Blue Cross Blue Shield of Arizona logo
Blue Cross Blue Shield of Arizona

Inspiring Health in Arizona for over 80 years.

Integrated Care Manager - Adult (Remote)

ManagerManagerFull TimeRemoteLeadTeam 1,001-5,000Since 1939H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

38 days ago

Salary

0

Seniority

Lead

No structured requirement data.

Job Description

Integrated Care Manager - Adult (Remote)

Blue Cross Blue Shield of Arizona

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: - Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week - Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week - Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month - Onsite: daily onsite requirement based on the essential functions of the job - Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. Purpose of the job Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes. This job description is primary for case management functions but can assist with utilization management if a business need arises. Qualifications REQUIRED QUALIFICATIONS Required Work Experience - 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer Required Education - Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D Required Licenses - Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN. Required Certifications - Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC). PREFERRED QUALIFICATIONS Preferred Work Experience - 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred) - 1-2 year (s) of experience working in a managed care organization Preferred Education - Bachelor's Degree in Nursing or Health and Human Services related field of study Preferred Licenses - N/A Preferred Certifications - Active and current certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC). ESSENTIAL job functions AND RESPONSIBILITIES - Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan. - Answer a diverse and high volume of health insurance related customer calls on a daily basis. - Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc. - Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests. - Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director. - Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries. - Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines. - Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements. - Maintain complete and accurate records per department policy. - Demonstrate ability to apply plan policies and procedures effectively. - When indicated to assist with team/project functions: - Collaborate with team to distribute workload/work tasks; - Monitor and report team tasks; - Communicate team issues and opportunities for improvement to supervisor/manager; - Support/mentor team members. - Participate in continuing education and current development in the field of medicine, behavioral health and managed care at least annually. - The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. - Perform all other duties as assigned. Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group. Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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Specialty Business Manager IBD Cincinnati, OH

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Takeda is proud in its commitment to creating a diverse workforce and providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, parental status, national origin, age, disability, citizenship status, genetic information or characteristics, marital status, status as a Vietnam era veteran, special disabled veteran, or other protected veteran in accordance with applicable federal, state and local laws, and any other characteristic protected by law.

Manager38 days ago
Full TimeRemoteTeam 10,001

By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda’s Privacy Notice and Terms of Use. I further attest that all information I submit in my employment application is true to the best of my knowledge. Job Description Are you looking for a patient-focused company that will inspire you and support your career? If so, be empowered to take charge of your future at Takeda. Join us as a Specialty Business Manager for our Cincinnati, OH territory. Here, everyone matters, and you will be an important contributor to our inspiring, bold mission. As a Specialty Business Manager working on the Gastroenterology Specialty Sales Team, you will be empowered to drive product demand in targeted physician offices, key clinics and hospital accounts. How you will contribute: - Research prospective Health Care Professionals (HCPs) to identify the right customer stakeholders to present complex clinical and business information on products and services including Gastroenterologists HCPs and professional or patient groups. - Use insight and consultative selling techniques to teach HCPs about their industry and offer unique perspectives on their business, which link back to Takeda's solutions. - Engage in clinical discussions with HCPs to discuss patients' needs, execute brand strategies and maximize sales growth within a specific geography. 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Demonstrate high ethical and professional standards at all times. - Strategically manage allocated resources provided including financial/budgets, managed markets, medical affairs, home office, etc. Minimum Requirements/Qualifications: Required: - Bachelor’s degree – BS/BA. - 3+ years of successful selling experience in pharmaceutical, biotech or medical device and/or relevant clinical or industry experience.; OR 2+years of successful selling experience at Takeda. - Ability to discuss therapeutic strategies to inform and influence decision makers - Ability to successfully develop and apply clinical and business expertise, and effective selling skills - Strong verbal, influencing, presentation and written communication skills - Reside within or close proximity to assigned geography Preferred: - 5 years experience selling in pharmaceutical, biotech or medical device and/or relevant clinical or industry experience. - Execution of marketing strategies at the local level - Demonstrated business and strategic planning skills to identify unique selling opportunities and adaptability to changing market conditions - Demonstrated understanding of managed care landscape and how it influences/impacts business - Strong collaboration skills and success working in teams - Experience with injectable/infused IBD (Inflammatory Bowel Disorder) products - Experience with managing and communicating complex reimbursement issues - Biological product launch experience - Experience in calling on Gastroenterologists LICENSES/CERTIFICATIONS: Valid Driver's License TRAVEL REQUIREMENTS: - Ability to drive and/or fly to meetings and client sites - Some overnight travel required – 25-50%, depending on geographic assignment TRAINING REQUIREMENTS: - This position and continued employment is contingent upon the employee successfully passing mandatory product training which includes written and oral examinations. - External Takeda Hires Only: During that training period, the employee will be classified as a non-exempt employee and will be eligible for overtime during the training period only in accordance with applicable federal and/or state law but the employee will not be eligible for any Takeda related sales incentive programs and/or other production based bonuses. 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The actual hourly wage offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. The actual hourly wage offered will be in accordance with state or local minimum wage requirements for the job location. U.S. based employees may be eligible for short-term incentives. U.S. based employees may be eligible to participate in medical, dental, vision insurance, a 401(k) plan and company match, short-term and long-term disability coverage, basic life insurance, a tuition reimbursement program, paid volunteer time off, company holidays, and well-being benefits, among others. U.S. based employees are also eligible to receive, per calendar year, up to 80 hours of sick time, and new hires are eligible to accrue up to 120 hours of paid vacation. EEO Statement Takeda is proud in its commitment to creating a diverse workforce and providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, parental status, national origin, age, disability, citizenship status, genetic information or characteristics, marital status, status as a Vietnam era veteran, special disabled veteran, or other protected veteran in accordance with applicable federal, state and local laws, and any other characteristic protected by law. Locations Ohio - Virtual Worker Type Employee Worker Sub-Type Regular Time Type Full time Job Exempt No

Ohio
$64 - $87 / hour
Takeda logo

Specialty Business Manager IBD, Indianapolis North

Takeda

Takeda is proud in its commitment to creating a diverse workforce and providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, parental status, national origin, age, disability, citizenship status, genetic information or characteristics, marital status, status as a Vietnam era veteran, special disabled veteran, or other protected veteran in accordance with applicable federal, state and local laws, and any other characteristic protected by law.

Manager38 days ago
Full TimeRemoteTeam 10,001

By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda’s Privacy Notice and Terms of Use. I further attest that all information I submit in my employment application is true to the best of my knowledge. Job Description Are you looking for a patient-focused company that will inspire you and support your career? If so, be empowered to take charge of your future at Takeda. Join us as a Specialty Business Manager for our Indianapolis, IN territory. Here, everyone matters, and you will be an important contributor to our inspiring, bold mission. As a Specialty Business Manager working on the Gastroenterology Specialty Sales Team, you will be empowered to drive product demand in targeted physician offices, key clinics and hospital accounts. 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Coach customer stakeholders and build consensus for Takeda's solutions within their organization. - Collaborate with partners on routing and resource utilization to maximize overall footprint performance. - Independently and collaboratively strategizing for solving deal-level challenges. - Attend all company-sponsored sales and medical meetings as directed by company management. - Actively pursue learning and professional development on efficient sales, communication and product knowledge training. - Perform company business in accordance with all regulations and policies and procedures. Demonstrate high ethical and professional standards at all times. - Strategically manage allocated resources provided including financial/budgets, managed markets, medical affairs, home office, etc. Minimum Requirements/Qualifications: Required: - Bachelor’s degree – BS/BA. - 3+ years of successful selling experience in pharmaceutical, biotech or medical device and/or relevant clinical or industry experience.; OR 2+years of successful selling experience at Takeda. - Ability to discuss therapeutic strategies to inform and influence decision makers - Ability to successfully develop and apply clinical and business expertise, and effective selling skills - Strong verbal, influencing, presentation and written communication skills - Reside within or close proximity to assigned geography Preferred: - 5 years experience selling in pharmaceutical, biotech or medical device and/or relevant clinical or industry experience. - Execution of marketing strategies at the local level - Demonstrated business and strategic planning skills to identify unique selling opportunities and adaptability to changing market conditions - Demonstrated understanding of managed care landscape and how it influences/impacts business - Strong collaboration skills and success working in teams - Experience with injectable/infused IBD (Inflammatory Bowel Disorder) products - Experience with managing and communicating complex reimbursement issues - Biological product launch experience - Experience in calling on Gastroenterologists LICENSES/CERTIFICATIONS: Valid Driver's License TRAVEL REQUIREMENTS: - Ability to drive and/or fly to meetings and client sites - Some overnight travel required – 25-50%, depending on geographic assignment TRAINING REQUIREMENTS: - This position and continued employment is contingent upon the employee successfully passing mandatory product training which includes written and oral examinations. - External Takeda Hires Only: During that training period, the employee will be classified as a non-exempt employee and will be eligible for overtime during the training period only in accordance with applicable federal and/or state law but the employee will not be eligible for any Takeda related sales incentive programs and/or other production based bonuses. 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U.S. based employees are also eligible to receive, per calendar year, up to 80 hours of sick time, and new hires are eligible to accrue up to 120 hours of paid vacation. EEO Statement Takeda is proud in its commitment to creating a diverse workforce and providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, parental status, national origin, age, disability, citizenship status, genetic information or characteristics, marital status, status as a Vietnam era veteran, special disabled veteran, or other protected veteran in accordance with applicable federal, state and local laws, and any other characteristic protected by law. Locations USA - IN - Virtual Worker Type Employee Worker Sub-Type Regular Time Type Full time Job Exempt No

United States
$64 - $87 / hour
Johnson & Johnson Innovative Medicine logo

Field Reimbursement Manager Immunology GI- Houston Southwest, TX

Johnson & Johnson Innovative Medicine

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity.

Manager38 days ago
Full TimeRemoteTeam 10,001

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at jnj.com. As guided by Our Credo, Johnson & Johnson is responsible to our employees who work with us throughout the world. We provide an inclusive work environment where each person is considered as an individual. At Johnson & Johnson, we respect the diversity and dignity of our employees and recognize their merit. Job Function: Market Access Job Sub Function: Reimbursement Job Category: Professional All Job Posting Locations: Corpus Christi, Texas, United States, Houston, Texas, United States of America Job Description: About Innovative Medicine Our expertise in Innovative Medicine is informed and inspired by patients, whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow. Join us in developing treatments, finding cures, and pioneering the path from lab to life while championing patients every step of the way. Learn more at https://www.jnj.com/innovative-medicine At Johnson & Johnson Innovative Medicine (JJIM), what matters most is helping people live full and healthy lives. We focus on treating, curing, and preventing some of the most devastating and complex diseases of our time. And we pursue the most promising science, wherever it might be found. Johnson & Johnson Innovative Medicine’s Patient Engagement and Customer Solutions (PECS) team is recruiting for a Field Reimbursement Manager which will be a field-based position. This is a field-based position and the territory includes Houston, TX; Victoria, TX; Corpus Christi, TX; Katy, TX; and Sugar Land, TX. PECS is committed to setting the standard on Patient Experience (Px), building more personalized, seamless, and supportive experiences to help patients start and stay on treatments across the portfolio. Job Description: An important aspect of patient unmet need includes helping them start and stay on their medicine for the best chance at treatment success. The Patient Engagement and Customer Solutions (PECS) organization serves patients, during their treatment journey with Janssen therapies, to help overcome challenges to fulfillment, on-boarding, and adherence. The Field Reimbursement Manager (FRM) is responsible for serving as the primary field-based lead for education, assistance, and issue resolution with healthcare providers (HCPs), and their office staff, with respect to patient access to J&J Immunology therapies. This role involves investing time (up to 50%) on-site with HCPs, assessing their education needs and facilitating collaboration with various stakeholders. A Day in the Life Every patient’s healthcare experience is unique - shaped by personal experiences and beliefs, the presence or absence of support networks, provider and payer dynamics, and socioeconomic factors. For many patients, the decision to start or stop a treatment is overwhelming. J&J recognizes this, and wants to create an experience that is personalized, helpful, and hopeful. Primary Responsibilities: Primary responsibilities include the following. Other duties may be assigned. Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, etc.) for core and launch products. - Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team - Act with a sense of urgency to address critical access and affordability issues for patients - Partner with managed care colleagues to understand current policies and potential future changes - Conduct field-based reimbursement and access support, education and creative problem-solving aligned to FRM Rules of Engagement - Build strong, trust-based relationships with customers in all assigned Immunology accounts - Manage territory logistics, routing, and account business planning - Maintain and grow knowledge of national, regional, local, and account market dynamics including coverage and coding requirements - Grow the knowledge of hub and specialty distribution channels to improve practice and patient support needs - Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS. Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial). - Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training Market Access Expertise: - Extensive knowledge of medication access channels (i.e., pharmacy and medical benefit including buy & bill and/or assignment of benefit (AOB) across multiple sites of care - Remains current on and anticipates changes in product coverage and access knowledge, marketplace conditions, and stakeholder practices to deliver the most effective delivery of approved materials - Understands and adapts to the changing healthcare ecosystem to customize resourcing and messaging to HCPs and HCP staff Qualifications Required Qualifications: - Bachelor’s degree (preferably in healthcare or business/public administration). An advanced business degree (MBA), or public health (MPH)) is preferred. - Minimum of 5 years of relevant professional experience - Account Management and/or Reimbursement experience working in the provider office setting, building strong customer relationship - Demonstrated expertise with both pharmacy and medical/buy & bill benefits, coding, and billing - Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes) - Ability to establish relationships, collaborate, and influence across a matrix organization - Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner - Superior communication skills (written and verbal) and efficient follow-through - Experience in working with patient support HUB services - Valid US driver’s license and a driving record in compliance with company standards - Ability to consistently maintain up to 50% travel - Permanent residence in the listed territory Preferred Qualifications: - Immunology disease state experience - Advanced degree and/or relevant certifications in prior authorization and/or billing and coding - Strong market access acumen as it relates to payer approval processes and business acumen - Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products - Excellent technical knowledge and expertise in payer policy, including all elements of reimbursement (coding, coverage, and payment) is preferred - Demonstrated competence with salesforce.com CRM use, Microsoft Word, and Excel Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act. Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants’ needs. If you are an individual with a disability and would like to request an accommodation, please contact us via https://www.jnj.com/contact-us/careers or contact AskGS to be directed to your accommodation resource. #frm2026 Required Skills: Preferred Skills: Account Management, Coaching, Competitive Landscape Analysis, Compliance Management, Consulting, Cross-Functional Collaboration, Escalation Management, Fact-Based Decision Making, Finance and Accounting Platforms, Financial Reports, Market Access Reimbursement, Market Opportunity Assessment, Performance Measurement, Pricing Strategies, Process Improvements, Strategic Thinking, Technical Credibility

United States
Aledade, Inc. logo

Senior Manager, Compensation

Aledade, Inc.

With Primary Care. For Primary Care.

Manager38 days ago
Full TimeRemoteTeam 501-1,000Since 2014H1B No Sponsor

• Design and operationalize innovative company-wide, national compensation strategy and programs; partner with People leadership and external compensation consultants on the strategy, design, and implementation of executive compensation programs. • Manage the end-to-end annual merit increase, bonus distribution, and equity grant processes. • Partner with business leaders to advise on and manage incentive compensation programs. • Manage a foundational and scalable job architecture structure including leveling, benchmarking and supporting our company-wide budgeting and forecasting. • Provide support and consultation of all compensation to leaders across Aledade. • Lead regular audits to ensure internal equity and compliance with evolving transparency laws.

United States