This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Help us elevate our member care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special needs Plan (D-SNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand D-SNP to change lives in new markets across the country. The Transition of Care Coach is responsible for care coordination of our members who are experiencing a significant change in health status which has resulted in the necessity of an emergency department visit, inpatient, skilled nursing, or rehabilitative stay. The TOC Coach ensures the member experiences a seamless transition to their next care setting and facilitates post-discharge goal attainment by: - Completing post-discharge questionnaire, which may be market specific. - Providing comprehensive discharge planning. - Ensuring the member has filled/received their medication(s) and has an understanding on how to take their ordered medications. - Providing benefit education. - Providing clinical assistance to determine appropriate services and supports due to member’s health needs (including but not limited to: Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports). - Evaluating health and social indicators. - Identifying and engaging barriers to achieving optimal member health. - Using discretion to apply strategies to reduce member risk. - Presenting cases at case conferences for multidisciplinary focus to benefit overall member management. - Facilitating overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the member’s condition(s) and abilities to self-manage. - Coordinating post-discharge meal delivery, assisting with securing DME, and helping to ensure timely physician follow-up. - Understanding Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel. - Updating the Care Plan for any change in condition or behavioral health status. Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. Assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality. Responsibilities - Responsible for completing outreach cadence calls and post-discharge questionnaires within required compliance driven timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and 30-day hospital readmissions. - Follows members identified as inpatient in hospitals (whether planned or unplanned admission) and then throughout the subsequent care continuum until member can return to prior level of functioning in the community. - Facilitates Interdisciplinary Care Team Meetings with Social Services, Care Management, PCP and other key players to discuss service needs and support safe transitions. Qualifications - 2+ years LPN nursing experience. - Proficiency in Microsoft Word, Excel, and Outlook. - LPN License. Requirements - 3+ years LPN nursing experience (preferred). - Self-motivated, energetic, detail-oriented, highly organized, tech-savvy Licensed Practical Nurses. - Discharge planning experience. - Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment while providing outstanding care. - Effective verbal and written communication skills. - Bilingual a plus! Education - Required: H.S. or Equivalent - MUST be an LPN. - Preferred: Associate's Degree, Bachelor's Degree. Benefits - Affordable medical plan options. - 401(k) plan (including matching company contributions). - Employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Pay Range The typical pay range for this role is: $22.40 - $48.67. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Outreach Care Specialist II is responsible for ensuring that appropriate member treatment plans are followed on moderately complex cases and for proactively identifying ways to improve the health of our members and meet quality goals. - Initiates and manages clinical referrals and orders including but not limited to: Specialists, Labs and Imaging Centers - Coordinates follow-up care plan needs for members by scheduling appointments with specialists or enrolling members in programs. - Assesses compliance with medical treatment plans via telephone or through on-site visits. - Identifies barriers to plan compliance and coordinates resolutions. - Identifies opportunities that impact quality goals and recommends process improvements. - Medical record audit support to support HEDIS/Star program goals - Coordinates identification of and referral to local, state or federally funded programs. - Coaches members on ways to reduce health risks. - Prepares reports to document case and compliance updates. - Establishes and maintains relationships with agencies identified in appropriate contract. - Participates in cross-functional teams on projects, initiatives, and process improvement activities. - Establishes and maintains relationships with vendors identified in appropriate contract. Qualifications - Requires a H.S. diploma or equivalent and a minimum of 3 years of related experience; or any combination of education and experience which would provide an equivalent background. - 2+ years of referral management and/or care coordination preferred. - BS/BA degree in a related field preferred. - Bilingual candidates preferred. - 3+ years of experience in healthcare industry preferred. - Certification/licensure in clinical or healthcare related field (i.e., Certified nurse assistant/medical assistant) with at least 2 years of patient-facing experience preferred. - 3+ years of experience with EMR, medical records or patient-facing interaction in any healthcare environment preferred. - 1+ years of clinical quality (HEDIS/Stars), and clinical data collection, abstraction or validation preferred. - Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook) preferred. - Experience with clinical systems (electronic medical record, care management or population health management) preferred. - Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or detailed information in a manner that others can understand, as well as ability to understand and interpret complex clinical information from others preferred. Requirements - Job Level: Non-Management Non-Exempt - Workshift: 1st Shift (United States of America) - Job Family: MED > Care Coord & Care Mgmt (Non-Licensed) Benefits - Market-competitive total rewards including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. - Medical, dental, vision, short and long term disability benefits. - 401(k) + match. - Stock purchase plan. - Life insurance. - Wellness programs and financial education resources.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Our team is actively recruiting for a Clinical Specialist I, CPT in Rapid City, SD. As a member of the clinical support team, you will be responsible for providing technical clinical expertise and support of the sales process to colleagues, current customers, and potential customers. You will work under general direction with clinical and sales teammates to identify and capitalize on sales opportunities by creating competency, comfort, and expertise with all Abbott Chronic Pain Therapies among physicians, support staff, and customers within assigned geography. This role involves a high degree of independence and requires exercising independent judgment in planning, organizing, and performing work. What You’ll Work On: - Provide technical, clinical, and programming assistance, primarily in support of 1-2 Territory Manager(s). - Assist Territory Managers in after-hours call support and activities. - Integrate into all accounts, build trust and relationships, and establish strong rapport with customers. - Be proficient in complex programming and case support. - Work seamlessly with Territory Manager(s) allowing them increased selling time. - Foster high trust relationships with customers, including regional team members. - Conduct PCP work and educational in-services, as directed. - Contact, visit, and engage clients and potential clients in the Company’s products and address any client questions and concerns. - Provide medical professionals with sales support, information, and training on the use of Company products and with staff education, in-services, and technical troubleshooting. - Develop and maintain an in-depth knowledge of assigned accounts and customers, including competitor activity. - Conduct evaluations and develop sales strategies for capital equipment opportunities within accounts. - Collect and study information about new and existing products and monitor competitor sales, prices, and products. - Provide feedback to providers both within and outside the operating room setting on the directions for use specific to implantable devices. - Attend trade shows and conferences to meet other sales representatives and clients and discuss new product developments. - Use clinical expertise to identify customer training and in-service needs with the goal of increasing customer usage, comfort, and understanding of all Abbott Chronic Pain Therapies product line. - Comply with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, Company policies, operating procedures, processes, and task assignments. - Provide sales support, clinical in-services, training, and guidance to current or potential customers. - Maintain positive and cooperative communications and collaboration with all levels of employees, customers, contractors, and vendors. - Perform other related duties and responsibilities, on occasion, as assigned. - Ability to travel 25% within assigned region and/or outside assigned region. Qualifications - Associates Degree or technical certification; preferred Bachelor’s Degree. - 1 - 2 years’ work experience, strong preference collaborating with patients in a clinical setting. - The ability to communicate, understand, and educate clinical data in the Chronic Pain Therapies space. - Strong clinical skills. - Excellent organizational, time management, and prioritizing skills. - Excellent interpersonal verbal, written, and presentation skills with the ability to effectively communicate at multiple levels and to large groups within and outside the organization. - Capable of building strong working relationships with internal/external customers. - Capable of working unpredictable schedules that may occasionally change on short notice due to operating room schedule changes and/or delays. - Accustomed to tight deadlines and managing multiple tasks. - Strong sense of urgency. - Ability to work in a highly matrixed and geographically diverse business environment. - Ability to work within a team and as an individual contributor in a fast-paced, changing environment. - Ability to leverage and/or engage others to accomplish projects. - Strong verbal and written communications with the ability to effectively communicate at multiple levels in the organization. - Multitasks, prioritizes, and meets deadlines in a timely manner. - Capable of engaging customers in selling conversations as needed and as directed by Territory Manager. Requirements - Patient interaction experience within a healthcare-related environment (Physical Therapy, medical product sales, RN, LPN). - Experience working in a broader enterprise/cross-division business unit model preferred. - 1-3 years’ experience with Abbott, or in a similar spinal cord stimulation (SCS) setting or with another implantable medical device company. Benefits - Career development with an international company where you can grow the career you dream of. - Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year. - An excellent retirement savings plan with high employer contribution. - Tuition reimbursement, the Freedom 2 Save student debt program, and FreeU education benefit - an affordable and convenient path to getting a bachelor’s degree. - A company recognized as a great place to work in dozens of countries around the world and named one of the most admired companies in the world by Fortune. - A company that is recognized as one of the best big companies to work for as well as a best place to work for diversity, working mothers, female executives, and scientists.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Clinical Quality Assurance Manager oversees quality assurance (QA) with clinical emphasis to ensure client satisfaction and revenue growth in the QA department. This position is responsible for: - QA training - Identification of root causes for QA issues - Continuous QA improvement - Measurement of outcomes to establish quality benchmarks Qualifications - Masters degree in a mental health field required; Doctorate degree preferred - Actively licensed at master’s level or above required - Degree in clinical and/or forensic psychology strongly preferred Requirements - Experience successfully leading, managing, training and motivating employees in a multi-disciplinary environment - Sound clinical knowledge which applies evidence-based practices in psychological assessment - Strong knowledge and understanding of client servicing, developing, and executing strategies to ensure client retention - Ability to think critically, flexibly, and creatively with tolerance for ambiguity - Utilization of sound clinical judgment in decision making and problem solving - High degree of entrepreneurial initiative, accountability, commitment, energy and drive - Excellent interpersonal and organizational skills - Excellent presentation, verbal and written communication, listening and consultative skills - Ability to interact effectively in stressful situations and maintain focus on problem-solving and solutions - Advanced computer skills, including Word, Excel and PowerPoint - Excellent time management skills with ability to meet deadlines - Strong analytical skills - Competence in psychological assessments and diagnosis - 5 years of post-license clinical experience required - At least 3 years in a clinical role that involved psychological assessment and psychological testing - 2 years of management experience required; preferably in healthcare, EAP, or disability insurance industries - 3 years Quality Assurance experience strongly preferred Benefits - Competitive benefits package including paid time off (PTO), parental leave, paid holidays - Insurance (medical, dental, vision, life, STD, LTD) - Flexible schedules - 401k program with company match - Profit sharing - Insurance benefits effective on the 1st of the month following hire Company Description At R3 Continuum, we believe our differences don’t divide us but teach us. R3 Continuum eagerly embraces diversity and is a committed Equal Opportunity Employer to all qualified applicants, ensuring individuals will not be discriminated against based on any protected classifications. Join a company dedicated to helping people and organizations be more resilient and thrive.