Job Summary: The Clinical Care Reviewer II - Post-Acute is responsible for conducting medical necessity reviews to determine the appropriateness of authorization for post-acute health care services including Skilled Nursing Facilities (SNF), Nursing Facilities (NF), Long Term Acute Care Hospitals (LTACH), and Inpatient Rehabilitation Facilities (IRF). This role assists with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled with a CareSource Management Group line of business, and monitors the delivery of healthcare services to ensure they are provided in a cost-effective manner. Essential Functions: - Conduct prospective, concurrent, and retrospective review of post-acute admissions and related services, including outpatient services provided in the post-acute setting according to established processes. - Complete clinical reviews for new and continued stays in post-acute services; assist in facilitating timely and cost-effective member discharges to the appropriate level of care. - Refer cases to CareSource Medical Directors when clinical criteria are not met or when a need for a case conference is identified. - Maintain knowledge of state and federal regulations governing CareSource, including state contracts, provider agreements, CareSource policies and procedures, benefits, and accreditation standards. - Identify and refer quality issues to the Quality Improvement department. - Identify and refer members receiving post-acute services to Care Management according to established processes, escalating new or changing member needs as necessary. - Document member discharge planning needs to support coordinated care and communicate with providers, care managers/care coordinators, discharge planners, CareSource Provider Relations, and other external stakeholders to support discharge planning activities. - Participate in required inter-rater reliability (IRR) audits to ensure consistency and accuracy in reviews. - Attend and participate in department huddles, team meetings, and all staff meetings; review meeting minutes and/or other collateral when unable to attend. - Provide guidance and support to non-clinical utilization management staff as needed. - Attend medical advisement and State Hearing meetings as requested. - Assist Team Leader with special projects or research tasks as requested. - Performs any other job related duties as requested. Education and Experience: - Completion of an accredited registered nursing (RN) degree program required - Three (3) years of clinical experience required - Med/surgical, emergency, acute clinical care or Post Acute Care experience preferred - Utilization Management/Utilization Review experience preferred - Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: - Basic data entry skills and internet utilization skills - Working knowledge of Microsoft Outlook, Word, and Excel - Effective oral and written communication skills - Ability to work independently and within a team environment - Attention to detail - Familiarity of the healthcare field - Proper grammar usage and phone etiquette - Time management and prioritization skills - Customer service oriented - Decision making/problem solving skills - Strong organizational skills - Change resiliency Licensure and Certification: - Current, unrestricted Registered Nurse (RN) licensure in state(s) of practice required - MCG Certification is required or must be obtained within six (6) months of hire Working Conditions: - General office environment; may be required to sit or stand for extended periods of time - Availability to work scheduled weekend and holiday hours to ensure continuous department coverage and support for reviews throughout the year, including all 365 days - Travel is not typically required Compensation Range: $62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

Title: Certified Tumor Registrar Location: Kansas City, MO, United States Remote Full-time Job Description: Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Certified Tumor Registrar Fully Flexible Schedule Sunday-Saturday!!! Sign-on bonus eligible!!!!* Job Summary and Qualifications As a Certified Cancer Registrar, work from home, you will be responsible for case finding and abstraction of cancer data for HCA hospitals. In this role you will: Completes case-finding for assigned facilities, including review of pathology reports, the disease index, suspense list in Meditech and merging appropriate cases into Metriq Responsible for reviewing medical records to abstract information according to the standards of the American College of Surgeons (ACOS) and the appropriate State Central Cancer Registry Performs timely abstraction of assigned cases to ensure compliance with ACOS standards, i.e. within six months of patient contact Completes edit checks and makes appropriate changes on a timely basis Follow ACOS and state data standards and coding instructions to abstract all reportable cases Attend state and national educational activities as approved by Director Submit data to the National Cancer Data Base (NCDB) in accordance with the annual Call for Data Submit data monthly to the appropriate State Central Cancer Registry Resolve errors resulting in the rejection of records from the NCDB and the state data systems What you will need: Oncology Data Specialist (ODS) certification required 1-3 years of Cancer Data Abstraction experience required 3-5 years of Cancer Data Abstraction or Medical Records experience preferred Benefits Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: - Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services - Wellbeing support, including free counseling and referral services - Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence - Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling - Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing - Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts Note: Eligibility for benefits may vary by location. Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you find this opportunity compelling, we encourage you to apply for our Certified Tumor Registrar opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing - apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Eligibility requirements apply!

Anticipated End Date: 2026-03-26 Position Title: Med Management Nurse (US) Job Description: Medical Management Nurse Location: This role enables associates to work virtually full-time, with the exception of 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 an accommodation is granted as required by law. Shift: Monday - Friday 9 am - 5:30 pm (EST) with 10 am - 7 pm (EST) shift rotation twice a month. Federal Employee Program - FEP, a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. The Medical Management Nurse is responsible for reviewing the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of a member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to the Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians. May work on special projects and helps to craft, implement, and improve organizational policies. How You Will Make an Impact: - Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. - Works with healthcare providers to promote quality member outcomes, optimize member benefits, and promote effective use of resources. - Determines and assesses abnormalities by understanding complex clinical concepts/terms and assessing members’ aggregate symptoms and information. - Assesses member clinical information and recognizes when a member may not be receiving the appropriate type, level, or quality of care, e.g., if services are not in line with diagnosis. - Provide consultation to the Medical Director on particularly peculiar or complex cases as the nurse deems appropriate. - May make recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment and experience. - Collaborates with case management nurses on discharge planning, ensuring the patient has the appropriate equipment, environment, and education needed to be safely discharged. - Collaborates with and provides nursing consultation to the Medical Director and/or Provider on select cases, such as cases the nurse deems particularly complex, concerning, or unclear. - Serves as a resource to lower-level nurses. - May participate in intradepartmental teams, cross-functional teams, projects, initiatives, and process improvement activities. - Educates members about plan benefits and physicians and may assist with case management. - Collaborates with leadership in enhancing training and orientation materials. - May complete quality audits and assist management with developing associated corrective action plans. - May assist leadership and other stakeholders on process improvement initiatives. - May assist with training lower-level clinician staff. Minimum Requirements - Requires a minimum of associate’s degree in nursing. - Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background. - Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required. - Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities, and Experiences: - Certification in the American Association of Managed Care Nurses is preferred. - Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products is strongly preferred. - Leadership skills are strongly preferred. 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.

• Support the statistical design for oncology clinical utility studies. • Serve as study statistician for multiple studies. • Author and review high-quality statistical deliverables, including statistical analysis plans (SAPs), and reports (TLFs, CSRs, publications) for cross-functional collaborators and stakeholders. • Recommend and apply novel statistical approaches where appropriate.