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.

Company : Allegheny Health NetworkJob Description : This is a remote/work from home role but preferred candidates will live within 50 miles of the Pittsburgh or Erie region. GENERAL OVERVIEW: Improves the overall quality and completeness of medical documentation; facilitates enhancements to clinical documentation through extensive interaction with physicians, nursing staff, case managers, other patient caregivers, and medical records coding staff to ensure that the appropriate reimbursement is received for the level of service rendered to all inpatients; ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes; educates all members of the patient care team on an ongoing basis. ESSENTIAL RESPONSIBILITIES: - Facilitate appropriate clinical documentation through concurrent, prospective, and retrospective medical record review (30%) - Facilitate modifications to clinical documentation through extensive interaction with physicians, nurses and ancillary staff based on knowledge of coding and HCC guidelines, documentation strategies, and clinical documentation requirements (25%) - Work collaboratively with coding professionals to assure documentation of diagnoses and comorbidities are a complete reflection of the patient's clinical status and care (10%) - Formulate credible clinical documentation clarifications to improve clinical documentation (10%) - Educates all internal customers on compliant documentation responsibilities, coding, and reimbursement issues, as well as performance improvement methodologies (15%) - Performs other duties as assigned or required (10%) QUALIFICATIONS: Minimum - High school/ GED - Bachelor's Degree in Nursing OR Relevant experience and/or education as determined by the company in lieu of bachelor's degree - 5 years in a nursing role - Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) ​ Preferred - Experience in Clinical Documentation Integrity (CDI) - Experience in Coding - Knowledge of ICD 10 and HCC coding guidelines - Knowledge of Electronic Medical Record (Epic) - Knowledge of Encoder (3M 360 Encompass) - Excellent communication skills - Critical thinking skills - Certified Coding Specialist (CCS) - Certified Outpatient Clinical Documentation Improvement Specialist (CCDS-O) - Certified Clinical Documentation Improvement Specialist (CCDS) - Certified Clinical Documentation Improvement Professional (CDIP) Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $30.10 Pay Range Maximum: $48.54 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Job Description This individual will manage all IRB reviews under the auspices of the Northwell Health Research Intelligence Institutional Review Board (IRB) and will oversee all IRB responsibilities related to newly implemented clinical research for Northwell. Additionally, this individual will review nonclinical trial, expedited or exempt research, as needed. The incumbent will specialize in concepts associated with FDA regulations and the research protocol review and submission process to ensure compliance with local, state, and federal regulations and guidance. The IRB analyst will assist researchers, staff, and other stakeholders with drafting and editing protocols and consent forms and interprets regulations when analyzing research submissions to identify research requirements. Conducting in-depth pre-reviews and drafting meeting minutes will be required. This individual provides feedback to investigators and research staff to guide them in making necessary modifications to submissions in order to meet applicable institutional, regulatory, and other requirements for obtaining approval and maintaining compliance with committee guidance. Job Responsibility - Analyzes, verifies, tracks and performs preliminary administrative review of items referred to IRB and communicates deficiencies or questions to investigators; assists in preparation of reports and correspondence related to IRB activities. - Reviews proposed research for compliance with federal, state and local regulations; determines category of review and assess risk; evaluates need for further clinical or professional review of research. - Provides support to investigators by assuring the accuracy of submissions and modifications; responds to investigators regarding deficiencies, inconsistencies or concerns. - Monitors continuing review of research for compliance; identifies and reports items of concern for further action. - Maintains accurate records, including database management; provides assistance in the performance of internal quality improvement activities. - Assists in facilitating and recording IRB meeting minutes and review activities. - Conducts and documents expedited IRB reviews of human subjects’ research. - Supports investigators in developing the IRB submissions for human subject research projects. - Operates under general guidance and work assignments are varied and require interpretation and independent decisions on course of action. - Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions. Other Key Responbilities: - Communication Management: - Manages personal and shared inbox to ensure prompt response to stakeholder concerns - Escalates matters of concern to the Senior IRB Director or IRB Manager as appropriate - Provides regulatory guidance to IRB members, Chair, and critical stakeholders as needed. - Meeting Preparation and Follow-up: - This individual has the primary responsibility of moving submissions through the office workflow in a timely manner, ensuring that submissions are review-ready prior to routing for committee review, conducting certain non-committee reviews, and generating correspondence after the review process is complete along with coordinating the activities of IRB - Coordinates regular IRB meetings and arranges ad Hoc meetings with the assistance of the IRB project manager, as needed, ensuring appropriate timing and preparation. - Evaluates all submission materials to determine consistency with IRB requirements for approval, including all local policies, applicable federal, state and local law and Good Clinical Practices - Maintains quorum during IRB meetings - Ensures appropriate communication of meeting determinations and timely follow up for all internal and external stakeholders - Works with senior leadership to draft communications, as needed, for internal and external communication of IRB determinations that impact on local, state, or federal law. - Office Management: - Conducts pre-review to ensure that submissions are review ready, routes submissions appropriately for either non-committee or committee review, and communicates review results to investigators and others as needed - Prepares for, coordinates and facilitates IRB Committee meetings, which includes, but is not limited to: Preparing submissions for review by the convened IRB, Assigning reviewers to submissions, Managing IRB meeting agenda volume, Confirming IRB member meeting attendance to ensure quorum, Monitoring quorum during IRB meetings, Documenting determinations made by the convened IRB, Generating IRB meeting minutes and correspondence - Provides feedback to leaders regarding updates/edits needed to the HRPP, IRB functions, and educational needs (deficiencies) of the IRB Committee, research community, and IRB staff - Identifies issues that arise within work processes and escalate to team leadership. - Maintains organization of documents for audit and accreditation - Maintains current working knowledge of the regulations for the safety and protection of human subjects in research and stays current of any changes to the regulatory landscape that may affect the research community - Customer Service: - Delivers high-quality service - Provides regulatory expertise, guidance, and administrative support with empathy, reliability, and professionalism. - Other Administrative Support: - Performs general administrative duties and event organization as needed. Job Qualifications: - Bachelor's Degree required, or equivalent combination of education and related experience. - Minimum 2 years experience in research administration, required. Highly Preferred Skills: - Exceptional organizational skills and attention to detail.  - Excellent communication skills, both oral and verbal.  - Ability to maintain a high level of professionalism and confidentiality.  - Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook). - Proficient in procedures associated with IRB record keeping and documentation.  - Ability to adapt to a fast-paced environment and manage changing priorities.  - A proactive problem-solver with strong critical thinking skills.  - Detail-oriented with the ability to multi-task and prioritize workload - Certified IRB Professional (CIP) expected after two years in the job based on certification requirements *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).