We are hiring a Home Health Case Manager at BCBST! In this role, you will support TennCare (Medicaid) members with complex medical, functional and social needs. You will coordinate home and community-based care, conduct required home visits, and support members transitioning to adult benefits. You’ll collaborate closely with providers and internal care teams using digital tools to identify care gaps, reduce hospitalization risk, and improve outcomes. To be successful in this role, in addition to the core job requirements, you'll bring strong clinical judgement, experience using digital tools to communication, and availability for home visits. You will be a strong candidate for this role if you have the following: home health or hospice nursing experience, pediatric experience, knowledge of MTLSS programs, and familiarity with community-based services. Note: - This is a remote, Monday–Friday (8:00 a.m.–5:00 p.m.) role with flexibility to support member needs, however this role requires traveling to members' homes monthly in the Memphis area. - Candidates must live within 50 miles of Memphis. - Sponsorship is not available for this role. Job Responsibilities - Supporting utilization management functions for more complex and non-routine cases as needed. - Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. - Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits - Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. - Digital positions must have the ability to effectively communicate via digital channels and offer technical support. - Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. - Various immunizations and/or associated medical tests may be required for this position. - This job requires digital literacy assessment. Job Qualifications License - Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience - 3 years - Clinical experience required - 5 years - Experience in the health care industry - For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required Skills\Certifications - Excellent oral and written communication skills - PC Skills required (Basic Microsoft Office and E-Mail) Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. *** This is a fully remote, full-time position requiring availability Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. *** Position Summary: Under the leadership and direction of the Executive Medical Director for Duals, the Lead Senior Medical Director provides strategic leadership and clinical oversight for complex populations—primarily DSNP/FIDE—and is responsible for leading a team of Senior Medical Directors/Medical Directors within the Center of Excellence (COE) Duals. This role drives medical management programs and policies that improve quality, cost, and outcomes across the continuum of care; integrates medical, behavioral, and social drivers of health; serves as a clinical and business liaison to internal teams, network providers, and state agencies; and ensures compliance, operational excellence, and superior member experience. Key Responsibilities: Leadership & Team Management • Lead, coach, and develop a team of Senior Medical Directors; foster collaboration among peers • Manage coverage schedules, vacations, team assignments, and change management. • Provide ongoing coaching and feedback to ensure peak performance; build a culture of continuous improvement and integrity • Development of “How” to solve the problem • Actively participate in scheduled team and leadership meetings at health plan, local, state, regional, and national levels supporting the EMD. • Strategy involvement, supporting goal setting, clinical leadership Clinical Oversight for DSNP/FIDE & Complex Populations • Responsible for clinical oversight of DSNP/FIDE complex populations. • Develop and lead clinical strategy and objectives for DSNP/FIDE, including clinical initiatives/programs to improve outcomes. • Facilitate/Improve interdisciplinary care team rounds for DSNP/FIDE members • Confer directly with CMOs/SMDs/MDs regarding care of patients with severe, complex, and/or treatment-resistant illnesses through peer review and educational interventions. Medical Management, Quality & Programs • Ensure compliance with clinical goals by monitoring care management performance; expand medical management programs to address member needs. • Assists to develop, implement, and interpret medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments. • Develop and guide implementation of programs ensuring providers deliver appropriate, high-quality, cost-effective health risk assessments (HRAs) and other evidence-based services. • Support preparation for program audits and/or certification processes; actively participate in internal/external quality improvement activities. • Help achieve or exceed HEDIS, Stars, and state performance targets; support Clinical Quality initiatives and peer review processes (Quality of Care and Quality of Service/grievance). • 20% of time on Cross Functional projects and initiatives • Functional P&L responsibility at the large account level for the markets involved • Owns the performance of the whole business relationships Performance Metrics & Success Measures • Clinical Outcomes (Quality): Preventive care & screening performance (HEDIS), chronic disease control (HbA1c, BP), transitions of care, hospital readmissions/PCR, medication adherence. • Utilization & Cost: Avoidable ED utilization, ambulatory-care sensitive admissions, total cost of care (PMPM), risk adjustment accuracy. • Member Experience & Equity: CAHPS scores, care coordination timeliness, health equity improvements. • Operational Performance: Program adoption/enrollment, provider engagement, compliance audit results, interdisciplinary rounds completion. • Subject matter expert on regions assigned / workstream • Regional responsibilities, assigned for assigned territory and oversight Required Qualifications: • MD or DO degree. • Current, active, unencumbered, unrestricted physician licenses in any state • Current and active Board Certification in an American Board of Medical Specialties discipline • 5+ years post-residency clinical practice, including complex population experience (minimum three years of specialty training). • 3+ years of managed care industry experience. • Ability to travel 10% • Proven ability to develop relationships with network/community physicians and providers. Preferred Qualifications: • Current, active, unencumbered, unrestricted physician licenses in IL, MI, NJ, and/or VA preferred • 1+ years of management experience leading a team of doctors/nurses with direct reporting • Strong proficiency with MedCompass • Project management or active project participation experience. • Substantial experience using electronic clinical systems. • Solid data analysis and interpretation skills with focus on key metrics. • Demonstrated team-player and team-building skills • Proven strategic thinking with ability to communicate a vision and drive results. • Solid negotiation and conflict management skills; creative problem-solving skills. Education: MD or DO, Board Certification as stated above Pay Range The typical pay range for this role is: $184,112.00 - $396,550.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Description Your experience matters Lifepoint Health is a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Behavioral Health Transfer Center RN joining our team, you’re embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. More about our team Our Access Point Behavioral Health Transfer Center serves as a centralized hub for coordinating timely and appropriate placement of individuals in need of acute behavioral health care. Operating 24/7, the center streamlines the transfer process by assessing clinical needs, verifying bed availability, and arranging transportation to ensure patients receive the right level of care without delay across 18 locations. Staffed by a team of 31 experienced mental health professionals, including clinicians, nurses, EMTs, and case managers, we serve as a liaison between referring facilities, facilitating over 6,000 transfers per month. Our goal is to reduce waiting times, prevent care gaps, and ensure seamless transitions for patients experiencing mental health or substance use crises. Here you will have the opportunity to work remotely in a dynamic, fast-paced, and mission-driven environment. How you’ll contribute A Behavioral Health Transfer Center LPN (Remote), who excels in this role: · Screen and coordinate patient admissions and transfers from hospitals and clinics · Use clinical decision-making and approved criteria to ensure the proper level of care · Collaborate with intake teams, physicians, nursing staff, and hospital departments to facilitate timely and appropriate placements · Monitor patient flow, track delays, and help improve access processes for better outcomes · Serve as a key liaison between facilities, patients, families, and providers — ensuring compassionate and efficient service · Navigating referrals submission to final acceptance in critical time (45 minutes) · Ensure compliance with EMTALA, Lifepoint Health policies, and quality standards. · Demonstrates strong clinical judgment, critical thinking, and the ability to multitask in a high-volume setting typing 30-40 wpm · Why join We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: · Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees. · Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. · Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. · Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). · Professional Development: Ongoing learning and career advancement opportunities. · Opportunity to impact lives at a critical access point in care · Supportive leadership and career development What we’re looking for · Active Compact LPN License · 3+ years of clinical experience in Behavioral Health or ED ( EmPath Unit) / Critical Care experience with Behavioral Health patients · High-speed internet access (minimum: 50 Mbps upload / 100 Mbps download) · Excellent communication skills and a commitment to patient-centered care · Demonstrates knowledge of regulatory requirements, EMTALA, Lifepoint Health Ethics and Compliance policies, and quality initiatives. EEOC Statement Lifepoint Health is an Equal Opportunity Employer. Lifepoint Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

About us LifeMD is a leading digital healthcare company committed to expanding access to virtual care, pharmacy services, and diagnostics by making them more affordable and convenient for all. Focused on both treatment and prevention, our unique care model is designed to optimize the patient experience and improve outcomes across more than 200 health concerns.  To support our expanding patient base, LifeMD leverages a vertically-integrated, proprietary digital care platform, a 50-state affiliated medical group, a 22,500-square-foot affiliated pharmacy, and a U.S.-based patient care center. Our company — with offices in New York City; Greenville, SC; and Huntington Beach, CA — is powered by a dynamic team of passionate professionals. From clinicians and technologists to creatives and analysts, we're united by a shared mission to revolutionize healthcare. Employees enjoy a collaborative and inclusive work environment, hybrid work culture, and numerous opportunities for growth. Want your work to matter? Join us in building a future of accessible, innovative, and compassionate care. About the role We are seeking an experienced, patient-centered telehealth Physician Supervisor to join our growing virtual care platform in a full-time capacity. This role is fully remote and will provide comprehensive medical care across weight management, men’s health, and urgent care service lines, overseeing performance, accountability, and management of MDs on platform. As a supervisor, you will also give feedback on clinical performance, do performance evals, etc. The ideal candidate holds multiple active U.S. state medical licenses, is comfortable practicing across jurisdictions, and is willing and qualified to serve as a Collaborating/Supervising Physician for Nurse Practitioners (NPs) in accordance with state regulations. This position includes a blend of synchronous (live video/phone) and asynchronous (store-and-forward, messaging-based) care delivery, with an emphasis on high-quality, compliant, and efficient virtual care. Key Responsibilities Payer Participation & Credentialing - Provide care to patients covered by commercial and government payers (including but not limited to Medicare and Medicaid, where permitted) - Willingness to enroll, credential, and re-credential with payer plans across multiple states as required - Collaborate with internal credentialing teams to maintain active payer participation and compliance Clinical Care - Provide high-quality telehealth services through synchronous and asynchronous encounters - Diagnose, treat, and manage patients across the following service lines: - Weight Management (including obesity medicine, metabolic health, and lifestyle counseling) - Men’s Health (e.g., testosterone therapy, erectile dysfunction, hair loss, sexual health) - Urgent Care (low-acuity conditions appropriate for telehealth) - Prescribe medications safely and appropriately in compliance with federal and state laws - Document all patient interactions accurately and timely in the electronic health record (EHR) - Escalate care appropriately when in-person evaluation or emergency care is required Collaboration & Supervision - Serve as a Collaborating/Supervising Physician for Nurse Practitioners, as required by state law - Review NP charts, prescriptions, and clinical decisions per regulatory and organizational standards - Provide clinical guidance, mentorship, and case consultation to NPs - Participate in required collaborative practice agreement (CPA) meetings, audits, and documentation Quality & Compliance - Maintain compliance with all applicable state-specific scope of practice, supervision, and telehealth regulations - Follow clinical protocols, evidence-based guidelines, and company policies - Participate in quality assurance, peer review, and clinical improvement initiatives - Stay current on telehealth best practices and regulatory changes across licensed states