Role Description The Utilization Review III position is responsible for the review, investigation, and resolution of member and provider appeals and grievances requiring clinical expertise. This role ensures compliance with regulatory requirements, accreditation standards, and organizational policies while promoting quality outcomes, member satisfaction, and STARs performance. The specialist works collaboratively with medical directors, clinical staff, and operational teams to support timely and accurate determinations and oversee clinician-to-clinician (C2C) challenge activities. - Conduct clinical review of member and provider appeals, including pre-service, concurrent, and post-service cases. - Evaluate medical necessity, appropriateness of care, and benefit coverage using clinical guidelines and evidence-based criteria. - Investigate grievances by reviewing medical records, claims, and related documentation to determine root cause and resolution. - Prepare clear, concise, and compliant determination letters that meet regulatory and accreditation standards (e.g., CMS, NCQA). - Collaborate with Medical Directors for cases requiring physician review and support case presentations as needed. - Oversee and support Clinician-to-Clinician (C2C) challenges, including coordination, documentation, and ensuring timely completion in accordance with regulatory requirements. - Monitor and assess the impact of appeals and grievances on STARs measures, identifying trends, risks, and opportunities for performance improvement. - Partner with quality and operations teams to address trends that may negatively impact STARs ratings and member experience. - Ensure all appeals and C2C activities are processed within required turnaround times. - Identify trends, quality concerns, and potential process improvement opportunities through case analysis. - Maintain accurate and complete documentation in case management systems. - Serve as a clinical resource for non-clinical staff regarding appeals, grievance processes, and clinical escalation pathways. - Participate in audits, regulatory reporting, and quality improvement initiatives as required. Qualifications - Active, unrestricted clinical license (RN or LPN license required). - 5+ years of clinical experience. - Prior experience in Appeals & Grievances, Utilization Management, or Managed Care strongly preferred. - Experience with C2C processes, regulatory turnaround requirements, and STARs metrics preferred. Requirements - Strong knowledge of medical terminology, clinical guidelines, and healthcare delivery systems. - Understanding of regulatory requirements (CMS, Medicare/Medicaid, commercial guidelines, NCQA standards). - Familiarity with STARs measures and how clinical decisions impact quality performance outcomes. - Excellent critical thinking and clinical decision-making skills. - Strong written and verbal communication skills, including the ability to translate clinical information into member-friendly language. - Exceptional attention to detail and organizational skills. - Ability to manage multiple priorities and meet strict deadlines. - Proficiency in case management systems and Microsoft Office applications. Benefits - Competitive medical, dental, vision plans. - PTO and Holidays. - Paid volunteer time off. - 401K contributions. - Caregiver services. - Generous total rewards package to support employees. Eligibility to work in the US Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. Equal Opportunity Employer We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

• Build the SAM capability (first 6–12 months) • Evaluate the SAM platform market and lead selection of a license management solution that fits team.blue ’s hybrid estate (on-prem, SaaS, cloud) • Implement the chosen platform end-to-end, including integration with Jira Service Management (our current ITSM and asset platform), finance systems and procurement workflows • Leverage existing data sources — including our ongoing Lakeside SysTrack POC for endpoint software usage telemetry — to accelerate the inventory baseline • Establish the operating model: processes, governance, RACI, and reporting cadence • Optimise license cost and compliance (ongoing) • Identify and execute cost-saving opportunities — true-downs, unused entitlements, overlapping tools, right-sizing — with measurable savings reported to the COO and CFO • Manage compliance posture for major vendors (Microsoft, Adobe, Atlassian, Autodesk and others) and lead audit defence • Own the renewal calendar and partner with Procurement on negotiation strategy, true-ups and contract terms • Drive centralisation of currently fragmented agreements (e.g. Adobe) into group-level contracts • Work hand-in-hand with Procurement on vendor strategy and Finance on cost allocation, chargeback and forecasting • Advise Enterprise Apps, EUS, EUC and Core IT teams on license-efficient architecture and tooling decisions • Support Post-Merger Integration (PMI) — rationalising overlapping software estates from acquired entities • Engage stakeholders across technical and non-technical functions, translating licensing and entitlement implications clearly, and actively listening to requirements to ensure tooling and license decisions reflect real customer needs • Build dashboards and KPIs: cost per user, license utilisation, savings realised, compliance risk • Define and enforce SaaS approval policy together with IT and Security to control shadow IT • Own software asset and license management processes end to end, ensuring adoption and adherence across teams while aligning with team.blue security policies and governance standards

Role Description Fraser is looking for Case Managers to work with individuals on the CADI/BI & DD waivers. Case Managers serve as an advocate to Fraser clients and connect clients to resources and services within the community. The ideal candidate will demonstrate compassion for clients and commitment to success. We seek candidates who are well organized, have experience working with developmental or intellectually challenged individuals, and have excellent documenting and case noting skills. - CADI/BI WAIVER Case Managers: Provide client-centered case management services to individuals receiving CADI/BI waiver services. Case Managers typically have about 35 clients on their caseloads and meet with clients two to three times per year. Caseloads are a majority of adults, with a small mix of children as well. - DD WAIVER & NON-WAIVER Case Managers: Provide client-centered case management services to individuals receiving DD services. Case Managers typically have about 43 clients on their caseloads and meet with clients two to three times per year. Caseloads are a mix of children and adults. Qualifications - Bachelor's Degree in social work, special education, psychology, nursing, human services, or other fields related to the education or treatment of people with developmental disabilities or related conditions. - If degree is in social work, social work licensure is required. - One year of experience with DD (Development Disability) populations or offer will be contingent on taking/passing the Relias I/DD course (paid expense by Fraser). - Experience (or at least a strong interest) in working with adults with serious and persistent mental illness. - Commitment to promoting diversity, multiculturalism, and inclusion with a focus on culturally responsive practice, internal self-awareness, and reflection. - Valid Minnesota Driver’s License with acceptable record. - Ability to pass DHS background study. Requirements - Commitment to promoting diversity, multiculturalism, and inclusion with a focus on culturally responsive practice, internal self-awareness, and reflection. Benefits - Scheduled performance feedback. - Career growth opportunities. - Employee Referral Bonuses. - Benefits for Full-time Employees (30+ hours per week): - Medical, dental, and vision insurance. - Health Savings Account (HSA) and Flexible Spending Account (FSA). - Employee Assistance Plan (EAP). - Life, AD&D, and Voluntary Life Insurance. - Long-Term Disability, Accident Insurance, Critical Illness Insurance, and Hospital Indemnity Insurance. - Pet Insurance. - 403(b) Retirement Plan with Company Match. - Work-Life Balance; 5 weeks of paid time off annually (18 days PTO + 9 Paid Holidays). Location, Schedule & Pay - Monday through Friday during standard business hours. Fully remote after first 3-6 months of onboarding is complete! - Supports Ramsey County. - To be considered for this role, you must reside in Minnesota / Twin Cities Metro Area. - Travel to meet with clients is required; client meetings may occur 2-3 times per week. - The starting pay for this role is $50,000 to $52,000 per year depending on qualifications + $1,500 hiring bonus (external candidates only). Why Join Fraser? - Meaningful Impact: Help individuals and families lead more connected, independent, and fulfilling lives. Your impact here is real — and lasting. - Competitive Pay & Benefits: Fraser offers fair pay and comprehensive benefits that support your health, well-being, and future goals. - Flexibility & Work-Life Balance: With flexible schedules, generous paid time off, and wellness programs, Fraser helps you care for others without sacrificing yourself. - Grow Your Career With Us: We invest in your development with training, licensure support, leadership pathways, and real opportunities to advance. - Culture That Lives Its Values: Inclusion isn’t just a buzzword — it’s how we operate. You’ll be seen, heard, and supported to bring your full self to work. - Thrive with Stability and Purpose: With nearly 90 years of trusted service and continued growth, Fraser is a nonprofit where you can build a lasting, mission-driven career.

Role Description KI und digitale Reizüberflutung machen eines deutlich: Echte Erlebnisse werden wertvoller, nicht weniger. Genau deshalb wächst REVO/VIBE – und genau deshalb suchen wir jetzt jemanden, der dieses Wachstum mitträgt. VIBE ist unsere Spezialisierung für Brand Spaces: Roadshows, Festivals, Messen. Wir bauen keine Stände – wir bauen Auftritte, die wirken. Der Unterschied: Jeder physische Moment wird durch Media, Social Content und Promoter-Crews zur Multichannel-Kampagne verlängert. Alles aus einem Haus, eine Strategie, ein Ansprechpartner für den Kunden. Wir wachsen stark in diesem Bereich. Wir wollen dem jetzt Rechnung tragen – mit einem erfahrenen Kopf, der gemeinsam mit uns noch weiter geht. Qualifications - Erfahrung mit Brand Spaces in der Praxis: Roadshows, Trucks, Festival-Setups, Messen. - Netzwerk zu Produktions- und Baudienstleistern – und ein Grundverständnis für Bau und Konstruktion: Was ist machbar? Was kostet wie viel? Quadratmeterpreise, Materialien, Aufbauprozesse. - Überzeugungsstärke und Sicherheit im Kundenkontakt – das ist der Kern. - Kommerzielles Grundverständnis: Kalkulation, Budgets, Verhandlung. - Keine Scheu vor operativer Arbeit – du wächst mit uns, nicht über uns. Requirements - Du bist das Gesicht bei namhaften nationalen und internationalen Kunden – von der Roadshow bis zum Festivalauftritt. - Du koordinierst Dienstleister, hältst Projekte auf Kurs und bist der Ansprechpartner, dem Kunden vertrauen. - Vertrieblich denkst du mit: Du erkennst, was Kunden brauchen, und überzeugst sie davon. - Was wir von dir brauchen: Kompetenz im Feld, Überzeugungskraft beim Kunden, Zuverlässigkeit in der Umsetzung. Benefits - Bestehende Kunden, laufende Projekte – kein Start bei null. - Direkter Draht zur Geschäftsführung, aktive Unterstützung und Förderung – auch wenn mal etwas nicht klappt. - Einstieg in eine starke Wachstums-Unit mit dem Ziel der Eigenständigkeit. - Zugriff auf alle REVO-Units: Media, Content, Personal – echter Rückenwind für deine Projekte. - Viel Einfluss und Gestaltungsraum beim Aufbau eines wachsenden Bereichs. - Remote zu 60 % möglich. - Ein erfahrenes, supernettes Team. - Spannende, abwechslungsreiche Marken & Projekte. - Attraktive Lage im Zentrum von Köln. - Homeoffice. - Jobticket + Jobrad/Bikeleasing. - Fitnessangebot. - Betriebliche Altersvorsorge. - Monatliche Events. Company Description REVO ist eine Full Thinking Agentur für Kommunikation im Herzen von Köln. Seit über 25 Jahren entwickeln wir Strategien, die Marken stark machen, und setzen diese in allen erdenklichen Medien um. Unsere Kernfelder sind Sales, Brands und Digital.