Our Mission To improve the health of the communities we serve through contemporary, innovative, quality healthcare solutions. Schedule: Monday - Friday (40hrs/week) About Us – Physician Reimbursement Center (PRC) Located inside the Freeman Business Center Vital part of our revenue cycle Our team consists of over eighty professionals that assure reimbursement for the valued services our clinicians provide What You’ll Do Performs a variety of duties in support of the quality assurance and compliance function of the Physician Reimbursement Center. Performs prospective chart reviews to ensure medical record accurately reflects the patient’s level of service, severity of illness and risk of mortality. Works closely with Medical Staff to clarify, assist and educate with documentation of evaluation and management coding. Requirements - Minimum of 3 years of clinical experience in an acute care setting, (ICU, Medical/Surgical or Emergency Department nursing preferred). - If homebound, must reside in one of the following states: Arkansas, Kansas, Missouri or Oklahoma. - Current Missouri Registered Nurse license or current Registered Nurse license from a compact state. If a compact license is held, it must be in the nurse state of residence. - Experience and skills in coding, billing and compliance. Preferred Requirements COSC Certification Freeman Perks and Programs - For eligible full time and part time employees Freeman offers a wide variety of career opportunities, a great work culture and generous benefits, most starting day one! - Health, vision, dental insurance - Retirement with employer match - Wellness program with discounts to Health Insurance or Cash Bonus with Participation - Milestone payments with longevity of employment - Paid Time Off (PTO) or Flex time off (FTO) - Extended sick pay - Learning Center designated only for Freeman Family members - Payroll deduction at different locations such as The Daily Grind, Freeman Gift Shop, Cafeteria, etc

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Cadence Health is seeking a skilled Licensed Practical/Vocational Nurse (LPN/LVN) to join our dynamic team. The LPN/LVN will play a crucial role in our mission by providing support to patients with chronic conditions. This position is remote, operating within the framework of a rapidly evolving healthcare technology startup environment. Schedule Requirements: - This role requires availability Friday through Sunday & every other Wednesday or Thursday. - Scheduled hours are 7:00 AM to 7:00 PM Eastern Time. What you'll do: - Conduct remote monitoring of patient vital signs, symptoms, and other health indicators. - Identify patients requiring immediate clinical intervention based on monitored data and established criteria. - Follow up promptly with patients showing abnormal readings to gather additional clinical information. - Collaborate closely with Cadence Nurses and Nurse Practitioners to ensure coordinated care management. - Maintain accurate clinical documentation and contribute to the development of comprehensive care summaries for healthcare providers. Qualifications - Licensed Practical/Vocational Nurse (LPN/LVN) with compact licensure. - Minimum 5 years of experience as an LPN/LVN. - Minimum 3 years of experience in a cardiology setting. - Strong ability to think critically and adapt swiftly to a dynamic work environment. - Experience working in remote patient monitoring or telemedicine settings is highly desirable. - Proficient in reading, writing, and communicating professionally and effectively within clinical documentation and with patients. - Familiarity with healthcare technology and a startup environment is a plus. Requirements - The anticipated compensation range for this role is $27 to $33 per hour, based on role scope, level, and location. - This position is remote and based in the United States. - Actual compensation will be determined based on factors including experience, skills, internal equity, and applicable law. Benefits - Company culture all about impact, shared growth mindset, empowerment, and integrity. - An opportunity to help improve the quality of life of millions of Americans. - Unique chance to support the development of an amazing product; Cadence’s in-house clinicians are our super users and beta testers. - Competitive salaries and quarterly incentives. - Medical, dental, and vision insurance. - Competitive PTO. - 401K and 401K match. - National and local discounts powered by TriNet. - Onboarding stipend for remote equipment and home office setup. - Paid Parental Leave. - Charitable Donation Match program.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are currently hiring a Case Manager Nurse to join our team! This is a remote position; Candidates MUST reside in California. What You Will Be Doing: - Under general supervision, conducts case management activities on assigned members where analysis, synthesis and evaluation of data and information are required. - Responsible for developing, implementing and evaluating individual care plans to ensure that care is rendered at the most appropriate level, for the requisite length of time, and in compliance with HPSJ, regulatory and contractual requirements. - Work is varied and complex and requires a moderate amount of discretion and independent judgement. Essential Functions: - Assesses and evaluates members care needs. - Educates member on HPSJ services and the case management process. - Develops complex care plans in partnership with member and member’s PCP. - Collaborates with member, his/her family, and external and internal resources to ensure understanding of and compliance with care plans. - Escalates high risk medical issues to Medical Director for review; approves or denies services as directed. - Monitors and evaluates progress at appropriate intervals; conducts appropriate interventions. - Supports and advises members on self-advocacy efforts. - Documents activities in appropriate HPSJ system(s) according to standards. - Tracks data as required; compiles data for, produces and submits routine reports. - Reviews care plans developed by LVN Case Managers and Entry Level Case Managers. Qualifications - Produces work that is accurate and complete. - Produces the appropriate amount of work. - Actively learns through experimentation when tackling new problems, using both successes and failures to learn. - Rebounds from setbacks and adversity when facing difficult situations. - Knows the most effective and efficient process to get things done, with a focus on continuous improvement. - Strong clinical skills as defined in California scope of practice guidelines for RNs. - In-depth knowledge of and proficient skills in administering protocols for utilization management, discharge planning and/or case management. - In-depth knowledge of health care delivery systems as they apply to case management. - Ability to read, interpret and apply clinical information, practice guidelines and other complex data and information. - Strong skills in assessment and analysis. - Strong problem-solving skills. - Basic negotiation skills. - Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people. - Strong oral and written communication skills, with the ability to communicate professionally to diverse individuals inside and outside of HPSJ, effectively explain complex information, and document according to standards. - Ability to use tact and diplomacy to diffuse emotional situations. - Ability to work independently and as part of a team. - Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines. - Strong customer service skills. - Basic skills in Word and Excel. - Ability to enter data into and navigate through multiple databases. - Ability to speak and be understood in English. - May require proficiency in one of HPSJ’s threshold languages (as defined by HPSJ’s Cultural and Linguistic Program). - Ability to handle confidential information with appropriate discretion. Requirements - Required within one year of hire: - In-depth knowledge of government sponsored programs and regulations as they apply to case management. - In-depth knowledge of managed care principles, practices and regulatory requirements as they apply to case management. Education and Experience - Required: - Graduation from an accredited nursing school. - At least three years clinical experience as an RN in a hospital or clinic. - At least three years performing case management, utilization management or discharge planning. - Preferred: - Experience as a clinician in a managed care setting. - Experience working with Medi-Cal and/or Medicare populations. - Certified Case Manager Designation. Licensure, Certification, Registration - Unrestricted California Registered Nurse license. Benefits - Competitive salary. - Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers. - Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays). - CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan. - Two flexible spending accounts (FSAs). - Employer-Paid Term Life and AD&D Insurance. - Employer-Paid Disability Insurance. - Employer-Paid Life Assistance Program. - Health Advocacy. - Supplemental medical, legal, identity theft protection. - Access to exclusive discount mall. - Education and training reimbursement in addition to employer-paid elective learning courses. - A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do. - A shorter commute – if you’re commuting from the Central Valley to the Bay Area. - Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects. Physical Demands - Work may require frequent sitting, standing, and walking, constant repetitive motion, frequent talking and listening, closeup and distance vision requirements. - Some work may require occasional travel based on the responsibilities of the position and business needs and occasional handling materials up to 50 pounds. Emotional/Psychological Demands - Ability to cope with a fast-paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, emotional and sensitive situations. Work Environment - Work may be performed in a remote, hybrid, or onsite setting depending on the requirements of the position and business needs. - For roles performed remotely, employees are expected to maintain a secure, distraction-free workspace, and reliable internet connectivity consistent with company standards.

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Clinical Pharmacist ReviewerJob Description The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (i.e. formulary exceptions, prior authorization, step therapy, quantity limit exceptions) for delegated products and services. Responsibilities - Responsible for the clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exception and tier exception; this includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client’s pre-approved criteria - Accountable for direct consultation with health care providers concerning non-formulary and clinical product coverage issues - Collaborate with team members to promote consistency of decisions across the pharmacist team - Other duties as assigned Minimum Qualifications - Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree - Current pharmacist license in good standing with the State Board of Pharmacy - 1 year of clinical experience; or equivalent training, education and/or experience Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications - Excellent verbal and written communication skills - Ability to work independently and as part of a team Preferred Qualifications - Managed care experience - Proficiency with Microsoft Office Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $51.92 - $88.46 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits). Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.