Job Profile Summary A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations. Duties/Responsibilities: ·The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations. ·The Medical Peer Reviewer will render determinations in the format and within timeframes to follow Regulatory and Operational policies. · The Medical Peer Reviewer will: ·Maintain productivity standards. · Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases/caseload from multiple lines of businesses ·Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members/internal medical departments as needed ·Complete mandatory Company compliance training and training in new systems and software. ·Enter each day’s hours worked in Workday, on the same day. ·Perform other duties as assigned ·Responsibilities may be adjusted based on changing needs of the organization. Weekday Requirements: ·The Medical reviewer requires 25 hours a week of coverage. The configuration of the 25 hours may change with the business needs, with a minimum of 3 days a week, 2 days at 8 hours and one day at 9 hours. Maximum of 5 days a week of coverage · The Medical Reviewer will take 8 hours off during the week after being primary coverage for a weekend, usually the following Friday. ·Each Medical Reviewer will cover one legal holiday /year and will be compensated Holiday pay and straight hours worked ·The Medical Reviewer is eligible for Paid Time Off (PTO) and is required to plan and schedule time off with their direct supervisor following the Company policy. Weekend Requirements: · Each Medical Reviewer is required to be primary coverage one weekend a month · Each Medical Reviewer is required to be available as back up, if needed, one weekend a month · Dental Reviewers have a fixed schedule Minimum Qualifications: Licensed M.D. or D.O. or D.M.D. or D.D.S. Board Certified in a specialty recognized by the American Board of Medical Specialties Preferred Qualifications: ·Board Certified in Internal Medicine , Family Practice, OBGYN, Emergency Medicine ·Previous, relevant experience in utilization management and clinical practice ·Knowledge of Medicare, Medicaid, and MLTC plans ·Time management, critical thinking, communication, and problem-solving skills ·Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies ·Knowledge of member satisfaction/incident management and regulations ·Knowledge of quality improvement methodologies Compliance & Regulatory Responsibilities: Ensures compliance to internal Healthfirst and external regulations. · Licensed M.D. or D.O. or D.M.D. or D.D.S. · Annual Compliance and other training as assigned, may include but not limited to hardware, software, and system training upgrades · Annual Inter-Rater Reliability (IRR) Testing · Complies with the Healthfirst Conflict of Interest Policy for Professionals WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: - Greater New York City Area (NY, NJ, CT residents): $122,907 - $188,020 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. **This role requires approximately 50% travel to support members in the Kansas City KS metropolitan area. Applicants have the flexibility to work remotely from their home the remaining time. We provide all required equipment and reimburse for mileage at the current IRS rate. The schedule is Monday - Friday, 8am - 5pm.** Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs. - Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome - Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care - Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members - Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans - Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs - Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met - Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators - May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners - Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits - Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Requires a Bachelor's degree and 2 – 4 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

As a Remote Scheduling Specialist at Community Health Systems (CHS) - Patient Access Center, you’ll play a vital role in quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including: - Paid Time Off (PTO) - Comprehensive Health Benefits - Medical, Dental & Vision - 401k with company match - Tuition reimbursement Job Summary The Scheduling Specialist is responsible for supporting scheduling functions across assigned hospitals, clinics, or centralized patient access centers and will be the first point of contact for patients. This focuses on managing patient appointment scheduling, helping with general patient needs, and accurately communicating patient needs to the clinical staff through centralized call center operations. The Scheduling Specialist ensures communications and appointments are accurate, timely, and compliant with organizational policies while fostering effective communication with clinicians, patients, and leadership. Essential Functions - Completes accurate patient appointment scheduling across multiple clinics, depending on assignment. - Receives inbound communication from clinicians, patients, and staff via phone, text, email, and/or call center platforms to address scheduling needs, and handle urgent or emergent requests. - Assesses caller needs to identify urgent clinical matters for immediate warm transfer to clinic staff. For non-urgent requests (refills, clinical questions), accurately documents and route communications to the appropriate staff via the EMR. - Verifies patient demographics and insurance information, ensuring compliance with applicable requirements. - Research patient requests within the medical record, provide necessary information, and resolve inquiries effectively while maintaining patient confidentiality. - Monitors EMR in-baskets, call center systems, and related technology (as needed) to manage communication workflows effectively. - Provides timely and professional service to patients, providers, and facility staff, ensuring positive experiences and adherence to standards. - Performs other duties as assigned. - Complies with all policies and standards. - This is a fully remote opportunity. Qualifications - H.S. Diploma or GED required - Bachelor's Degree in Healthcare Administration, Business Administration, or a related field preferred - 1-3 years of experience in scheduling, operations, or healthcare administration required - 1-3 years of experience in physician/provider scheduling, patient appointment scheduling, or call center operations Knowledge, Skills and Abilities - Proficiency in scheduling software, EMR systems, and Microsoft Office Suite. - Excellent verbal and written communication skills with strong customer service orientation. - Delivers prompt, courteous, and knowledgeable support to customers. - Strong problem-solving skills and attention to detail. - Ability to manage multiple priorities in fast-paced hospital, clinic, or call center environments. - Knowledge of healthcare industry standards, patient confidentiality, and compliance protocols. We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers. This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.

Overview Manages the after-hours on-call administrative operations for assigned branches. This position is 100% remote for overnight, weekends, and holidays. Ensures that patient care and services are delivered appropriately and timely during after-hours and holiday coverage. Impacts patient, family and referral source satisfaction directly. The ideal candidate will be proficient with Homecare Homebase (HCHB), both PointCare and back office / R2 application. Responsibilities - Triage hospice calls appropriately during assigned shift and all company holidays. - Provide an environment which fosters continuous quality assessment performance improvement (QAPI); maintain high standards of patient care, integrity and cost effectiveness. - Provide a focused effort to reduce unnecessary hospitalizations and emergency department (ED) trips during after-hours and holidays. - Receive, review and enter patient referral information appropriately. Work with local branch to schedule patient admission during the weekend or holiday ensuring a same day admission philosophy. - Enter on-call coordination note in patient electronic record for all triaged calls. - Promote effective performance and delivery of after-hours hospice; guide clinicians appropriately. - Assist in the orientation of new triage nurses. - Contact local leadership appropriately for follow-up on time sensitive issues. Qualifications - Must be a registered nurse (RN). - Must have two years of full-time experience in hospice nursing. - Proficiency with Homecare Homebase, both R2 and PointCare is required. - Must have 5 years of full-time experience as a RN. - Must have one year of full-time experience in a supervisory hospice RN position.. - Must be able to work assigned shift and all company holidays. Additional Information Ever-mindful of the need for employees to care for themselves and their families, Enhabit offers competitive benefits that support and promote healthy lifestyle choices. Subject to employee eligibility, some benefits, tools and resources include: - 30 days PDO – Up to 6 weeks (PDO includes company observed holidays) - Continuing education opportunities - Scholarship program for employees - Matching 401(k) plan for all employees - Comprehensive insurance plans for medical, dental and vision coverage for full-time employees - Supplemental insurance policies for life, disability, critical illness, hospital indemnity and accident insurance plans for full-time employees - Flexible spending account plans for full-time employees - Minimum essential coverage health insurance plan for all employees - Electronic medical records and mobile devices for all clinicians - Incentivized bonus plan Enhabit Home Health & Hospice is an equal opportunity employer. We work to promote differences in a collaborative and respectful manner. We are committed to a work environment that supports, encourages and motivates all individuals without discrimination on the basis of race, color, religion, sex (including pregnancy or related medical conditions), sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, genetic information, or other protected characteristic. At Enhabit, we celebrate and embrace the special differences that makes our community extraordinary.