Role Description The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies established medical necessity criteria to obtain, analyze, and accurately document clinical information from medical records in support of utilization determinations. The UMRN works collaboratively with providers, medical directors, and internal teams to ensure timely, compliant, and high-quality review processes. WHAT YOU'LL BE DOING - Utilization Review & Clinical Determinations: - Performing timely reviews of healthcare services, including precertification and concurrent reviews, using approved medical necessity criteria. - Accurately documenting clinical findings, criteria application, and determinations in accordance with regulatory and accreditation standards. - Communicating review determinations (written and/or verbal) to providers, members, and other required parties within established timeframes. - Clinical Collaboration: - Collaborating with the Medical Director and Peer Reviewer(s) on cases requiring further review of: - Medical necessity - Appropriate treatment plans - Intensity and duration of inpatient or outpatient services - Quality of care concerns - Interfacing routinely with ordering providers and provider organizations; communicate with members or their representatives when appropriate. - Integrating Artificial Intelligence (AI) into daily workflow. Offer feedback and assist in ‘teaching’ AI to make AI tools more reliable and user-friendly. - Care Coordination & Quality Support: - Initiating referrals of identified patients to disease management or population health programs to support continuity and quality of care. - Participating in quality management activities and performance improvement initiatives. - Assisting in the development of UM/PHM Committee materials and packets, including review of cases impacting performance metrics and identification of trends within assigned IPA(s). - Compliance & Professional Standards: - Maintaining strict confidentiality of member information and case documentation. - Ensure ongoing compliance with federal and state regulatory requirements across multiple jurisdictions and medical groups. - Integrating current knowledge of medical group guidelines and URAC standards into daily review activities. - Maintaining continued professional growth and education consistent with current nursing practice standards and the Illinois Nurse Practice Act. Qualifications - Registered Nurse with an active and unrestricted Illinois State License. - Three years of experience in a variety of health care settings. - Knowledge of utilization review, managed care, and community health. - The State of Illinois requires Nursing Professional Staff to complete 20 hours of CE per 2-year license renewal cycle. - Computer skills including Microsoft 365 (Word, Excel, PowerPoint, etc). - Strong organizational, writing, and speaking skills are necessary. - Ability to prioritize and react based on rapidly changing business needs. - Excellent clinical judgment, compassion, and a positive attitude. Requirements - Interest in Informatics. - Knowledge in Population Health and Disparities. - Previous Health insurance experience. Benefits - Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs. - Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered. - Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution. - Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected. - Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times. - Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals. - Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need. - Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

Role Description Join Komplex Care and support a young adult with complex needs in a rewarding, person-centred care role. - Provide 2:1 support to a young man in the home environment and, where required, in the community. - Work closely with the family and wider care team to deliver safe, compassionate, high-quality care. - The child has the following clinical needs: - ALD - SLD - LD - ADHD - Hyper Mobile Joints - Support with: - Personal care - Medication administration - Moving and handling - Following care plans and therapeutic routines - Provide safe, person-centred care. - Support with personal care and medication administration. - Monitor the client's health and respond appropriately to changing needs. - Assist with mobility. - Work closely with family members and healthcare professionals. - Follow care plans, risk assessments and clinical guidance. Qualifications - Level 2 or Level 3 NVQ/QCF in Health and Social Care is desirable. Requirements - Experience within complex care with a minimum of 3 months. - Knowledge of ADHD. - A calm, compassionate and reliable approach. - Confidence supporting adults with complex needs. - Strong communication and teamwork skills. Benefits - Competitive pay. - Ongoing training and clinical support. - Career development opportunities. - 24/7 GP access for you and your family. - Free mental health support. - Life insurance. - Employee rewards and discounts. - Employee of the Month recognition.

Role Description The Admissions Specialist plays a critical role in facilitating the intake process for individuals seeking behavioral health services. This position is responsible for managing all aspects of admissions documentation, ensuring accuracy, compliance, and confidentiality throughout the process. The specialist serves as a primary point of contact for prospective clients and their families, providing clear communication and support to guide them through admission procedures. By coordinating with clinical and administrative teams, the Admissions Specialist helps to streamline patient flow and optimize service delivery. Ultimately, this role contributes to the organization's mission by ensuring timely and compassionate access to behavioral health care. Qualifications - High school diploma or equivalent; associate degree or higher preferred. - Experience working in behavioral health settings or related healthcare environments. - Proficiency in admissions documentation and data entry. - Strong organizational skills and attention to detail. - Ability to maintain confidentiality and adhere to HIPAA regulations. Requirements - Bachelor’s degree in healthcare administration, social work, psychology, or a related field (preferred). - Familiarity with electronic health record (EHR) systems and insurance verification processes. - Experience in customer service or patient advocacy within behavioral health. - Knowledge of behavioral health terminology and treatment modalities. - Certification related to healthcare admissions or behavioral health services. Responsibilities - Conduct thorough intake assessments and gather necessary documentation for behavioral health admissions. - Verify insurance coverage and eligibility to facilitate smooth admission processes. - Maintain accurate and confidential records in compliance with regulatory standards and organizational policies. - Communicate effectively with clients, families, and healthcare providers to coordinate admission logistics and answer inquiries. - Collaborate with clinical staff to ensure timely placement and appropriate care planning for incoming patients. - Monitor and update admission status and documentation within electronic health record systems. - Assist in resolving any issues or barriers that may delay or complicate the admission process. Skills The Admissions Specialist utilizes behavioral health knowledge daily to understand client needs and the nuances of mental health care admissions. Proficiency in admissions documentation ensures that all client information is accurately recorded and compliant with legal standards, which is essential for smooth processing and billing. Strong communication skills are employed to interact compassionately and clearly with clients, families, and clinical teams, facilitating trust and cooperation. Organizational skills are critical for managing multiple admissions simultaneously while maintaining meticulous records. Additionally, familiarity with healthcare software and insurance processes supports efficient verification and data management, reducing delays and improving overall patient experience. Benefits - Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits. - Expanded Coverage – Options for domestic partners and a wider network of in-network providers. - Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching. - Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more. - Student Loan Repayment – Available for nurses and therapists. - Retirement Benefits – 401(k) plan through Voya to help employees plan for the future. - Generous PTO – A robust paid time off policy to support work-life balance. - Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

• Support the collection and maintenance of information on qualified IBD clinical trial sites in Romania and Moldova. • Help keep site capability information up to date, including investigator experience, patient access, and basic operational readiness. • Support feasibility activities by helping coordinate CDA execution, collecting site input, and assisting with feasibility questionnaires. • Review feasibility responses for completeness and consistency before internal or CRO/sponsor review. • Help prepare feasibility information for CROs, sponsors, and internal stakeholders. • Track feasibility status, open questions, and next steps. • Support site start-up activities from feasibility through regulatory and contractual readiness, SSV/SIV preparation, activation, and early recruitment readiness. • Collect, organize, and quality-check site-level documents using CRO and sponsor templates. • Check documents for missing items, expired credentials, formatting issues, and basic inconsistencies before submission. • Help prepare sites for selection visits and initiation visits by sharing document requirements, timelines, and expectations. • Attend site visits when requested and appropriate. • Maintain start-up checklists and trackers under the guidance of internal team members. • Flag blockers or delays early and escalate them to the appropriate internal contact. • Support activation planning and help sites prepare for patient screening activities after regulatory approval. • Serve as a day-to-day operational contact for sites in Romania and Moldova during feasibility and study start-up. • Coordinate site questions and route them to the appropriate internal, CRO, or sponsor contact when needed. • Communicate with PIs, study coordinators, site staff, CRO start-up teams, and internal stakeholders. • Help sites understand Iterative Health services, tools, checklists, and workflows. • Maintain clear, professional, and timely communication with sites and study partners. • Maintain accurate updates in Salesforce, Asana, study trackers, and other relevant systems. • Track action items, document status, owners, due dates, and follow-up items. • Support basic reporting on feasibility turnaround, document completion, SSV/SIV readiness, activation timelines, and site responsiveness. • Help identify recurring document or start-up issues and share them with the internal team. • Follow established processes and contribute suggestions for improvement when appropriate. • Perform related duties as requested