Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Care Manager (RN) - Must live in IA
Location
United States
Posted
88 days ago
Salary
0
Seniority
Lead
No structured requirement data.
Job Description
Care Manager (RN) - Must live in IA
Molina Healthcare
This opportunity is fully remote, managing critical incidents. No travel or field visits. Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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Role Description Overall strategic and operational responsibility for leading, developing and driving the performance of the German sales team within Urology Care. This role ensures sustainable growth, profitability and strong market positioning, while leading the Homecare team, Key Account Management and the direct sales team. - Build and sustainably establish a high-performance, growth-oriented sales culture aligned with the Business Unit strategy. - Drive revenue, margin and market share targets with clear KPI orientation. - Provide active field coaching and leadership to enhance sales performance and closing effectiveness. - Deliver regular reporting of strategic initiatives and business results to the Senior Sales Manager DACH. - Further develop and optimize the product portfolio to ensure sustainable revenue and profitability growth. - Strategically position Teleflex as a leading partner within Urology Care. - Ensure compliance with regulatory requirements and adherence to Teleflex Core Values. - Develop and implement an integrated sales and business strategy for the German market. - Lead, motivate and systematically develop the sales team, including talent management and succession planning. - Take ownership of business planning, forecasting and resource allocation. - Identify new market opportunities and strategic growth areas in close collaboration with Marketing and Training. - Build and maintain long-term relationships with strategically relevant customers and stakeholders. - Represent the company at congresses and industry events. - Foster a culture of ownership, accountability and entrepreneurial thinking within the team. Qualifications - Strong medical background combined with extensive and proven successful field sales experience. - Minimum of 6 years of sales experience within the medical environment, ideally with several years of leadership experience. - Experience in strategic medical device sales in Germany. - Proven capability in managing complex product portfolios and market structures. Requirements - Strong leadership and coaching capability with high performance orientation. - Strategic thinking combined with strong entrepreneurial mindset. - Excellent communication and presentation skills across all organizational levels. - Strong analytical and business acumen. - Proven ability to build and maintain long-term customer and stakeholder relationships. - Advanced MS Office skills and experience with CRM systems. - High level of self-motivation, decisiveness and change agility. - Languages: Very good German and English skills. Benefits - Working Environment: Remote / Field-based. - Approximately 40% travel within Germany and occasional participation in European meetings.
About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely. Primary Responsibilities • Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. • Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments. • Collaborates with healthcare partners to ensure timely review of services and care. • Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. • Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards • Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate. • Triages and prioritizes cases and other assigned duties to meet required turnaround times. • Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations. • Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements. • Duties as assigned. Essential Qualifications • Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment. • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) • Must be able to work independently. • Must be detail oriented and have strong organizational and time management skills. • Adaptive to a high pace and changing environment- flexibility in assignment. • Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review. • Proficient in MCG and CMS criteria sets • Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred. • Working knowledge of URAC and NCQA. • 2+ years’ experience in a UM team within managed care setting. • 3+ years’ experience in clinical nurse setting preferred. • TPA Experience preferred. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™. Company Mission Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners. Company Vision Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
Pharmacist Consultant
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Our Company PharMerica Overview Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression! PharMerica’s consultant pharmacist teams lead the industry in clinical excellence. Amid higher acuity, greater regulatory scrutiny, and staffing challenges, PharMerica consultant pharmacists provide clinical services that drive facility compliance, prescriber engagement, and optimized medication therapy for our residents. Our consultant pharmacists are dedicated facility medication experts who: - Make an impact through medication optimization helping our residents live their best lives - Lead care teams providing value to prescribers and nursing staff - Navigate cost containment strategies to reduce drug spend and nursing time Intensely focused on the local delivery of services, our consultant pharmacist team’s high quality medication management and clinical support enables facilities to optimize care delivery, reduce regulatory risk, and adapt to rapid change. The Pharmacist Consultant is a remote role and will be responsible for covering the following territories. Qualified candidates must reside within the territories listed below. Worthington OH; Cincinnati OH An Immunization Certification through an accredited organization (ie. APhA) is required We offer: DailyPay Flexible schedules Competitive pay Shift differential Health, dental, vision and life insurance benefits Company paid STD and LTD Employee Discount Program 401k Paid-time off Tuition reimbursement Non-retail/Closed-door environment Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today! Responsibilities - Evaluates physician medication orders for appropriateness of drug, dosage, potential interactions, route of administration and stability. Makes recommendations for therapy changes to the physician and facility staff as appropriate - Reviews the drug regimen and clinical indicators of each resident as assigned at least monthly and reports any irregularities to the Director of Nursing, Administrator and the attending physicians with a written report of findings and recommendations - Documents all communication with physicians, nurses, other members of the healthcare team and patients/residents and their family members - Maintains knowledge of pharmacy laws and federal and state regulations concerning long-term care - Works cooperatively as a member of a team - Maintains knowledge of pharmaceutical care practices for long term care residents Qualifications - Bachelor’s degree from an accredited School of Pharmacy or Pharmacy Doctorate - Current license required. Dual license preferred - One-year experience in acute, long-term care or home health preferred - Consultant or Clinical Pharmacist experience preferred - IV clinical experience preferred - Must be able to work weekends or outside of normal business hours when needed - Ability to lift patient charts repetitively - Ability to stand for long periods of time - Good customer service skills - Ability to learn and understand state and federal regulations for long-term care - Understand of formulary management About our Line of Business PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.
Health Systems Medical Affairs Director - PA, NJ, DE
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Please click here if you need an accommodation during the application or hiring process. As an Equal Employment Opportunity Employer, we provide equal opportunities to all employees and applicants for employment and prohibit discrimination on the basis of race, color, age, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability status, or other applicable legally protected characteristics. As a federal contractor, we comply with all affirmative action requirements for protected veterans and individuals with disabilities. For more information about personal rights under the U.S. Equal Opportunity Employment laws, visit: EEOC Know Your Rights EEOC GINA Supplement We are proud to be a company that embraces the value of bringing together, talented, and committed people with diverse experiences, perspectives, skills and backgrounds. The fastest way to breakthrough innovation is when people with diverse ideas, broad experiences, backgrounds, and skills come together in an inclusive environment. We encourage our colleagues to respectfully challenge one another’s thinking and approach problems collectively. Learn more about your rights, including under California, Colorado and other US State Acts U.S. Hybrid Work Model Effective September 5, 2023, employees in office-based positions in the U.S. will be working a Hybrid work consisting of three total days on-site per week, Monday - Thursday, although the specific days may vary by site or organization, with Friday designated as a remote-working day, unless business critical tasks require an on-site presence.This Hybrid work model does not apply to, and daily in-person attendance is required for, field-based positions; facility-based, manufacturing-based, or research-based positions where the work to be performed is located at a Company site; positions covered by a collective-bargaining agreement (unless the agreement provides for hybrid work); or any other position for which the Company has determined the job requirements cannot be reasonably met working remotely. Please note, this Hybrid work model guidance also does not apply to roles that have been designated as “remote”. The salary range for this role is $190,800.00 - $300,300.00 This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. An employee’s position within the salary range will be based on several factors including, but not limited to relevant education, qualifications, certifications, experience, skills, geographic location, government requirements, and business or organizational needs. The successful candidate will be eligible for annual bonus and long-term incentive, if applicable. We offer a comprehensive package of benefits. Available benefits include medical, dental, vision healthcare and other insurance benefits (for employee and family), retirement benefits, including 401(k), paid holidays, vacation, and compassionate and sick days. More information about benefits is available at https://jobs.merck.com/us/en/compensation-and-benefits. You can apply for this role through https://jobs.merck.com/us/en (or via the Workday Jobs Hub if you are a current employee). The application deadline for this position is stated on this posting. San Francisco Residents Only: We will consider qualified applicants with arrest and conviction records for employment in compliance with the San Francisco Fair Chance Ordinance Los Angeles Residents Only: We will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance Search Firm Representatives Please Read Carefully Merck & Co., Inc., Rahway, NJ, USA, also known as Merck Sharp & Dohme LLC, Rahway, NJ, USA, does not accept unsolicited assistance from search firms for employment opportunities. All CVs / resumes submitted by search firms to any employee at our company without a valid written search agreement in place for this position will be deemed the sole property of our company. No fee will be paid in the event a candidate is hired by our company as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails. Employee Status: Regular Relocation: No relocation VISA Sponsorship: No Travel Requirements: 50% Flexible Work Arrangements: Remote Shift: Not Indicated Valid Driving License: Yes Hazardous Material(s): n/a Job Posting End Date: 04/7/2026*A job posting is effective until 11:59:59PM on the day BEFORE the listed job posting end date. Please ensure you apply to a job posting no later than the day BEFORE the job posting end date. Requisition ID:R389470



