At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Pharmacy SIU Investigator - RemoteJob Description The Special Investigations Unit (SIU) Investigator is responsible for conducting standard investigations of potential pharmacy, member, and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively identifies improvement opportunities in investigation procedures and FWA prevention efforts ensure proper identification of potential FWA. The SIU Investigator prepares investigative reports for leadership, remediation actions, recovery efforts, internal committees and/or referral to state and federal law enforcement agencies. Responsibilities - Develop investigative plans, documents and justification to support investigations; evaluate impact of changing circumstances or newly discovered evidence to a previously developed investigation plan; proactively communicate plans, progress and changes to department leadership and other internal or external stakeholder - Obtain and review factual and reliable evidence to support investigative outcomes; evidence reviews may include invoice documentation, entity interviews, background checks, pharmacy documentation, licensing information, proof of delivery and payment level information - Evaluate reports of potential fraud in SIU and make recommendations on next steps; ensure investigative action aligns to department policy and practice; provide recommendations to audit operations and/or SIU regarding enhancements or required changes to process - Adhere to evidentiary requirements in compliance with federal, state and local laws pertaining to investigations and fair claims handling practices; evaluate risk to determine how best to proceed with investigations based on the allegations, quality metrics and other performance indicators required per SIU procedures - Recommend referrals to client SIUs, regulatory agencies, and/or law enforcement; recommend retention of experts or private investigators, surveillance or other expenditures to support investigations - Other duties as assigned Minimum Qualifications - Bachelor's degree in Criminal Justice, Healthcare or related area of study or the equivalent combination of education and relevant work experience; HS diploma or GED is required - 2 years of work experience in investigation, audit, healthcare or legal Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications - Change agile with a willingness and ability to adjust direction based upon changing priorities and business need while working with a high degree of autonomy - Ability to think critically, problem solve and use appropriate judgement to make decisions and provide risk advice to internal and external partners while anticipating the broad impact of decisions - Ability to establish trust, respect and credibility and form effective working relationships with individuals at all levels of an organization; collaborate effectively cross-functionally and with clients, law enforcement and other key stakeholders - Ability to distill complex concepts or situations into concise and compelling communications - Knowledge and understanding of pharmacy and medical claims processing environment Preferred Qualifications - Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) - National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) - Licensed Practical Nurse (LPN) or Registered Nurse (RN) - Experience working with RxClaims and/or JUDI - Previous audit and investigation experience - Pharmacy background within retail, mail order, hospital, or compounding setting - Data mining experience - Excel experience Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits). Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

Clinical Trial Associate (Start-up Support) ICON plc is a world-leading healthcare intelligence and clinical research organization. We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join us on our mission to shape the future of clinical development What you will be doing - The SSU Clinical Study Administrator is responsible for ensuring vendor spreadsheets are completed correctly and processed (submitted to vendor or global team) according to study team guidelines. - SSU CSA will attend weekly Study Team meetings to report on vendor Spreadsheets. - SSU CSA will participate in vendor management activities Your profile - Bachelor's degree or relevant clinical trial experience - Industry expereince in clinical trial support required (CRO/Pharma) with a focus on vendor support during Start-Up - Experience with vendor management, strong verbal & written communication skills, - and strong organizational skills - Previous administrative experience - Proven organizational and administrative skills - Computer proficiency - Display excellent organization and time management skills, excellent attention to detail, and ability to multi-task in a high-volume environment with shifting priorities - Team oriented and flexible; ability to respond quickly to shifting demands and - opportunities - Working knowledge of the Clinical Study Process and an understanding of the range of working procedures relating to study Start-up, together with an understanding of the ICH/GCP guidelines - Ability to develop advanced computer skills to increase efficiency in day-to-day tasks - Good interpersonal skills and ability to work in an international team environment - Willingness and ability to train others on study administration procedures - Integrity and high ethical standards What ICON can offer you: Our success depends on the quality of our people. That’s why we’ve made it a priority to build a diverse culture that rewards high performance and nurtures talent. In addition to your competitive salary, ICON offers a range of additional benefits. Our benefits are designed to be competitive within each country and are focused on well-being and work life balance opportunities for you and your family. Our benefits examples include: - Various annual leave entitlements - A range of health insurance offerings to suit you and your family’s needs. - Competitive retirement planning offerings to maximize savings and plan with confidence for the years ahead. - Global Employee Assistance Programme, TELUS Health, offering 24-hour access to a global network of over 80,000 independent specialised professionals who are there to support you and your family’s well-being. - Life assurance - Flexible country-specific optional benefits, including childcare vouchers, bike purchase schemes, discounted gym memberships, subsidised travel passes, health assessments, among others. Visit our careers site to read more about the benefits ICON offers. At ICON, inclusion & belonging are fundamental to our culture and values. We’re dedicated to providing an inclusive and accessible environment for all candidates. ICON is committed to providing a workplace free of discrimination and harassment. All qualified applicants will receive equal consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please let us know or submit a request here. Interested in the role, but unsure if you meet all of the requirements? We would encourage you to apply regardless – there’s every chance you’re exactly what we’re looking for here at ICON whether it is for this or other roles. Are you a current ICON Employee? Please click here to apply

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!