• Line manage, coach, mentor, and develop Clinical Research Associates across multiple experience levels. • Manage hiring, onboarding, performance management, and professional development activities. • Oversee resource allocation, workload planning, and utilization across clinical trials. • Collaborate with Project Managers and cross-functional teams to ensure successful study delivery. • Monitor staff performance and support operational efficiency through established departmental metrics. • Implement departmental quality controls and contribute to the development and continuous improvement of quality systems and processes. • Prepare for and participate in internal audits, sponsor audits, and regulatory inspections. • Support trial execution by resolving operational challenges and facilitating communication between project teams and investigational sites. • Participate in feasibility assessments for new and ongoing studies. • Support business development activities, including client meetings, networking events, and operational discussions, as needed.

Role Description Provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. - Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and NCQA guidelines, and other applicable requirements. - Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed. - Works with delegation oversight analytics representatives on monitoring of performance reports from delegated entities. - Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. - Assists with delegation oversight committee meetings. - Works with delegation oversight leadership to develop and maintain delegation assessment tools, policies and reporting templates. - Assists with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. - Participates as needed in joint operation committees (JOCs) for delegated groups. - Assists in preparation of documents for CMS, state Medicaid, NCQA and/or other regulatory audits as needed. Qualifications - At least 3 years experience in health care, including 2 years experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience. - Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. - Knowledge of audit processes and applicable state and federal regulations. - Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines. - Ability to collaborate effectively with team members and internal departments. - Strong attention to detail with a focus on maintaining quality in all tasks. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Requirements - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ). 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 The Clinical Quality Nurse performs clinical quality audits and reviews of prior authorization, inpatient acute and post-acute, complex case management, transitions of care, disease management, and medical claims review case work to evaluate compliance with department policies and regulatory requirements. This role works closely with Case Management leadership to create and revise operational process documents that are used in evaluating case work on audit. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Evaluate medical management case work including Prior Authorization, Inpatient Acute and Post-Acute, Complex Case Management, Transitions of Care, and Clinical Claims to determine/verify whether medical necessity criteria were met using industry guidelines (CMS, Health Plan policies, MCG, InterQual, NCQA). - Verify that time requirements for case work were met according to regulatory and departmental standards (CMS, NCQA). - Verify that service providers were in network, or that a gap in network coverage was present. - Follow relevant regulatory guidelines, policies, and procedures in reviewing clinical case documentation and medical necessity criteria selection (e.g., CMS, MCG, InterQual, NCQA). - Follow relevant regulatory guidelines, policies, and procedures in reviewing complex case management, transitional case management, and disease management, to ensure care planning process meets regulatory and departmental requirements (NCQA). - Verify if outreach for additional information was required and followed regulatory guidelines. - Verify that required communication to members and providers was completed as required by regulatory requirements and department policies. - Run/pull/prioritize relevant data/reports (e.g., case level data, audit trends, audit samples). - Manipulate and leverage multiple databases (e.g., provider panels, medical review databases) to sort, search, and enter information. - Identify incomplete/inconsistent information in case reviews and document missing criteria/documentation/concerns. - Provide guidance to clinical staff to improve/standardize case review. - Identify and report quality of care concerns appropriately. - Report inconsistencies/problems with prior authorization, admissions, case management, transitions of care, and/or medical claims case review to appropriate parties for resolution. - Maintain HIPAA requirements for sharing minimum necessary information. - Create and revise process documents in collaboration with process owners. Position Details: - Schedule: Full time, 40 hours/weekly, Monday through Friday, 8:00AM - 4:30PM (Serving EST). - Department: Clinical Quality & Audit. - Location: Telecommuter. Qualifications - Unrestricted current RN licensure in state of residence. - 1+ years of experience conducting medical necessity reviews utilizing established criteria such as CMS guidelines, MCG, InterQual, or NCQA standards. - 1+ years of experience managing complex cases, including care coordination, resource utilization, and multidisciplinary collaboration to achieve optimal outcomes. - Experience operating within multiple platforms that house case documentation and clinical records. - Proficiency in Microsoft Office using Word, Excel, and PowerPoint. - Proven excellent interpersonal and communication skills (both written and oral). - Proven solid critical thinking and decision-making skills. - Proven ability to work on a multi-disciplinary team. Requirements - Bachelor of Science, Nursing (Preferred). - 3+ years of experience in managed care (Preferred). - *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - Salary range: $60,200 - $107,400 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.

• Act as a central liaison among the university, Site Based Learning team, clinical sites, faculty, and students. • Ensure the successful planning, implementation, and evaluation of nursing practicums. • Develop, manage, and maintain clinical affiliation relationships and partnerships across multiple regions. • Oversee scheduling and placement logistics for licensure track programs in the SoNHS. • Monitor site readiness and student satisfaction through feedback loops and evaluation tools. • Serve as a liaison between the university and clinical partners, resolving issues related to placement, student performance, or site logistics.