Reconsideration Analyst I (RAI) Overview: J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels. Position Purpose: Performs routine appeals work. Serve as a support person for the reconsideration professionals and physician reviewers for second level reconsiderations resolutions. Works under close supervision, with minimal latitude for the use of initiative and independent judgement. Essential Responsibilities: - Coordinates the delivery of appeals case files resolution documents and reconsideration decisions from and to the external entities. - Build a reconsideration case file from evidence submitted or auto forwarded from Plans and analyzes each case to ensure it meets the requirements for a valid reconsideration as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities. - Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal. - Inputs appropriate data regarding reconsiderations into the applicable required systems. - Responds to reconsideration from appellants/providers. - Routes or responds to telephonic and/or written inquiries from appellants/ about reconsiderations or about the reconsiderations process from appellants/or their legally designated representatives. - Identifies any suspected instances of fraud and/or abuse and immediately inform management of such issues. - Stays abreast of changes in regulations and practices, policies and procedures. - May submit requests for re-determination files and completed reconsideration and Administrative Law Judge (ALJ) decisions to relevant entities. - May support the processing of reopenings following receipt of ALJ remands. - Participates in special projects and performs other duties as assigned. Minimum Qualifications Education - High School Diploma or equivalent Experience - One (1) year of general office experience College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.) - Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred Knowledge, Skills and Abilities Some Knowledge of - Research techniques - Medicare appeals program - Applicable systems and applications - Applicable laws, rules and regulations Some Skill in - Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency - Prioritizing and organizing work assignments - Researching, analyzing and interpreting policies and state and federal laws and regulations - The use of personal computers and applicable programs, applications and systems Ability to - Meet production and quality standards - Multitask and meet deadlines - Exercise logic and reasoning to define problems, establish facts and draw valid conclusions - Make decisions that support business objectives and goals - Identify and resolve problems or refer issues appropriately - Communicate effectively verbally and in writing - Adapt to the needs of internal and external customers - Show integrity and ethical behavior, respect for confidentiality, business ethics and organizational standards - Assures compliance with company policies, procedures, and guidelines including cybersecurity, regulatory, contractual and accreditation entities J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.

Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Responsibilities Under minimal direction, the Beaker Analyst will be responsible for the design, build, testing, training, and support of the Electronic Health Record (EHR) system. The Analyst requires little or no supervision as they build, maintain the system and exercise independent judgement and discretion in carrying out day-to-day support related activities. The Analyst performs complex design and analysis tasks related to the hospital business operations. The Analyst will also act as a mentor to other members of the Beaker team. #LI-KT1 #remote Qualifications Required qualifications: - Bachelor's degree in Healthcare Informatics, Nursing, Computer Science, Information Technology, or related field. - Certification in Epic applications (e.g., Epic Beaker, etc.) and any new certifications must be obtained within 3 months of hire. - Two (2) years of experience implementing, configuring, and supporting Epic EHR applications. - Proficiency in system configuration, customization, and optimization within the Epic environment. - Strong understanding of hospital business operations and structure, clinical workflows, general requirements in an integrated delivery system, and use of IT applications in the practicing healthcare environment. - Strong computer skills including Windows, Outlook, Word, Excel, Visio, and PowerPoint - Technical expertise in subject matter areas demonstrated by documented experience in analysis, process design and workflow, research, installation/implementation, and support of EHR systems. - Ability to independently prioritize work assignments, meet deadlines and manage multiple projects and/or priorities. - Customer service oriented and excellent communication and organizational skills. - Able to travel up to 50% and take calls as needed. Preferred qualifications: - Prior experience in EMR implementations and/or support. - Experience with project management methodologies and tools. Pay Transparency Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $68,640.00 to $124,800.00 on an annualized basis. The compensation estimate noted above is specific to California and has not been adjusted for any other geographic location. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure. Employment Status Full Time Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf Privacy Notice Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

Patient Support Supervisor Location: Stoughton and Phoenix Area Preferred (other locations considered based on unique situations) Shields is seeking an experienced person who loves to work with and lead people, has strong management skills, who is highly motivated self-starter who is looking for a challenging career with a fast-growing company in specialty pharmacy management services. Applicants should be results-oriented with a positive outlook and a clear focus on high quality. A natural forward planner who critically assesses their own performance. The ideal candidate should have front-line employee management experience with a background in pharmacy or healthcare. Applicant should be service-oriented, motivational in their style and have a clear focus on performance accountability and employee development. The applicant must be able to work as a member of a close-knit team. A Patient Support Supervisor is a key leadership position supporting Shields Health Solutions Patient Support team. This position will provide day-to-day leadership for a significant portion of Patient Support Center and will be responsible for leading a team of Patient Support team members. This person is primarily responsible to ensure either/both of the following: Manage all responsible work of assigned sites/clinics and ensure service level metrics are reached in accordance with contract requirements. The leader is responsible for ensuring the adoption and continuity of best practices, providing ongoing support, coordinating coverage, coaching, performance management and professional development of the team, and any other support team members. Key Responsibilities: - Directly lead and manage a team of Patient Support Associates to ensure medication adherence through refill management OR timely and accurate prior authorization and financial assistance support to assist patients in obtaining medication. - Proactively manage support in assigned hospitals and/or clinics to ensure patients receive medications on-time - Lead and manage a Patient Support team to ensure all service level goals are met and patients receive the highest quality care - Manage all aspects of ADP, Paid Time Off (PTO), and Time Reports for team members - Complete audits of team in supported systems required to ensure efficient workflow - Manage responsiveness to new request in supported systems - Provide front-line supervision and ongoing coaching and performance management to Patient Support team - Monitor and acting on all forms of communications between the Patient Support team and other clinical teams as needed - Work with on-site management at hospital partners for any collaboration calls, such as quarterly calls, kick off calls, as needed calls - Patient Support team meetings: create agendas, run meeting, follow-up - Hospital Management meeting: calls with on-site manager to review current status, identify areas for improvement, and areas of success - Record keeping/notes of all collaboration calls and team meetings - Provide guidance/assistance/troubleshooting in daily tasks for Patient Support team members as requested by team - Review and address any concerns with Patient Support team, and hospital partners as needed - Establish efficient workflows between the Patient Support team and liaison team via collaboration with clinical integration team and on-site managers. - Provide insight to various teams across company for growth and development opportunities as needed - Work with various teams for special projects - Report on hiring needs based on implementation roll outs - Assist in interviewing, and onboarding new team members - Coordinate access requests for new hires - Coordinate training with Clinical Training Team - Absorb overflow work in times of short staffing or excess workload - Investigate research needed for data analytics team, contracting team as needed - Manage on site pharmacy relations and workflows through some/all of the following: reversal of claims, delivery slips, coordination of care, phone calls - Use discretion and maintain confidentiality of highly sensitive and private data. - Ability to lead, manage, and motivate team members that are in both remote working environments and/or at on-site Shields hub locations - Reports to Director or Manager of Patient Support Center Experience/Requirements Required Licensure/Certification: - We are seeking experienced pharmacy technicians who are registered with the State of employment and also nationally certified as a CPhT. Should certification need to be obtained for a particular state or updated at the time of employment, the applicant will commit to obtaining the required certification within a mutually agreed upon timeframe. Continued employment is contingent upon meeting these requirements. - Required 3+ years of pharmacy technician experience (3-5+ years’ experience preferred in Specialty Pharmacy) - Strongly preferred leadership experience (i.e. Team Lead or equivalent type role or experience where you have led other team members even if they do not directly report to you) Education: - Required: High School diploma / GED required - Preferred Education: High School / GED (Bachelor’s degree is preferred or actively working toward degree) - Preferred Training: Training on leadership/management theory and its practical applications in the workplace (on-line / classroom / self-study) Skills: - Strong communication presence with ability to influence without formal authority - Ability to make decisions and negotiate with more senior leaders that results in a mutual and positive outcome - Excellent leadership and interpersonal skills - Ability to effectively train and inspire Patient Support team leaders to be more independent - Strong operational management skills and able to evaluate trends and identify opportunities for program improvement - Ability to manage projects and see them through effective completion - Manage and prioritize workload while meeting deliverables and expectations - Ability to effectively train employees, lead by example and use motivational techniques to improve/maintain employee engagement - Patient-centered, organized, high-integrity, motivational, attention to detail, dependable, quality focus, empathetic, good listener/communicator, a good teacher, able to lead a group of individuals - Ability to use discretion and maintain confidentiality of highly sensitive and private health information - Strong communication skills, highly proficient in Microsoft Office particularly Excel and Word - Strong phone skills - Knowledge and skills using Pharmacy dispensing or EMR systems (knowledge of the Willow, Qs1, and RX30 software system a plus) and able to identify relevant information with a focus on quality is also desirable. - Proficient in excel using basic formulas, data manipulation, graph creation, and other moderately advanced excel skills - Possess strong organizational skills - Remote positions not in a Shields core location (Stoughton, Phoenix): Willingness to travel up to 20% if needed to meet job requirements California residents employed by or applying for work at Shields have certain privacy rights. Please review our: California Workforce Privacy Notice and Privacy Policy. By providing your mobile number, you agree to receive text messages from Shields Health Solutions related to job opportunities, interview scheduling, and recruiting updates. Message and data rates may apply. You may opt out at any time by replying 'STOP.' Consent is not a condition of employment. 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.

BeOne continues to grow at a rapid pace with challenging and exciting opportunities for experienced professionals. When considering candidates, we look for scientific and business professionals who are highly motivated, collaborative, and most importantly, share our passionate interest in fighting cancer. General Description: We are seeking a highly motivated candidate to join our Clinical Pharmacology and Pharmacometrics (CPP) group. The successful candidate will support a variety of Clinical Pharmacology activities, including tasks related to non-compartmental analysis (NCA), data visualization, table generation, quality control (QC) of results, and data curation to support novel small molecules and biologics assets in the company portfolio. This role requires a strong STEM background and proficiency in data manipulation tools such as R and/or Phoenix WinNonlin (WNL). Exposure to clinical pharmacology and pharmacometric approaches for characterizing pharmacokinetic profiles; assessing drug/food interaction potential; characterizing QT prolongation potential, etc is desirable but not required. Essential Functions of the Job: You will work with experienced colleagues in the CPP group on facilitating the following activities to support Exploratory Analyses, CSRs, Health Authority responses, or Marketing authorization/NDA/BLA submissions: - Non-Compartmental Analysis (NCA): - Perform NCA to characterize the pharmacokinetics of drug candidates. - Interpret and report NCA results. - Data Visualization and Table Generation: - Create visualizations and tables to effectively communicate pharmacokinetic and pharmacodynamic data. - Ensure accuracy and clarity in data presentation. - Quality Control (QC) of Results: - Perform QC checks on analysis results to ensure data integrity and compliance with internal and regulatory standards. - Document QC processes and findings. - Data Curation and Engineering: - Modify large datasets to prepare for analysis. - Utilize tools such as R and Phoenix WNL to streamline workflows. - Support assembly of relevant ClinPharm datasets. Supervisory Responsibilities: - Assist with and/or lead internal trainings periodically Computer Skills: - Proficiency in using R for data manipulation, visualization, and basic statistical analyses is required. - Hands-on experience in performing NCA using Phoenix WinNonlin is preferred. - Experience or exposure with one or more of the following is desirable: NONMEM, Berkeley Madonna, Simcyp, Gastroplus, Matlab. - Exposure to working with and manipulating large datasets Education Required: - A B.S. with 5+ years relevant work experience, a M.S. with 4+ years relevant work experience, or PhD with 2+ years relevant work experience. - Education: Pharmacokinetics, Pharmaceutical Sciences/Pharmacy, Biomedical Engineering, Bioinformatics, Data Sciences, Mathematics, or related STEM discipline Other Qualifications: - Demonstrated commitment to problem solving and developing creative solutions - Detail oriented to ensure accuracy and thoroughness of work - Ability to multi-task - Ability to adapt to fast-moving timelines and quick turnaround times - Strong written and oral communication skills - Strong drive to learn and apply emerging technologies such as AI, ML, or other tools to improve daily task efficiencies Travel: N/A Global Competencies When we exhibit our values of Patients First, Driving Excellence, Bold Ingenuity and Collaborative Spirit, through our twelve global competencies below, we help get more affordable medicines to more patients around the world. - Fosters Teamwork - Provides and Solicits Honest and Actionable Feedback - Self-Awareness - Acts Inclusively - Demonstrates Initiative - Entrepreneurial Mindset - Continuous Learning - Embraces Change - Results-Oriented - Analytical Thinking/Data Analysis - Financial Excellence - Communicates with Clarity Salary Range: $120,100.00 - $160,100.00 annuallyBeOne is committed to fair and equitable compensation practices. Actual compensation packages are determined by several factors that are unique to each candidate, including but not limited to job-related skills, depth of experience, certifications, relevant education or training, and specific work location. Packages may vary by location due to differences in the cost of labor. The recruiter can share more about the specific salary range for a preferred location during the hiring process. Please note that the listed range reflects the base salary or hourly range only. Non-Commercial roles are eligible to participate in the annual bonus plan, and Commercial roles are eligible to participate in an incentive compensation plan. All Company employees have the opportunity to own shares of BeOne Medicines Ltd. stock because all employees are eligible for discretionary equity awards and to voluntarily participate in the Employee Stock Purchase Plan. The Company has a comprehensive benefits package that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness. We are proud to be an equal opportunity employer. BeOne does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, Title I of the Americans with Disabilities Act of 1990, and any other applicable federal, state or local laws, applicants who require reasonable accommodation in the job application process may contact accommodationsus@beonemed.com.