***Remote with field travel in Walworth & Waukesha Counties, WI*** JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Ability to operate proactively and demonstrate detail-oriented work. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. • Ability to work independently, with minimal supervision and demonstrate self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. • In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications • Certified Case Manager (CCM). • Experience working with populations that receive waiver services. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

LPN Care Coordinator with Skilled Nursing Experience (Fully Remote) (Spanish Speaking Required) Overview: The Care Coordinator is responsible for developing and providing care coordination services directly to Alopex clients’ patients. Reports To: RN Supervisor Department: Clinical Operations Job Description: As an LPN Care Coordinator, you will play a pivotal role in managing and coordinating care for patients enrolled in Alopex’s services. You will work closely with patients, primary care providers, and other specialists to develop, implement, and monitor individualized care plans. Your goal is to ensure that patients receive the highest level of care through ongoing communication and coordination. - Conduct a detailed review of EMR records. - Develop and maintain individualized Care Plans for management of patients. - Implement and coordinate all care management activities relating to patients across the continuum of care. - Communicate with the patient’s clinical care team. Care management must be performed in a timely manner. - Monitor patient progress toward desired outcomes through assessment and evaluation. - Maintain accurate and detailed documentation related to medication, problems, goals, interventions, preventative care, etc. - Conduct monthly care calls to the patients enrolled in the program. - Address all needs/concerns including any follow up needed for patients. - Educate patients on chronic conditions and reinforce the provider’s directions related to chronic conditions. - Evaluate and address social determinants to health and begin to link community resources; then, enter them in the system. - Evaluate/assess medical conditions and be able to identify and address changes in a clinically appropriate manner. - Adhere to all policies & procedure as outlined by Medicare and Shifox/Alopex - Perform other duties as assigned. Qualifications and Skills Required: - Bilingual (English/Spanish) Required - Possess a minimum of two (2) years’ experience providing patient-centered care. - Possess a minimum of one (1) year experience in skilled nursing. - Have experience working with electronic medical records. - Can perform nursing assessments, problem identification, and care plan development. - Is adaptable to new technology – experience with computer documentation. - Has excellent time management skills. - Can assess, evaluate, and problem-solve patients’ conditions and concerns. - Possesses strong verbal and written communication skills. - Is meticulous and dedicated to providing accurate documentation. - Is dependable and focused on achieving goals. Work Location, Shift & Schedule This position is remote (please see remote requirements below). Shifox/Alopex full-time employees generally work Monday-Friday, 8:00 am-6:00 pm or according to the business hours of your clients’ practices. If working part-time, you and your supervisor will agree on a work schedule. Remote Position Requirements: - Reliable Internet – all programs used by care coordinators are internet-based - PC or Laptop capable of running multiple internet programs at once - A quiet and professional work environment suitable for speaking with patients about sensitive information and Protected Health Information (PHI). Compensation: $26 - $27 / hour Alopex is an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Transfer Center Specialist II (RN) coordinates the acceptance of patients into LifePoint Health system and facilitates patient transfer process with patients going out of LifePoint Health system to non-LifePoint health system. The Transfer Center Specialist (RN) performs initial admission screening and acceptance using approved clinical criteria to assure patient acceptance and admission are consistent with current protocols and procedures. The Transfer Center Specialist (RN) works in collaboration with multiple departments within the hospital and facilitates relationships with facilities, physicians, and nursing staff. The Transfer Center Specialist (RN) will work closely with the Bed/Capacity Coordinator to identify, trend and report barriers to patient throughput. This is a Remote, Full-Time opportunity. Salary Range: $29-34/hr. We are looking for experience RNs to perform the following duties: - Coordinates all components related to the admission/transfer or consult of emergent, urgent, and elective patients into an accepting facility from referring hospitals, clinics, urgent care clinics and physician offices with guaranteed appropriate level of care in timely manner, offering appropriate mode of transport as needed. - Systematic processing of patient acuity and expert level of clinical decision making, to facilitate the patient flow through the continuum of care utilizing electronic resources. - Ability to document and prioritize patient information to formulate an accurate picture of the patient and his/her condition for accepting physicians, nurses, or other healthcare workers. - Stays up to date with all departmental procedures, protocols, and communications to ensure adherence of appropriate process for final referral resolution. - Assign Transfer Priority Level for triage / transport of patients to prioritize bed and transportation resources. - Maintain Transfer Center data collection and provide feedback to referring facility on patient transition and outcomes. - Demonstrates Knowledge of human growth and development, assessment, range of treatment and care of patients for all ages of patients served. - Screens admissions, using approved criteria, for appropriateness of level of care orders and assignments of status and bed type. - Competent in the application of Medical Necessity criteria. - Educates nurses, physicians, and ancillary staff in level of care and admission/transfer issues/opportunities. - Through effective and professional communication, acts as a liaison between and with physicians, patient/family, hospital staff and patient care areas, outside agencies to promote efficient patient flow. - Demonstrates knowledge of regulatory requirements, EMTALA, Lifepoint Health Ethics and Compliance policies and quality initiatives. Monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as they relate to the provision of Transfer Center functions and Bed Management Services (as needed). - Tracks and trends barriers to patient flow, makes recommendations and develops action plans to improve processes and systems. - Flags call for Transfer Center leadership to review and escalate issues to facility Administrative Leadership. - Engages in departmental “team” approach to ensure all elements are communicated (both written and verbal) to facilitate patient transfer and/or throughput. - Coordinate with Bed/Capacity Coordinator for timely transfer, appropriate bed assignment and to ensure the patient’s information is accurate and viable. - Adheres to established protocol, procedure, and standard of care, escalates issues through the established Chain of Command in a timely manner. - Maintains current and accurate information in Electronic Health Care Record. - Actively participate in new employee orientation and on-going training, staff meetings, and continuous quality improvement projects. - Efficiently take all inbound calls and make necessary outbound calls to meet productivity goals set by the department. - Must be able to multitask by attentively listen and simultaneously type 38-40 wpm. - Must meet Internet speed requirements: Upload 50 or more; Download 100 or more. - Provides superior customer service with all interactions. - Must have clear understanding about the Transfer Center Key performance indicators and be a part of the Access Point Vision to reach the goals. Qualifications - Graduate of an accredited school/college and holds applicable current licensure in state of residence (RN). Associate’s/bachelor’s degree preferred. - Current licensure in State of Residence. Preferred Compact License. - Must maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education. - Three years of related clinical experience in an acute care setting (ED or Critical Care Preferred). - Ability to communicate effectively in oral, written, and electronic formats. - Must be able to multitask by attentively listening and simultaneously type more than 35 wpm. - Must meet Internet speed requirements: Upload 50 or more; Download 100 or more. Benefits - We offer an excellent total compensation package, including a competitive salary and benefits. - Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. - We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Review Coordinator will report directly to the Senior Director of RCM. This team member will be responsible for handling: - Pre-certifications - Authorizations - Retro-authorizations - Appeals - Medical records requests - Chart auditing duties The Utilization Review Coordinator should be a subject matter expert on payor requirements and expectations. This role requires strategic planning and coordination with on-site providers and the revenue cycle department to obtain optimal utilization review outcomes. Responsibilities - Utilization Review on Behalf of the Clinics: - Prescreen referrals to project/anticipate authorizations. - Provide recommendations regarding level of care/services and treatment planning. - Conduct live reviews with payors and level of care chart reviews. - Clinically negotiate authorization outcomes with the payor. - Coordinate Peer-to-Peer (P2P) Review preparation and assist with scheduling. - Establish internal authorization or denial determinations for No Authorization Required (NAR) requests. - Establish post denial appeal response recommendations. - Obtain portal access to any utilization review portals for an efficient and scalable process. - Interdepartmental Relations and Communication: - Coordinate with the clinical team on requests with clinically weaker presentations. - Coordinate all concurrent insurance reviews with clinicians and medical team. - Provide ongoing feedback and recommendations for improvement. - Attend and participate in daily huddles/weekly rounds as the payor expert. - Communicate with relevant parties about any issues with coverage or denials. - Partner with intake, utilization review, and finance for best practices. - Timely completion of the Denial Notification process. - Accurate Data Entry: - Document deficiencies for identification on the daily reporting. - Timely documentation of authorization in KIPU/Avea. - Upload authorization letters to KIPU/Avea UR module. - Clinical Auditing: - Notify the primary therapist of any missing documentation or delinquent services. - Review medical records for quality clinical documentation and compliance. - Run daily reports to ensure that all information needed for timely review has been entered into the EMR. - Policy Compliance: - Ensuring compliance with legal, regulatory, and policy requirements. - Process Improvement: - Identifying clinical problems and proposing innovative solutions. - Additional job duties as assigned. Qualifications - Bachelor's degree in Social Work, Nursing, or any related field. - Clinical or UR experience in PHP or IOP levels of care. - 1-2 years of experience in the healthcare industry in utilization review or clinical care. - Expert understanding of patient documentation, chart auditing, and state and federal regulations. - Proficient in MS Office applications and ability to learn department and job-specific software systems. - Demonstrate organizational skills. - Demonstrate effective verbal and written communication skills. - Demonstrate analytical skills when problem-solving. - Demonstrate high attention to detail and a high degree of accuracy. Benefits - Health & Wellness: - Medical, dental, vision, HealthJoy unlimited therapy, UHC wellness program, HSA/FSA options, and pet insurance. - Time Off: - Responsible PTO covering vacation, sick leave, and select federal holidays. - 401(k): - With company match. - Professional Development: - $1,500 tuition reimbursement for ongoing education or CEUs, and opportunities for cross-licensure when applicable.