This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Nurse Case Manager (NCM) is an integral part of an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members, specifically for Medicare and Community Care membership. The NCM seeks to establish telephonic relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with member specific needs and quality metrics developed by the NCM and support team. - Regular telephonic assessments, care planning, and identifying member specific priorities. - Familiarity with quality metrics including STARS and HEDIS as well as guiding factors within the NCQA standards. - Emphasis on complex case management, reducing readmission rates, and ensuring that members’ needs are met at time of transition from ER/inpatient hospitalization to home. - Understanding the effect of social determinants of health on health outcomes and aligning members with community supports. Qualifications - Graduate from an accredited school of nursing mandatory. - Bachelors (or advanced) degree in nursing or a health care related field preferred. - Active, unrestricted license as a Registered Nurse in Massachusetts. - Certification in Case Management strongly desired. - Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation. - 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required. - Understanding of hospitalization experiences and the impacts and needs after facility discharge required. - Experience working face to face with members and providers preferred. - Experience with telephonic interviewing skills and working with a diverse population required. - Home Health Care experience preferred. - Effective case management and care coordination skills preferred. - Familiarity with NCQA, CAHPS and Stars/HEDIS metrics preferred. Requirements - Excellent communication and interpersonal skills with members and providers via telephone and in person. - Exceptional customer service skills and willingness to assist ensuring timely resolution. - Excellent organizational skills and ability to multi-task. - Appreciation and adherence to policy and process requirements. - Independent learning skills and success with various learning methodologies. - Knowledgeable about software systems including Microsoft Office Products. - Ability to effectively respond and adapt to changing business needs. Benefits - Pay range for this position is $88,000 - $95,000 per year. - Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Become a part of our caring community and help us put health first The Pharmacy Stars Improvement Lead will be a part of a collaborative Pharmacy Stars team which is accountable for Humana’s Stars patient safety measure performance. The Pharmacy Stars Improvement Lead will autonomously develops, implements, and manages clinical program strategies to improve Medicare members' medication adherence and appropriate medication use with specific focus on telehealth and in-home methods of care delivery. The Pharmacy Stars Improvement Lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action. Use your skills to make an impact Required Qualifications - Bachelor's Degree in Business, Finance, Health Care or a related field - 2 or more years of project leadership experience - Prior Medicare/Medicaid experience - Strategic thinking and planning capabilities; organized and detail-oriented - Excellent communication skills - Enthusiasm and motivation essential; a confident change-agent; strong presentation skills (oral and written) - Ability to operate under tight deadlines - Successful track record in facilitating and consulting across teams and managing projects - Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business need - Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data - Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint Preferred Qualifications - Master's Degree in Business Administration, Health Administration or a related field - Provider relations experience - Prior managed care experience - Understanding of metrics, trends and the ability to analyze and identify gaps in care - Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus - Understanding of CMS Stars and performance measure knowledge and experience a plus - Background working in quality improvements Additional Information: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at home requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 03-19-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 115,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: Summary The Clinical Site Lead drives study execution and operational excellence across Abbott Cardiovascular therapies (Vascular, Cardiac Rhythm Management, EP, Structural Heart, and Heart Failure). Recognized resource in protocol execution, increasing product and disease state knowledge, procedure support (as needed), procedure outcomes and early indication of trends, clinical trial enrollment, and ICH-GCP and clinical research application. Adheres to specified site nomination, qualification, and startup processes. Leads ongoing training/retraining of all site stakeholders to ensure protocol adherence. Continuously reviews, manages, and influences all aspects of site’s recruitment and data collection performance (enrollment, discrepancy resolution, compliance, etc.). Proactively utilizes appropriate operational metrics to minimize screen failure, attrition rate, etc. Monitors to ensure compliance with applicable regulatory requirements, Good Clinical Practice, and accuracy standards inclusive of site initiation, periodic, and close-out visits. May be consulted in the following areas: study design, site payments, site audits, local document review, study documents preparation, and submission to site or competent authority/ethics committee. Main Responsibilities With limited direction from leadership: 1. Develop and maintain a productive clinical territory: - Identify, develop, and maintain sites capable of delivering start-up goals, study participation levels and required data quality. - Understand and assess investigators’ interests and qualifications. - Identify appropriate investigators as defined by study-specific requirements and by the applicable regulatory code. - Maintain open communication and relationships with key site personnel including the Principle Investigator, Research Coordinator, as well as regulatory and legal personnel. - Provide ongoing technical support to customers and field staff. - Facilitate communication between clinical sites and other Abbott clinical staff (e.g., operations management, study team, Site Contracts Associate), as needed. 2. Manage all aspects of study lifecycle to include site regulatory and quality: Start Up - Nominate, approach, and complete qualification processes including establishing site/sponsor expectations for study execution. - Facilitate all aspects of the start-up process and site initiation visits - Understand regulatory and legal requirements for study participation at a level that allows for appropriate collaboration with Abbott clinical staff, e.g. Site CRA, Site Contract Associate. - Train facility staff regarding protocol requirements and technology. Enrollment - Develop site-specific strategies to promote appropriate patient enrollment. - Identify site successes and challenges and assist in implementing techniques that promote study goal achievement. - Continuously evaluate site study performance and provide timely feedback to site. - Attend study procedures and follow-ups when indicated (or ensure trained personnel attend). Regulatory and Quality - Core level Abbott certification and/or equivalent level proficiency - Develop site-specific strategies to avoid deviations. - Educate site on tools to facilitate compliance. - Provide timely feedback to the sites on key compliance indicators. - Escalate non-compliant sites according to corporate policy. - Collect essential documents, identify and obtain missing data, data corrections, reviewing adverse events and protocol deviations. - Review data and source documentation from investigational sites for accuracy and completeness - Facilitate resolution of data queries and action items at clinical sites - Promptly reports the findings of monitoring visits according to Abbott processes. - Maintain accurate, detailed and complete records of monitoring visits. 3. Provide training and procedure coverage: - Apply clinical and technical expertise to train site and Abbott staff for clinical trials and applicable commercial launches. - As needed, provide clinical and technical expertise for clinical trial procedure support - Attend study procedures and follow-ups (or ensure trained personnel attend). 4. Collaborate with commercial partners: - When appropriate, collaborate in the education of local sales groups on new product launches. - When appropriate, contribute to the education of customers on new and existing Abbott products. - Meet with key customers where Abbott GCO presence can elevate the customer experience. - Act as an additional resource for technical questions and troubleshooting. 5. Identify and adapt to shifting priorities and competing demands. 6. Remain current on developments in the field of expertise including clinical and Abbott product knowledge, competitive positioning and published scientific and economic evidence. - Maintain at least one area of expertise and function as a local clinical and technical resource. 7. Possess independent problem-solving skills and ability to make decisions. 8. Exhibit excellent oral and written communication skills. Require Qualifications: - Bachelors Degree (± 16 years) Related field OR an equivalent combination of education and work experience - Working technical knowledge and application of concepts, practices and procedures. General understanding of business unit/group function. Will perform this job in a quality system environment. Failure to adequately perform tasks can result in noncompliance with governmental regulations. Works on problems of moderate scope where analysis of situations or data requires a review of identifiable factors. Exercises judgment within defined procedures and practices to determine appropriate action. Has a broad knowledge of technical alternatives and an understanding of their impact on the systems environment. - Minimum 2 years Related work experience with a good understanding of specified functional area Preferred Qualifications: - Bachelor’s Degree Or Master’s Degree in engineering, science, health science, nursing, or a related field, OR equivalent or related experience in cardiology or clinical research. - 2 + years of progressively more responsible relevant clinical trial experience in the cardiovascular field. - Competency in catheterizaion lab and operating room protocol and procedures. - Ability to travel approximately 75%, including internationally. The base pay for this position is $61,300.00 – $122,700.00In specific locations, the pay range may vary from the range posted. JOB FAMILY: Clinical Affairs / Statistics DIVISION: MD Medical Devices LOCATION: United States of America : Remote ADDITIONAL LOCATIONS: WORK SHIFT: Standard TRAVEL: Yes, 50 % of the Time MEDICAL SURVEILLANCE: No SIGNIFICANT WORK ACTIVITIES: Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day), Keyboard use (greater or equal to 50% of the workday) Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans. EEO is the Law link - English: http://webstorage.abbott.com/common/External/EEO_English.pdf EEO is the Law link - Espanol: http://webstorage.abbott.com/common/External/EEO_Spanish.pdf

Anticipated End Date: 2026-03-19 Position Title: Nurse Case Manager I Job Description: Nurse Case Manager I Location: Must reside within commuting distance of one of our Pulse Point offices. Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health. The Nurse Case Manager I will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Duties are performed telephonically. How you will make an impact: - Ensures member access to services appropriate to their health needs. - Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. - Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. - Coordinates internal and external resources to meet identified needs. - Monitors and evaluates effectiveness of the care management plan and modifies as necessary. - Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. - Negotiates rates of reimbursement, as applicable. - Assists in problem solving with providers, claims or service issues. Minimum Requirements: - Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. - Current, unrestricted RN license in applicable state(s) required. - Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: - Certification as a Case Manager is preferred. For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager and a BS in a health or human services related field preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $77,280 to $115,920. Location: Washington State In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.