You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. - Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal - Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards - Communicates with members, providers, facilities, and other departments regarding appeals requests - Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards - Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests - Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: - LPN - Licensed Practical Nurse - State Licensure required or - LVN - Licensed Vocational Nurse required or - RN - Registered Nurse - State Licensure and/or Compact State Licensure required or - LCSW- License Clinical Social Worker required or - LMHC-Licensed Mental Health Counselor required or - LPC-Licensed Professional Counselor required or - Licensed Marital and Family Therapist (LMFT) required or - Licensed Psychologist required - For Health Net of California: RN license required Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. - Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal - Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards - Communicates with members, providers, facilities, and other departments regarding appeals requests - Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards - Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests - Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices - Performs other duties as assigned - Complies with all policies and standards This is a fully remote position. Candidates with an active RN license and utilization management experience are highly preferred. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: - LPN - Licensed Practical Nurse - State Licensure required or - LVN - Licensed Vocational Nurse required or - RN - Registered Nurse - State Licensure and/or Compact State Licensure required or - LCSW- License Clinical Social Worker required or - LMHC-Licensed Mental Health Counselor required or - LPC-Licensed Professional Counselor required or - Licensed Marital and Family Therapist (LMFT) required or - Licensed Psychologist required Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Overview We are looking for team members who are passionate about challenging and significant work for the good of every patient. We are searching for individuals who are compassionate, serve with a purpose, are dedicated to supporting their team, and who seek excellence every day. Sound like a perfect match? Apply now - we can't wait to hear from you! Why Join IU Health? As Indiana’s largest and most comprehensive healthcare system, and the number 1 ranked healthcare system in Indiana, we offer: - 401(K) retirement savings with employer match - Tuition reimbursement - Student loan forgiveness - Government program that may allow qualifying participants to have the remainder of their student loan balance forgiven (after a set amount of time and specific qualifications have been met). - Employee Assistance Program – Counseling at no cost to you - Healthy Results - Participation in our team member wellness programs award points that contribute toward a biweekly financial incentive in your paycheck! The more you participate, the more you earn! Description: Clinical Pharmacists, also referred to as Caseload Pharmacists, are responsible for managing individualized patient care. A dedicated Clinical Pharmacist is assigned to each patient for the duration of care, prioritizing patient safety and outcomes. The duties of the Clinical Pharmacist role include: - Coordinating Care - Providing clinical oversight - Managing prescriptions for a designated group of patients - Strong communication skills are essential for this role, as it involves continuous interaction with providers and their staff, other pharmacists, nurses, and patients. - This role offers the flexibility to work remotely up to 80% of the time. Provides comprehensive, value-based medication-related care to achieve definite outcomes that improve a patient's quality of life. Acts in collaboration with other healthcare professionals in the shared responsibility for patient medication therapy outcomes. Key job duties may consist of ensuring safety and effectiveness of the medication use process, processing and dispensing medications per order or prescription, medication therapy monitoring, regulatory compliance, maintaining oversight over pharmacist extenders, maintaining the security of medications, and protecting the confidentiality of patient information. Provides medication information support for medical and nursing staff, ensuring continuity of care, and identifies potential challenges and intervenes, if necessary, to medication-related issues. - Requires Doctor of Pharmacy (PharmD) or Bachelor's of Science in Pharmacy prior to 2006. - Successful completion of an ASHP accredited PGY1 or PGY2 residency may be required. - Requires 0-3 years of relevant experience. - Requires current Indiana Pharmacist license or eligibility for Indiana licensure as a Pharmacist. - Board certification or other specialized training may be required. - Basic Life Support certification through the American Heart Association (AHA) may be required. - May require travel to IU Health facilities. - May require weekend rotations. - Indiana University Health has nearly 40,000 team members, including more than 3,600 physicians and 1,200 advanced practice providers, and we’re home to the largest nursing network in Indiana with more than 9,000 nursing team members at over 800 sites of care. - IU Health is ranked No. 1 in Indiana by U.S. News & World Report, Riley Children's Health is ranked among the top children's hospitals in the country by U.S. News & World Report. - A unique partnership with the Indiana University School of Medicine – one of the nation’s largest medical schools – gives patients access to groundbreaking research and innovative treatments, and it offers team members access to the latest science and the very best training – advancing healthcare for all. - With 15 hospitals, including seven with Magnet designation and eight with Pathways to Excellence designation, our team members are leading the way through excellence. - At Indiana University Health, your personal and professional growth is a top priority. You will have access to many diverse opportunities to learn and develop in meaningful ways that matter most to you, such as advanced clinical training, leadership development, promotion opportunities and cross training development. - Indiana University Health is invested in the lives of Hoosiers, leading the transformation of healthcare to make Indiana one of the nation’s healthiest states. Indiana University Health is Indiana’s most comprehensive health system, with 15 hospitals and nearly 40,000 team members serving Hoosiers across the state. We’re looking for team members who are inspired by challenging and meaningful work for the good of every patient. People who are compassionate and serve with a purpose. People who aspire to excellence every day.

Community Health Worker/Promotor(a) de Salud at Zócalo Health Remote: Must reside in San Bernardino County Compensation: $29.00 - $31.00 per hour About Us Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos. We are developing a new approach to care that is designed around our very own shared and lived experiences and brings care to our gente. Founded in 2021 on the idea that our communities deserve more than just safety nets, we are backed by leading healthcare and social impact investors in the country to bring our vision to life. Our mission is to improve the lives of our communities—communities that have dealt with generations of poor experiences. These experiences include waiting hours in waiting rooms, spending mere minutes with doctors who don’t speak their language, and depending on their youngest kids to help them navigate our complex healthcare system. At Zócalo Health, we meet our members where they are, bringing care into their homes and neighborhoods through our team of community-based care providers and virtual care offerings. We partner with community-based organizations, local healthcare providers, and health plans that recognize the value of culturally aligned care, which are not limited to brief interactions in an exam room. Together, we are building a new experience that revolves around the use of modern technology, culturally competent primary care, behavioral health, and social services to provide a radically better experience of care for every member, their family, and the communities we serve. We are committed to expanding our reach to serve more members and their communities. We are looking for passionate individuals who share our belief that healthcare should be accessible, personalized, and rooted in the community. Join us in our mission to ensure that no one has to navigate the complexities of the healthcare system alone and that everyone receives the local, culturally competent care they deserve. Role Description Our care model is designed to meet members wherever they are—whether in their homes, online or in their community. Community Health Workers are integral to our mission of providing culturally aligned and accessible care to the Latino community. They build trust through shared cultural and linguistic backgrounds, improving patient engagement and access to care. Zócalo Health is looking for a Community Health Worker to work directly with our patients to help them navigate their health and social needs. You will work with an assigned panel of members dealing with unmet social needs and numerous health conditions. You will educate patients on disease prevention and healthy behaviors, coordinate comprehensive care by scheduling appointments and facilitating follow-ups, and address social determinants of health by connecting patients with essential community resources. Your work enhances patient advocacy and satisfaction and reduces healthcare costs by preventing unnecessary hospital visits. You will also help organize community events and gather valuable health data, ensuring our care model is responsive to the community’s needs, promoting overall health equity and better outcomes for our members. This position reports to the Community Health Worker Manager. You will work primarily in your community, with some work-from-home responsibilities. The Community Health Worker will contribute in the following ways: - Play an active role in patient registration and enrollment, including organizing community engagement and outbound calls to patients. - Conduct outreach (virtually and in-person) to patients scheduled for appointments and complete initial intake. - Engage with a panel of assigned patients to provide care navigation, appointment logistics, prescription drug support, lab support, referral coordination, care plan adherence, and resource sharing. - Assess for social determinants of health (SDOH) needs and enroll patients in SDOH programs, including care planning development, referral to community resources, coaching, and graduation planning. - Collaborate with a multidisciplinary care team to contribute to care plans, triage requests, and solve complex patient needs. - Document all patient and care team interactions across multiple systems and tools. - Participate in community events to support patient activation and trust-building, including relationship-building with key contacts, facilitating group education sessions, and liaising with community organizations. - Provide culturally and linguistically appropriate health education and information. - Assist with federal and state support program enrollment, appointment scheduling, referrals, and promoting continuity of care. - Support individualized goal setting using motivational interviewing. - Conduct individual social needs assessments. - Provide social support by listening to patient concerns and referring to appropriate support resources. - Attend and participate in community events as a Zócalo Health representative. - Coordinate internal clinical services. Qualifications Language/Culture - Fluency (verbal and written) in English and Spanish. - Knowledgeable of Latino customs and cultural norms (preferred) Education - High school diploma or GED (minimum). Licenses/Certifications (CA only) - Must possess a Community Health Worker certification, which included field experience as a requirement for completion -OR- - Demonstration of 2,000+ hours of CHW work (paid or volunteer) in the past three years and willingness to obtain a Community Health Worker certification within 18 months of hire date Experience - 1-3 years healthcare experience or healthcare navigation within the community. - 2 - 5 years of community work, advocacy, engagement, or organizing. - Previous working experience in related jobs (health promotion, project coordination, social research, administration). - Familiarity with Google workspace. (preferred) - Past experience documenting in an EHR. (preferred) - Training in motivational interviewing. (preferred) Complementary competencies and skills - Comfortable working with multiple computer applications simultaneously and willingness to learn new technologies and frameworks. - Team player who builds effective working relationships. - Ability to train others. - Well-known in and have strong ties to the local Latino community. (preferred) - Well versed in local resources to support SDOH needs. (preferred) COVID-19 vaccination requirement - Zócalo Health requires all members of the care team to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. - You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. Flexible and able to travel to other communities - Willing to travel to support community events and in person patient appointments. - Have reliable sources of transportation. Benefits & Perks - Ground floor opportunity; shape the direction of a fast-growing, high impact healthcare company - Comprehensive benefits (medical/dental/vision) - Generous home office stipend - Competitive compensation - Generous PTO policy including 6 paid holidays. You must be authorized to work in the United States. We are open to remote work anywhere in the locations outlined in this job description. At Zócalo Health Inc., we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.  Those seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.