Job Description The Episodic Care Manager is responsible for performing clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based on medical necessity and contractual benefits. Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system. What You'll Do Clinical Evaluation and Review • Receive assigned cases for varied member services (i.e. inpatient, outpatient, DME) • Review and evaluate cases for medical necessity against medical policy, benefits and/or care guidelines and regulations. • Complete work in accordance with timeliness, production, clinical quality/accuracy and compliance standards • Provide notifications to member and/or provider, according to regulatory requirements. • Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed. • May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelines Collaboration and Documentation • Communicate and collaborate effectively with internal and external clinical/non-clinical staff (including MDs) to coordinate work • Appropriately and fully document outcome of reviews and demonstrate the ability to interpret and analyze clinical information • Utilize detailed clinical knowledge to summarize clinical review against the criteria/guidelines to provide necessary information for MDs. What You'll Bring • RN with 3 years of clinical experience or LPN with 5 years of clinical experience • Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties What You’ll Get - The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community  - Work-life balance, flexibility, and the autonomy to do great work   - Medical, dental, and vision coverage along with numerous health and wellness programs   - Parental leave and support plus adoption and surrogacy assistance   - Career development programs and tuition reimbursement for continued education   - 401k match including an annual company contribution   - Learn more   Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $73,698.00 - $117,917.00 Skills _____________________________________________________________________ JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

Job Description Provides counsel and advice to top management on significant Clinical Program Management matters, often requiring coordination between organizations. Focuses on providing thought leadership and technical expertise across multiple disciplines. Recognized internally as “the go-to person” for the most complex Clinical Program Management assignments. Represents company externally and serves as conduit to educate and enable care coordination between stakeholders resulting in an optimal healthcare experience and customer satisfaction. Serves as clinical advisor to the sales organization, providing ongoing product and industry knowledge/education that positively influence cost, quality and customer satisfaction. Essential Functions - Serve as business owner to necessary client work that involves Medicare operational and implementation benefits changes - Understand client's existing clinical benefit and business philosophy to help avoid unnecessary clarifications - Accurately capture and document clinical benefit requirements in collaboration with business stakeholders - Provide excellent customer service and act as a trusted client advisor - Work with internal partners to ensure all implications of requested clinical benefit requirements are vetted, understood and communicated as necessary - Provide operational Subject Matter Expertise (SME) to Clinical Account Executives/Implementation Manager (CAE/IPM’s), Client Benefit Administrators (CBA), Clinical Application Teams (DCRS, FRS, CRS, Criteria), Product Owners - Manages and tracks all requests to ensure timelines are met - Develop a deep understanding of claims adjudication system and associated clinical applications - Leads the development, preparation, and presentation of project plan including execution and delivery for each client(s) assigned - Participates and contributes in formal and informal training programs and professional development activities which may include taking, developing, and/or conducting sessions Skills - Ability to multi task and communicate effectively - Microsoft office with a strong understanding of Excel and Access - Written and verbal communication (listening, feedback; translating complex ideas/processes), collaboration, analytical thinking/critical thinking, results-oriented and organizational skills - Must have the ability to work on multiple tasks, prioritize, resolve complex issues, and have strong project management skills - Ability to learn multiple internal reporting and analytic tools for client management - Provide project and administrative support to the team and escalate issues, risks, concerns as needed - Ability to manage timelines and meet tight client deadlines - Advanced problem solving skills and the ability to work collaboratively with other departments to create solutions and to resolve issues - Must be able to work under pressure and perform continual follow up in a timely manner in order to meet tight deadlines Education and Qualifications - Current U.S. Pharmacist License, Pharm.D. - Minimum of 3 years licensure experience preferred in managed care or with previous PBM experience - Knowledge of PBM industry/Managed care/Value Based healthcare industry is desirable If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 95,500 - 159,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Registered Nurse Patient Navigator, PRN REMOTEAbout City of Hope, City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the U.S., and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked top 5 in the nation for cancer care by U.S. News & World Report at its core, City of Hope’s uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas. The Intake Nurse Navigator (INN), RN functions as a member of the multidisciplinary team as an advocate and educator for new patients from the initial intake phone assessment in preparation for the first visit with the onsite care team. The INN utilizes the nursing process, including assessment, planning, and evaluation to navigate new patients through the new patient intake process. With effective assessment skills and clinical knowledge, the INN evaluates whether the patient’s clinical condition makes them an appropriate candidate for safe travel to City of Hope. The Intake Nurse Navigator serves as a liaison between the patient, family and multidisciplinary teams/providers aiding in coordination of a patient’s first appointment, thereby facilitating streamlined initial evaluations and mitigating identified barriers to care. The Intake Nurse Navigator acts in compliance with hospital site (ATL, CHI, CAL, PHX) and enterprise policies/procedures as well as the state specific Nurse Practice Act. The successful candidate: - Must be able to work one (1) day per week, 8 hour shift between Monday - Friday 7a-7p, Pacific Standard Time. - Uncover and assess cancer treatment history which includes diagnosis, type of treatment, names and addresses of treating physicians and or facilities. Works closely with OIS representatives and new patient schedulers when evaluating patient’s appropriateness for visiting the organization. Upon initial visit, interview patients and meets with them to ascertain clinical appropriateness to receive care at affiliated facilities, as well as clinical appropriateness for any clinical trials. Complete preadmission clinical evaluations and makes recommendations assessing the patient’s needs related to the medical diagnosis, treatment providers, treatment options and financial resources. Ensure proper and timely documentation in patient’s EMR and all outside records, imaging is received and current for evaluation. Follow patient through treatment decision to ensure there are no gaps in care to keep the patient moving timely through to treatment decision, resolving barriers as they arise. - Promote inter and intra departmental collaboration, nurture relationships with others and is viewed positively by co-workers. Respond appropriately to negativity, seeks to promote understanding and mutual achievement of goals. Strong orientation toward services excellence. Utilize brand platform for consistent deployment of services. Seek opportunities for organization improvement, consistently apply thinking to departmental operations to enhance or improve services. Demonstrate an orientation toward achievement and professional growth, actively seek and initiate self-improvement through continuing education and/or participation in work projects that offer developmental challenges. - Facilitate and/or assist with admissions via the intake process. Collaborate and develop plans of care (huddles) with teams from intake, medical oncology, specialty clinics and CAM ensuring the patient is educated on the proposed plan of care. Provide clarity and address concerns the patient and family may have. Facilitate multi-disciplinary patient education to ensure a thorough understanding of the proposed plan of care. Act as liaison between Oncology Information Services (OIS) and the Medical Center care providers in all aspects of service recovery anticipating the needs of the patient. Facilitate a positive interaction between OIS and the Medical Center to ensure optimum attention to the Mother Standard of Care. - Carry own share of responsibility and willingly help others. Support the goals of the department and participates in department performance improvement. Attend required staff meetings. Plan workflow to assure timely completion of relevant responsibilities. Ensure that encounters are documented, new chart is complete and contains necessary items for physician. - Apply problem solving techniques to the intake evaluation process. Plan workflow to assure timely completion of relevant responsibilities. Ensure that new chart is complete and contains necessary items for physician. Assess special travel needs and work closely with support staff to ensure all details are coordinated for the upcoming patient visit. - Demonstrate knowledge of patient safety goals relevant to the work environment. Demonstrate knowledge of hospital variance reporting system and appropriate management procedures for unexpected occurrences. Demonstrate appropriate response to organizational disaster codes. Complete annual department Hazardous Communications Training. Complete required CE Direct. Consistently follow organizational guidelines for effective hand hygiene. As indicated, follow guidelines for standard and transmission-based precautions. Adhere to facility policies and procedures including assisting in maintaining the Joint Commission standards. Qualifications Your qualifications should include: - Graduate of an accredited school of nursing - State-issued Registered Nursing (RN) license. Successful completion and verification of the California state registered nursing license within 90 days of employment. - BLS - Oncology Certified Nurse highly preferred City of Hope is an equal opportunity employer. To learn more about our comprehensive benefits, click here: Benefits Information City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

Posting Date 03/16/2026 3201 S 323rd St, Federal Way, Washington, 98001-5023, United States of America Join DaVita Integrated Kidney Care (IKC) as a Care Coordinator It takes a village to care for our patients, and as a Care Coordinator (CC), you’ll be at the heart of that Village. You’ll be a key player on our care team, helping some of our most complex patients navigate their chronic conditions while ensuring they receive the highest quality care. You’ll work closely with Nurse Practitioners and RN Case Managers to coordinate care, facilitate resources, and keep the patient journey moving smoothly. DETAILS: - Location: Remote, work from home. This is currently a Remote position. However, we value in-person patient care and may transition to a hybrid-remote model in the future. - Schedule: Monday–Friday, full-time schedule with the ability to accommodate patient availability- flexibility is key. No nights, No weekends, No on call. Daily may start time between 7:00–8:00 AM - Home environment must include a quiet, private office space with high-speed internet (Ether cable may be required) to support efficient use of all programs. Responsibilities: - Coordinate care for patients by ensuring access to eligible resources/programs and assisting with referrals and provider appointments - Perform outbound calls and respond to inbound calls from patients, providers, and Village resources - Complete non-clinical screenings and pathways under the guidance of the Manager; escalate to Integrated Care Nurse as needed - Assist the clinical team with moving patients through the continuum of care by completing tasks as directed - Identify eligible resources for members and collaborate with Integrated Care Nurses, dialysis clinics, health plans, and other stakeholders to help members enroll in programs - Communicate directly with patients in a timely and professional manner - Maintain accurate, complete, and confidential documentation - Demonstrate exceptional two-way communication, both oral and written - Act in alignment with DaVita’s mission and values to deliver high-quality patient care Qualifications: - High school diploma or GED required - 2+ years of experience in a professional office environment - Ability to handle confidential information with discretion and sound judgment - Strong verbal communication skills - Proficiency in Microsoft Office, Excel, and Outlook - Prior experience with Electronic Medical Records preferred - Commitment to service excellence and patient satisfaction - Ability to work autonomously while collaborating effectively with the team - Home workspace must provide a quiet, private environment with reliable high-speed internet Preferred Qualifications: - 1–3 years clinical medical office experience - CNA or MA experience is a plus - Experience coordinating care (referrals, care management, etc.) - Familiarity navigating insurance payers - Experience in direct patient care or support - Prior medical office environment experience Why You’ll Love Working Here: - Make a direct impact on the lives of patients with complex chronic conditions - Be part of a mission-driven, collaborative care team - Flexible hybrid schedule with opportunity for professional growth What We’ll Provide: More than just pay, our DaVita Rewards package connects teammates to what matters most. Teammates are eligible to begin receiving benefits on the first day of the month following or coinciding with one month of continuous employment. Below are some of our benefit offerings. - Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out - Support for you and your family: Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more - Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita’s online training platform StarLearning. #LI-TS2 At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. This position will be open for a minimum of three days. The Wage Range for the role is $21.50 - $27.50 per hour. If a candidate is hired, they will be paid at least the minimum wage according to their geographical jurisdiction and the exemption status for the position. Washington Exempt: $80,168.40/year Washington Non-exempt: Bellingham: $19.13/hour, Burien: $21.63/hour, Everette: $20.77/hour, Unincorporated King County: $20.82/hour, Renton: $21.57/hour, Seattle: $21.30/hour, Tukwila: $21.65/hour, Remainder of Washington state: $17.13/hourFor location-specific minimum wage details, see the following link: DaVita.jobs/WageRates Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.