At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Senior Clinical Administrative Nurse is an outreach‑intensive role in which the nurse spends approximately 90%25 of the workday on the phone attempting engagement with membership. Using clinical expertise, the nurse conducts structured outreach to engage members, assess needs, and introduce available clinical services in support of organizational engagement goals. In addition to outbound outreach, the role supports members and their covered families with health care system navigation and care coordination. Acting as a clinical liaison, the nurse collaborates with members, caregivers, medical providers, and internal and external clinical teams to facilitate coordinated, efficient care using a clinically informed and operationally driven approach. Success in this role requires comfort spending most of the workday on the phone, sustained outbound calling, efficiency in member engagement, and the ability to balance clinical assessment with operational productivity expectations. Candidate must be willing to work weekdays 11:00 am – 8:00 PM CST, including Saturdays 8:00 am – 5:00 PM CST. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Provide members with tools and educational support to navigate the health care system and manage health concerns effectively and cost efficiently - Assist members with adverse determinations, including support through the appeals process - Educate members on the use of UMR internet based wellness tools and resources - Educate and guide members regarding behavioral health and substance use disorder (BHSUD) services - Provide ER steerage and education on appropriate emergency department utilization and alternative levels of care - Conduct outreach to members to provide pre admission counseling - Conduct outreach to members and caregivers to support discharge planning - Track all activities and maintain complete documentation to support customer reporting - Accept referrals through designated processes; collaborate in evaluating available services and coordinate required medical care and community referrals - Comply with all policies, procedures, and documentation standards across applicable systems, tracking mechanisms, and databases - Contribute to treatment plan discussions - Perform other duties as assigned You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - Current and unrestricted RN compact license - Ability to obtain additional state licensure as needed - 2+ years of acute nursing experience - 2+ years of behavioral health nursing experience - 2+ years of case management experience - Basic computer proficiency (i.e. MS Word, Outlook) - Proven ability to function independently and responsibly with minimal supervision Preferred Qualifications: - Bachelor’s degree in nursing - CCM - 2+ years managed care experience - Critical care, pediatric, med-surg and/or telemetry experience - Utilization management experience - Adverse Determination experience - Telecommute experience Soft Skills: - Demonstrated excellent verbal and written communication skills - Excellent customer service orientation - Proven team player and team building skills - Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #uhcpj

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Clinical Staff Pharmacist RemoteJob Description The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (e.g. formulary exceptions, prior authorization, step therapy, quantity limit exceptions) for delegated products and services. Responsibilities - Process the clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exception and tier exception; this includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client’s pre-approved criteria - Consult directly with healthcare providers to address non-formulary and clinical product coverage issues - Collaborate with team members to ensure consistent decision-making across the pharmacist team - Respond to medication-related inquiries via phone, providing accurate information to patients, providers, and clinics regarding medications, formulary options, and coverage questions - Other duties as assigned Minimum Qualifications - Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree - 1 years of work experience in clinical, retail, hospital, or managed care - Current pharmacist license in good standing with the State Board of Pharmacy Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications - Strong verbal and written communication skills - Ability to work efficiently with computers and digital tools ​ Preferred Qualifications - Managed care experience Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job Potential pay for this position ranges from $51.92 - $88.46 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits). Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.   We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

We are seeking a Centralized Clinical Support Staff member who is passionate about making a difference in our community. At Lone Star Circle of Care (LSCC) we strive for exceptional, equitable patient care that leads to healthier communities. Our Centralized Clinical Support Staff (CCSS) provides indirect patient care through telephonic and electronic communications, effectively engaging patients and supporting clinic-based teams. Working under general supervision, the CCSS exercises judgment and some discretion in routine situations. The CCSS will collaborate with employees at all levels within the organization, must be able to maintain professional working relationships, and provide excellent customer service. If you have the ambition and desire to work in a friendly and fun environment, LSCC is the place for you! A Day in the Life of a Centralized Clinical Support Staff member may look like this: - Provide front-line customer service, including scheduling appointments and verifying insurance benefits using electronic telephone and EHR systems - Obtain, evaluate, and accurately record patient information in the Electronic Health Record (EHR) system - Conduct patient outreach via text, email, mail, or phone using LSCC’s navigation center call platform - Accurately document all patient and clinical interactions in the EHR, ensuring entries are clear, concise, and grammatically correct - Communicate patient or family concerns to the appropriate healthcare provider - Collaborate with LSCC providers through electronic communication (e.g., bidirectional tasking and care coordination templates in the EHR) to support optimal patient care - Contact external healthcare organizations to confirm the status of patient appointments or referrals - Process referral orders from providers to support care coordination - Under the supervision of team RNs and as licensure permits, assist with tasks such as responding to provider requests, completing medication prior authorizations, processing referrals, filing triage reports, medical records, and lab letters - Assume responsibility for his/her own professional development and for sharing knowledge with others - Perform administrative tasks such as faxing, scanning, and managing bulk communications - Participate in required training, meetings, and quality improvement initiatives - Perform all other duties as assigned We ask our Centralized Clinical Support Staff member to possess a minimum of: - High School Diploma or GED - One (1) year of experience in a medical office or healthcare setting. The following experience/skills are preferred: - Medical Assistant (MA) certification or medication experience - Minimum of two (2) years of work in the healthcare field involving direct interaction with an EHR - Previous experience in pre-authorization/pre-certification and insurance verification - Bilingual English/Spanish language skills Key Success Factors Some key factors that will make an individual successful in this role: - Time management - Problem solving skills - Detail oriented - Team player Benefits LSCC offers a competitive benefits package, including: - Competitive salary; - Medical, Dental, and Vision insurance; - LSCC paid Life insurance; - LSCC paid Short-Term and Long-Term Disability insurance; - Paid Time Off; and - 403b Employee Retirement Plan

Role Description We’re recruiting for an experienced Clinical Lead to support individuals with Learning Disabilities, Autism, and behaviours that challenge across community-based services in the South of England. This is a fantastic opportunity for a clinically strong professional who is passionate about delivering high-quality, person-centred care while leading, training, and developing care teams to achieve the best possible outcomes. This role is perfect for: - A Registered Nurse (RNLD/RMN) or experienced Allied Health Professional - Someone with strong experience supporting behaviours that challenge - A professional with proven training, mentorship, and competency sign-off experience - A confident clinical leader who thrives working across multiple community services In this role, you will: - Oversee a caseload of individuals with complex learning disabilities and autism - Lead on clinical quality, ensuring safe and effective care delivery - Support and mentor care teams, building capability and confidence - Deliver training and sign off competencies across services - Develop and implement behaviour support strategies and care plans - Work closely with families, MDTs, and commissioners to achieve positive outcomes - Promote best practice in Positive Behaviour Support (PBS) and person-centred care Qualifications - Registered Nurse (RNLD/RMN) or experienced Allied Health Professional - Strong experience supporting behaviours that challenge - Proven training, mentorship, and competency sign-off experience - Confident clinical leader Requirements - Experience overseeing a caseload of individuals with complex learning disabilities and autism - Ability to lead on clinical quality and ensure safe and effective care delivery - Skills in supporting and mentoring care teams - Experience in delivering training and signing off competencies - Capability to develop and implement behaviour support strategies and care plans - Ability to work closely with families, MDTs, and commissioners - Knowledge of Positive Behaviour Support (PBS) and person-centred care Benefits - Salary £50,000 – £60,000 DOE - Community-based role with autonomy and flexibility - Opportunity to shape and influence clinical practice across services - Supportive leadership and governance structure - Ongoing professional development and career progression