Company : Highmark Inc.Job Description : JOB SUMMARY This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members. ESSENTIAL RESPONSIBILITIES - Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. - For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment. - Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved. - Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. - Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization. - Other duties as assigned or requested. EDUCATION Required - High School Diploma/GED Substitutions - None Preferred - Bachelor's Degree in Nursing EXPERIENCE Required - 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience Preferred - Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT) - Experience working with the healthcare needs of diverse populations - Understanding of the importance of cultural competency in addressing targeted populations LICENSES AND CERTIFICATIONS Required - Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment. Preferred - Certification in Case Management SKILLS - Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion - Broad knowledge of disease processes - Understanding of healthcare costs and the broader healthcare service delivery system - Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data - Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization - Ability to work in a high performing team environment that requires flexibility - Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills - Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy LANGUAGE REQUIREMENT (Other than English) None TRAVEL REQUIREMENT 0% - 25% PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS Position Type Office-Based Teaches/Trains others regularly Rarely Travels regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (Sales employees) Does Not Apply Physical Work Site Required No Lifting: up to 10 pounds Rarely Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $57,700.00 Pay Range Maximum: $107,800.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

About us Pomelo Care is the national leader in evidence-based healthcare for women and children. We deliver personalized, high-quality clinical interventions from reproductive care and pregnancy, infant care and pediatrics, to hormonal health through perimenopause and menopause, with long-term preventive care and condition management. Our model delivers 24/7 multispecialty care to address the medical, behavioral, and social factors that most significantly impact outcomes for women and children. We partner with payers, employers, and providers to expand access to quality healthcare across the system. Role Description Your North Star: Provide direct patient care and clinical oversight that optimizes outcomes for pregnant people and newborns through population-based implementation of evidence-based care. In this role you will: - Be accountable for improving clinical outcomes for empaneled patients, by overseeing their medical care - Attend daily clinical huddles focused on collaboration across a clinical pod, including RNs, LCSW, and RDs - Review complex patient cases, develop care plans, and support other members of the clinical team in providing them with evidence-based care - Monitor adverse events and hold clinical retros to identify any areas for improvement in Pomelo’s protocols - Lead development and review of evidence-based medical protocols and algorithms related to obstetric and women’s health Requirements - Must have active compact RN license - Minimum of 4 years of experience as an APP - Extensive obstetric experience, including treating high-risk patients, as well as some experience caring for infants - A passion for and demonstrated effectiveness in optimizing evidence-based care and perinatal outcomes - Experience using data to drive patient engagement, activation, and outcomes - Experience leading successful teams, with track record of outstanding collaboration and teamwork - A sense of urgency to improve outcomes coupled with exceptional organization and attention to detail - A growth mindset with the ability to approach process change and ambiguous situations with enthusiasm, creativity, and accountability - Facility using multiple tech platforms, with an eagerness for advising about platform improvements and adapting to new systems - Eager to thrive in a fast-paced, metric-driven environment - Phenomenal interpersonal and communication skills Education and training - NP or CNM with significant experience in obstetrics and some experience in infant care Bonus points for - Telehealth and/or remote monitoring experience - Experience in outpatient or home-based management of higher-risk patients Schedule: - 2x12 - 11am - 11pm ET - Set schedule, 2 weekdays per week - No weekends required Why you should join our team By joining Pomelo, you will get in on the ground floor of a fast-moving, well-funded, and mission-driven startup where you will have a profound impact on the patients we serve. And you'll learn, grow, be challenged, and have fun with your team while doing it. We strive to create an environment where employees from all backgrounds are respected. We value working across disciplines, moving fast, data-driven decision making, learning, and always putting the patient first. We also offer: - Competitive healthcare benefits - Generous equity compensation - Generous PTO policy At Pomelo, we are committed to hiring the best team to improve outcomes for all mothers and babies, regardless of their background. We need diverse perspectives to reflect the diversity of problems we face and the population we serve. We look to hire people from a variety of backgrounds, including but not limited to race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status. Our salary ranges are based on paying competitively for our company’s size and industry, and are one part of the total compensation package that also includes equity, benefits, and other opportunities at Pomelo Care. In accordance with New York City, Colorado, California, and other applicable laws, Pomelo Care is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including qualifications for the role, experience level, skillset, geography, and balancing internal equity. A reasonable estimate of the current salary range is $110,000-$135,000. We expect most candidates to fall in the middle of the range. We also believe that your personal needs and preferences should be taken into consideration, so we allow some choice between equity and cash. #LI-Remote Potential Fraud Warning Please be cautious of potential recruitment fraud. With the increase of remote work and digital hiring, phishing and job scams are on the rise with malicious actors impersonating real employees and sending fake job offers in an effort to collect personal or financial information. Pomelo Care will never ask you to pay a fee or download software as part of the interview process with our company. Pomelo Care will also never ask for your personal banking or other financial information until after you have signed an offer of employment and completed onboarding paperwork that is provided by our People Operations team. All official communication with Pomelo Care People Operations team will come from domain email addresses ending in @pomelocare.com. If you receive a message that seems suspicious, we encourage you to pause communication and contact us directly at careers@pomelocare.com to confirm its legitimacy. For your safety, we also recommend applying only through our official Careers page. If you believe you have been the victim of a scam or identity theft, please contact your local law enforcement agency or another trusted authority for guidance.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Be Part of Something Radically Different. At Holon Health, we’re not just tweaking the system—we’re rebuilding it for the people it’s failed. We provide whole-person care to justice-involved individuals living with Substance Use Disorder (SUD)—care that meets people where they are, sees their full humanity, and builds pathways to long-term recovery, not short-term fixes. Everything we do is designed to deviate from the status quo—from the way we treat our clients to the way we care for our team. We know that meaningful work can’t happen without flexibility, trust, and self-care, so we lead with a culture of compassion, inclusion, and respect. If you’re ready to join a team that’s rewriting the rules and centering people at every turn, read on. Holon Health is seeking an experienced and compassionate Nurse Practitioner living and licensed in Utah to support individuals with SUD through collaborative, integrated care. In this role, you'll work closely with our hybrid Care Navigator, Case Manager, and Peer Recovery Specialist teams. This position requires candidates to be physically located in Utah. It offers remote flexibility and is structured as a full-time (40 hours/week) position. You’ll provide telehealth-based assessments, medication management, and care coordination to support clients on their recovery journey—and be part of a forward-thinking team breaking down barriers to behavioral healthcare. Qualifications - A licensed and experienced Nurse Practitioner - Physically located in Utah - Deeply compassionate toward individuals living with SUD and mental health challenges - Experienced in addiction medicine or psychiatry, with a commitment to person-centered care - A strong collaborator who thrives in integrated and team-based care models - Adaptable to evolving schedule needs as our care model grows - Organized, flexible, and capable of navigating complex systems - Clear and confident in virtual communication with both clients and team members Requirements - Active and unrestricted NP license in Utah (multiple and additional state licenses are a plus), with current physical residence in the state of Utah required - Active DEA license (and CDS where applicable) - Several years of experience in behavioral health, addiction medicine, or psychiatry - Board certification in specialty preferred - Strong documentation skills and proficiency in EHR platforms Benefits - Competitive hourly compensation plus quarterly incentive - Unlimited PTO - Health, dental, vision, life and disability insurance for full-time team members - 401(k) with company match for all - A flexible schedule and room to grow Company Description Diversity, equity, and inclusion aren’t just values at Holon—they’re the foundation of everything we do. We welcome people of all backgrounds, identities, and lived experiences, and we believe our team is stronger when it reflects the communities we serve. We’re proud to be an equal opportunity employer and we encourage candidates from underrepresented backgrounds to apply—even if you don’t meet every qualification.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description CLFC Healthcare & Communications is seeking a board-certified Gastroenterology Physician to provide clinical services at the VA Maine Healthcare System in Togus, ME. This is a full-time contract position supporting one of the nation's oldest VA facilities, serving a predominantly rural and aging Veteran population across the state of Maine. The role includes a remote work component and requires VA credentialing and privileging. Key Responsibilities - Comprehensive GI Consultation and Management: Evaluate and manage the full spectrum of gastrointestinal disorders including inflammatory bowel disease, hepatitis C, cirrhosis, GERD, peptic ulcer disease, GI malignancies, and functional GI disorders in the Veteran population. - Endoscopic Procedures: Perform diagnostic and therapeutic upper endoscopy (EGD), colonoscopy, and related interventional procedures including polypectomy, hemostasis, dilation, and PEG placement per facility privileging. - Colorectal Cancer Screening Program: Participate in the VA colorectal cancer screening initiative, managing screening colonoscopies, surveillance schedules, and follow-up for high-risk Veterans per VA and USPSTF guidelines. - Hepatology Services: Manage chronic liver disease including viral hepatitis treatment protocols, cirrhosis monitoring, hepatocellular carcinoma surveillance, and pre/post-transplant evaluation coordination. - Interdisciplinary Collaboration: Coordinate care with primary care, surgery, oncology, radiology, and pathology services. Participate in tumor boards, GI case conferences, and quality improvement initiatives. - Documentation and Compliance: Maintain accurate and timely clinical documentation in CPRS/VistA, complete procedure reports, and adhere to VA clinical practice guidelines and regulatory requirements. Qualifications - Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school - Board certified in Gastroenterology (ABIM) - Completion of ACGME-accredited Gastroenterology fellowship - Active, unrestricted medical license in any U.S. state (Maine license or ability to obtain required) - Active DEA registration - Current BLS certification - U.S. citizenship required (VA federal contract requirement) - Ability to pass VA background investigation and obtain credentials/privileges at VA Maine Preferred Qualifications - Prior VA or federal healthcare experience - Experience with CPRS/VistA electronic health records - Advanced endoscopy training or hepatology subspecialty experience - Experience serving rural or underserved patient populations - Active Maine medical license Compensation and Benefits - Rate: $225 - $290 per hour (independent contractor) - Malpractice insurance coverage provided by CLFC - Credentialing and privileging support - Flexible scheduling with remote work component - Long-term, stable federal healthcare assignment - Professional development support About the Location Togus, ME is located in the Augusta area in central Maine. The VA Maine Healthcare System serves Veterans across the entire state through its main campus and community-based outpatient clinics. Maine offers outstanding quality of life with access to world-class outdoor recreation, a thriving food and arts scene in nearby Portland, and a close-knit community atmosphere.