Summary Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Location: This is a remote position, from 8:30am to 5pm Monday through Friday. What You’ll Do: - Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. - Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. - Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. - Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). - Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. To Qualify For This Position, You'll Need The Following: - Required Education: Associate's in a job related field. - Degree Equivalency: 2 years job related work experience. - Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. - Required Skills and Abilities: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. - Required Software and Tools: Microsoft Office. - Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as social worker from the United States and in the state of hire (in Div. 6B) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager. We Prefer That You Have The Following: - Preferred Work Experience: 7 years-healthcare program management. 4+ years of Renal/ Nephrology experience. - Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. - Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

• Monitoring clinical trial sites to ensure adherence to study protocols, regulatory requirements, and Good Clinical Practice (GCP) standards. • Conducting site visits to assess site performance, resolve issues, and provide support to ensure successful trial execution. • Collaborating with cross-functional teams to ensure timely and accurate data collection and reporting. • Providing training and guidance to site staff and other CRAs to maintain high standards of clinical trial conduct. • Building and maintaining effective relationships with site personnel and stakeholders to facilitate smooth trial operations.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Naveris is seeking a Clinical Operations Associate to join our Business Operations team. The Clinical Operations Associate will collaborate directly with ordering providers and sales team to ensure a streamlined and efficient ordering process, helping patients undergoing surveillance for HPV-driven cancers benefit from routine NavDx testing. Candidates should be highly organized and analytical self-starters who bring a positive attitude, integrity, and enthusiasm as we advance cancer surveillance and patient care. Reporting to the Clinical Operations Manager, the Clinical Operations Associate will: - Collaborate closely with ordering providers and the sales organization to deliver streamlined and efficient operational support for NavDx test orders, focusing on cancer recurrence monitoring. - Coordinate closely with field-based Product Development Managers, Naveris Patient Navigation Specialists, and clinical staff in provider offices to ensure consistent patient access and seamless ordering processes for NavDx testing. - Equip medical practices and ordering providers with relevant resources and information to support optimization of their NavDx surveillance testing protocols. - Build and maintain trusting relationships with contacts at ordering accounts to ensure seamless and efficient NavDx test ordering, reporting, and patient management. - Collaborate closely with the sales team, Patient Navigation team, and clinical teams to proactively communicate with customers and patients to ensure appropriate access to NavDx testing. - Monitor and analyze physician ordering patterns, proactively identifying practices that could benefit from enhanced collaboration or additional operational support. - Ensure data integrity and accuracy within our systems through diligent data entry, verification, and maintenance. - Drive provider portal adoption and customer satisfaction by responding promptly to incoming inquiries, addressing technical questions, and facilitating efficient order processing. - Work closely with the CLIA laboratory team, reimbursement team, and providers to ensure test order accuracy and avoid test processing and claim processing delays. - Maintain physician notification settings to ensure timely and accurate communication of surveillance testing results. - Provide clear guidance, onboarding assistance, and ongoing operational support to new physicians and clinical teams implementing NavDx surveillance protocols at their institutions. - Identify opportunities to streamline ordering processes and recommend improvements to enhance the overall customer and patient experience. - Execute special projects as directed by Business Operations leadership to drive efficiency and support achievement of company objectives. Qualifications - Bachelor’s degree required, or equivalent combination of education and commensurate professional experience. - 2-5 years of successful full-time work in a fast-paced environment with a focus on clinical operations or analytics. - Experience working in commercial-stage, high-growth life sciences or diagnostics companies, or in a physician office, clinic, or hospital providing support for patients and healthcare providers. - Experience with Excel, Salesforce.com, Tableau and/or other business intelligence tools. - Effective communicator with demonstrated ability to engage with customers. - Experience engaging with healthcare professionals (nurses, physician assistants, physician office staff) is highly beneficial. - Consistently operates at the highest level of integrity and does not compromise ethical standards. - Proficiency in Excel, Salesforce.com, and Tableau with the ability to analyze data, create reports, and manage dashboards. Requirements - Compliance with legal and regulatory requirements of HIPAA. - Acceptance and adherence to all policies and standards at Naveris. - Responsibility for reporting any suspected violations or abuse. - Completion of HIPAA training when joining the company. Company Description Naveris is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We don’t just accept differences - we celebrate and support them. We do not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

About Leap Leap is one of the fastest-growing benefits solutions and a category-defining pioneer in employer specialty pharmacy. We are reshaping how life-changing therapies are delivered and financed, ensuring patients get the treatment they need while employers finally get a fair deal. Specialty drugs and infusions represent nearly 10% of all healthcare spend and are the fastest-growing cost category for employers. Leap tackles this challenge with a novel approach: eliminating hidden markups, expanding access to high-quality infusion providers, and bringing clarity and fairness to how therapies are priced and paid for. We’re proud to partner with numerous Fortune 500 companies and leading TPAs. Each patient we serve creates immediate ROI: lower costs, improved access, and better care. Join us as we redefine what’s possible in specialty care. About the Role The Clinical Intake Coordinator ensures members are successfully onboarded into care by collecting complete and accurate intake information and preparing each case for a seamless transition to the care team. You will engage members directly, gather and validate intake documentation, and deliver high-quality handoffs that allow Care Guides to begin ongoing care without additional follow-up. The role partners closely with Care Guides, Member Growth, and Care Operations to move members efficiently through the intake pipeline. This position reports to the Care Guide Clinical Manager. Key Responsibilities Member Engagement & Intake - Conduct proactive outreach to members via phone, SMS, and email to collect required clinical intake information. - Serve as the primary point of contact for patient inquiries, delivering clear and empathetic communication throughout the intake process. - Gather and validate patient demographic, clinical, and treatment information required to initiate care. Care Coordination & Scheduling - Schedule and confirm treatment appointments while coordinating with nursing agencies and infusion providers. - Verify medication receipt and ensure patients understand treatment preparation requirements prior to therapy. - Prepare comprehensive handoffs to Care Coordinators, including intake summaries, supporting documentation, and next steps. Insurance & Authorization Support - Verify member eligibility and benefits, confirming insurance coverage, payer details, and cost-sharing information needed to initiate care. - Support preparation of prior authorization documentation and track authorization, renewal, and extension status. Operational Excellence & Compliance - Identify and escalate urgent clinical or safety concerns to licensed clinical staff according to protocol. - Maintain accurate documentation across CRM and EHR systems to ensure continuity of care. - Uphold strict HIPAA compliance and member privacy standards in all communications and records. Qualifications Required: - Active certification or licensure as a Medical Assistant (CMA/RMA), Licensed Practical Nurse (LPN), or Pharmacy Technician (CPhT or state-licensed). - 2+ years of experience in patient intake, care coordination support, or member outreach within a healthcare environment. - Experience verifying insurance benefits and supporting prior authorization workflows. - Familiarity with infusion therapy concepts or specialty medication workflows. - Strong written and verbal communication skills with the ability to build trust with patients remotely. - Experience using CRM, EHR, or healthcare operations systems. Preferred: - Experience in infusion centers, specialty infusion programs, or virtual care operations. - Experience working in a healthcare startup or fast-paced care delivery environment. - Spanish fluency (spoken and written). At Leap, we’re building an outlier company with real impact — and that takes focus, energy, and commitment. If that excites you, we’d love to hear from you. Leap is an equal opportunity employer and welcomes applicants from all backgrounds. We’re committed to building a team that reflects a diversity of perspectives, experiences, and identities.