• Monday - Friday; 8am to 5pm • Medical Assistant with experience in Primary Care setting preferred • Medical terminology required • Must have healthcare experience • Remote work - ***MUST LIVE IN ARIZONA*** HonorHealth is looking for support as a Population Health Navigator who will work closely with 5 - 6 primary care clinics to assist in closing quality and risk gaps to improve the organization’s overall performance. To be successful in this role one must be familiar with the basic functions of excel, proficient in other Microsoft products, and demonstrate strong communication skills. This role involves working with several different electronic systems, therefore one must be comfortable with working with new technology and adapt well to change. This position will require a high volume of patient outreach as well as correspondence with providers and clinic staff to improve quality and risk performance. Our ideal candidate must meet the minimum requirements of the role that includes a HSD/GED, one (1) year outpatient, ambulatory care, specialty care, population health or community health experience along with one (1) year working knowledge of medical terminology. Additionally, a high level of comfortability on the phone and great email etiquette. The ability to learn quickly and absorb information will also allow you to be successful in this role. Limited travel is required for quarterly meetings and other team meetings that may occur with a reimbursement for mileage. Overview Looking to be part of something more meaningful? At HonorHealth, you’ll be part of a team, creating a multi-dimensional care experience for our patients. You’ll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact. HonorHealth offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives. Visit honorhealth.com/benefits to learn more. Join us. Let’s go beyond expectations and transform healthcare together. HonorHealth is one of Arizona’s largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area. The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more. With nearly 17,000 team members, 3,700 affiliated providers and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations of a traditional healthcare system to improve the health and well-being of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Population Health Navigator is responsible to assist the department in ongoing Healthcare Effectiveness Data and Information Set (HEDIS) collection and Quality Improvement Activities to close gaps in care for insurance companies, Innovation Care Partners (ICP) and other internal quality projects. This position includes ongoing quality improvement activities to assure the organization's quality programs with ICP are implemented and meet all requirements for successful quality metric reporting. Essential Functions - Collaborates with onsite leadership, medical assistant and providers at each clinic for gap closure and to complete quality care goals. Assist clinical teams with proper documentation/requirements for quality requirements. - Participates in chart scrubbing, retrieval of medical records and data collection to support monthly and ongoing Innovation Care Partners (ICP) initiatives for quality improvement and to close outstanding care gaps. - Identify all patients with outstanding care gaps via roster from ICP or insurance payer. Pre-screen all scheduled patients via Electronic Medical Records (EMR) to identify opportunities to close gaps. Follow outreach protocols to schedule patients for necessary visits, labs, procedures, etc. - Analyze quality measures and identify opportunity trends for better patient health outcomes. Update health maintenance as indicated during chart auditing. - Ability to use multiple insurance and quality data bases with ICP to support successful Care Gap closure for patients. - Responsible for ongoing data submission to ICP and insurance payers. - Participate in monthly ICP meetings or webinars. - Performs other duties as assigned. Education - Associate's Degree or 2 years' work related experience Business, Health Administration or related field - Preferred - High School Diploma or GED - Required Experience - 1 year outpatient, ambulatory care, specialty care, population health or community health experience. - Required - 1 year working knowledge of medical terminology - Required - Other Prior medical assistant (MA) experience in a primary care setting - Preferred Licenses and Certifications

This is a remote field-based role requiring travel in St. Clair and Madison Counties. Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. 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 member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services 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 and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • Collaborates with licensed care managers/leadership as needed or required. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. •Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and 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. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications • Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. • Experience working with populations that receive waiver services. 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

This is a remote field-based role requiring travel within Johnson and Muscatine Counties. Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. 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 member assessments within regulated timelines, including in-person home visits as required. • Facilitates comprehensive waiver enrollment and disenrollment processes. • Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. • Assesses for medical necessity and authorizes all appropriate waiver services. • Evaluates covered benefits and advises appropriately regarding funding sources. • Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services 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 and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. • Identifies critical incidents and develops prevention plans to assure member health and welfare. • Collaborates with licensed care managers/leadership as needed or required. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years health care experience, including at least 1 year of experience working with persons with disabilities/chronic conditions long-term services and supports (LTSS), and 1 year of experience in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. •Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Demonstrated knowledge of community resources. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work independently, with minimal supervision and self-motivation. • Ability to demonstrate responsiveness in all forms of communication, and 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. • In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements). Preferred Qualifications • Certified Case Manager (CCM), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. • Experience working with populations that receive waiver services. 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

Description We're growing - Join our award winning culture as we serve members in your area! The RN Care Manager (RN CM), as part of an interdisciplinary team (IDT) with a Care Manager, serves Lakeland Care's (LCI) members, the frail elderly, adults with physical disabilities, and adults with intellectual/developmental disabilities. The RN Care Manager does not provide hands-on care; it provides care management and service coordination to LCI members. The RN care manager arranges for provision of services and supports based on a comprehensive assessment of the member's identified outcomes and needs. The IDT monitors the provision of services based on the member-centered plan per LCI policy and procedures, and Department of Health Services (DHS) contract requirements. Position requires traveling in the field/community visiting members. Responsibilities & Competencies: - Coordinate and participate in home visits and care conferences involving the member, their supports, and providers. - Coordinate acute and primary care services, care transitions, and related follow-up care. - Conduct in-person comprehensive, strengths-based assessment of the member's outcomes, needs and risks; perform reassessment as condition changes. - Develop, coordinate, monitor and evaluate the members’ outcome-based member-centered plans, considering cost and effectiveness in authorizing services and choosing providers. - Implement risk mitigation strategies to promote the member’s health, safety and independence while respecting the member’s rights to appeal and grieve. - Maintain member records as required by DHS contract and LCI policy. - Build and maintain an effective and collaborative working relationship with Care Manager partner and various departments/stakeholders. - Participate in team meetings and on-going trainings to stay abreast of policies, procedures, and state/federal regulations. - Maintain the confidentiality of member information and protected health information (PHI) in accordance with HIPAA and state/federal regulations. - Provide nursing care in accordance with the Nurse Practice Act. Requirements - Current License to practice as a Registered Nurse in the State of Wisconsin. - Bachelor’s degree in nursing strongly preferred. - Two (2) or more years of skilled nursing experience preferred, ideally in gerontology/disabilities and/or home care. - Ability to access members’ homes which are not required to comply with the ADA regulations. - Ability to lift up to 25lbs. - Current driver’s license, acceptable driving record and proof of adequate insurance. ------------------------------------------------------------------------------------------------- Lakeland Care is a Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), we provide long-term care services to eligible elders and individuals with physical and intellectual or developmental disabilities. Currently we serve members in 22 counties and have 11 offices throughout the Central to North East region of Wisconsin. Our Mission Empowering individuals. Strengthening communities. Inspiring futures. Our Vision To create a world we all want to live in. Our Core Values Kindness – We believe kindness is always possible and that no compassionate act is ever wasted. Inclusion – We believe that open hearts and open minds are the only path to a brighter future. Trust – We believe that honesty is still in style and that promises still have power. We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.