ABOUT ACCOMPLISH Accomplish Health is a rapidly-growing, venture-backed leader providing telemedicine obesity care. We are redefining remote medical weight management and medical bariatrics through evidence-based stigma-free care, managed by obesity specialized clinicians and dietitians. Our mission is to provide people living with obesity with access to the high-quality evidence-based treatment they deserve. Our comprehensive clinical model leverages pharmacotherapy (prescription drugs), nutrition therapy, health coaching, and connected devices (i.e. scales, blood pressure cuffs), which has generated best-in-class clinical outcomes for our patients (12-month Weight Loss of 22% vs. industry norm of 5-16%) and in turn extraordinarily high patient satisfaction (NPS of ~90, Satisfaction Levels of >95%). By providing care in a completely virtual environment, we can provide enhanced access for patients in even the most remote locations, while providing clinical opportunities to medical professionals across the country. We partner with health systems and bariatric practices across the US, to provide our obesity care services to their patients in need, either through direct referral partnerships or joint ventures, with strong traction to date. Key Responsibilities: - Deliver prompt and insightful triage (via phone or messaging) to aid patients in making informed healthcare decisions, applying critical thinking and clinical assessment skills alongside established protocols to ensure accurate patient care. - Communicate proactively with providers and care team members to ensure seamless coordination and timely resolution of patient needs. - Consistently provide confidential, high-quality, stigma-free, person-centered care and a superior patient experience. - Record complete, timely, and legible medical documentation, ensuring appropriate encounter-related billing services. - Utilize and support a detailed, software-enabled clinical model that leverages pharmacotherapy, nutrition therapy, health coaching, and remote physiological monitoring to help patients with obesity and other metabolic conditions achieve their weight loss and wellness goals. Qualifications: - BSN plus a minimum of 3 years of recent related experience as a Registered Nurse. Experience in obesity medicine and/or bariatrics a plus. - Either an active license in a compact state OR an active unrestricted eNLC. - Strong communication, clinical assessment, and computer skills required. - Demonstrated excellent written/verbal communication skills. - Competency in the genetic, biological, environmental, social, and behavioral factors that contribute to obesity and a thorough understanding of the treatment of obesity. - Candidates should have strong computer skills and excellent phone skills to work with providers, patients, and administrators What We Offer: - A competitive salary commensurate with your experience - Excellent benefits including healthcare, dental and vision - Participation in the Employee Stock Option Plan - Flexible PTO - Opportunities for professional development and advancement. - A collaborative and supportive work environment. More about Accomplish Health: - We are a remote-first progressive and technology focused workplace. - We are a mission-driven organization made up of veteran entrepreneurs and healthcare professionals passionate about treating obesity and other metabolic conditions. - We are a data-centric, objective focused, collaborative, and iterative culture where feedback and open communication are encouraged. - Our investors are top venture capitalists and entrepreneurs who have backed or founded unicorns like Zocdoc, Grove, Ginkgo Bioworks, Sweetgreen, Udemy, Clover Health, ASAPP and Moat. - We care about the well being and growth of our patients, employees, and communities. Accomplish Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: The Prior Authorization Clinician is responsible for reviewing all proposed hospitalization, home care, and inpatient/outpatient services for medical necessity and efficiency to ensure members receive the appropriate and timely care to support members in achieving optimal health outcomes. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions/Responsibilities: · Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines applying evidenced-based InterQual® criteria, Medical Policy and benefit determination. · Performs utilization review activities, including pre-certification, concurrent and retrospective reviews according to guidelines. · Determines medical necessity of each request by applying appropriate medical criteria to first level reviews and utilizing approved evidenced based guidelines / criteria · Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. · Reviews, documents, and communicates all utilization review activities and outcomes including, but not limited to, all inquiries made and received regarding case communication. · Refers cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines, or when guidelines are not available. · Referrals must be made in a timely manner, allowing the Physician Reviewer time to make appropriate contact with the requesting provider in accordance with departmental policy and within each Medicaid, ACA, CMS or NCQA mandated turnaround times (TAT). · Demonstrates strong interpersonal and communication skills when conducting reviews, interacting with physicians and staff, and ensures compliance with training on related policies and procedures. · Sends appropriate system-generated letters to provider and member · Provides guidance and coaching to other utilization review nurses and participate in the orientation of newly hired utilization nurses · Follows all departmental policies and workflows in end-to-end management of cases. · Participates in team meetings, education, discussions, and related activities · Maintains compliance with Federal, State and accreditation organizations. · Identifies opportunities for improved communication or processes · May participate in audit activities and meetings · Documents rate negotiation accurately for proper claims adjudication · Identify and refer potential cases to Care Management · Performs all other related duties as assigned Qualifications: Education: · Nursing degree or diploma required Preferred/Desirable: · Bachelor’s degree · Medicare and Medicaid knowledge Experience: · 2+ years prior authorization experience and evidence-based guidelines (InterQual Guidelines) · Managed care experience · All employees working remotely will be required to adhere to WellSense’s Telecommuter Policy Licensure, Certification or Conditions of Employment: · Active RN License in the state of NH, or a compact eligible state that includes NH · Pre-employment background check · Ability to take after hours call, including evening/nights/weekends Competencies, Skills, and Attributes: · Strong oral and written communication skills. · Strong clinical judgement and critical thinking skills to assess complex cases and determine appropriate levels of care. · Excellent communication and interpersonal skills to engage effectively with internal and external stakeholders · Ability to work independently in a remote environment while maintaining adherence to timeliness and regulatory requirements. · Proficiency in Microsoft Office applications and data management systems. · Demonstrated organizational and time management skills · Strong analytical and clinical problem-solving abilities with focus on quality improvement initiatives Working Conditions and Physical Effort: · Fully remote position with possible travel to the Charlestown, MA office for team meetings and training sessions. · Fast paced and dynamic work environment requiring adaptability and focus. · Minimal physical effort required; primarily desk-based tasks such as documentation and virtual meetings. · Regular and reliable attendance is essential. Compensation Range $35.58 - $51.44 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This range is based on Boston-area data, and is subject to modification based on geographic location. About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Role Description GoTo Telemed is seeking experienced, licensed Physician Assistants (PA-C) to join our growing network of independent telehealth providers. This is a flexible, 1099 independent contractor opportunity allowing you to practice across multiple states with complete autonomy over your schedule while maintaining collaborative relationships with supervising physicians. We provide comprehensive support infrastructure including training, HIPAA-compliant digital platforms, EHR/EDI systems, collaborative practice agreement templates, and optional malpractice insurance coverage, enabling you to focus on delivering quality patient care. - Position Type: 1099 Independent Contractor (Self-Employed) - Work Schedule: Flexible – Set Your Own Hours - Location: Remote (Multi-State, U.S.) - Compensation Structure: Fee-for-Service Model - Collaboration Model: Remote Supervision via Telehealth/Chart Review/Secure Messaging Qualifications - Graduation from an accredited Physician Assistant Program (Master's degree minimum) - Active certification by the National Commission on Certification of Physician Assistants (NCCPA) - PA-C credential required - Current, passing score on the Physician Assistant National Certification Examination (PANCE) within past recertification period - Active, unrestricted PA-C license in at least one U.S. state (multi-state preferred) - Current DEA registration (or eligible to obtain) for controlled substance prescribing states - Unrestricted medical license/certification with no disciplinary history, sanctions, or criminal convictions - Clean background check with no criminal convictions or pending charges Requirements - Conduct comprehensive virtual consultations via secure HIPAA-compliant video conferencing platform (GoTo Telemed) - Perform thorough patient assessment including chief complaint, history of present illness, past medical history, past surgical history, social history, family history, allergies, medications, and review of systems - Develop appropriate differential diagnoses based on available telehealth assessment techniques - Provide evidence-based medical evaluation, diagnosis, treatment recommendations, and prescriptions as clinically appropriate within PA scope of practice - Document all clinical encounters accurately, completely, and timely in integrated Electronic Health Records (EHR) system - Generate and transmit prescriptions electronically through certified pharmacy networks - Communicate findings, diagnoses, and treatment plans clearly to patients, ensuring informed consent and patient understanding - Establish appropriate diagnostic and follow-up plans aligned with standard of care - Recognize and appropriately refer conditions outside PA scope of practice or requiring higher level of care - Maintain professional communication and comprehensive clinical documentation standards across all patient interactions - Perform clinical triage and determine appropriateness of telehealth vs. in-person evaluation - Establish and maintain collaborative practice agreements with supervising physician(s) in all states where patient care is delivered - Communicate clinical decisions, complex cases, and treatment plans with supervising physician(s) via telehealth, secure messaging, phone, or chart review - Seek consultation from supervising physician for cases outside established protocols or requiring additional clinical guidance - Ensure collaboration arrangements meet state-specific supervision requirements and regulatory standards - Maintain documentation of collaborative communications and supervision activities - Comply with state-specific collaborative practice agreement requirements - Maintain active, unrestricted PA-C license(s) in all states where patient care is delivered - Maintain current PANCE certification or PANCA recertification - Ensure DEA registration in all states where controlled substance prescribing occurs - Verify state-specific telehealth regulations and patient location requirements prior to each consultation - Maintain current knowledge of state-specific PA scope of practice, prescriptive authority, and telehealth-specific compliance rules - Comply with each state's controlled substance prescribing rules, including Prescription Monitoring Program (PMP) requirements - Comply with federal HIPAA Privacy Rule, Security Rule, and Breach Notification requirements - Ensure compliance with all state medical board regulations specific to PA practice in each jurisdiction - Maintain proper documentation of licensure status, DEA registration, and collaborative agreements - Utilize GoTo Telemed video conferencing and appointment scheduling system proficiently - Access and document patient information in integrated EHR system (GoTo Telemed platform) - Understand and comply with EDI standards for claims submission and eligibility verification - Maintain competency with secure messaging, appointment reminders, and patient communication features - Troubleshoot basic technical issues; escalate technical problems to platform support team - Protect patient privacy and maintain confidentiality within digital environment - Complete all mandatory HIPAA and platform-specific security training - Maintain awareness of telehealth-specific documentation and billing requirements - If applicable, collaborate with assigned RN/LPN staff for patient screening, triage, and care coordination - Communicate clinical decisions clearly to nursing team - Ensure proper coordination between PA care delivery and nursing supervision - Participate in case conferences and clinical consultations as needed - Maintain professional documentation of all coordinated care encounters - Complete comprehensive onboarding and platform training program - Maintain current Physician Assistant Certification through NCCPA - Participate in ongoing competency assessments and quality improvement initiatives - Respond to peer review, credentialing inquiries, and licensing board communications within required timeframes - Maintain current certifications including BLS and ACLS (or equivalent) - Engage in continuing education and professional development as required by state licensing boards and professional standards - Participate in quality audits, chart reviews, and compliance monitoring activities - Report clinical or technical issues that may impact patient safety immediately - Maintain compliance with prescriptive authority limitations and state pharmacy board regulations Benefits - Flexible work schedule - Comprehensive support infrastructure - Optional malpractice insurance coverage

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The remote inpatient review nurse assists patients through the continuum of care in collaboration with the patient’s primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Assures that services are provided at the most appropriate, cost effective level of care needed to meet the patient’s medical needs while maintaining safety and quality. Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time (Required) GENERAL DUTIES/RESPONSIBILITIES: 1. Performs reviews of inpatients with complex medical and social problems. 2. Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician. 3. Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting. 4. Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on acceptable evidence-based guidelines used by AHC. 5. Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities. 6. Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary. 7. Communicates and collaborates with IPA/MG as necessary for effective management of Members. 8. Assigns and provides daily oversight of the activities and tasks of the CCIP Coordinator. 9. Records communications in EZ-Cap and/or case management database. 10. Arranges and participates in multi-disciplinary patient care conferences or rounds. 11. Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure. 12. Monitors for any over utilization or underutilization activities. 13. Generates referrals as appropriate to the QM department. 14. Enters data as necessary for the generation of reports related to case management. 15. Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management. 16. Performs other duties as assigned. Minimum Requirements: Experience: • Required: Minimum 3 years of general case management skills. Minimum of two years of experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay: including review of diagnosis and length of stay. Two consecutive years related experience in a managed care setting as an inpatient case manager • Preferred: Experience with a Senior population. Education: • Required: Successful completion of an accredited Licensed Vocational Nursing Program • Preferred: Associates or Bachelors Degree Specialized Skills: • Required: - Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. - Excellent critical thinking skills related to nursing utilization review - Knowledge of Medicare Managed Care Plans - Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; - Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly - Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. - Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. - Report Analysis Skills: Comprehend and analyze statistical reports. • Preferred: Knowledge and experience in complex/catastrophic case management preferred Licensure: Required: - Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact) - Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1 While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear. 2 The employee is frequently required to reach with hands and arms 3 The employee is occasionally required to climb or balance and stoop, or kneel 4 The employee must occasionally lift and/or move up to 20 pounds. 5 Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. Pay Range: $77,905.00 - $116,858.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.