Registered Nurse - Utilization Management I--------------------------------------------------------------- The Registered Nurse – Utilization Management I is responsible for supporting one or more specific utilization management (UM) program functions within the Clinical Operations department. UM program functions include Benefit Management, Benefit Review and Appeals and Grievances. Together they support the healthcare needs of members, determine the best medically appropriate services, and apply clinical-based criteria for decision-making while managing medical expenses. Estimated Hiring Range: $100,350.00 - $122,650.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- General Duties - Communicate with members and/or providers in a professional manner and in accordance with State and Federal requirements as needed to complete requests. - Maintain confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards. - Refer members to care coordination per policies and procedures. - Maintain accurate and complete documentation. - Collaborate with Medical Directors to determine medical necessity and appropriateness of care for benefits requested and/or rendered. - Work with clinical support staff to ensure service requests, authorizations and/or grievances are managed in accordance with state and federal guidelines. - Identify and refer potential quality of care issues for peer review. - Ensure that authorization decisions are based on organizational policy and state and federal coverage rules. - Gather and submit documents for third party case review; this includes all documentation and follow-up activities. - Issue denial notices based on established unit protocols and state and/or federal requirements. - Assist with periodic audits, general quality management and improvement activities, and other regulatory activities as needed. - Foster collaboration with teams across the Clinical Operations department to ensure work and goals are met. - Meet or exceed department production, timelines, and quality standards established for level I. - May participate in departmental workgroups or projects as assigned. - Support testing for system updates and implementations as assigned. - May help train new staff and teammates as assigned. - Cross train in additional functional focus areas as assigned. Duties Specific to Functional Focus Area: - Benefit Management - Review provider pre-service requests and determine benefit coverage within Medicare, Medicaid or durable medical equipment. - Benefit Review - Determine appropriate level of care and length of stay for inpatient members to include hospitals, skilled nursing facilities, long term acute care hospitals, inpatient rehabilitation hospitals, and respite care programs. - Review inpatient admission for re-insurance clinical reporting. - Appeals and Grievance - Assemble evidence and build clinical cases for administrative hearings or Independent Review Entity (IRE) reviews. - Function as a CareOregon representative in administrative hearings. - Assist with the analysis and summary of data for written reports and public presentations as needed. - Communicate with members, providers, health plan administrators to manage grievances and appeals and provide case status updates as needed.  - Investigate and use clinical judgement to identify quality of care or safety issues and present findings to an oversight committee. Organizational Responsibilities - Perform work in alignment with the organization’s mission, vision and values. - Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. - Strive to meet annual business goals in support of the organization’s strategic goals. - Adhere to the organization’s policies, procedures and other relevant compliance needs. - Perform other duties as needed. Experience and/or Education Required - Current unrestricted Oregon RN license - Minimum 2 years RN experience [OR 1 year RN experience AND 3 years’ experience in healthcare setting role(s) such as billing, coding, medical assistant, etc.] Preferred - More than 1 year RN experience - Healthcare utilization management experience in the functional focus area (Appeals and Grievance, Benefits Review or Benefit Management) - Experience with Medicaid and/or Medicare utilization management Knowledge, Skills and Abilities Required Knowledge - Knowledge of Medicaid health plan and Medicare benefits - Knowledge of applicable DMAP rules and regulations - Knowledge of ICD-10, CPT, and HCPCS codes - Familiarity with the principles of utilization management - Familiarity with healthcare documentation systems Skills and Abilities - General computer skills including use of Microsoft Office applications and internet search functions - Ability to use review criteria in accordance with departmental policies - Ability to adhere to HIPAA regulations e.g., maintaining confidentiality of protected health information - Ability to interpret and apply complex policies and procedures - Ability to review work for accuracy - Ability to independently prioritize work - Ability to use critical thinking and problem-solving skills - Strong spoken and written communication skills - Strong interpersonal and customer service skills - Ability to work effectively with diverse individuals and groups - Ability to learn, focus, understand, and evaluate information and determine appropriate actions - Ability to accept direction and feedback, as well as tolerate and manage stress - Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day - Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

• Monitor license utilization across the organization to identify "shelfware" (unused software). • Act as the primary point of contact for vendors (e.g., Microsoft, AWS, Cisco). • Negotiate volume discounts, tiered pricing, and favorable Service Level Agreements (SLAs). • Conduct regular internal audits to ensure all software usage matches the legal license entitlement, avoiding heavy "true-up" penalties. • Use SaaS Management Platforms (SMPs) to automate onboarding/offboarding workflows, ensuring licenses are reclaimed immediately when an employee leaves. • Bridge the gap between Finance (budgeting), IT/Security (vetting tools for compliance), and Operations (ensuring the right tools are available).

• Provide deep category expertise and consultative leadership across Autodesk’s global Technology portfolio • Own category strategy development and execute sourcing initiatives • Design and implement innovative commercial models • Execute global RFPs and supplier evaluations focused on total value • Manage strategic relationships and ensure supplier governance

PO Requisition Processing and Contract Drafting Coordinator/ Project Coordinator 6312 Location: Novato, CA Hybrid Full-time Description Verista’s 500 experts team up with the world’s most recognizable brands in the life science industry to solve their business needs. The nature of our business is to empower growth and innovation within the scientific community and to help researchers, organizations, and companies solve some of the world’s most pressing healthcare challenges. Verista provides innovative solutions and services that empower informed decision-making and are the result of our significant investment in our people and our capabilities. Our ability to grow is driven by world-class people who thrive in a team environment and share our mission to enable life sciences clients to improve lives. Our talented and dedicated professionals are committed to making an impact every day. Company Culture Guidelines & Values: - We empower and support our colleagues - We commit to client success at every turn - We have the courage to do the right thing - We encourage an inclusive environment where our colleagues feel respected, engaged, and challenged. - We constantly acquire new skills and learn from our experiences to enhance our collective expertise Overview: We are seeking a highly organized and detail-oriented Project Coordinator to support capital expenditure (CapEx) projects within a facilities and engineering environment. This individual will play a critical role in project controls, financial coordination, and procurement activities, ensuring projects are executed efficiently, compliantly, and in alignment with organizational standards. The ideal candidate will bring strong experience in project coordination, financial tracking, and cross-functional collaboration, with the ability to manage multiple priorities in a fast-paced, regulated setting. Project Coordinator Responsibilities: • Support project controls processes, procedures, and systems for capital expenditure projects • Maintain and communicate Facilities Notices (will be trained, no prior experience is required) • Maintain and communicate Fire System Scheduler (will be trained, no prior experience is required) • Process purchase requisitions and change orders • Perform financial cross check on all requisitions for quality and CPC contracts processing standards • Perform self-authoring of contracts for all requisitions and change orders • Monitor purchase orders and identify potential issues and risks • Prepare and present requisition status reports to project stakeholders. • Identify opportunities to improve project controls processes and systems and make recommendations • Ensure compliance with relevant regulations and industry standards • Actively participate and support the contracts processing team • Collaborate daily with the Legal, Procurement, and offshore database teams • Comfortable in High Volume Job processing Requirements: - Bachelor’s degree in Business, Engineering, Construction Management, or related field preferred - 2–5+ years of experience in project coordination, project controls, or capital projects support - Experience with purchase requisitions, purchase orders, and financial tracking/reporting - Strong proficiency in Microsoft Office (Excel, Word, PowerPoint); experience with ERP systems is a plus - Familiarity with regulated environments (pharmaceutical, biotech, or manufacturing) is preferred - Onsite job requirement in Novato, CA on a hybrid basis For US geography, the salary range for this position is shown below. The actual salary is dependent upon a variety of job-related factors such as professional background, training, work experience, location, business needs, market demand, and competitive market practice. Therefore, in some circumstances, the actual salary could fall outside of this expected range. This salary range is subject to change and may be modified in the future. *Verista is an equal opportunity employer. National (US) Range $65,000 - $104,439 USD Benefits Why Choose Verista? - High growth potential and fast-paced organization with a people-focused culture - Competitive pay plus performance-based incentive programs - Company-paid Life, Short-Term, and Long-Term Disability Insurance. - Medical, Dental & Vision insurances - FSA, DCARE, Commuter Benefits - Supplemental Life, Hospital, Critical Illness and Legal Insurance - Health Savings Account - 401(k) Retirement Plan (Employer Matching benefit) - Paid Time Off (Rollover Option) and Holidays - As Needed Sick Time - Tuition Reimbursement - Team Social Activities (We have fun!) - Employee Recognition - Employee Referral Program - Paid Parental Leave and Bereavement Verista collects and processes personal data in accordance with applicable data protection laws