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Shields Health Solutions logo
Shields Health Solutions

Elevating Specialty Pharmacy

Regional Team Lead - Prior Authorizations - Certified Specialty Pharmacy Technician

Medical ReviewerMedical ReviewerFull TimeRemoteLeadTeam 501-1,000Since 2011H1B No SponsorCompany SiteLinkedIn

Location

Worldwide

Posted

91 days ago

Salary

0

Seniority

Lead

No structured requirement data.

Job Description

Regional Team Lead - Prior Authorizations - Certified Specialty Pharmacy Technician

Shields Health Solutions

Role Description This role blends leadership and patient advocacy responsibilities, supporting the supervisor in ensuring the team has the tools and guidance needed to succeed while maintaining direct patient care responsibilities. Job Duties - Patient Advocacy & Clinical Support - Maintain direct patient support responsibilities including benefit investigations, prior authorizations, and financial assistance programs. - Troubleshoot insurance rejections and claim issues. - Communicate professionally with patients, clinicians, and payors. - Demonstrate clear and concise documentation practices to ensure accurate, timely, and compliant record-keeping across patient interactions and workflow processes. - Team Leadership & Support - Assist the supervisor in monitoring daily team activities and work queues. - Provide mentorship and stabilization support for new hires. - Share and educate team members on workflow best practices and system navigation. - Support clinic growth and stabilization efforts across therapeutic areas. - Provide coverage for clinics with staffing gaps or PTO needs. - Manage overflow work needs of supported clinics. - Lead by example, fostering a collaborative and positive team culture. - Build strong relationships with internal teams, clinic partners, and cross-functional teams. - Actively participate in team meetings, training sessions, and knowledge-sharing forums. - Operational Excellence - Perform audits to ensure workflow adherence and quality standards. - Contribute to special projects and process improvement initiatives. - Report feedback and insights to supervisors to optimize team performance. - Monitor Key Performance Indicators (KPIs), assess gaps in meeting site and organizational goals, and develop targeted action plans to drive continuous improvement. - A core responsibility of this role is to ensure the team consistently achieves performance metrics that reflect broader organizational objectives, with a focus on collective outcomes rather than individual contributions. Qualifications - Nationally certified Pharmacy Technician (CPhT via PTCB or ExCPT). - Registered or willing to register with the state of employment. - 2+ years of experience in specialty pharmacy, patient engagement, or prior authorization. - Internal candidates: Minimum 6 months in the Patient Support Center. - Proven track record of exceeding performance expectations and service levels. Company Description Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Clinical Educator

MCG Health

We lead the healthcare community to deliver patient-focused care.

Medical Reviewer91 days ago
Full TimeRemoteTeam 201-500H1B Sponsor

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This role primarily serves Basic and Standard clients that are typically single-site payor/provider organizations with low to medium-complexity solutions, including CareWeb and interactive systems. - Possess a deep understanding of MCG Health's software solutions, guidelines, and products to support Basic and Standard clients. - Assess the client's current operations and recommend workflows that support effective and maximized use of MCG solutions. - Update, revise, and manage training programs, materials, and documentation such as user guides, reference materials, and FAQs for comprehensive training support. - Communicate clinical concepts and software functionality to healthcare professionals with varying levels of expertise. - Partner with Basic and Standard clients, Care Strategy, and Account Management to develop customized education plans. - Engage clients in the learning process through the collaborative development of annual or ongoing education plans. - Tailor training programs to meet the unique needs and workflows of healthcare facilities and professionals, ensuring they can effectively integrate MCG Health's solutions into their practice. - Assess and identify opportunities for expanded use of licensed MCG solutions. - Serve as an advocate for MCG Health's customers, conveying their needs and concerns to the product development team and assisting in prioritizing feature requests. - Conduct webinars, workshops, and educational events for healthcare organizations and individuals, including both on-site and virtual training. - Design training curricula tailored to different healthcare roles, such as physicians, nurses, case managers, and/or utilization review specialists. - Author written training proposals and training summaries to define the scope and outcome of training. - Partner with Clinical Educator II, Senior Clinical Educator, and/or Principal Clinical Educator mentors to perform general management of clients, feedback on presentation/training, escholar webinars, client calls, developing an education plan or other duties. - Identify potential risks to successful solution implementations and collaborate proactively with other MCG teams to improve success. - Participate in education initiatives conducted by Principal Educators in areas such as Reviewer Statistics Dashboard (RSD), Customer Value Initiative Reporting (CVI), System Admin, or other tools and software. - Stay current with clinical research, industry developments, and healthcare best practices to enhance the quality of training content. - Monitor individual dashboards to achieve adherence to departmental metrics. - Support a culture that reflects all virtues of the Ideal Team Player. - Support the MCG culture which values collaboration and support, empowerment, ownership, excellence, and passion. 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Worldwide
$86.1K - $120.5K / year
Job Closed

Qualified Nutritionist

Catholic Charities of Buffalo

Founded in 1923, Catholic Charities of Buffalo is a nonprofit social services organization dedicated to providing a “beacon of hope for those in need.” A ch

Medical Reviewer91 days ago

Qualified Nutritionist Location: Dunkirk United States - 45,455-49,479 per year Depending on Experience - Salary - Full Time - Health, Dental, Vision, PTO, 403B, Paid Holidays Job Description: Overview Catholic Charities is seeking a full-time WIC Qualified Nutritionist in the Dunkirk, NY office located in Chautauqua County. The Qualified Nutritionist works cooperatively with all staff to ensure smooth and efficient clinic flow. Administers the nutrition related components of the WIC Program, following the policies and procedures of the NYS Department of Health WIC Program Manual. Determines participant medical and nutritional eligibility. Catholic Charities is non-profit human services agency that strives to empower individuals, children, and families across the eight counties of Western New York. For more than 100 years, Catholic Charities of Buffalo has provided HOPE to individuals and families of all faiths, backgrounds, and circumstances. As the most comprehensive provider of human services in Western New York, Catholic Charities delivers wide-ranging programs to address systemic poverty, sudden financial crisis, hunger, behavioral health, workforce readiness, family stability, legal immigration and resettlement, and help for older adults. As a trauma-informed agency, we strive to support the total wellbeing of clients and employees. Catholic Charities prioritizes wellness and diversity through various committees such as: CARE (Compassion, Acceptance, Respect for Everyone) Committee to create an inclusive environment where every individual feels seen, heard, and valued; Trauma-Informed Care (TIC) Committee to lead agency efforts in creating and maintaining a trauma-informed workplace; Wellbeing Committee to empower staff to reach their full potential through personal wellness and community support; and the Safety Committee to maintain a physically and psychologically safe and welcoming environment for all. Job Responsibilities - Provide Participant Centered Nutrition Services (PCNS) by phone or in person. - May conduct all duties of the Competent Professional Authority (CPA), Nutrition Assistant (NA) and Program Support Staff. - Assist participant with WIC Health online nutrition education. - Enroll participants by completing a nutritional assessment, program eligibility and determine nutrition risk. - Prescribe, tailor, authorize, issue, and reissue all food packages. Document nutrition services provided, including referrals and follow-up. - Review and approve formula requests requiring medical documentation in consultation with the Health Care Provider. - Conducts nutrition risk assessment to determine all nutrition risk criteria and program eligibility. - Coordinate nutrition education, including breastfeeding promotion and support that is responsive to the identified needs/ interests of each high-risk participant. - Conducts breastfeeding assessments and provides counseling in regard to any breastfeeding concern or issues. Refer to Designated Breastfeeding Expert as needed. - Refers participants to other health-related and social services, as necessary. - Tracks high- risk participants' progress in improving their health and document for outcomes. - Ensure the efficient flow of the assessment and education processes. - Complete required Catholic Charities, WIC and DOH trainings. - Maintain continuing education credits as required by position. - Comply with the Agency's Compliance Program, Code of Ethics, laws, regulations, and ethical standards applicable to your position in the WIC program and Catholic Charities. - Provides leadership and assist in orienting, training and mentoring new Local Agency staff. - Provides oversight and guidance to the CPA and NA staff. - Travels to all sites, transports laptops, computers and other equipment to sites. - May have to lift up to 30lbs. - Performs other duties as assigned. Qualifications - Registered Dietician Nutritionist (RD/RDN) OR - Bachelors, master's or PhD in Nutrition - Basic computer skills - Must have reliable transportation, with the ability to travel to other WIC sites and transport equipment (sometimes in the middle of workday) such as laptops, printers, medical equipment, nutrition materials and scanners. Why You'll Love Working Here - 37.5 hours per week, hybrid/flexible schedule - 25 PTO days per year (PTO is prorated based on start date) - 13 paid holidays per year (Part‑time holiday pay depends on the employee's regular schedule) - Medical, dental, and vision insurance plans - 403(b) retirement plan with employer contribution after six months - Employer‑paid life insurance and Employee Assistance Program (EAP) - Training & development opportunities As an Equal Opportunity Employer, Catholic Charities of Buffalo is committed to providing equal employment opportunities to all individuals, regardless of race, religion, color, national origin, citizenship, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, or any other protected characteristic. Catholic Charities of Buffalo will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities, unless such accommodations would impose an undue hardship on the operation of the business.

New York

Qualified Nutritionist

Catholic Charities of Buffalo

Founded in 1923, Catholic Charities of Buffalo is a nonprofit social services organization dedicated to providing a “beacon of hope for those in need.” A ch

Medical Reviewer91 days ago

Qualified Nutritionist - WIC: Women, Infants, & Children - 2121 Main Street, Buffalo, NY, USA - 45,455-49,479 per year Depending on Experience - Salary - Full Time - Health, Dental, Vision, PTO, 403B, Paid Holidays Job Description: Overview Catholic Charities is seeking a full-time WIC Qualified Nutritionist in Erie County. The Qualified Nutritionist works cooperatively with all staff to ensure smooth and efficient clinic flow. Administers the nutrition related components of the WIC Program, following the policies and procedures of the NYS Department of Health WIC Program Manual. Determines participant medical and nutritional eligibility. Catholic Charities is non-profit human services agency that strives to empower individuals, children, and families across the eight counties of Western New York. For more than 100 years, Catholic Charities of Buffalo has provided HOPE to individuals and families of all faiths, backgrounds, and circumstances. As the most comprehensive provider of human services in Western New York, Catholic Charities delivers wide-ranging programs to address systemic poverty, sudden financial crisis, hunger, behavioral health, workforce readiness, family stability, legal immigration and resettlement, and help for older adults. As a trauma-informed agency, we strive to support the total wellbeing of clients and employees. Catholic Charities prioritizes wellness and diversity through various committees such as: CARE (Compassion, Acceptance, Respect for Everyone) Committee to create an inclusive environment where every individual feels seen, heard, and valued; Trauma-Informed Care (TIC) Committee to lead agency efforts in creating and maintaining a trauma-informed workplace; Wellbeing Committee to empower staff to reach their full potential through personal wellness and community support; and the Safety Committee to maintain a physically and psychologically safe and welcoming environment for all. 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Document nutrition services provided, including referrals and follow-up. - Review and approve formula requests requiring medical documentation in consultation with the Health Care Provider. - Conducts nutrition risk assessment to determine all nutrition risk criteria and program eligibility. - Coordinate nutrition education, including breastfeeding promotion and support that is responsive to the identified needs/ interests of each high-risk participant. - Conducts breastfeeding assessments and provides counseling in regard to any breastfeeding concern or issues. Refer to Designated Breastfeeding Expert as needed. - Refers participants to other health-related and social services, as necessary. - Tracks high- risk participants' progress in improving their health and document for outcomes. - Ensure the efficient flow of the assessment and education processes. - Complete required Catholic Charities, WIC and DOH trainings. - Maintain continuing education credits as required by position. - Comply with the Agency's Compliance Program, Code of Ethics, laws, regulations, and ethical standards applicable to your position in the WIC program and Catholic Charities. - Provides leadership and assist in orienting, training and mentoring new Local Agency staff. - Provides oversight and guidance to the CPA and NA staff. - Travels to all sites, transports laptops, computers and other equipment to sites. - May have to lift up to 30lbs. - Performs other duties as assigned. Qualifications - Registered Dietician Nutritionist (RD/RDN) OR - Bachelors, master's or PhD in Nutrition - Basic computer skills - Must have reliable transportation, with the ability to travel to other WIC sites and transport equipment (sometimes in the middle of workday) such as laptops, printers, medical equipment, nutrition materials and scanners. Why You'll Love Working Here - 37.5 hours per week, hybrid/flexible schedule - 25 PTO days per year (PTO is prorated based on start date) - 13 paid holidays per year (Part‑time holiday pay depends on the employee's regular schedule) - Medical, dental, and vision insurance plans - 403(b) retirement plan with employer contribution after six months - Employer‑paid life insurance and Employee Assistance Program (EAP) - Training & development opportunities Applicants must reside in New York State to be considered. Compensation range may vary based on factors including but not limited to skills, education, location and experience. Apply today at: https://ccwny.applicantpro.com/jobs/ As an Equal Opportunity Employer, Catholic Charities of Buffalo is committed to providing equal employment opportunities to all individuals, regardless of race, religion, color, national origin, citizenship, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, or any other protected characteristic. Catholic Charities of Buffalo will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities, unless such accommodations would impose an undue hardship on the operation of the business.

New York
Mass General Brigham logo

Dietitian, Cardiac Rehabilitation

Mass General Brigham

Mass General Brigham connects a full spectrum of care across a system of academic medical centers, specialty and community hospitals, physician networks, a heal

Medical Reviewer91 days ago

Title: Dietitian, Cardiac Rehab Location: Newton United States time type: Part time job requisition id: RQ4055586 Job Description: Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Located at 2014 Washington Street, in Newton, the Newton-Wellesley Cardiac Rehabilitation Program is a medically supervised program of lifestyle change to help patients regain strength, endurance, and skills to modify their risk of future cardiac events. We are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), a measure of excellence and quality. We are seeking a per diem Dietitian, to work 4 hours a week. This is an exciting opportunity to work alongside our nurses, dietitians, physical therapists, and behavioral health team who specialize in cardiac rehab to develop treatment plans and establish goals for our patients which may include patients from cardiac events or diseases such as MI, PCI, valve surgery, CABG, heart failure, heart transplant, angina, and other complex varieties of heart disease. The dietitian will demonstrate advanced knowledge pertaining to the evaluation, design, and standards of nutrition care for patients who qualify for or are enrolled in cardiac rehabilitation. This dietitian will provide education to individuals and groups on nutrition. Function as an essential member of a multidisciplinary team providing special expertise to patients and families participating in the Cardiac Rehabilitation program. If you are looking to apply your medical nutrition therapy experience to motivate clients to create behavior changes, this is the role for you! Job Summary Responsible to provide advanced clinical and administrative responsibilities within clinical nutrition in addition to managing the comprehensive medical nutritional care of patients which includes providing nutrition assessment, development of nutrition care plans, diet modification, nutrition education, and all activities involved in the nutritional needs of the patient population. Essential Functions: - Provides advanced clinical dietitian responsibilities which may include specialty or advanced patient population, participation in clinical care forums to serve as resource on nutrition related concerns, mentors new staff, and evaluation of new products. - Assist leadership team in program planning and proposals to improve processes or improve efficiency. - Based on multiple criterion including assessment of nutritional needs, physician's orders, clinical data, interdisciplinary health care plans, and standards of quality nutritional care that appropriately meet age, psychosocial and physical needs of patients, the dietitian develops and implements nutrition plan of care for patients. - Documentation of all nutrition related information including assessment, nutrition therapy recommendations and care plan, follow up data and changes, diet consultation results, discharge planning, daily clinical activities, and other related orders and pertinent information. - Counsel, educate, and develop resources and materials for the education of patients on families on prescribed therapeutic diets. Instruct patients to properly monitor blood glucose. - Provide education to patients individually and in a group or classroom sitting. - Compliance with American Heart Association, American College of Cardiology, and American Association of Cardiovascular and Pulmonary Rehabilitation guidelines. - Criticial thinking, problem solving, and collaboration. - Strong communication: both written and verbal. - Perform other duties as assigned. - Comply with all policies and standards. Qualifications Education Bachelor's Degree Clinical Dietitian required or Master's Degree Dietitian Required Can this role accept experience in lieu of a degree? No Licenses and Credentials Dietitian and Nutritionist [State License] Preferred Registered Dietitian [RD] Preferred Registered Dietitian Nutritionist [RDN] Preferred Experience Clinical Dietitian experience with multiple patient populations 3-5 years required Additional Job Details (if applicable) Work Location: 2014 Washington Street Scheduled Weekly Hours: 0 Employee Type: Per Diem Work Shift: Day (United States of America) Pay Range: $67,537.60 - $98,238.40/Annual Grade: 7 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 4100 Newton-Wellesley Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Massachusetts
Job Closed