Company : Highmark Inc.Job Description : JOB SUMMARY This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives. ESSENTIAL RESPONSIBILITIES - Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. - Function in accordance with applicable state, federal laws and regulatory compliance. - Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. - Promote quality and efficiency in the delivery of care management services. - Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. - Practice within the scope of ethical principles. - Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. - Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member. - Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. - Develop and sustain positive working relationships with internal and external customers. - Utilize outcomes data to improve ongoing care management services. - Other duties as assigned or requested EDUCATION Required - None Substitutions - None Preferred - Bachelor’s Degree in Nursing EXPERIENCE Required - 3 years of related, progressive clinical experience in the area of specialization - Experience in a clinical setting Preferred - Experience in UM/CM/QA/Managed Care LICENSES AND CERTIFICATIONS Required - Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional specific state licensure(s) may be required depending on where clinical care is being provided. Preferred - Certification in utilization management or a related field SKILLS - Working knowledge of pertinent regulatory and compliance guidelines and medical policies - Ability to multi task and perform in a fast paced and often intense environment - Excellent written and verbal communication skills - Ability to analyze data, measure outcomes, and develop action plans - Be enthusiastic, innovative, and flexible - Be a team player who possesses strong analytical and organizational skills - Demonstrated ability to prioritize work demands and meet deadlines - Excellent computer and software knowledge and skills Languages (Other than English) None Travel Requirement 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches/trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Does Not Apply Works primarily out-of-the office selling products/services (sales employees) Does Not Apply Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely, Occasionally Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $68,400.00 Pay Range Maximum: $105,900.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Study Manager - Respiratory (COPD) - Home Based ICON plc is a world-leading healthcare intelligence and clinical research organization. We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join us on our mission to shape the future of clinical development What you will be doing: Study Manager Support - Assists the SM Study Lead and study team with the operational conduct of clinical studies (e.g., CTT minutes, clinical supplies planning/tracking, lab specimen tracking, imaging data reconciliation, status update reports, study closeout activities) - May support a single study or multiple studies - May lead a study with limited scope (e.g., Survival Follow-up) - May be responsible for tracking study timelines and will be proficient in project management tools - May interact with internal and external stakeholders (study sites, vendors, committees, etc.) in support of clinical study objectives What you need to have: Educational Requirements - BS/BA/MS/PhD with 2+ yrs clinical research experience Minimum Years of Experience - Pharmaceutical and/or clinical drug development experience beneficial but not required - Respiratory (COPD) experience highly preferred - Demonstrated oral and written communication skills - Excel and PP experience required - To qualify, applicants must be legally authorized to work in the United States or Canada, and should not require, now or in the future, sponsorship for employment visa status What ICON can offer you: Our success depends on the quality of our people. That’s why we’ve made it a priority to build a diverse culture that rewards high performance and nurtures talent. In addition to your competitive salary, ICON offers a range of additional benefits. Our benefits are designed to be competitive within each country and are focused on well-being and work life balance opportunities for you and your family. Our benefits examples include: - Various annual leave entitlements - A range of health insurance offerings to suit you and your family’s needs. - Competitive retirement planning offerings to maximize savings and plan with confidence for the years ahead. - Global Employee Assistance Programme, TELUS Health, offering 24-hour access to a global network of over 80,000 independent specialised professionals who are there to support you and your family’s well-being. - Life assurance - Flexible country-specific optional benefits, including childcare vouchers, bike purchase schemes, discounted gym memberships, subsidised travel passes, health assessments, among others. Visit our careers site to read more about the benefits ICON offers. At ICON, inclusion & belonging are fundamental to our culture and values. We’re dedicated to providing an inclusive and accessible environment for all candidates. ICON is committed to providing a workplace free of discrimination and harassment. All qualified applicants will receive equal consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please let us know or submit a request here. Interested in the role, but unsure if you meet all of the requirements? We would encourage you to apply regardless – there’s every chance you’re exactly what we’re looking for here at ICON whether it is for this or other roles. Are you a current ICON Employee? Please click here to apply

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Senior Contract Manager - Managed Care Location Cleveland Facility Remote Location Department Ohio Market Finance-Finance Job Code T34033 Shift Days Schedule 8:00am-5:00pm Job Summary Job Details Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. As a Senior International Contract Manager, you will negotiate contracts on behalf of CCF within an assigned business area, evaluate new business opportunities, and manage the administrative, legal, operational, and financial aspects of contract negotiations. In this role, you will contribute to contracting strategy development, including business planning and implementation. A caregiver in this position works remotely from 8:00 a.m. -- 5:00 p.m. This role is required to meet with the team annually in Cleveland for a half-day, on-site meeting. Seeking candidates who reside in Ohio, Florida or Nevada. A caregiver who excels in this role will: - Negotiate contracts on behalf of CCF within assigned business area. - Evaluate new business opportunities. - Manage administrative, legal, operational and financial issues related to contact negotiation. - Participate in contracting strategy development including business planning and implementation issues. - Prepare, coordinate and manage contract negotiation process. - Identify and evaluate opportunities and financial terms for assigned contracts. - Assess potential legal risk in the context of contract provisions. - Develop appropriate legal and financial contract language. - Coordinate and participate in legal review. - Prepare responses, letters of agreement and key contract provisions. - Prepare and implement strategies for business growth. - Identify and target specific areas for development. - Initiate and develop relationships. - Track history and progress. - Serve as the principal contact for third-party payers and internal clients in the development, negotiation and review of proposed agreements. - Review contractual performance of both parties to ensure compliance with terms and to identify conflicts or changes requiring resolution at contract renewal - Develop methodology and review models that consistently and objectively evaluate the financial impact of proposals. - Update methodologies as contract issues change. - Prepare responses to Request for Proposals (RFP) as required. Minimum qualifications for the ideal future caregiver include: - Bachelor’s Degree in healthcare, finance, marketing or related field and five years of experience in contract management - OR High School Diploma / GED or equivalent and 9 years of related experience - Strong background involving managed care contracting with health systems to include hospital, professional, ancillary services - Experience with Fee for Service and Value Based negotiations for Commercial, Medicaid, Medicare Advantage and Marketplace plan types - Understanding of Revenue Cycle and Managed Care Business Operations - Managed care experience - Experience across multiple service lines (e.g., heart and vascular, transplant, women’s health) - Health system–based managed care contracting experience - Experience with claims payment methodologies and operations - Hands-on experience negotiating and managing health insurance contracts - Working knowledge of contemporary healthcare policies, practices, operations and reimbursement methodologies - Knowledge of physician practice management, hospital administration and operations - Rate and contract negotiation and influencing skills Preferred qualifications for the ideal future caregiver include: - Master's Degree - 10 years of experience in contract management - Certified Public Accountant (CPA) or Certified Management Accountant (CMA) (for Finance-related contracts) - Strategic contracting experience - Experience with transplant and high-cost drug negotiations Physical Requirements: - Ability to communicate and exchange accurate information. - Ability to perform work in a stationary position for extended periods. - Ability to work with physical records or operate a computer or other office equipment. - In some locations, ability to travel throughout the hospital system. - In some locations ability to move up to 25 lbs. Personal Protective Equipment: - Follows Standard Precautions using personal protective equipment as required for procedures. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster. Cleveland Clinic is pleased to be an equal employment opportunity employer.

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 115,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: Job Title Territory Manager, CPT - Dallas, TX Working at Abbott At Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life. You’ll also have access to: - Career development with an international company where you can grow the career you dream of. - Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year - An excellent retirement savings plan with high employer contribution - Tuition reimbursement, the Freedom 2 Save student debt program and FreeU education benefit - an affordable and convenient path to getting a bachelor’s degree. - A company recognized as a great place to work in dozens of countries around the world and named one of the most admired companies in the world by Fortune. - A company that is recognized as one of the best big companies to work for as well as a best place to work for diversity, working mothers, female executives, and scientists. Neuromodulation Our Neuromodulation business includes implantable devices compatible with mobile technology to help people who suffer from chronic pain and movement disorders. These non-opioid therapies allow us to provide interventional pain therapy to patients throughout the pain continuum. The Opportunity As a member of the regional sales team, the Territory Manager will be responsible leading the strategy within an assigned territory to accomplish planned objectives as to sales volume, market penetration, and profitability while ensuring alignment and collaboration across the team and with sales leadership. The incumbent will work in a highly matrixed, geographically diverse environment under general direction with clinical and sales teammates to identify and capitalize on sales opportunities by creating competency, comfort, and expertise with Abbott therapies among physicians, support staff and customers. The incumbent will perform work that involves a high degree of independence and will exercise sound judgment in planning, organizing, and performing work while continually seeking to improve territory efficiency. What You’ll Work On - Identifies strategies to increase referrals of Abbott therapies and overcome barriers that are restricting the national growth and adoption of the therapies - Integrates into accounts, builds trust, and establishes strong rapport with with new and existing customers, key opinion leaders (KOLs), and industry leaders - Generate additional sales revenue in assigned region by running initiatives targeted at increasing referrals of eligible patients - Exercises considerable latitude in determining the technical objective of work assignments - Trains and mentors new Territory Mangers - Collects and studies information about new and existing products and monitors competitor sales, prices and products - Ensures prompt follow-up of sales leads, investigation of complaints, and timely completion and filing of standard reports - Fosters high trust relationships with colleagues including the regional teams and area leadership - Conducts evaluations and develops sales strategies for capital equipment opportunities within accounts - Coordinates implanting schedules of aligned Territory Managers and Clinical Specialists - Interfaces and interacts with patients up to 50% of the time - Demonstrates fiscal responsibility by effectively managing consigned inventory used in the territory - Analyzes sales statistics, prepares reports, and performs required administrative sales duties such as filing expense account reports, scheduling appointments, and making travel plans - Exercises authority to make sales commitments for assigned efforts and is accountable for results - Attends trade shows where new products and technologies are showcased; meet other sales representatives and clients to discuss new product developments - Complies with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, company policies, operating procedures, processes, and task assignments - Maintains positive and cooperative communications and collaboration with all levels of employees, customers, contractors, and vendors - Performs other related duties and responsibilities, on occasion, as assigned Required Qualifications - Bachelor’s degree in a related field - an equivalent combination of education and work experience - 8+ years of sales experience in medical devices - 4+ years of work experience in Neuromodulation - Ability and willingness to travel within assigned area on a regular basis (% of travel varies by area) - Capable and willing to work an unpredictable schedule that may change on short notice - Excellent verbal, written and presentation skills with the ability to effectively communicate at multiple levels and to large groups within and outside the organization - Capable of managing multiple projects and accustomed to tight deadlines Preferred Qualifications - Prefer bachelor’s degree in biomedical engineering or related field - Prefer candidates with demonstrated leadership capabilities Apply Now Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives: www.abbottbenefits.com Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity. Connect with us at www.abbott.com, on Facebook at www.facebook.com/Abbott, and on Twitter @AbbottNews. The base pay for this position is $43,900.00 – $109,200.00In specific locations, the pay range may vary from the range posted. JOB FAMILY: Sales Force DIVISION: NM Neuromodulation LOCATION: United States of America : Remote ADDITIONAL LOCATIONS: WORK SHIFT: Standard TRAVEL: Yes, 25 % of the Time MEDICAL SURVEILLANCE: No SIGNIFICANT WORK ACTIVITIES: Continuous standing for prolonged periods (more than 2 consecutive hours in an 8 hour day), Continuous walking for prolonged periods (more than 2 hours at a time in an 8 hour day), Driving a personal auto or company car or truck, or a powered piece of material handling equipment Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans. EEO is the Law link - English: http://webstorage.abbott.com/common/External/EEO_English.pdf EEO is the Law link - Espanol: http://webstorage.abbott.com/common/External/EEO_Spanish.pdf