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.

Description Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! Specialty infusion prior authorization experience required. Hours are Monday-Friday 930a-6p Central Time. Soleo Health Perks: - Competitive Wages - 401(k) with a Match - Referral Bonus - Paid Time Off - Great Company Culture - Annual Merit Based Increases - No Weekends or Holidays - Paid Parental Leave Options - Affordable Medical, Dental, & Vision Insurance Plans - Company Paid Disability & Basic Life Insurance - HSA & FSA (including dependent care) Options - Education Assistance Program The Position: The Prior Authorization Coordinator ensures seamless patient care by maintaining prior authorizations, copay assistance, and verifying existing insurance coverage for ongoing services. Responsibilities include: - Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits - Verify insurance benefit information monthly via multiple methods such as online tools, calling payors or processing test claims - Generates a prior authorization expiration report weekly, bi-weekly, or monthly - Review clinical documents for prior authorization/pre-determination submission purposes - Secures prior authorization, pre-determination, or medical review - Contact prescriber’s office to obtain information that is required to complete ongoing re-authorization and verification of benefits - Places outbound calls to patients or prescriber’s offices to notify of any delays due to more information needed to process or due to a prior authorization - Document insurance coverage of medications, administration supplies, and related infusion services including prior authorization requirements and coordination of benefits - Provides exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner - Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided - Generates patient forms - Maintains up to date prior authorization report - Other duties as assigned Schedule: - Monday-Friday 930a-6p Central Time. Requirements - High school diploma or equivalent required - At least 2 years of specialty infusion intake/admissions and/or reimbursement experience - Previous medical and pharmacy benefit experience is required - Initiating and securing prior authorizations, pre-determination, and appeals - Ability to interpret payor contract fee schedules based on NDC and HCPCS units - Ability to effectively handle multiple priorities within a changing environment - Basic level skill in Microsoft Excel and Word About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference! Soleo’s Core Values: - Improve patients’ lives every day - Be passionate in everything you do - Encourage unlimited ideas and creative thinking - Make decisions as if you own the company - Do the right thing - Have fun! Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture. Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

This opportunity is available for individuals that reside in the following areas with a compact license: - Colorado, Georgia, Indiana, Kentucky, Massachusetts, Minnesota, Mississippi, Ohio, Pennsylvania, Virginia, Washington, Louisiana, and Iowa. The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the BCBSM online messaging platform. The Care Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals. - Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors. - Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum. - Assess the member's health, psychosocial needs, cultural preferences, and support systems. - Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes. - Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services). - Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family. - Advocate for members and promote self-advocacy. - Deliver education to include health literacy, self-management skills, medication plans, and nutrition. - Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary. - Accurately document interactions that support management of the member. - Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care. - Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care. - Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency. - Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals - Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM). QUALIFICATIONS - Nursing Diploma or Associates degree in nursing required. - Bachelor’s degree in nursing strongly preferred. - 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required. - 1 year of case management experience in a managed care setting strongly preferred. - Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred. - Current, active, and unrestricted Michigan Registered Nurse license required - Certification in Case Management (CCM) required or to be obtained within 18 months of hire - Certification in Chronic Care Professional (CCP) preferred - Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member’s outcomes. - Empathetic, supportive and a good listener. - Proficient in motivational interviewing skills. - Demonstrated time management skills. - Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member. - Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.). - Must embrace teamwork but can also work independently. 8. Excellent interpersonal and communication skills both written and verbal.

Global Study Manager 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 We are currently seeking a Global Study Lead to join our diverse and dynamic team. As the Global Study Lead, you will hold a crucial role in ensuring the successful delivery of all clinical aspects of the studies. Your expertise and leadership will be instrumental in managing the clinical portion of the budget, developing effective monitoring plans, and driving enrollment to meet project objectives. Moreover, you will liaise with stakeholders, identify and mitigate risks, and provide comprehensive reporting on all clinical activities. What you will be doing: - Budget Oversight Oversee the clinical portion of the budget to ensure efficient resource allocation. - Ensuring Effective Study Oversight: Develop monitoring plans and tools, ensuring effective study oversight. - Optimizing Performance: Train and mentor Clinical Research Associates (CRAs) to optimize their performance. - Timely Study Start-Up & Enrollment: Drive enrollment and lead study start-up activities, adhering to timelines. - Improving Study Integrity Review trip reports and implement corrective and preventative action plans when necessary. - Building Productive Relationships: Foster productive relationships with Sponsors, vendors, and cross-functional teams. Your profile: - A minimum of 4+ years of experience in a Clinical Trial Management position at a CRO or Pharmaceutical Organization. - Bachelor's degree in health, life sciences, or other relevant fields of study. - At least 10+ years of relevant experience in clinical trial management. - Preferred: 2+ years of monitoring experience. - Experience in managing complex or global trials is advantageous. - Preferred: Experience in managing all trial components from start-up to database lock. - Preferred: Experience in coaching/mentoring other CTMs, leading a team of CTMs, and participating in departmental initiatives. - Fluency in English (reading, writing, speaking). 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