Summary Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Location: This is a remote position, from 8:30am to 5pm Monday through Friday. What You’ll Do: - Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. - Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. - Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. - Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). - Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. To Qualify For This Position, You'll Need The Following: - Required Education: Associate's in a job related field. - Degree Equivalency: 2 years job related work experience. - Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. - Required Skills and Abilities: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. - Required Software and Tools: Microsoft Office. - Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as social worker from the United States and in the state of hire (in Div. 6B) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager. We Prefer That You Have The Following: - Preferred Work Experience: 7 years-healthcare program management. 4+ years of Renal/ Nephrology experience. - Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. - Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Job DetailsPosition Type: Part TimeSalary Range: $15.00 HourlyABOUT RELYMD RelyMD is a telemedicine company on a mission to simplify people's lives by delivering reliable, trusted medical care anytime and anywhere. We are proud to help lead the national movement to break down barriers to high-quality, on-demand care and to drive the march toward value-based medicine. POSITION OVERVIEW The Care Coordinator (Part-Time) plays a key role in supporting RelyMD's telehealth operations by ensuring a seamless and positive experience for both patients and providers. In this role, you will assist with patient intake, coordinate provider assignments, and facilitate patient discharge and customer support needs. We are looking for someone who is detail-oriented, compassionate, able to multitask, and confident navigating technology in a fast-paced virtual environment KEY RESPONSIBILITIES Conduct patient intake and verify demographic and insurance information using web-based EHR systems Coordinate provider assignments and manage care handoffs in real time Facilitate patient discharge and follow-up communications Provide responsive customer support to patients and providers via phone, chat, and video platforms Accurately document patient interactions and care coordination activities in the EHR Collaborate with clinical and operational teammates to maintain workflow efficiency Maintain compliance with HIPAA and all applicable privacy and security standards REQUIRED QUALIFICATIONS Medical background required; Medical Assistant (MA) or Licensed Practical Nurse (LPN) credential preferred Demonstrated proficiency with computers and web-based software — the ability to independently navigate platforms and learn new systems quickly is essential to success in this role Prior experience using an Electronic Health Record (EHR) or similar clinical platform Strong written and verbal communication skills with a professional, patient-centered approach Exceptional attention to detail and ability to multitask in a high-volume, remote environment Reliable high-speed internet connection and a quiet, distraction-free home workspace Availability to work daytime 12-hour shifts (7:00 AM – 7:00 PM or 9:00 AM – 9:00 PM), 12–24 hours per week, including weekends as needed Must be 18 years of age or older and authorized to work in the United States TECHNICAL & WORKSPACE REQUIREMENTS Ability to remain in a stationary position for extended periods while performing computer-based tasks Proficiency operating standard equipment: computer, keyboard, mouse, and headset Clear and effective communication via phone, video, and chat platforms Ability to occasionally lift or move office items or equipment weighing up to 10 pound Independent Physicians Resource, Inc. is committed to the principles of equal employment opportunity and strives to avoid all discrimination. All qualified employees and applicants are entitled to equal opportunities and treatment regardless of race, national origin, religion, sex, sexual orientation, gender identity, age, or physical or mental disability (subject to the ability to perform the essential functions of the job).

Imagine a career at one of the nation's most advanced health networks. Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work. LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day. Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network. Summary Coordinates all patient scheduling activities including appointments, procedures, and exams for multiple hospital, physician practice, outpatient departments, modalities, and facilities. Facilitates communication between staff, referral sources and physician offices regarding concerns/issues related to scheduling. Job Duties - Collects clinical information, obtains insurance, and verifies patient demographics to ensure appropriate scheduling of screening and diagnostic tests. - Schedules patients for physician appointments and diagnostic test procedures. - Educates patients, families and physician offices regarding department protocols, procedures, insurance, referrals and testing criteria. - Monitors practice protocols and department procedures and makes recommendations for improvement. - Utilizes scheduling software and other patient-specific software applications to facilitate patient access into the network. - Serves as a resource for staff, physicians, and referring offices. - Strives to reduce errors, minimize rework and defects through conscientious defects and attention to detail. Minimum Qualifications - High School Diploma/GED - 6 months medical office, call center or customer service oriented work experience or - in lieu of work experience, the completion of an Associate's Degree program or higher will be accepted. - Ability to maintain strict level of confidentiality. - Ability to work in a fast paced environment while handling multiple responsibilities. - Detail-oriented with the ability to enter information accurately into electronic systems. - Demonstrates ability to handle stressful situations. - Proficient in Microsoft Office applications. Preferred Qualifications - Familiarization with EMR and scheduling systems such as EPIC, PHS etc. - Bi-lingual English/Spanish. Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR. Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require. Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities. https://youtu.be/GD67a9hIXUY Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes. Work Shift: Day Shift Address: 1200 S Cedar Crest Blvd Primary Location: REMOTE IN PENNSYLVANIA Position Type: Remote Union: Not Applicable Work Schedule: Tuesday to Saturday 9-5:30 Department: 1004-13006 COH-Patient Access Center

Job Title: Nutrition Coach Location: Remote Company: Meta Care Inc. Job Type: Full-time Must have background as a registered dietician or nutritionist (This position will not require use of this licensure) Overview: National healthcare benefits organization seeking a Full-Time experienced Nutritionists to work in a fully remote position. This professional will assist our members in making positive and lasting lifestyle changes to benefit their health and overall well-being. S/he will coach clients through the process of developing a healthy mindset, improve their nutritional choices, and encourage them to meet individual goals. This position is non-clinical with a focus on education to impact lifestyle change. Responsibilities include but are not limited to: - Assesses, identifies, and addresses the nutritional needs of its members. - Demonstrates a broad nutritional knowledge of disease states including but not limited to diabetes, obesity, and other medical conditions. - Incorporates cultural sensitivity and positive lifestyle changes into care. - Collaborates with other disciplines to promote continuity of care. - Educates and coaches patients between visits to encourage compliance. - Provides telephonic counseling for individuals and groups - Develops and implements group programs for high-risk populations. - Utilizes technical resources to facilitate online group sessions. - Collects data relating to target population to evaluate the program and outcomes. - Participates in QI initiatives. - Assists members as needed. - Manages, maintains, and follows up on assigned members to ensure ongoing engagement and progress. - Proficient in the creation of individualized care plans tailored to each member’s needs. - Must see a minimum of 8 members per day. - Demonstrates excellent adaptability to technology platforms, with a required minimum typing speed of 80 words per minute (wpm). - Will attend and participate in on-site conferences and meetings for clients as supervisor requires which will require travel. - Required to develop quarterly business reviews that summarize work for past 90 days, current and projected. - Perform other duties as requested Key Qualifications: - Proven experience as a nutritionist. - Strong proficiency in creating and implementing care plans. - Exceptional ability to manage, maintain, and follow up with assigned members. - Comfortable and efficient in using technology platforms; minimum typing speed of 80 wpm required. - Excellent communication and organizational skills. - Ability to work independently and as part of a multidisciplinary team. Compensation/Benefits: Full time with 90% employer pays health benefits $65,000 to $75,000 annually - Paid Time Off: 15 days accrued per calendar year. Absent state sick time laws, no paid or unpaid PTO will be approved prior to 90 days of employment. - Sick Leave Policy, all full-time employees begin accruing sick leave immediately and my use it as it is accrued. Employees can accrue a maximum of 48 hours per year. Unused hours can roll from year to year, capped at a maximum of 80 hours. Once this cap is reached, no additional hours will be accrued until the total falls below the threshold. - Holidays: 7 days: New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, Day after Thanksgiving and Christmas Day* - Benefits: Meta Care will pay 90% of “single” medical premium should you choose to opt in Dental and Vision Insurance is available. You would be responsible for paying 100% of the premium for that coverage. - Must be able to travel and will be fully covered expenses**