures, claim editing etc., and proactively seeks out appropriate contacts to help implement solutions. </li></ul> <ul><li>Mentor and educate SIU team members on clinical aspects of fraud schemes </li></ul> Required Qualifications: <ul><li>MD or DO with active license, preferably in emergency medicine or primary care </li></ul> <ul><li>5+ years of clinical practice experience </li></ul> <ul><li>Strong analytical and problem-solving skills </li></ul> <ul><li> Excellent communication and leadership abilities </li></ul> Preferred Qualifications: <ul><li>3+ years supporting healthcare fraud investigations or related field </li></ul> <ul><li>Board Certification in Emergency Medicine</li></ul> Education: <ul> <li>Active and current state medical license without encumbrances</li> <li>M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience</li> </ul> Pay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. 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: 07/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director - SIU (Special Investigations Unit)

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 Summary This individual contributor position reports to the Lead Director, Medicare Member Materials. This is an exciting opportunity to join our team! You will be responsible for directly creating and influencing our Medicare materials, specifically the Mid-Year Enrollee Notification of Available Supplemental Benefits, sent to all beneficiaries outlining usage of supplemental benefits during the plan year.This role involves logic-based programming similar to advanced Excel formulas, not back-end software development.What You Will DoWhether it’s developing strategic logic-based configurations or troubleshooting issues in document logic, your role will be a very important one to ensuring our documents are created accurately. Day to day responsibilities include:<ul> <li>Responsible for configuration logic and rules for Medicare Advantage health plan documents using our proprietary front-end document authoring tools</li> <li>Participating in peer review and auditing to support accuracy</li> <li>Identifying coding issues and debugging</li> <li>Troubleshooting application errors</li> <li>Identifying gaps in processes or organization, and challenge self and others to develop and implement solutions</li> <li>Supporting a sense of urgency regarding managing tasks and timelines</li> <li>Promoting synergy through inter-departmental partnerships</li> <li>Managing projects and tasks in an independent manner</li> <li>Influencing all stake holders to support key projects/programs to ensure positive outcomes that deliver on results</li> <li>Collaborating and partnering with other functional/business areas to ensure all workflow processes and interdependencies are identified and addressed</li> <li>Acting as an advocate for change requiring influencing others to see the value in project</li> </ul> Required Qualifications<ul> <li>3+ years of Medicare member materials experience at a regional or national health plan</li> <li>3+ years of experience supporting health care applications</li> <li>Ability to use logical thinking to design efficient front-end rules and logic (similar to conditional formulas or scripting) to achieve desired outcomes</li> <li>Ability to troubleshoot document logic or rule-based configuration errors as well as application errors</li> <li>Ability to meet strict deadlines</li> <li>Excellent communication and interpersonal skills</li> <li>Strong attention to detail</li> <li>Drives change to improve performance results, organization effectiveness and/or systems/quality/services (e.g., policies, processes or systems)</li> </ul> Preferred Qualifications<ul> <li>Prior experience in working with translation vendors to support creating multi-lingual materials</li> <li>Demonstrated success working to build new technologies and software to support member materials compliance</li> <li>Knowledge of Medicare Advantage rules, including the Medicare Managed Care Manual and Medicare Marketing Guidelines</li> <li>Familiarity with markup or logic-based languages (e.g., HTML, XML, or conditional scripting)</li> <li>Master’s degree</li> </ul> EducationBachelor's degree or equivalent experiencePay RangeThe typical pay range for this role is:$67,900.00 - $149,328.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. 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: 06/15/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr. Manager, Medicare Member Materials Configuration

<h1>Company Overview</h1>Credit First National Association is a private label credit card bank and the consumer credit division of Bridgestone Americas. The Bridgestone Americas family of enterprises, including CFNA, is comprised of more than 50 production facilities and 55K employees throughout the Americas. We provide the consumer credit solution for the Firestone Complete Auto Care, Tires Plus, and Wheel Works brands, in addition to customized retail credit services for more than 8,000 other tire and automotive retailers nationwide. At our office in Cleveland, OH, more than 300 professionals gather each day to run a successful private label credit card program. We invest in our community and strongly believe that meaningful commitment to a wide variety of philanthropic organizations builds a better world and a brand that makes us proud.<h1>Job Category</h1>Legal, Compliance &amp; Audit<h1>Position Summary</h1>We’re currently looking for a Lead Bank Auditor (CFNA) to join our team. The preferred work schedule is Hybrid out of Cleveland, OH or Nashville, TN. ** Open to fully remote work ** This role will be responsible for executing and leading audit assignments for CFNA, Bridgestone’s credit card bank. The Lead Bank Auditor (aka Lead Auditor) is responsible for assessing and evaluating the risk landscape/control environment of the bank through audit engagements/other advanced audit techniques, reporting to the Chief Auditor in the performance of all assigned duties. Travel is approximately 10%.<h1>Responsibilities</h1><ul> <li>Primarily serves as Lead Auditor and main point of contact for the business, driving the completion of planning, fieldwork, and reporting of audit engagements and other activities timely and with high quality.</li> <li>Reviews work of team members, providing valuable feedback/questions for their development, when applicable; Provides guidance to team members on the use of audit business systems, applications, and/or audit tools to create queries and ad hoc reports.</li> <li>Identifies control weaknesses and process gaps for opportunities of enhancements in the current operating environment and developing recommendations for corrective action; prepare audit issues and audit reports for review by audit leadership.</li> <li>Challenges the corporate risk assessment and audit methodology for continuous improvement in audit practices.</li> <li>Reviews, analyzes, and interprets data collected from various sources to verify completeness and accuracy of data outputs to ensure valid conclusions are drawn from audit testing</li> <li>Determines the best methods to lead audit engagements, continuous monitoring and advisory activities, special reviews, and investigations to ensure adequate evaluation of key risks and controls at the bank.</li> </ul>Nice to Have:<ul> <li>Certifications: CPA, CIA, CRCM, CISA, CBA, CFE, CFF</li> <li>Credit Union experience</li> <li>Credit Card Experience</li> </ul><h1>Minimum Qualifications</h1><ul> <li>Minimum of 8 years of practical work experience in public accounting, internal audit, banking, information technology or related business experience. Minimum of 6 years of work experience is required if applicant has a master’s degree.</li> <li>Master’s degree or relevant certification (e.g. CPA, CIA, CRCM, CISA, CBA, CFE, CFF) required; bachelor’s degree in business or related field such as Finance, Accounting, Business, or Information Technology.</li> <li>Deep understanding of risks and internal controls and the ability to evaluate and determine adequacy and efficiency of controls.</li> <li>Intermediate knowledge of laws and regulations relevant to financial services; experience in auditing credit card and consumer lending processes preferred.</li> <li>Advanced critical thinking, problem-solving, project management, and verbal and written communication skills to demonstrate a strong ability to interface effectively with various levels of management</li> </ul>What we offerAt Bridgestone, what really matters is to foster co-creation opportunities and empowering you to be creative and curious to make mobility safer, more efficient, and more sustainable for future generations. Whatever role you fill, when you represent Bridgestone, you are a valued teammate, and part of our larger mission to “Serve Society with Superior Quality”, for that, we offer you more than just a competitive compensation; we will provide you:<ul> <li>A supportive and engaging onboarding experience to ensure a smooth transition into our team.</li> <li>The opportunity to develop and grow, through training and regular mentorship.</li> <li>Corporate Social Responsibility activities.</li> <li>A truly global, dynamic and challenging work environment.</li> <li>Agility and work/life effectiveness and your long-term well-being.</li> <li>A diverse and inclusive team.</li> </ul>Bridgestone is proud to be an Equal Employment Opportunity employer. It is our policy to consider for employment all individuals regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, gender, sex, sexual orientation, gender identity and/or expression, genetic information, veteran status, or any other characteristic protected by federal, state or local law. Employment EligibilityIf hired, a Form I-9 Employment Eligibility Verification must be completed at the start of employment. Temporary work authorization or the need for sponsorship may disqualify you from employment.

FirestoneBridgestone

Lead Bank Auditor

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. **We are currently hiring for 8 Financial Counseling roles, all REMOTE with varying shifts.** Bilingual candidates will be prioritized! The Financial Counselor will be responsible for counseling patients or parties responsible for payment. The Patient Financial Counselor will educate patients on their responsibilities and potential options. The PFC is responsible for accurately and compassionately explaining to the patient their financial obligations during the financial counseling session. In addition, the counselor must obtain any necessary pre-certifications or authorizations and assist with any financing or third-party applications. In this role, the successful candidate must display a strong sense of patient care and attention to detail. Here’s what you will experience working as a Financial Counselor: <ul> <li>Explain financial responsibilities for services received payment options and collection procedures to patients or parties responsible for payment. </li> <li>Counsel patients regarding insurance benefits and recommend alternative sources of payment and financial assistance when appropriate. </li> <li>Contact insurance carriers or other sources and act as an advocate for the patient. </li> <li>Initiate process for collecting prepays due and perform follow up activity to insure maximum collection is achieved. </li> <li>Identify hospital, public and private financial assistance programs for patients unable to meet their financial obligations. </li> <li>Work with Case Management, Clinical Staff, Medicaid Vendor, and Family Independence Agency to assist patients and families in completing assistance program applications and determine eligibility and coverage. </li> <li>Notify manager, physician and servicing department of possible delay of service for any elective, urgent admissions, procedures and scheduled diagnostic testing which have not been approved prior to the date of service. </li> <li>Maintain accurate documentation of pre-processing information. </li> <li>Provide assistance to uninsured patients and families in completing and filing Medicaid or assistance program applications with the appropriate agency. </li> <li>Perform all other duties and projects as assigned. </li> </ul>Required Skills: <ul> <li>High school diploma is required </li> <li>At least one year of call center experience </li> <li>Attention to detail </li> <li>Strong customer service experience </li> <li>Ability to multi-task and navigate between multiple systems simultaneously </li> <li>Ability to handle a large volume of incoming calls </li> </ul>For this US-based position, the base pay range is $17.25 - $24.73 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>#tj2022 #healthcare #customerservice #financialcounseling #banking #LI-TJ2022 #REMOTE

12 Other Jobs in Tennessee