This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Women’s Health Field Medical Team Lead is an integral member of the Field Medical Affairs Leadership Team. The Team Lead provides leadership and management of the Women’s Health Medical Science Liaison (MSL) and Clinical Liaison (CL) teams in support of and alignment with Medical Affairs and Organon corporate objectives. - Build, on-board, lead, manage, develop, and coach the Women’s Health MSL/CL team. - Define territories and geographic locations of FMDs based on KOL mapping data and business needs, and track qualitative and quantitative metrics to meet objectives. - Create, anticipate, update, and implement training plans and field-based training curriculum to ensure MSLs/CLs possess the highest levels of product and disease expertise and scientific acumen. - Actively manage MS/CL performance assessments, provide and document on-going coaching, assist with creation and execution of development plans, and monitor performance against expectations. - Proactively and compliantly collaborate with Commercial and other internal stakeholders and direct MSLs appropriately within legal and compliance policies to implement medical strategies that support launch operating plan and corporate objectives to establish Organon as a leader in Women’s Health. - Collaborate on the development and implementation of the scientific communication plan, medical-to-medical materials, and conduct of research including facilitation of investigator-initiated trials as well as investigator selection, relationship management, and site performance for Organon sponsored research. - Maintain scientific and technical expertise in Women’s Health. Qualifications - PharmD, PhD, MD or equivalent education with demonstrated ability to effectively lead and coach scientific/medical colleagues. - Five plus years pharmaceutical industry experience in a field-based medical role with proven competency in HCP engagement and education. - Three plus years direct management experience of Field Medical teams. - Women’s Health experience is preferred. - Ability to develop and maintain strong, collaborative, and long-term relationships with colleagues, healthcare providers, decision makers, and organizations. - Demonstrable effective leadership skills (by example and through accomplishments), and the ability to step forward to handle challenges within scope of authority. - Excellent interpersonal skills in both one-on-one and group settings and dedicated team player. - Strong oral communication, written communication, presentation, and coaching skills. - Highly motivated self-starter with an entrepreneurial spirit and commitment to personal and career development. - Desire to work in a quickly changing and fast-paced growing business. - Unrelenting dedication to delivering results and a desire to shape the strategic goals of the business. Willing to roll up your sleeves to get the job done. - Ability to overcome ambiguity and challenge the status quo. - Manage multiple programs with competing and aggressive timelines - prioritize activities and work independently. - Excellent written and oral communication skills. Experienced presenter of key messages to broad audiences including Senior Stakeholders. Requirements - #LI-Remote Benefits - Under various U.S. state laws, Organon is required to provide a reasonable estimate of the salary range for this job. Final salary determinations take a number of factors into account including, but not limited to, primary work location, relevant skills, education level, and/or prior work experience. - The applicable salary range for this position in the U.S. is stated below: $185,200.00 - $315,100.00. - Benefits offered in the U.S. include a retirement savings plan, paid vacation and holiday time, paid caregiver/parental and medical leave, and health benefits including medical, prescription drug, dental, and vision coverage in accordance with the terms and conditions of the applicable plans.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Health Plan Data and Medical Policy Clinician analyzes data, as well as coverage, payment, and coding policies, reviews findings, and informs, supports, and makes recommendations to Utilization Management leadership as well as other Clinical Programs at Martin’s Point Healthcare. The Senior Clinical Analyst uses their extensive clinical and coding knowledge and analytical expertise to guide and educate leaders on health plan data clinical optimization from a range of operational lenses and levels of analysis as well as informing system configuration, data feed requirements, and reporting specifications. This individual develops medical policies for the purpose of Utilization Management and Medical Necessity determinations. This individual will also assist in development and maintenance of Prior Auth List. Qualifications - Associates degree in nursing - BSN preferred - Current, unrestricted Registered Nurse licensure in Maine - One or more of the following Certified Professional Coder Certifications (CPC, CCS, CCA, CPMA) - 5+ years medical management experience in a managed care setting including Quality Management, Case Management, Disease Management, Utilization Management and Population Health - Experience related to reporting and analysis of health care data ideally in the areas of managed care, health care delivery, code sets, and/or reimbursement - Experience with ICD10, CPT, HCPCS, and Revenue coding and payment systems for managed care - Experience with creating medical policies under the Medical Policy Committee - Experience with Prior Auth list review, addition and deletion of codes driven by evidence and utilization data - Experience in creating, reconciling, summarizing, and analyzing data with SQL knowledge preferred Requirements - Knowledge of health plan system application configuration/functionality and reporting - Maintains working knowledge of DOD, CMS, NCQA, CCMC, State/Federal regulations, and contractual obligations that affect HMD activities and departmental processes through collaboration with all related health plan departments - Maintains exemplary knowledge of each health plan line of business and impact(s) to HMD functions - Maintains exemplary knowledge of coding principles - Maintains knowledge of payment systems (IPPS, OPPS, PFS, DRG, APC, DMEPOS, …) and impact on reimbursement - Maintains an understanding of health plan quality standards and measurements - Maintains knowledge of managed care computer systems, features, reporting, claims system, and claims processing practices including systems used throughout Martin’s Point (e.g., QNXT, Athena, Salesforce, Microsoft Office, iPro, SharePoint, Optum products, Cognos, Tableau, SQL Server Management, etc.) Skills - Excellent interpersonal, verbal, and written communication skills including team building, and quality improvement skills Abilities - Demonstrates an understanding of and alignment with Martin’s Point Values - Demonstrated ability to manage, organize and prioritize workload and multiple competing demands in a timely accurate manner and function independently - Demonstrated knowledge of project management principles including ability to identify root causes and implement creative solutions with strong analytical and problem-solving skills - Ability to manage complex interdepartmental processes utilizing data to inform decision making and evaluate impacts. Aptitude for matching business requirements to potential software solutions

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves utilizing clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program for preauthorization for mental health services. - Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions. - Works within a call center setting. Qualifications - 3+ years of post-clinical licensure experience in behavioral health - 3+ years knowledge of mental health and substance abuse disorders - Valid unrestricted independent professional behavioral health clinical license to practice per state regulations in the state they reside in (one or more or equivalent is required: LPC, LMFT, LCSW, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist or RN) - Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps - Must be able to talk on the telephone and type at the same time, this is a queue-based job Requirements - Direct clinical experience in a hospital setting or prior Utilization Management experience (preferred) - If RN, Bachelor's degree in nursing required with emphasis on Behavioral Health or Psychology - If BH-licensed, Masters degree in Social Work, Counseling, Psychology required Benefits - Affordable medical plan options - 401(k) plan (including matching company contributions) - 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

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Imagine360 is seeking a Disease Management Care Coach, Behavioral Health RN to join the team! The Behavioral Health RN Care Coach is responsible for providing telephonic coaching and educational resources to people with chronic health conditions. The RN serves patients with medical, behavioral health, mental health, and/or neurodevelopmental disorder needs. Coaching topics include medication compliance, nutrition, physical activity, and care coordination. Responsibilities include assessment, coordination, planning, monitoring, and evaluation. The RN will receive member referrals from non-Behavioral Health Case Managers and Disease Management clinicians to support the Behavioral Health needs of those members. Position Location: 100% remote - Provide telephonic coaching, and information and referral services to program participants managing various chronic health conditions with clinical oversight assistance - Assess participant needs using scripted assessments - Communicate, as needed, with service delivery partners, physicians, and other health professionals to provide care coordination - Review pertinent medical history, current diagnosis, and pharmaceutical data via information database system with clinical oversight - Assist participant in forming realistic goals related to overall health - Determine and provide relevant community and/or healthcare resources that help support participant's goals - Promote wellness and provide education regarding preventative care measures - Effectively assess, coach and graduate clients from care, resulting in appropriately managed caseloads - Document participant activities and coaching/counseling sessions in established format in the case tracking software In addition to performing standard Care Coach roles, Registered Nurses are involved in clinical decision-making and patient education. The scope of practice for nursing work includes, but is not limited to: - Rationale for the effects of medications and treatments - Implement measures to promote a safe environment for clients and others - Accurately report: - Administration of medication and treatments - Client response - Contact with other health care team members - The client's status including signs and symptoms - Nursing care (education) rendered - Respect the client's right to privacy by protecting confidential information - Promote and participate in education and counseling to a participant based on health needs - Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner - Know, recognize, and maintain professional boundaries of the nurse-client relationship Qualifications - Nursing Degree from an accredited college or university - 3+ years' experience working with Behavioral/Mental Health patients or programs Requirements - Must have intermediate knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software - Active and unrestricted Compact Registered Nurse License required Benefits - Multiple Health plan options - Company paid employee premiums for disability and life insurance - Parental Leave Policy - 20 days PTO to start / 10 Paid Holidays - Tuition reimbursement - 401k Company contribution - Company paid Short & Long term Disability plus Life Insurance - Professional development initiatives / continuous learning opportunities - Opportunities to participate in and support the company's diversity and inclusion initiatives Company Description Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions. Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation.