Become a part of our caring community As a RN Care Manager, you will enjoy a true work-life balance with no night or weekend shifts. Reporting to the Manager of Care Coaching, you will support members enrolled in the Wisconsin Family Care Program providing essential care coordination, support, and education. You will make a difference in the lives of those you serve and within your own community. You will: - Assess members, focusing on health and safety needs, to develop a comprehensive Member Care Plan (MCP). - Conduct regular health assessments - Coordinate with acute and primary care providers. - Educate members on disease processes and related risks, nutrition, exercise and lifestyle modifications to support informed decision-making while respecting each person's autonomy. - Document in member files within required DHS contract timeframes. - Participate in member monthly phone contacts and travel to attend in person visits in members setting. - Work remotely from your home and travel approximately 40% of the time to visit your members. Use your skills to make an impact Required Qualifications - Associate degree in nursing - Licensed Registered Nurse in the state of Wisconsin (in good standing) Preferred Qualifications - Reside within 45 mins or less of the assigned coverage area - Previous Care Management experience Additional Information - Location: Marshfield, WI - Travel: Up to 40% - Typical Workdays/Hours: Monday through Friday, 8:00 am – 4:30 pm CST. Driving This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. Mileage reimbursement is provided for work-related travel. Eligible mileage includes: - Travel from your home to your first work location of the day. - Travel between client or assignment locations during the workday. - Travel from your final work location back to your home. WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - Satellite, cellular and microwave connection can be used only if approved by leadership. - Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum. About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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.

• Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes • Monitor business processes and systems to assure integrity and compliance in billing and claims payment • Lead teams of analysts to appropriately investigate all possible fraud, waste and abuse referrals • Develop customized fraud plans to meet contract and federal requirements • Develop educational materials to identify/validate waste activities as requested by the health plan and on an ad-hoc basis • Respond to RFP requests and implement new policies per contractual obligation • Attend state/federal meetings as required by specific contracts • Prepare/present the FWA program to state/federal personnel upon request, specifically during readiness reviews, and immediately following the go live or upon state agency personnel changes • Review post-payment cases with appropriate parties to obtain refund • Prepare and distribute monthly and quarterly saving reports

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. 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. The training period will consist of live instruction, independent study, role play, and other training related activities which should take no more than 8 hours per day and 40 hours total in a workweek. - After successful passage of the mandatory product training examinations, the employee will be transitioned to exempt status and will no longer be eligible for overtime. They will then be paid on a bi-weekly basis and eligible to participate in various Takeda related sales incentive programs and/or contests. Takeda Compensation and Benefits Summary We understand compensation is an important factor as you consider the next step in your career. We are committed to equitable pay for all employees, and we strive to be more transparent with our pay practices. For Location: Ohio - Virtual U.S. Hourly Wage Range: $63.51 - $87.31 The estimated hourly wage range reflects an anticipated range for this position. 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