Role Description We are hiring an experienced RN Medical Virtual Assistant to support a U.S.-based healthcare and patient advocacy organization focused on compassionate, patient-centered care. This role is ideal for Registered Nurses (RNs) looking to transition into a long-term remote healthcare career while still utilizing their clinical knowledge, patient assessment skills, and care coordination experience. You will work closely with leadership and patients to support: - Virtual patient assessments - Care planning and follow-ups - Medicare navigation - Medication reconciliation - Care coordination and administrative support The company utilizes an AI-assisted healthcare platform to streamline workflows, patient interviews, and documentation while maintaining high-quality patient care. Qualifications - Minimum 2 years of nursing experience - Registered Nurse (RN) preferred - Strong clinical assessment and patient care planning skills - Experience in care coordination, patient follow-ups, and remote patient support or virtual healthcare - Strong understanding of healthcare workflows and patient care systems - Excellent English communication skills (written and verbal) - Highly organized with strong multitasking abilities Requirements - Must be proficient in speaking and writing English very clearly - Must have relevant work experience - Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding (mandatory) - Must be available for video meetings with your camera on (when needed) Benefits - Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication - Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks - HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients - Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention - Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule - Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client - Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best - Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance

Role Description The BCBA Senior Care Advocate (SCA) plays a key role in supporting the behavioral health needs of our members across multiple lines of business, including Commercial and Medicaid. The SCA is responsible for conducting initial, concurrent reviews, and utilization management for a variety of levels of care, including inpatient, residential, intensive outpatient, and partial hospitalization programs. This position requires solid clinical judgment, organizational skills, and the ability to effectively manage multiple priorities in a fast-paced environment. In addition to clinical work, the SCA will perform critical administrative functions, including reviewing and processing denials, documenting medical necessity, and completing the appeals process in compliance with state, federal, and plan-specific guidelines. Candidates must be available to work 8:00 am – 5:00 pm PST work hours. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Conduct utilization reviews for behavioral health services across multiple levels of care using established medical necessity criteria (InterQual, MCG, ASAM, etc.) - Evaluate clinical information and determine medical necessity and level of care using established guidelines and criteria - Develop, implement, and monitor individualized ABA treatment plans for members diagnosed with Autism Spectrum Disorder - Proficiently manage cases across various lines of business including Medicaid, HPN, and Commercial - Participate in live rounds with internal teams and/or medical directors to present cases and collaborate on care determinations - Review and process medical necessity and administrative denials and associated documentation with accuracy and timeliness - Complete and manage appeals cases according to required timelines and regulatory standards - Collaborate with other departments to resolve complex member needs and support care transitions - Monitor workload, prioritize tasks effectively, and demonstrate solid time management and multitasking abilities - Adhere to all organizational policies, regulatory requirements, and confidentiality standards Qualifications - RN or Master’s degree in social work, or related behavioral health field (LCSW, LPC, MFT etc.) - Active, unrestricted behavioral health license in the state of residence - Willing and able to obtain a Nevada state license upon hire - Current Board-Certified Behavior Analyst (BCBA) certification - 3+ years of behavioral health clinical experience in an inpatient/acute or outpatient setting - 2+ years of experience providing ABA therapy and supervising treatment plans Requirements - Current, unrestricted Nevada state license - Experience in managed care or health plan settings - Experience with denials and appeals processing - Proven solid knowledge of InterQual criteria - Familiarity with Medicaid, and Commercial benefit structures and utilization management protocols Soft Skills - Solid verbal and written communication skills - Excellent interpersonal, organizational, and critical thinking skills - Detail-oriented with solid critical thinking and decision-making skills - Ability to work independently and within a team in a remote or office-based environment - Proficient in using clinical systems, Microsoft Office applications, and electronic documentation platform - Proven ability to multi-task in a high-volume, deadline-driven setting Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) Salary The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

Role Description Collects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing, and deploying reports to provider networks and other end users for operational and strategic analysis. - Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. - Provides technical expertise, manages relationships with operational leaders and staff. - Directs staff assigned to their projects, maintains internal work plans as well as project work plans to meet reporting needs of the Health Plan. - Acts as a resource to HCS staff for mentoring, coaching, and analysis questions. - Responsible for staff time keeping, performance coaching, development, and career paths. - Daily management of Healthcare Analytics team. - Allocates new report/project requests (workload distribution). - Coordinates with Health Plan departments to meet data analysis and database development needs. - Reviews, evaluates, and improves Company business logic and data sources. - Reviews Health Plan analyst work products to ensure accuracy and clarity. - Reviews regulatory reporting requirements and Health Plan project documentation. - Maintains reporting service level benchmarks for Healthcare Analytics team. - Represents Healthcare Analytics department in cross-departmental and operational meetings. - Serves as liaison between Corporate IT and Health Plan regarding reporting needs. - Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns, and medical management. - Interfaces and maintains positive interactions with Health Plan and Corporate personnel. - Management of Health Plan Encounter workflow process. Qualifications - Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. - 3 years management or team leadership experience. - 10 years’ work experience preferable in claims processing environment and/or healthcare environment. - Strong knowledge of SQL 2005/2008 SSRS report development. - Familiar with relational database concepts, and SDLC concepts. Requirements - Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field (preferred). - 3 – 5 years supervisory experience (preferred). Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Are you an experienced nurse with a background in case management? Are you interested in the opportunity to work from home? UPMC Health Plan is looking for you! We are hiring a full-time Telephonic Care Manager to support the Special Needs Plan team. This position will be predominantly working from home and will work standard EST daylight hours, Monday through Friday. Preference will be given to candidates with a Pennsylvania or Compact RN license. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers. Responsibilities include: - Identifying members' medical, behavioral, and social needs and barriers to care. - Developing a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. - Collaborating and facilitating care with other medical management staff, other departments, providers, community resources, and caregivers to provide additional support. - Following members by telephone or other electronic communication methods. Qualifications - Minimum of 2 years of experience in a clinical setting and case management nursing required. - A minimum of 5 years nursing experience is highly preferred. - BSN preferred. - Ability to interact with physicians and other health care professionals in a professional manner required. - Excellent verbal and written communication and interpersonal skills required. - Computer proficiency required. - Meet minimum internet system/service and speed/latency requirements as set forth by UPMC. - Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily. Requirements - Case management certification or approved clinical certification preferred. - Registered Nurse (RN). - Act 34 clearance. - Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. - Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.