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Overview Are you looking for a rewarding career as a Payor Contract Manager? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S. Attractive pay <ul> <li>$80 - $112K</li> <li>Bonus eligible</li> </ul> Enjoy many perks and benefits <ul> <li>A full benefits package (with affordable health insurance options.)</li> <li>401k with a match.</li> <li>Up to $500 in wellness rewards and up to $1,200 in free healthcare services paid for by Amedisys yearly.</li> <li>Mental health support.</li> <li>Infertility coverage, adoption reimbursement and paid parental leave.</li> <li>Paid time off and paid holidays.</li> <li>And more.</li> </ul> Don't just take it from us "After working for Amedisys for almost 5 years I feel that from the CEO on down, there is a culture of sincerely wanting to be a great employer - and it shows. The pay is above average, the benefits are great, and the paid time off is generous."- Amedisys employee Why Amedisys Amedisys is a leading provider of home health, hospice, and high-acuity care, dedicated to helping patients and families navigate the complex healthcare system. With a focus on compassionate, patient-centered care, you would be joining a team of professionals committed to improving the lives of those they serve. Responsibilities <ul> <li>Responsible for achieving prioritized contracting targets for market.</li> <li>Collaborates with director and payor contracting to achieve regional/market goals and contract targets.</li> <li>Accountable for a service line strategy (e.g., home health, hospice, personal care or ACO), including understanding and informing standard rate logic, language, and business requirements to inform and influence portfolio strategies.</li> <li>Ensures successful execution of projects for the payor contracting team including, but not limited to, payor contracting initiatives that are associated with global contract/coding updates and merger/acquisition activity.</li> <li>Completes contracting efforts associated with addition/termination of locations/markets.</li> <li>Reviews, vets, and prioritizes requests for new contracts.</li> <li>Preps initial due diligence documentation and recommended action plan for regional leadership team/director/senior vice president as required.</li> <li>Conducts market research to proactively identify risks/opportunities to inform market strategies.</li> <li>Maintains relationships with vendors, payors and other third parties in order to enhance strategic relationships.</li> <li>Monitors and maintains database and related contracting information system payor files for accurate and timely claims processing.</li> <li>Performs other duties as assigned.</li> </ul> Qualifications Requirements <ul> <li>Bachelor's degree in business or related field.</li> <li>Five years of experience in managed care contracting and contract-related accountabilities in or around home health, hospice, health plan or large health care system.</li> </ul> Our compensation reflects the cost of labor across several U.S. geographic markets and may vary depending on location, job-related knowledge, skills, and experience. Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

Amedisys

Payor Contract Manager - Remote

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.Requisition Job DescriptionPosition SummaryLeads the work and deliverables of multiple marketing campaigns for Aetna Voluntary plan sponsors. Supports initial enrollment and ongoingenrollment communication needs, as well as works on special projects throughout the year. Works cross-functionally with sales,implementation and account management constituents, and externally with human resources and consultants.What you will do<ul> <li>Acts as a top-level specialist on project and program planning and develops comprehensive program plans that encompass objectives, deliverables, timelines, and resource allocation.</li> <li>Adapts project and program plans to ensure alignment with business objectives and reinforce organizational standards.</li> <li>Applies highly developed knowledge of financial management principles to manage cost estimation, tracking, and budget reporting for programs and projects.</li> <li>Coaches’ junior-level project and program managers on how to utilize key performance indicators (KPIs) to measure progress and analyze project and program outcomes.</li> <li>Coordinates knowledge sharing among project teams to highlight success stories and improve project and program management practices through insights.</li> <li>Creates a continuous improvement plan for the project and program department to enhance delivery processes and outcomes.</li> <li>Designs the change management protocol to effectively respond to obstacles that may arise during project and program lifecycles.</li> <li>Utilizes data visualization tools and techniques to present project and program data in a visually appealing easily understandable format.</li> <li>Participates in project/program team training and development activities to enhance project management skills and knowledge.</li> </ul>Required Qualifications<ul> <li>5 + years marketing experience</li> <li>3 to 5 years project management experience</li> <li>Proven communication skills, including writing, presentation, and negotiation skills.</li> <li>Proven track record in meeting project milestones.</li> </ul>Preferred Qualifications<ul> <li>8-10 years of experience related to marketing communications, enrollment technology, customer service and processes, including project consultation preferred.</li> <li>3 to 5 years healthcare experience</li> <li>Expert proficiency with Microsoft Office, inDesign and other marketing software.</li> </ul>Education<ul><li>Bachelor's degree or equivalent professional work experience.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 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: 06/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Senior Marketing Manager Project Program Management (IC)

What you can expect As an Engineering Manager - Cloud Native, you'll lead an engineering delivery team. The team, based in India, builds and supports cloud-native solutions in the CPQ and Order to Cash business areas. You'll collaborate with an agile team, address challenges, and contribute to Zoom's growth as a customer-focused organization, delivering high-quality software in a dynamic environment. This is an exciting opportunity to play a pivotal role in building our platform. About the Team The team builds and supports cloud-native solutions across CPQ, Order to Cash, and more. We work with technologies like Vue.js, Java, Spring Boot, REST APIs, MongoDB, and AWS to deliver high-quality software. This is a dynamic and challenging role. We’re looking for an experienced people manager with a robust engineering background, a go-getter attitude, and a sharp eye for detail. The ideal candidate is hands-on, thrives on solving problems, and enjoys mentoring and collaborating with others. If you're excited about leading Zoom’s continued transformation into a nimble, customer-focused enterprise applications team, we’d love to hear from you. What we’re looking for • Have Bachelor in Computer Science, Engineering, MIS or equivalent • Have overall 12+ and at least 4+ years of experience as an Engineering Manager • Have proficiency in fullstack software development using server-side technologies like Java, Spring MVC, RESTful APIs, microservices, multithreading, and low-latency API development • Be able to build user-centric UI experience with React, Typescript or Vue. Have proficiency in relational (MySQL) and NoSQL (MongoDB, DynamoDB) databases, distributed caching (Redis, Memcache), and search technologies (Elasticsearch, Lucene). • Have experience with AWS/GCP/Azure, CI/CD tools (Jenkins), containerization (Docker), version control (Git), and build tools (Maven, Gradle). • Display excellent communication skills, familiarity with third-party integrations, design patterns, Agile methodologies, and software internationalization. • Have an understanding of common performance patterns and anti-patterns in distributed systems • Hire and retain top-class engineers by providing career growth, and mentoring, while taking intelligent risks to improve the way work is done • Have flexibility in working hours as you will be working with a global teamWays of Working Our structured hybrid approach is centered around our offices and remote work environments. The work style of each role, Hybrid, Remote, or In-Person is indicated in the job description/posting.Benefits As part of our award-winning workplace culture and commitment to delivering happiness, our benefits program offers a variety of perks, benefits, and options to help employees maintain their physical, mental, emotional, and financial health; support work-life balance; and contribute to their community in meaningful ways. Click <a href="https://careers.zoom.us/benefits" target="_blank">Learn</a><a href="http://careers.zoom.us/benefits" target="_blank"> </a>for more information.About Us Zoomies help people stay connected so they can get more done together. We set out to build the best collaboration platform for the enterprise, and today help people communicate better with products like Zoom Contact Center, Zoom Phone, Zoom Events, Zoom Apps, Zoom Rooms, and Zoom Webinars. We’re problem-solvers, working at a fast pace to design solutions with our customers and users in mind. Find room to grow with opportunities to stretch your skills and advance your career in a collaborative, growth-focused environment. Our Commitment​At Zoom, we believe great work happens when people feel supported and empowered. We’re committed to fair hiring practices that ensure every candidate is evaluated based on skills, experience, and potential. If you require an accommodation during the hiring process, let us know—we’re here to support you at every step.If you need assistance navigating the interview process due to a medical disability, please submit an <a href="https://form.asana.com/?k=OIuqpO5Tv9XQTWp1bNYd8w&amp;d=1127274756253361" target="_blank">Accommodations Request Form</a> and someone from our team will reach out soon. This form is solely for applicants who require an accommodation due to a qualifying medical disability. Non-accommodation-related requests, such as application follow-ups or technical issues, will not be addressed.#LI-Remote

Zoom

Engineering Manager - Cloud Native

Sr Business Analyst, Business Planning Analyst - Capital One Shopping (Remote-Eligible)This is your opportunity to join Capital One's fast-growing consumer app. Within Capital One, the Shopping team is working on a new consumer product that seeks to change the way people buy things online. Our mission is to deliver a best-in-class shopping and savings experience for our millions of customers while driving incremental and sustainable sales for our merchant partners.The Strategic Planning team is looking to hire a Business Planning Analyst, who will play a crucial role in shaping our growth trajectory. This is an exciting opportunity to contribute to our success by focusing on strategic hiring planning and optimizing capital allocation in a fast paced environment. You will serve as a key partner to leadership and delivery teams, providing insights and support to achieve our ambitious goals.To be successful in the role, you will need to be a well-rounded 'business athlete’ - a creative, analytical, and technically proficient problem solver who understands both the dynamics of the business and the tech landscape. The ideal candidate is resourceful, motivated, and self-sufficient, with demonstrated success in spearheading cross-functional projects that drive the growth and success of a business.General Responsibilities: <ul> <li>Develop and maintain comprehensive investment plans aligning with business objectives and growth projections</li> <li>Build business cases and conduct analysis to assess the potential and performance and of R&amp;D investments</li> <li>Create and manage financial models to forecast product level revenue and ROI metrics</li> <li>Work closely with Sales, Growth, and Product teams to understand and influence revenue impacts from operational strategies</li> <li>Partner with talent acquisition and department leaders to ensure effective execution of growth plans and delivery goals</li> <li>Establish and track key performance indicators (KPIs) to monitor team progress and delivery against commitments</li> <li>Develop and maintain reporting dashboards to provide real-time visibility into portfolio performance</li> <li>Work closely with colleagues across Capital One including: IT, Sales, Operations, Finance and others to drive improvement in quality, volume, service, and profitability </li> <li>A proven track record of decision making and problem solving based on analytics</li> <li>Strong business judgment, leadership and integrity: He/she should be a tenacious decision maker, able to bring a healthy, aggressive, yet responsible approach to business </li> <li>Solid people leadership experience: Ability to build and leverage the capabilities of a high-performing team, as well as business partners across the enterprise. He/she should foster innovation, drive critical decisions, hold business partners accountable, and be able to consistently deliver results </li> <li>Strong executive communication skills: Impeccable written and oral communication credentials, coupled with strategic influencing skills and the ability to drive agreement through intellect, interpersonal and negotiation skills </li> <li>Clear results orientation: display an intense focus on achieving both short and long term goals. He/she should be able to drive and execute an agenda in an uncertain and fluid environment </li> <li>Successful track record of thriving in a fast paced, entrepreneurial and dynamic environment. Previous consulting experience is a plus </li> </ul>Capital One is open to hiring a Remote Employee for this opportunity.Basic Qualifications:<ul> <li>Bachelor’s Degree in any quantitative field (Business, Math, Economics, Finance, Statistics, Science, Engineering)</li> <li>At least 1 year of experience in analysis</li> <li>At least 1 year of experience in SQL querying</li> </ul>Preferred Qualifications:<ul> <li>Master’s Degree in Business or quantitative field such as Finance, Economics, Physical Sciences, Math, Statistics, Engineering</li> <li>1+ years of experience in Statistical model building</li> <li>1+ years of experience in market research</li> <li>2+ years of experience in SQL querying</li> <li>2+ years of experience in business analysis</li> <li>1+ years of experience in consulting</li> </ul>Capital One will consider sponsoring a new qualified applicant for employment authorization for this position.The minimum and maximum full-time annual salaries for this role are listed below, by location. Please note that this salary information is solely for candidates hired to perform work within one of these locations, and refers to the amount Capital One is willing to pay at the time of this posting. Salaries for part-time roles will be prorated based upon the agreed upon number of hours to be regularly worked.New York, NY: $118,900 - $135,700 for Sr. Business Analyst Remote (Regardless of Location): $99,100 - $113,100 for Sr. Business Analyst McLean, VA: $109,000 - $124,400 for Sr. Business Analyst Candidates hired to work in other locations will be subject to the pay range associated with that location, and the actual annualized salary amount offered to any candidate at the time of hire will be reflected solely in the candidate’s offer letter.This role is also eligible to earn performance based incentive compensation, which may include cash bonus(es) and/or long term incentives (LTI). Incentives could be discretionary or non discretionary depending on the plan.Capital One offers a comprehensive, competitive, and inclusive set of health, financial and other benefits that support your total well-being. Learn more at the <a href="https://www.capitalonecareers.com/benefits" target="_blank">Capital One Careers website</a>. Eligibility varies based on full or part-time status, exempt or non-exempt status, and management level.This role is expected to accept applications for a minimum of 5 business days.No agencies please. Capital One is an equal opportunity employer committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age, national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, citizenship, immigration status, protected veteran status, or any other basis prohibited under applicable federal, state or local law. Capital One promotes a drug-free workplace. Capital One will consider for employment qualified applicants with a criminal history in a manner consistent with the requirements of applicable laws regarding criminal background inquiries, including, to the extent applicable, Article 23-A of the New York Correction Law; San Francisco, California Police Code Article 49, Sections 4901-4920; New York City’s Fair Chance Act; Philadelphia’s Fair Criminal Records Screening Act; and other applicable federal, state, and local laws and regulations regarding criminal background inquiries.If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation, please contact Capital One Recruiting at 1-800-304-9102 or via email at <a href="#">RecruitingAccommodation@capitalone.com</a>. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodations.For technical support or questions about Capital One's recruiting process, please send an email to <a href="#">Careers@capitalone.com</a>Capital One does not provide, endorse nor guarantee and is not liable for third-party products, services, educational tools or other information available through this site.Capital One Financial is made up of several different entities. Please note that any position posted in Canada is for Capital One Canada, any position posted in the United Kingdom is for Capital One Europe and any position posted in the Philippines is for Capital One Philippines Service Corp. (COPSSC).

Capital One

Sr Business Analyst, Business Planning Analyst - Capital One Shopping (Remote-Eligible)

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<ul> <li>Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. </li> <li>Acts as a subject matter expert by providing training, coaching, or responding to complex issues. </li> <li>May handle customer service inquiries and problems.</li> </ul>Additional Responsibilities <ul> <li>Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. </li> <li>Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.</li> <li>Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.</li> <li>Insures all compliance requirements are satisfied and all payments are made against company practices and procedures.</li> <li>Identifies and reports possible claim overpayments, underpayments and any other irregularities.</li> <li>Performs claim rework calculations.</li> <li>Distributes work assignment daily to junior staff.</li> <li>Trains and mentors claim benefit specialists.</li> <li>Makes outbound calls to obtain required information for claim or reconsideration.</li> </ul>Required Qualifications<ul> <li>2+ years medical claim processing experience.</li> <li>Experience in a production environment.</li> <li>Demonstrated ability to handle multiple assignments competently, accurately and efficiently.</li> </ul> Preferred Qualifications<ul> <li>Self funded medical claim processing experience.</li> <li>DG system knowledge.</li> </ul>Education<ul> <li>High School Diploma or GED required.</li> <li>Preferred Associates degree or equivalent work experience.</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $42.35This 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: 05/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Claim Benefit Specialist

Overview Are you looking for a rewarding career? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S. Attractive pay $90,000.00 - $100,000.00 annually Our compensation reflects the cost of labor across several U.S. geographic markets and may vary depending on location, job-related knowledge, skills, and experience. What's in it for you A full benefits package with choice of affordable PPO or HSA medical plans. Paid time off. Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan. Up to $500 in wellness rewards for completing activities during the year. Use these rewards to support your wellbeing with spa services, gym memberships, sports, hobbies, pets and more.* Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program. 401(k) with a company match. Family support with infertility treatment coverage*, adoption reimbursement, paid parental and family caregiver leave. And more. Please note: Benefit eligibility can vary by position depending on shift status. *To participate, you must be enrolled in an Amedisys medical plan. **For full-time caregivers meeting certain requirements. Responsibilities As the Business Development Analyst Trainer, you will be responsible for providing analytics training support to the Business Development staff, enhancing employee engagement, performance and understanding. Key functions include developing, coordinating and facilitating centralized analytics learning and training for both new hires and experienced Business Development representatives.Plans, develops, and delivers onsite or virtual training programs to Business Development staff and regional teams across the organization focused on analytics including but not limited to market data, referral sources, admissions, and account overviews. <ul> <li>Conducts training sessions specific to line of business (LOB) analytics, providing insights and specified uses.</li> <li>Provides instruction on the basics of utilizing Power BI and Trella, including navigation and best practices.</li> <li>Develops tutorials for Trella and Power BI, using real-world scenarios to enhance learning.</li> <li>Guides newly hired Business Development leaders through their line of business (LOB) available reports and scorecards, ensuring comprehension of data and system navigation.</li> <li>Educates new hires on the available scorecards and reports, explaining their purpose and usage.</li> <li>Designs learning solutions to meet the identified learning needs of Business Development staff; prepares goals and outcome measures to evaluate program effectiveness.</li> <li>Conducts needs assessments to determine specific analytics focused continuous learning needs for tenured Business Development staff.</li> <li>Evaluates effectiveness of learning programs and resources.</li> <li>Collaborates with training team to assess/design analytics learning solutions to meet identified learning needs.</li> <li>Complies with policies, procedures and regulatory mandates including but not limited to abiding to the terms of the Amedisys Compliance Program.</li> <li>Performs other duties as assigned.</li> </ul> Qualifications Required: <ul> <li>Bachelor's degree in healthcare, education, business, analytics, Data Science or a related field or equivalent work experience.</li> <li>Two (2+) years' experience in training/coaching.</li> <li>Two (2+) years' experience in analytics.</li> <li>Proven track record in training and development roles, especially in analytics.</li> <li>Proficiency in analytics tools such as Power BI, Trella, Tableau, or similar platforms.</li> <li>Strong understanding of data analysis and business intelligence.</li> </ul> Preferred: <ul> <li>Master's degree in healthcare, education, analytics or business or related field.</li> <li>Five (5+) years' experience in Hospice or Home Health field.</li> <li>Two (2+) years in content writing and development.</li> <li>Experience in developing training materials and tutorials.</li> </ul> Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

Business Development Analytics Trainer

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 SummaryCVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Key Responsibilities of the UM Nurse Consultant (Includes but is not limited to)<ul> <li>Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.</li> <li>Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.</li> <li>Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.</li> <li>Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.</li> <li>Communicates with providers and other parties to facilitate care/treatment.</li> <li>Identifies members for 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>Registered Nurse (RN) with current unrestricted US licensure required.</li> <li>2+ years clinical practice experience as an RN required.</li> <li>2+ Years Utilization Management experience.</li> <li>Must be willing to travel to the local office as needed if living within approximately 45 minutes/miles.</li> </ul>Preferred Qualifications<ul> <li>Bilingual proficiency in Arabic, Korean, or Spanish preferred.</li> <li>1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications.</li> </ul>Education<ul> <li>Associate’s degree in Nursing.</li> <li>BSN preferred.</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$29.10 - $62.32This 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: 06/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant

Overview Are you looking for a rewarding career as an RN OASIS and coding specialist? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S. Attractive pay <ul><li>$70,000-$75,000</li></ul> Enjoy many perks and benefits <ul> <li>A full benefits package with choice of affordable PPO or HSA medical plans.</li> <li>Paid time off.</li> <li>Up to $1,300 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan.</li> <li>Up to $500 in wellness rewards for completing activities during the year. Use these rewards to support your wellbeing with spa/massage/salon services, gym memberships, fitness classes, sports, hobbies, pets and more. *</li> <li>Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program.</li> <li>401(k) with a company match.</li> <li>Family support with infertility treatment coverage*, adoption reimbursement, paid parental and family caregiver leave.</li> <li>And more.</li> </ul> Please note: Benefit eligibility can vary by position depending on shift status. *To participate, you must be enrolled in an Amedisys medical plan. What's in it for you <ul> <li>Community-based care centers with a supportive and inclusive work environment.</li> <li>Better work/life balance and increased flexibility compared to other settings.</li> <li>Job stability and the opportunity to advance with a growing company. </li> <li>The opportunity to make a meaningful impact on the lives of patients and their families providing much needed care where they want to be - in their homes.</li> </ul> Don't just take it from us "After working for Amedisys for almost 5 years I feel that from the CEO on down, there is a culture of sincerely wanting to be a great employer - and it shows. The pay is above average, the benefits are great, and the paid time off is generous." - Amedisys employee Why Amedisys Amedisys is a leading provider of home health, hospice, and high-acuity care, dedicated to helping patients and families navigate the complex healthcare system. With a focus on compassionate, patient-centered care, you would be joining a team of professionals committed to improving the lives of those they serve. Responsibilities <ul> <li>Receives and reviews patient OASIS assessments for assigned care centers.</li> <li>Reviews OASIS patient status items compared to other related patient documentation to verify completeness and accuracy.</li> <li>Assists in evaluating needs of the patient and suggests referrals to other disciplines as indicated by the patient's needs.</li> <li>Identifies need for OASIS/documentation education and communicates group needs to care center leadership and supervisor.</li> <li>Communicates any delays in processing assessments to supervisor and care center.</li> <li>Performs other duties as assigned.</li> </ul> Qualifications <ul> <li>Current unencumbered license to practice as an RN.</li> <li>One year ICD-9 or ICD-10 coding and OASIS experience.</li> <li>HCSD or BCHH-C ICD-10 certification.</li> <li>OASIS (COS-C/HCS-O) certification.</li> </ul> Our compensation reflects the cost of labor across several U.S. geographic markets and may vary depending on location, job-related knowledge, skills, and experience. Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

OASIS and Coding 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 SummaryThe Account Executive owns the relationship with the broker. The goal of this role is to build and maintain broker relationships for an exceptional experience for our clients. This is achieved through communicating and demonstrating Meritain's total cost of care, through simplicity, transparency and versatility. Responsibilities of the Account Executive role include: - Relationship management/Consultative services - Prepare and issue renewal proposal - Confirm sold proposal and plan changes - Ensure client is up to date with compliance requirements - Salesforce management - Virtual open enrollment meetings - Attend implementation calls- Stop Loss &amp; Ad-hoc reporting- Point solution upsell - May require travel to offsite locations for in-person meetingsRequired Qualifications<ul> <li>2-5 years Group Health employee benefit experience </li> <li>Renewal process experience</li> <li>2-5 years Client Management experience</li> <li>Excellent verbal and written communication skills</li> <li>Ability to successfully establish and maintain relationships with internal business partners (underwriting, sales, operations, business analytics, etc.)</li> <li>Ability to work collaboratively with both internal and external business partners</li> <li>Exhibit consistency in follow through on outstanding items to point of resolution</li> <li>Demonstrate accuracy in information shared internally and externally</li> <li>Ability to participate and/or successfully host client meetings as appropriate</li> <li>Demonstrate adherence to PHI and HIPPA policies</li> <li>Health/Life Major Lines Producer License (or must obtain post-hire within 90 days) </li> </ul>Preferred Qualifications<ul> <li> Stop-loss/Self-funded Health Insurance Plan experience</li> <li>Understand competitive environment and market opportunities</li> <li>Bachelors Degree </li> </ul>Education:<ul><li>High School Diploma or GED</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$51,686.00 - $101,286.00This 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. 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: 07/04/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Account Executive (Meritain Health)

<h1>Financial Services - Data Risk Management, Manager</h1> <h1>Financial Services - Data Risk Management, Manager</h1> <a href="https://pwc.wd3.myworkdayjobs.com/US_Experienced_Careers/job/NY-New-York/Financial-Services---Data-Risk-Management--Manager_619741WD?source=US_EXP_Careers" target="_blank">Apply</a> Job Category Data and Analytics Level Manager Specialty/Competency Data, Analytics &amp; AI Time Type Full time Travel Requirements Up to 60% Job ID 619741WD Location(s) NC-Charlotte, IL-Chicago, DC-Washington, MA-Boston, NJ-Florham Park, NY-New York A career within Data and Analytics services will provide you with the opportunity to help organisations uncover enterprise insights and drive business results using smarter data analytics. We focus on a collection of organisational technology capabilities, including business intelligence, data management, and data assurance that help our clients drive innovation, growth, and change within their organisations in order to keep up with the changing nature of customers and technology. We make impactful decisions by mixing mind and machine to leverage data, understand and navigate risk, and help our clients gain a competitive edge. Our team helps clients navigate various analytics applications to get the most value out of their technology investment and foster confidence in their business intelligence. As part of our team, you'll help our clients implement enterprise content and data management applications that improve operational effectiveness and provide impactful data analytics and insights. To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future. As a Manager, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to: <ul> <li>Develop new skills outside of comfort zone.</li> <li>Act to resolve issues which prevent the team working effectively.</li> <li>Coach others, recognise their strengths, and encourage them to take ownership of their personal development.</li> <li>Analyse complex ideas or proposals and build a range of meaningful recommendations.</li> <li>Use multiple sources of information including broader stakeholder views to develop solutions and recommendations.</li> <li>Address sub-standard work or work that does not meet firm's/client's expectations.</li> <li>Use data and insights to inform conclusions and support decision-making.</li> <li>Develop a point of view on key global trends, and how they impact clients.</li> <li>Manage a variety of viewpoints to build consensus and create positive outcomes for all parties.</li> <li>Simplify complex messages, highlighting and summarising key points.</li> <li>Uphold the firm's code of ethics and business conduct.</li> </ul> The Opportunity As part of the Data and Analytics - Business Intelligence team you are responsible for leading efforts in developing and implementing data-driven strategies to drive business growth and enhance decision-making. As a Manager, you guide and mentor your team, facilitating the successful planning, execution, and completion of projects while maintaining exemplary standards and leveraging team strengths to meet client expectations. You play a crucial role in aligning data initiatives with organizational goals, managing data strategy programs, and embracing technology and innovation to improve delivery. Responsibilities - Oversee the planning and completion of data initiatives, maintaining quality standards - Align data strategies with organizational objectives to drive growth - Leverage team strengths to meet and exceed client expectations - Manage data strategy programs to improve decision-making - Foster a culture of continuous improvement and learning within the team What You Must Have - Bachelor's Degree in Computer and Information Science, Computer and Information Science &amp; Accounting, Economics, Economics and Finance &amp; Technology, Operations Management/Research, or Statistics - 5 years of experience What Sets You Apart - Master's Degree in Computer Science, Computer Engineering, or Engineering preferred - Proficiency in data risk management and technology risk management - Developing data-driven strategies for business growth - Aligning data initiatives with organizational goals - Managing data strategy program success - Programming using Python and SQL - Designing advanced analytics solutions and AI/ML models - Understanding of Master Data Management and Data Governance - Supporting reliable and scalable solutions architectures Learn more about how we work: <a href="https://pwc.to/how-we-work" target="_blank">https://pwc.to/how-we-work</a> PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: <a href="https://pwc.to/H-1B-Lottery-Policy" target="_blank">https://pwc.to/H-1B-Lottery-Policy</a>. All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer. The salary range for this position is: $100,000 - $232,000, plus individuals may be eligible for an annual discretionary bonus. For roles that are based in Maryland, this is the listed salary range for this position. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation and more. To view our benefits at a glance, please visit the following link: <a href="https://pwc.to/benefits-at-a-glance" target="_blank">https://pwc.to/benefits-at-a-glance</a> <h1>Financial Services - Data Risk Management, Manager</h1> <a href="https://pwc.wd3.myworkdayjobs.com/US_Experienced_Careers/job/NY-New-York/Financial-Services---Data-Risk-Management--Manager_619741WD?source=US_EXP_Careers" target="_blank">Apply</a>

185 Jobs in Woodland Hills, MD 20736, USA