You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote Role: Seeking RN with NICU experience. Must reside in Oklahoma. Hours: Monday-Friday, 8AM to 5PM Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. - Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care - Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member - Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered - Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines - Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings - Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members - Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines - Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities - Collaborates with care management on referral of members as appropriate - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: - RN - Registered Nurse - State Licensure and/or Compact State Licensure 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

About the Role The Clinical Navigator is responsible for utilizing professional clinical skills, including the ability to foster patient relationships through empathy and clinical experience, to provide personalized, high-touch support to patients throughout their musculoskeletal care journey. The role will engage with patients and providers to provide expert, clinically relevant, evidence-based care navigation. The Clinical Navigator will manage the intake process, including telephonic outreach to engage patients with the TailorCare program and manage a series of touch points throughout the care journey as the trusted clinical advocate. Each Clinical Navigator will be assigned to a specified patient caseload in which they are responsible for managing. The touch points will uncover patient barriers and internal motivators, guiding patients from onboarding and therapy initiation to milestone celebrations, motivation, maintenance, and eventual “graduation” from the program. You’ll work collaboratively to enhance the patient experience and support patient compliance and persistence initiatives by building individual relationships with patients. As a patient educator, you will provide ongoing education and therapy support to the patient, their caregiver, clinical staff, and/or support network. Primary Responsibilities - Conduct outreach to patients eligible for TailorCare and educate them on the value of the program - Conduct intake assessments to identify patient clinical issues and needs - Provide health coaching throughout the journey to support adherence and compliance to their treatment plan - Provide condition education and shared decision making with patients to identify the correct treatment plan to meet their goals - Demonstrates empathy and effectively engages patients, creating a personalized relationship-based connection built on trust and rapport - Utilize motivational patient interviewing tools to quickly and accurately anticipate and address patient barriers; personalize patient messaging concisely, within established time parameters, and in a way that resonates with the patient - Communicate effectively; understand and influence patient initiation and support processes, encourage patient confidence and accountability to help patients start and stay on therapy - Provide information to the care team and proactively reach out after the clinical decision has been made to start patients on new care pathways - Provide continuous updates, guidance, and triaging when needed and most importantly ensuring that the patient is driving towards the right health outcomes. - Collaborate with provider teams, ancillary services and other community support programs - Perform other duties as assigned Qualifications - Doctor of Physical Therapy, Doctor of Physiotherapy (DPTs), or Master of Physical Therapy (MPTs) required - PT with current, unrestricted license in Georgia (Compact License preferred - You may be asked to apply for and maintain additional licenses over time) - Previous telephonic patient support environment experience, including use of an inbound/outbound call system, with seamless warm transfers - Strong communication and written skills to a variety of audiences, and experience working with a treatment team - Proven adaptability to changing business demands and problem solving in a fast-paced environment - Experience in motivational patient interviewing and coaching behavior change - Ability to work within established guardrails while maintaining personal rapport with the patient - Self-starter with proven adaptability to changing business demands and product relevance in a fast-paced environment - High level of comfort with technology, including Microsoft Office products, working on dual monitors, CRM, and strong typing skills are required - 3+ years orthopedic experience Skills - Previous telephonic patient support environment experience, including use of an inbound/outbound call system, with seamless warm transfers - Previous experience with remote/telemedicine care delivery Location This role is 100% remote, but preferred home location in Georgia for knowledge of the local community. GA PT/RN license is required. This position is classified as temporary and is not eligible for company-sponsored benefits, including medical, dental, vision, paid time off, or holiday pay. What's In It For You - Meaningful Work: We are dedicated to our mission and deeply value our patients and each other. Each day offers the opportunity to make a positive impact. - Work Environment: We operate as a remote-first company with options for a hybrid work model in Nashville. - Time Off: Our generous paid time off (PTO) and holiday plans ensure you have ample time to rest and recharge. - Family First: We offer paid parental leave and support a healthy work-life balance, encouraging flexibility and autonomy. We love talking about our family and pets! - Comprehensive Benefits: From Day 1, employees enjoy medical, dental, vision, life, and disability insurance, wellness resources and an employer HSA contribution. - Fair Compensation: We are committed to equitable pay for all team members and support your future goals with a 401k plan that includes employer matching. - Community: We foster an inclusive environment where you can rely on your teammates, share honest feedback, and feel comfortable being your authentic self at work each day. TailorCare seeks to recruit and retain staff from diverse backgrounds and encourages qualified candidates to apply. TailorCare is an equal opportunity employer and does not discriminate on the basis of age, sex, gender identity/expression, sexual orientation, color, race, creed, national origin, ancestry, religion, marital status, political belief, physical or mental disability, pregnancy, military, or veteran status.

Description Position Overview: MedOne is hiring a detail-oriented clinical reviewer that is a certified pharmacy technician to assess medication therapy, support prior authorization processes, mentor data entry staff, and collaborate across teams to ensure timely, high-quality service delivery. About MedOne: MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price. What You'll Do: - Support operations of MedOne Clinical Services - Conduct clinical assessments to evaluate the appropriateness of medication therapy as part of the clinical review/prior authorization process. - Communicate clinical review decision to pharmacies and providers - Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements - Complete Proactive Prescriber Outreach Program (PPOP) calls and requests as assigned. - Provide mentorship to the Data Entry Specialist team as required. - Assist Member Advocate and Account Management teams with patient or provider requests not requiring pharmacist intervention. - Works to promote a team environment - Support the operation and maintenance of existing MedOne Clinical Services - Assists and supports members of MedOne Pharmacy Benefit Solutions - Portrays the company in a positive image - Required to abide by all rules, regulations and policies of the employer - Other duties as assigned What You'll Bring to MedOne - Familiarity with PAHub processes; with 6-12 months of relevant DES experience within the last 12 months preferred. - Detail-oriented with a high degree of accuracy. - Strong interpersonal, written, and verbal communication skills. - Ability to work independently and manage time effectively. - Excellent customer service and teamwork skills - Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations (for remote employees) - Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint) - Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus. - Must be able to type at a minimum of 30 words per minute - Must be able to work independently, meets deadlines, establish priorities, and be flexible - Must be able to stand/sit for long periods of time within limited space - Must be able to lift up to 25 pounds - Must be able to work cooperatively with MedOne staff Why MedOne? At MedOne, we believe that a healthy team is a happy team. We offer a collaborative work environment, competitive benefits, and opportunities for growth—all while helping to make a difference in people’s lives. Our top core value is to prioritize your well-being. To support you in living this value, we offer: - Competitive salary and bonuses that reward your performance. - Comprehensive health, dental, and vision insurance + additional benefits - 401(k) with company match to secure your future. - Generous paid time off and holidays. - Opportunities for professional growth and development. - A vibrant and collaborative work culture. Location: Offices in either Dubuque, IA, or Kansas City, MO, or the position can be remote within the United States. Employment Type: Full-Time, Hourly Reports to: Clinical Review Technician Supervisor How to Apply: If you're enthusiastic about helping others and eager to join a dynamic team, we’d love to hear from you. Apply now and take the first step toward a rewarding career at MedOne! You can submit your application through our careers page. MedOne is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Job Offers are contingent on passing a background check and drug screen. MedOne is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Job Offers are contingent on passing a background check and drug screen.

Overview The Clinical Delivery SharePoint Organization Intern will support the Clinical Delivery department by organizing, standardizing, and improving the usability of the department’s SharePoint site. This internship is a short‑term, project‑based role focused on inventorying existing content, improving document structure and naming conventions, and enhancing overall accessibility and usability of departmental resources, including expansion of the chatbot capabilities. The intern will collaborate with department leadership and subject matter experts to ensure content is logically organized, current, and aligned with departmental and information governance standards. This role provides hands‑on experience in documentation management, content governance, and cross‑functional collaboration within a healthcare services environment. Responsibilities - Conduct an inventory of existing Client Services SharePoint content, including folders, libraries, pages, and documents. - Assess current organization, naming conventions, version control, and duplication of content. - Collaborate with department stakeholders to understand how content is used and identify gaps or outdated materials. - Propose and implement an improved SharePoint structure, including standardized folder hierarchy and naming conventions. - Reorganize and migrate approved content into the new structure while maintaining data integrity and appropriate access controls. - Archive, flag, or document outdated or duplicate content based on guidance from leadership - Identify and implement enhancements to chatbot functionality. - Assist in developing simple reference materials or guidance (e.g., “how to use this site”) to support long‑term sustainability. - Ensure all activities align with company information governance, data sensitivity, and documentation standards. - Provide a summary of completed work, recommendations, and suggested next steps at the conclusion of the internship. - Complete all special projects and other duties as assigned. - Must be able to perform duties with or without reasonable accommodation. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Qualifications - Currently enrolled in or recently completed a degree program in Business, Communications, Information Systems, or a related field. - Interest and some experience in utilizing AI solutions. - Strong organizational skills and attention to detail. - Familiarity with Microsoft SharePoint and Microsoft 365 tools (Word, Excel, PowerPoint). - Ability to analyze information, identify patterns, and recommend practical solutions. - Strong written and verbal communication skills. - Ability to work independently and manage project‑based tasks in a remote environment. Mental Requirements: - Ability to organize and synthesize large amounts of information. - Communicating with others to exchange information and clarify requirements. - Problem‑solving and critical thinking. - Interpreting documentation and applying standards consistently. - Ability to manage multiple tasks and meet project timelines. - Strong organizational skills with clear written and verbal communication. - Ability to work independently while collaborating with a distributed team. Physical Requirements and Working Conditions: - Must be able to provide high-speed internet access / connectivity and office setup. - Must be able to provide a dedicated, secure work area. - Remaining in a stationary position, often standing or sitting for prolonged periods. - Repeating motions that may include the wrists, hands, and/or fingers. - Communicating with others to exchange information. - Assessing the accuracy, neatness and thoroughness of the work assigned. - No adverse environmental conditions expected The base compensation for this role is $21.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law. Date of posting: 3/31/2026 Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/31/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected. #LI-Remote#LI-JB1#intern #LI-DNP