div.content { background: #6c6f70 } div.joqReqDescription { background: #FFF repeat-y; !important; font family: Century Gothic; !important text-align: left; color: #000; width: 900px !important; margin: 0 auto !important; position: relative; -webkit-column-count: 1; -moz-column-count: 1; padding-top: 480px; padding-left: 5px; padding-bottom: 50px; } div.joqReqDescription strong{ font family: Century Gothic !important; font-size: 14px; color: #000; } div.joqReqDescription p{ font family: Century Gothic !important; padding-left:0px; width: 892px; } div.joqReqDescription div.image-box { width: 900px; text-align: center; display: block; top: 0px; left: 5px; position: absolute; height: 150px; } div.joqReqDescription div.header-box { background-color: #0043FA; position: absolute; top: 380px; display: block; font-family: Century Gothic !important; font-size: 30px; color: rgb(255, 255, 255); font-weight: bold; width: 883px; left: 5px; height: 72px; padding-left: 17px; padding-top: 15px; } The Clinical Nurse Reviewer plays a crucial role in Comfort Medical by evaluating and assessing medical records, progress notes, and healthcare Certificates of Medical Necessity (also known as CMN’s or Prescriptions) to ensure compliance with industry standards, federal and state regulations, and quality of care. This position requires a strong understanding of medical terminology, healthcare protocols, and attention to detail to maintain the highest standards of patient care and safety. Major Areas of Accountability - Review and analyze patient medical records, ensuring accuracy, completeness, and compliance with relevant regulations and guidelines. - Collaborate with healthcare professionals, including physicians, nurses and appropriate staff, to ensure receipt of proper documentation. - Responsible for understanding and adhering to all Medicare Local and National Coverage Determinations (LCD’s and NCD’s), policy articles, government rules and regulations, and contracted payor policies pertaining to services and products provided. - Will work closely with the department Manager and external resources to accurately interpret and explain policy documentation requirements to all company stakeholders. - Responsible for navigating between multiple computer-based systems to accurately review audits/appeals as assigned - Will identify and communicate deficiencies/discrepancies in documentation while complying with company policies & procedures. - Ensure audit/appeal packets are assembled and submitted correctly according to department policies and procedures within the defined timeframe. - Effectively communicates with Comfort Medical internal stakeholders clinical need qualifications and regulatory requirements. - Serve as a clinical resource for non-medical staff. - Support training and education on clinical need qualifications, justification, and regulatory requirements when knowledge gaps are identified for internal associates. - Participate in peer review processes to assess the quality of care provided by other clinicians, offering constructive feedback and recommendations for improvement. - Analyze and provide feedback to Comfort Medical stakeholders with respect to trends in clinical patient care and identify opportunities for quality improvement. - Responsible for keeping Manager informed of deficient audits/appeals, patterns, errors, or other systematic problems identified. - Responsible for understanding and adhering to all company and department policies, procedures, and process documents. - Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the MedTech Code of Conduct, and company policies. - Responsible for additional duties assigned by the department’s management. Basic Qualifications - College Degree in healthcare, nursing, or related fields. - Minimum of 2 years’ experience working as a clinical nurse reviewer or in utilization management. - Must have active LPN or RN Certification in the state in which they reside (must maintain certification). - Ability to work collaboratively and independently and stay on task. - Strong background knowledge in healthcare regulatory, government policy, and contracted payer policy. - Excellent medical terminology skills. - Excellent written and verbal communication skills. Preferred Qualifications - 5+ years’ DME industry experience (urological/ostomy) - EHR system experience - Certified Professional in Healthcare Quality (CPHQ) At Coloplast, we believe in recognizing and rewarding the contributions of our employees. Our total rewards package is designed to support your well-being, foster your professional growth, and ensure a healthy work-life balance. Here is some of what you can expect: - Health and Wellness: Comprehensive medical, dental, and vision insurance plans to keep you and your family healthy. Plus, access to company sponsored wellness programs and mental health resources, paid leave of absence for qualifying events and generous paid parental leave for both birthing and non-birthing parents. - Financial Security: A competitive 401(k) plan with company match that vest immediately, financial planning services to help you secure your future, and corporate discount programs for goods and services. - Work-Life Balance: Generous paid time off, flexible work hours, and flexible work arrangement options to help you balance your personal and professional life may be available. - Professional Development: Opportunities for continuous learning and career advancement through training programs, mentorship, and tuition reimbursement. - Recognition and Rewards: Recognition programs to celebrate achievements and contributions, including peer recognition, bonuses, awards, and special events. - Community and Culture: A supportive work environment where everyone feels valued and has a sense of belonging. Participate in team-building activities, volunteer opportunities, and company-sponsored events. Sustainability strategy that outlines our ambitions for how to run our company in a more sustainable way. - • Competitive Compensation: The compensation range for this position is $80,740 - $100,000. Actual compensation is influenced by a variety of factors including but not limited to skills, experience, qualifications, and geographic location. Hired candidates may be eligible to receive additional compensation in the form of bonuses and/or incentives. div.joqReqDescription { background :#FFF repeat-y !important; color:#000; } Comfort Medical provides an extensive selection of name brand catheter and ostomy supplies to thousands of customers nationwide. Our attention to detail, unmatched customer service, and dedication to helping our customers live happier, healthier lives are just a few of the many reasons we are one of the fastest growing catheter and ostomy supply companies in the nation!​ Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies. Comfort Medical is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification. 60909 #LI-CM #LI-REMOTE

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance RN Field Case Manager This Field Case Manager will cover our Phoenix, AZ region and must live in this area in order to be considered. Must be an RN and have as least 1.5 years of prior Field Case Manager workers compensation experience. ​ PRIMARY PURPOSE OF THE ROLE: Sedgwick Field Case Managers work face to face with their injured workers and medical providers to facilitate; though advocacy, progressive medical treatment, and timely return-to-work; while acting as a liaison and providing communication between all involved parties. While frequent travel is required, you will maintain a home-based office. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. - Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. - Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment that allows face to face interaction with injured workers and medical professionals. - Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. - Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. . ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Serve as patient advocate to support, guide and coordinate care for injured workers, families and caregivers as they navigate through the recovery process. - Assist injured workers in achieving recovery and autonomy through advocacy, communication, education, identification of service resources and service facilitation. - Identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source EDUCATION AND LICENSING RN licensure required. Valid driver’s license required. High speed internet required. TAKING CARE OF YOU BY - Offering a blended work environment. - Supporting meaningful work that promotes critical thinking and problem solving. - Providing on-going learning and professional growth opportunities. - Promoting a strong team environment and a culture of support. - Recognizing your successes and celebrating your achievements. - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. #nurse #fieldcasemanager Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Overview Who We Are Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com. Responsibilities Ready to Job Summary As a Case Manager RN, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. May be required to work evening and/or weekend shifts. What You'll Actually Do Essential Functions/Responsibilities/Duties - Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs. - Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs. - Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals. - Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions. - Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care. - Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance. - Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis. - Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports. - Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information. - Evaluate and make referrals for wellness programs. - Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low-risk cases ensuring confidentiality according to Company policy and HIPAA - Perform Utilization Review for assigned members. - Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues. Qualifications What You Bring to Our Team Education and Experience - Graduation from an accredited Registered Nursing (RN) program. - Possession of a current California RN license; a multi-state license will also be required. - Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience. - Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management. Required Knowledge, Skills, and Abilities - Knowledge of medical claims and ICD-10, CPT, HCPCS coding. - Ability to critically evaluate claims data and determine treatment plan, discharge planning experience. - Ability to work independently making decisions and problem solving - Knowledge of community resources and alternate funding programs. - Computer proficiency or working knowledge of Microsoft Office Suite. - Excellent interpersonal, communication and negotiation skills. - Strong customer orientation. - Good time management skills and highly organized. Work Environment At Personify Health we value and celebrate diversity, and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than this, diversity is our strength, and a catalyst in our ability to change lives for the good. Physical Requirements - Must be able to remain in a stationary position 50% of the time. - The person in this job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities. - Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. - Frequently positions self to maintain files in file cabinets. - Frequently moves boxes or equipment weighing up to 25 pounds. - Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations. - Must be able to observe details at close range. Disclaimer This job description is not intended to contain a comprehensive list of activities, duties, or responsibilities, but constitutes a general description of the scope and function of the role within the company. Activities, duties, and responsibilities are subject to change at any time with or without notice. Benefits The Highlights: - Competitive base salary and benefits effective day one - Comprehensive medical and dental through our own health solutions (yes, we use what we build) - Paid Time Off—rest and recharge time is non-negotiable - Mental health support, retirement planning, and financial protection - Professional development with clear career progression and learning budgets - Mission-driven culture where diverse perspectives drive real impact on people's health Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a base salary range of $34-$38 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing. Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access. - Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines - Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination - Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment - Performs data entry to maintain and update various authorization requests into utilization management system - Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer - Remains up-to-date on healthcare, authorization processes, policies and procedures - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. Knowledge of medical terminology and insurance preferred. Pay Range: $17.84 - $28.02 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act