• Lead the planning, execution, and oversight of assigned clinical studies from study start-up through closeout, ensuring compliance with Good Clinical Practices (GCP), ICH guidelines, applicable regulatory requirements, study protocols, and company SOPs. • Partner cross-functionally with Medical Affairs, Data Management, Clinical Operations, Regulatory Affairs, Client Services, Finance, Legal, and external vendors to achieve study objectives and timelines. • Oversee and manage CROs, vendors, and investigational sites, including oversight visits, site payment management, and review and approval of monitoring visit reports, as applicable. • Manage study timelines, enrollment metrics, vendor performance metrics, study budgets, and vendor payments. • Proactively identify operational risks, enrollment challenges, and execution barriers, implementing mitigation strategies to ensure successful study completion. • Collaborate with Legal and investigational sites to support contract and budget negotiations and ensure study activities remain within approved scope and financial objectives. • Lead study team meetings and provide regular updates to stakeholders and senior management on study progress, risks, and key milestones. • Contribute to the development and review of study-related documents, including protocols, informed consent forms, laboratory manuals, study plans, site training materials, and SOPs. • Support data review, database lock activities, clinical study reports, regulatory submissions, inspections, and audit readiness efforts. • Ensure appropriate site training and ongoing support to investigators and study personnel, promoting protocol compliance and high-quality study conduct. • Oversee sample management activities and coordinate closely with Clinical Operations to ensure timely and accurate processing of study specimens. • Review and approve study-related invoices and expenditures, ensuring alignment with approved budgets and financial goals.

Role Description Provide best-in-class personalized patient services to ensure a positive patient experience in support of Sanofi General Medicines business priorities. Driven by the complexity of patient identification, treatment administration intricacies, and access gateways, this role must support both internal and external care teams in the overall patient journey. The Clinical Educator (CE) is a key field-based member of the Tzield Patient Services team and subject matter expert for Tzield and T1D. In this high touch role, the CE will assist patients and caregivers with accessing Sanofi’s FDA-approved 14-day T1D infusion therapy. The CE provides disease and product information and ongoing support, when appropriate, to T1D Patients and their caregivers. The CE establishes and maintains a strong working relationship with: - Endocrinology Health Care providers (MD, NP, PA) - HCFs (Nurses, Pharm D, Leadership) - HHA nurses who provide in-home care for our patients The CE provides sophisticated and in-depth education on the product and related access hurdles to ensure a seamless experience for patients. He/she is a subject matter expert and critical thinker on disease state, product, administration, and services. The CE works collaboratively with cross-functional team members to facilitate timely and ongoing access to therapy and has a high level of emotional intelligence to navigate both internal and external partners and customers. They are solely responsible for ensuring that all patients are given an opportunity to participate in our Patient Mentor program and facilitate the set-up and delivery of the interaction. CE's must also ensure full compliance with all corporate and industry policies and legal and regulatory requirements, for all field activities and report all AEs. This is a regionally aligned field-based role. Join the team transforming care for people with immune challenges, rare diseases, cancers, and neurological conditions. In Specialty Care, you’ll help deliver breakthrough treatments that bring hope to patients with some of the highest unmet needs. Main Responsibilities - Leads education and awareness efforts of disease state, inheritance, diagnostic and product information to patients and families through telephone communication, live/virtual patient and family meetings, and patient education programs. - Facilitates a Patient Mentor program by setting up and moderating a 1:1 interaction for new patients. - Assesses all enrolled patients’ needs and develops action plans that facilitate the treatment process as recommended by the patient’s healthcare provider. - Works with cross-functional partners to identify patient-specific barriers and develop action plans for resolution. - Demonstrates accountability for action plan execution and drives for success and results. - Supports the complex pull-through process of Tzield patients by maintaining excellent communication with the Matrix team, HCPs, and the Patient. - Provides ongoing education to the HCPs regarding the infusion process based on the approved PI. - Delivers in-depth disease and product in-services for home health care providers of patients receiving Sanofi treatment within the home to ensure optimal care and adherence to prescribed dosing. - Maintains expertise through continuing medical and scientific education including attendance at relevant symposiums, scientific workshops, preceptorships, and review of key journals, and successful completion of internal training programs. - Increases disease awareness by completing community and healthcare advocate educational outreach programs. - Meets documentation requirements in CRM system to facilitate tracking of critical metrics. - Delivers on key objectives established annually. - Participates/travels to Patient support programs as needed. - Must be able to travel extensively (60 to 80%). - Ensures full compliance with all corporate and industry policies and legal and regulatory requirements for all regional commercial activities. Qualifications - Bachelor’s or Master’s Degree in Health Care/ Life Sciences/ Nursing or related subjects. - 3+ years of experience in biotechnology, pharmaceutical, or healthcare industry. Requirements - 3+ years previous experience in a field-based commercial or medical role in a pharmaceutical or biotech company desired. - Prior product launch experience. - Ability to present to small and large groups of patients, caregivers, and Health Care professionals. - Ability to travel up to 80% within a territory is required; ability to travel to meetings/trainings/programs as necessary - additional travel will be required within the assigned geography. - Valid Driver’s License. - Previous commercial and/or clinical experience with IV infusions is preferred. - Previous T1 Diabetes experience strongly preferred, CDE certification. Benefits - Bring the miracles of science to life alongside a supportive, future-focused team. - Discover endless opportunities to grow your talent and drive your career, whether it’s through a promotion or lateral move, at home or internationally. - Enjoy a thoughtful, well-crafted rewards package that recognizes your contribution and amplifies your impact. - Take good care of yourself and your family, with a wide range of health and wellbeing benefits including high-quality healthcare, prevention and wellness programs, and at least 14 weeks’ gender-neutral parental leave.

Role Description The Clinical Pharmacist is responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. This position is also responsible for the education of physicians and influencing of prescribing patterns to reduce BCBSM’s drug benefit payout and improve the quality of the benefits as it relates to our members. The incumbent serves as the liaison to the Medical Policy department assisting with the development of medical policy as it applies to drugs. - Provides clinical coverage review for medication requests. - Develops, implements, and updates Drug Utilization Review/Due Programs. - Provides effective and efficient communication of pharmacotherapy issues. - Develops and implements a variety of behavior modification principles to influence physicians to prescribe appropriately. - Identifies target physicians, establishes credibility and utilizes both verbal and written communications to modify behavior. - Serves as the key clinical support person for researching prescription drug inquiries. - Develops, implements and monitors the Corporate Drug Information Center. - Develops, implements and continually updates physician and patient educational materials. - Supports Drug Formulary development and serves on the BCBSM P and T Committee. - Serves as liaison to medical Policy assisting with the development of medical policy as it applies to drugs. - Participates in clinical and operational process improvement and cost savings opportunities. - Supports review and resolution of clinical and compliance grievances and appeals. - Supports clinical initiatives related to NCQA, HEDIS, CAHPS and STAR measures. - Adheres to Pharmacy Policies and Procedures. Qualifications - Must have superior oral and written communication skills and expertise in the design of presentations. - The incumbent must have the ability to obtain and devise relevant data and information from existing MIS Systems. - An understanding or knowledge of drug claims processing systems and/or medical information systems is preferred. - Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. - Ability to write reports, business correspondence, and procedure manuals. - Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Requirements - Relevant combination of education and experience may be considered in lieu of degree. - Bachelor’s degree or Doctorate in Pharmacy. - Current unrestricted Pharmacy License required, MI Pharmacy License preferred. - Three years of experience consulting with physicians on pharmaceutical issues or completion of an accredited American Society of Health-System Pharmacists/Academy of Managed Care Pharmacy, AMCP/ASHP, Managed Care Pharmacy or Pharmacy Practice Residency. - Drug Information Specialist with proven background and skills may also be considered. Benefits - Pay Range: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. - It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $107,000 and $179,300. - EEO Statement: All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability. - Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.

Clinical Denials and Appeals RN US - Remote (Any location) Full time job requisition id 40382 Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: - Conduct pre‑ and post‑service medical necessity reviews for inpatient, observation, and outpatient hospital encounters using evidence‑based criteria such as InterQual and Milliman Care Guidelines. - Perform retrospective medical record reviews to validate completeness and accuracy of physician and clinical documentation supporting level of care and services rendered. - Identify denial root causes and determine appeal viability based on payer policies, regulatory guidance, and clinical standards. - Prepare, submit, and track clinical appeals, including written appeals. - Collaborate with Patient Access, Case Management, Utilization Management, Coding, and Mid‑Revenue Cycle teams to resolve denials and prevent recurrence. - Research and apply payer‑specific policies, CMS regulations, and contractual language to support appeal arguments. - Track and report denial and appeal outcomes, identify trends, and provide recommendations for process improvement and staff education. - Maintain accurate documentation of all review activities in hospital and payer systems in accordance with compliance standards. What You Will Need: - Current unrestricted Registered Nurse license in the state you reside - Bachelor's degree and 4-6 years of prior relevant experience in acute care clinical experience in hospital setting or Associates Degree and 6-8 years of prior relevant experience in acute care clinical experience in hospital setting (Relevant experience may be substituted for formal education or advanced degree). - Experience in clinical denials, utilization review, case management, or appeals required What Would Be Nice To Have: - Bachelor of Science in Nursing - Master’s degree in Nursing - Experience with InterQual and/or Milliman Care Guidelines, and electronic medical record systems. - Compact State RN License - Experience with inpatient level‑of‑care denials, DRG downgrades, and CMS payer rules. - Strong knowledge of hospital revenue cycle workflows, medical necessity review, and payer regulations. - Excellent analytical, organizational, and written communication skills with the ability to independently manage multiple cases. The annual salary range for this position is $68,000.00-$113,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs. What We Offer: Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include: - Medical, Rx, Dental & Vision Insurance - Personal and Family Sick Time & Company Paid Holidays - Position may be eligible for a discretionary variable incentive bonus - Parental Leave - 401(k) Retirement Plan - Basic Life & Supplemental Life - Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts - Short-Term & Long-Term Disability - Tuition Reimbursement, Personal Development & Learning Opportunities - Skills Development & Certifications - Employee Referral Program - Corporate Sponsored Events & Community Outreach - Emergency Back-Up Childcare Program About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.