Job DetailsJob Location: Norwood, MA 02062Position Type: Full TimeSalary Range: $30.00 - $31.25 HourlyTravel Percentage: NoneCraving a New Adventure? Flex Your Clinical Skills Right from Your Couch! Are you a Registered Nurse (RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? MES has the perfect opportunity for you! We’re looking for a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll be responsible for ensuring that Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates. Why This Role Rocks: 100% Remote – Enjoy the flexibility of working from home! Impactful Work – You’ll play a key role in ensuring the quality and compliance of critical reports. Pick a Schedule That Works for You – Monday through Friday with rotating weekend shifts. Three days of 7:00am-3:30pm EST and two days of 12:00pm-8:30pm EST. Responsibilities include: Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensure that all client instructions and specifications have been followed and that all questions have been addressed. Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report. Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assist in resolution of client complaints and quality assurance issues as needed. Ensure all federal ERISA and state mandates are adhered to at all times. Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned. If you’re a motivated, energetic RN ready to take on an exciting new challenge, we want you on our team! At MES, we offer a dynamic environment where your skills will shine. QualificationsHigh school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability. Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance. MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Clinical Outreach Specialist | PHIL Location: Remote role About the Company: Founded in 2015, PHIL is a San Francisco-based, Series D health-tech startup that is building a platform that interfaces between doctors, pharmacies, and patients to streamline the process of patients receiving their specialty pharmaceutical prescriptions. Our mission is to ensure consistent, reliable, and affordable access to prescribed medicines for our patient community. Partnering with pharmaceutical manufacturers, PHIL offers digital patient access services to improve health outcomes for patients across the U.S. by delivering affordable and timely access to higher-cost specialty therapeutics. Headquartered in Scottsdale, AZ with operational hubs in Scottsdale and Columbus, OH, the company currently employs over 120 individuals and expects to double its employee base in the coming year. The team at PHIL is a group of like-minded individuals from varying backgrounds, passionate about creating a new and innovative healthcare platform that is focused on the prescriber and patient experience. Ready to join our team of mission-driven, analytical, and passionate people? Keep reading! Position Overview The Clinical Outreach Specialist role will help drive PHIL’s engagement with the Health Care Providers (HCPs) who prescribe medicines to our patients. You will be a part of a dedicated team focused on expanding PHIL’s HCP relationships by directly engaging with HCPs and their offices – from developing rapport with office staff and understanding office protocols to educating them on PHIL processes to introducing them to new product launches on the PHIL platform. A successful candidate will be able to maintain a “customer service” mindset and approach in all interactions with physicians and office staff. You will be able to understand PHIL’s internal processes and clearly explain them to offices. You will be responsible for responding to office feedback, identifying opportunities for improvements, and working with internal teams to develop solutions. You will be able to readily learn new information and adjust daily activities as we implement new office engagement strategies and introduce new programs. Key Responsibilities - Provide excellent customer service by communicating effectively with prescribers and office staff via phone call and digital message formats - Provide effective cold call outreach to build office relationships and maintain ongoing rapport with offices and physicians - Understand and explain end-to-end prescription lifecycle to provider offices with appropriate level of detail - Understand and explain program-level rules, expected patient copays, and expected processing timelines and be able to accurately and clearly explain to prescribers and office staff - Provide best practices to pursue coverage for patients via the prior authorization process - Triage, resolve, and respond to order-related escalations or one-off requests - De-escalate providers by using active listening, determining the correct root cause, and reassuring HCPs about solutions and our ability to serve - Recommend solutions for internal teams at PHIL based on feedback to prevent errors and improve Health Care Partners experience - Understand needs of HCPs based on their patient population and behavior and recommend effective solutions to increase medication access for patients Ideal Candidate Background and Competencies - Prior experience working in physician offices or other healthcare delivery environments - Prior experience with electronic health record (EHR) platforms - Has a working understanding of medical prescription processing, including electronic prescription submission and prior authorization processing - Experience in making cold outreach calls - Strong interpersonal skills to engage with offices and develop good working rapport with office staff and physicians alike - Willingness to learn and understand operational workflows in order to quickly determine root causes and to help suggest solutions - Can pinpoint and diagnose feedback from HCPs and turn it into meaningful and actionable insights to drive improvements across the organization - Can communicate professionally and courteously to reduce HCP churn and improve patient outcomes - Solution-oriented approach to find sustainable solutions for our HCPs - Excellent written and oral (phone) communication skills - Team player who wants to help build up others - Ability to be flexible in daily work activities as strategies and program needs change Benefits: - Ground floor opportunity with one of the fastest-growing startups in health-tech - Fully remote working environment in these states: AZ, CA, CO, FL, GA, IA, ID, IL, IN, MA, MI, MO, NC, NH, NJ, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV (occasional travel may be required) - Competitive compensation (commensurate with experience) - Full benefits (medical, dental, vision) - 401(k) PHIL Inc. is an equal-opportunity employer.

The job profile for this position is Clinical Program Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. 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. 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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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: Working at Abbott At Abbott, you can do work that matters, grow, and learn, care for yourself and your family, be your true self, and live a full life. You’ll also have access to: - 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 a 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 worldwide 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 the best place to work for diversity, working mothers, female executives, and scientists. The Opportunity This position is a field-based position based in Chicago, IL in the Cardiac Rhythm Management division. As a global leader in Cardiac Rhythm Technologies, we focus on innovative technologies that can improve the way doctors treat people with heart arrhythmias or irregular heartbeats. What You’ll Work On Under general direction, the CRM Product Support Specialist provides comprehensive engineering, sales, educational, and technical support. This role responds to field inquiries from physicians, healthcare professionals, patients, and field sales staff regarding CRM (Cardiac Rhythm Management) products. Key Responsibilities: - Clinical Interface: Acts as a clinical interface between the medical community and the business. - Relationship Building: Demonstrates the ability to build and sustain credible business relationships with customers and share product expertise accordingly. - Comprehensive Support: Provides engineering, sales, education, and clinical support in response to field inquiries on an as-needed basis. Demonstrates a thorough command of all CRM products, related product and technical knowledge, trends, and players. - Training and Education: Develops, leads, and/or facilitates training sessions and other programs on CRM products for healthcare professionals. - Sales Support: Provides additional back-up support to CRM Sales Representatives. Required Qualifications - Bachelor’s degree in Bio-Medical Engineering, related field or equivalent healthcare experience. - A minimum of 3+ years of related experience or a program certification from an accredited cardiac training program. - Must have the capability to obtain certification in CRM products. - Demonstrated knowledge of cardiology, electro-physiology, or cardiac electro-physiology procedures. - Familiarity with cath lab and operating room procedures and protocol - Demonstrate advanced knowledge of cardiac pacing systems. - Must apply engineering skills and abilities to interpret and solve complex clinical problems. - Must possess strong written and verbal communication skills, along with excellent interpersonal, presentation, analytical, and organizational abilities. Additionally, must be able to meet deadlines effectively. - Must be detail-oriented and capable of working independently. - Must be able to collaborate effectively with engineers, technical specialists, vendors, and customers to achieve assigned goals. Additionally, must be capable of managing multiple assignments simultaneously and efficiently. - Must have extensive personal computer skills, including experience with Microsoft Office or equivalent software, for tasks such as graphics, word processing, databases, and authoring programs, to develop presentation materials. Apply Now Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives: www.abbottbenefits.com Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity. Connect with us at www.abbott.com, on Facebook at www.facebook.com/Abbott and on Twitter @AbbottNews. The base pay for this position is $68,000.00 – $136,000.00In specific locations, the pay range may vary from the range posted. JOB FAMILY: Support Services DIVISION: CRM Cardiac Rhythm Management LOCATION: United States of America : Remote ADDITIONAL LOCATIONS: WORK SHIFT: Standard TRAVEL: Yes, 50 % of the Time MEDICAL SURVEILLANCE: Not Applicable SIGNIFICANT WORK ACTIVITIES: Continuous standing for prolonged periods (more than 2 consecutive hours in an 8 hour day), Continuous walking for prolonged periods (more than 2 hours at a time in an 8 hour day), Driving a personal auto or company car or truck, or a powered piece of material handling equipment 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