manager clinical services

Grace Health

<div><p>Grace Health is seeking a skilled and dynamic <b>Manager of Clinical Services</b> to oversee our specialties clinical teams - (Chiropractor, Optometry, Podiatry, Physical Therapy). This leadership role is critical in ensuring the delivery of high-quality patient care and supporting the success of our clinical programs.</p>
<p>We offer a <b>competitive salary</b>, a <b>comprehensive benefits package</b>, and a <b>sign-on bonus of $2,000</b> for the right candidate! <b>($1,000 after successful completion of your probationary period and $1,000 after 6 months).</b></p>
<div><b>BENEFITS</b><br>
<ul><li>Medical, vision, dental, life and disability insurance</li><li>401K match</li><li>8 paid holidays</li><li>Generous PTO accrual</li><li>Employee wellness program focusing on physical, mental, and financial wellness</li><li><b>No weekend shifts</b></li></ul></div><br>
<p><b>EXAMPLES OF DUTIES:</b> (This list may not be all inclusive.)</p>
<p>1. Oversees department operations ensuring that high quality patient-centered healthcare is provided with excellence in quality, service, and access.</p>
<p></p><ul><li>Promotes a team-based environment where patient-centered healthcare is provided with excellence in quality, services, and access.</li><li>
Collaborates with staff to establish clear expectations, monitoring performance, and tracking progress toward departmental goals.</li><li>
Oversees the day-to-day functions of the department.</li><li>
Maintains and evaluates data related to departmental performance, including staff and operational efficiencies, customer service, productivity, staffing, and costs. Identifies and implements opportunities for performance and financial improvement.</li></ul>
<p>2. Process improvement and workflow optimization.</p>
<ul><li>Commits to a focus on continuous improvement of workflow processes and procedures.</li><li>
Identifies opportunities for process improvement using efficient and cost-effective approaches, follows PDSA process for implementation of changes.</li></ul>
<p>3. Collaboration with other leaders and staff to achieve high performance in operations.</p>
<ul><li>Works closely with patient services managers to problem-solve operational issues involving clinical services such as patient schedules, access, and daily flow.</li><li>
Collaborates with other clinical managers to establish and implement organizational policies and procedures, ensuring consistency across all departments.</li><li>
Works closely with clinical managers to evaluate, enhance systems, forms, procedures, and methods used in providing clinical care.</li><li>
Collaborates with providers on clinical services. Participates in process improvement discussions for meeting patient care and customer service objectives.</li><li>
Contributes to the preparation of the annual budget and takes a lead role in managing financial resources.</li></ul>
<p>4. Strategic planning, financial management and overall management and direction.</p>
<ul><li>Manages department staffing needs, including hiring, evaluations, training and policy compliance. Conducts supervisory responsibilities in conjunction with Human Resources.</li><li>
Leads and develops staff by providing feedback, building skills and knowledge, and developing a high-performing team.</li><li>
Supports the organizational mission and contributes to the development of organizational objectives and policies, ensuring that employees understand them.</li><li>
Coordinates with Finance on the development and maintenance of the departmental budget; monitors and addresses spending and ongoing budgetary compliance.</li><li>
Establishes departmental performance benchmarks/expectations and reviews performance compared to established expectations.</li><li>
Collaborates with leadership to develop strategies that support departmental growth, identify new revenue opportunities, reduce costs, and address future needs through innovation and strategic partnerships</li></ul><div>
Professional/Technical Knowledge, Skills &amp; Abilities<br>
<br>
<ul><li>Possesses the equivalent of formal training in healthcare, usually in the form of a major in nursing, related field as part of a Bachelor's Degree program or related work experience.</li><li>Must know all aspects of the trade as it is performed in the organization, sufficient to effectively train or instruct others, and to serve as a resource to employees.</li><li>Maintains current knowledge of standards of care, typically acquired through continuing medical education.</li></ul></div><p>
Technical Skills</p><ul><li>Demonstrates necessary proficiency with all electronic clinical systems, including electronic health record (EHR), clinical workflow communication system, and scheduling systems, in use at the health center.</li><li>Prepares documents in Microsoft Word, including creating tables, charts, graphs and other elements.</li><li>Uses Microsoft Excel to analyze data, including the use of formulas, functions, lookup tables and other standard spreadsheet elements.</li></ul>
<p><i>Education:</i> Graduation from an accredited school of nursing; BSN preferred.</p>
<p><i>Experience:</i> Minimum four years of professional nursing preferred or equivalent experience in health care. One year of management experience, including supervision, preferred.</p>
<p><i>Certificate/License:</i> <b>Current RN license in the State of Michigan</b>. Current BCLS certification.</p></div>

Manager of Clinical Services - Chiropractor, Optometry, Podiatry, Physical Therapy

Baylor Scott & White Health

<div><h4 class="jobSectionHeader"><b>About Us</b></h4><p>
Here at Baylor Scott &amp; White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.</p><p>
Our Core Values are:</p><ul><li>
We serve faithfully by doing what's right with a joyful heart.</li><li>
We never settle by constantly striving for better.</li><li>
We are in it together by supporting one another and those we serve.</li><li>
We make an impact by taking initiative and delivering exceptional experience.</li></ul><h4 class="jobSectionHeader"><b>
Benefits</b></h4><p>
Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott &amp; White Benefits Hub to explore our offerings, which may include:</p><ul><li>
Immediate eligibility for health and welfare benefits</li><li>
401(k) savings plan with dollar-for-dollar match up to 5%</li><li>
Tuition Reimbursement</li><li>
PTO accrual beginning Day 1</li></ul><p><i>
Note: Benefits may vary based upon position type and/or level.</i></p><h4 class="jobSectionHeader"><b>
Job Summary</b></h4><p>
The Clinical Research Manager oversees the administration of department-based clinical research. This position develops and monitors operating and capital budgets related to clinical research projects and helps to ensure departmental compliance with institutional, state and federal regulations and standards related to clinical research.</p><h4 class="jobSectionHeader"><b>
Essential Functions of the Role</b></h4><ul><li>
Oversees the administration of department-based clinical research to include conducting research, managing day-to-day operations, designing and implementing standard operating procedures, scheduling, interfacing with multi-users and maintaining supplies and equipment. Coordinates strategic planning to achieve short and long-term goals and priorities for the Clinical Research team.</li><li>
Develops and submits the operating and capital budgets to appropriate departmental administration. Contributes to negotiations with pharmaceutical, biotech and device companies and other agencies for clinical research contracts and study budgets. Coordinates communication between Principal Investigators, other personnel and departments with regards to financial issues.</li><li>
Participates in the development, implementation and administration of standard operating procedures and policies for Clinical Research.</li><li>
Interviews, counsels, evaluates, hires and recommends termination of assigned personnel. Educates, mentors and provides orientation and ongoing training for Clinical Research staff to ensure qualified personnel.</li><li>
Prepares schedules, makes job assignments and maintains appropriate personnel records in accordance with established policies and procedures.</li><li>
Works with investigators and industry to develop scientific protocols, concepts and tools to conduct clinical research effectively.</li></ul><h4 class="jobSectionHeader"><b>
Key Success Factors</b></h4><ul><li>
One year of supervisory or management experience.</li><li>
BLS Certification preferred per department requirements.</li><li>
Research Certification or other certifications per specialty area preferred per department requirements.</li><li>
Demonstrated commitment to effective customer service delivery.</li><li>
Ability to work productively as a member of a team or work group.</li><li>
Proven written and oral communication skills.</li><li>
Proven computer skills; including Microsoft Office, Excel and PowerPoint.</li><li>
Ability to manage time delicate projects in order to meet deadlines.</li><li>
Proven ability to establish and maintain effective working relationships.</li><li>
Excellent leadership skills.</li></ul><h4 class="jobSectionHeader"><b>
Belonging Statement</b></h4><p>
We believe that all people should feel welcomed, valued and supported.</p><p><b>
QUALIFICATIONS</b></p><ul><li>
EDUCATION - Bachelor's or 4 years of work experience above the minimum qualifications</li><li>
EXPERIENCE - 4 Years of Experience</li></ul></div>

Manager Clinical Research

HealthRIGHT 360

HealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment.
<br>This is a union eligible position.
<br><br>
JOB SUMMARY
<br>HealthRIGHT 360, a nonprofit organization and a family of programs, is committed to providing accessible and comprehensive healthcare services to vulnerable populations. Our mission is to tackle systemic barriers to healthcare and promote health equity for all. We offer a wide range of services, including mental health care, residential and outpatient substance use treatment, and primary health services. Additionally, we provide transitional support for individuals re-entering the community after involvement in the criminal justice system. By integrating physical and behavioral health, we empower individuals to overcome challenges by addressing social determinants of health, fostering resilience, and facilitating recovery.
<br><br>
San Mateo MAT Clinic is a small, growing community health clinic that provides care to underserved San Mateo County population. Medical Assistant is an essential member of the care team and is responsible for information management, coordination, care, and support.
<br><br>
The Physician (MD/DO) serves as a clinical leader responsible for delivering high-quality primary care and substance use disorder treatment to HealthRIGHT360 (HR360) SM clinic patients within an integrated care model. This role supports the growth of the practice and fosters effective team collaboration.
<br>The Physician provides overall clinical oversight and supervision of Advanced Practice Providers, including establishing collaborative agreements, offering ongoing guidance, and contributing to clinical reviews, performance evaluations, peer review processes, and hiring and termination decisions for providers and clinical support staff. Additionally, the physician oversees the broader healthcare treatment team and supervises medical assistant functions under the provider’s scope.
<br>KEY RESPONSIBILITIES
<br><br>
<b>Clinical Care Responsibilities:</b><br>
<ul>
<li>Provides comprehensive care, within the scope of credentialed privileges and standardized procedures, to HR360 patients within an integrated delivery model according to pre-arranged schedules, documenting care promptly and following charting protocols and applicable CA state licensing requirements.</li>
<li>Completes patient sessions in a timely manner.</li>
<li>Ensures appropriate follow-up for all aspects of ordered care (e.g., specialty referrals, laboratory results, radiology reports, etc.).</li>
<li>Responds to patient requests for information and assistance (e.g., form completion, prescription refills, etc.) in a timely manner.</li>
<li>Works collaboratively with mental health staff to facilitate integration between primary care and mental health in order to improve patient outcomes.</li>
<li>Provides on-call after-hours availability on a rotating basis, as requested by supervisor.</li>
<li>Obtains and maintains licensure, DEA registration and BCLS/CPR certification.</li>
<li>Attends continuing professional education programs, at the request or with the approval of supervisor, demonstrating participation in required hours of continuing medical education according to California law.</li>
</ul>
<b>Leadership/Supervision Responsibilities:</b><br>
<ul>
<li>Provides clinical leadership, supervision and oversight to advanced practice providers, support staff, nurses, medical assistants, patient care coordinators, and interns/students.</li>
<li>Enters into collaborative agreement with an advanced practice provider including full supervision in addition to clinical supervision, input into the performance appraisal, peer review and hiring or termination of the provider or clinical support staff.</li>
<li>Demonstrates comfort in changing systems, champions change, and leads change processes.</li>
</ul>
<b>Performance and Quality Improvement Responsibilities:</b><br>
<ul>
<li>Meets benchmarks for applicable quality indicators as noted in the annual quality improvement plan including the development of an appropriately sized continuity panel of patients and the maintenance of current productivity standards.</li>
<li>Along with colleagues, assists in continuous quality improvement through on-going problem/needs identification and problem solving and, as requested, acts as change champion or lead in improvement activities.</li>
</ul>
<b>Organizational Responsibilities:</b><br>
<ul>
<li>Supervises advanced practice providers, support staff including nurse and medical assistants, students, interns and residents.</li>
<li>Maintains availability for various administrative/clinical duties as requested by supervisor (e.g., case presentations, In-service training to staff.)</li>
<li>Represents HealthRIGHT 360 at and/or attends professional conferences, in-service trainings, and meetings at the request or with approval of supervisor.</li>
<li>Completes all mandatory trainings on an annual basis).</li>
</ul>
And, other duties as assigned.
<br><br>
QUALIFICATIONS
<br>Education, Certification, and Experience
<br><ul>
<li>M.D. or D. O. degree from an accredited school, 2 years recent experience in similar setting.</li>
<li>Board Certified Licensure as a physician in the State of California, without any limitations on his/her license to practice in his/her specialty.</li>
<li>Minium 2-3 years of practice in community health center or relevant practice/experience</li>
<li>Eligible to participate in the CMS Medicaid/Medicare reimbursement programs.</li>
<li>Experience managing patients presenting with opioid dependency, co-occurring disorders, homelessness, and/or HIV/AIDS management.</li>
<li>Experience working successfully with issues of substance abuse, mental health, criminal background, and other potential barriers to economic self-sufficiency.</li>
</ul>
<b>Desired:</b><br>
<ul>
<li>Experience with EPIC</li>
<li>Experience working with populations with varying lifestyles, ages, sexual orientations, ethnic and culture backgrounds and economic status</li>
<li>Experience working successfully with issues of substance abuse, mental health, criminal background, and other potential barriers to economic self sufficiency</li>
<li>Spanish, Cantonese, Vietnamese or other Medicaid threshold language</li>
</ul>
Knowledge and Skills
<br><ul>
<li>Culturally competent and able to work with a diverse population.</li>
<li>Strong proficiency with Microsoft Office applications, specifically Word Outlook and internet applications.</li>
<li>Knowledge of third party payer regulations, California practice guidelines and malpractice laws, Title 22, HIPAA regulations, Bureau of Primary Health Care FQHC program regulations.</li>
<li>We will consider for employment qualified applicants with arrest and conviction records.</li>
<li>Must complete a background check and livescan.</li>
</ul>


Physician (On-Call) - MAT Clinic Services

Vaya Health

<div><div><b>LOCATION:</b> Remote &ndash; this is a home based, virtual position. The person in this position must reside in North Carolina or within 40 miles of the NC border.</div><div></div><div><b><br>
Work Schedule:</b> Sunday &ndash; Wednesday 10am-9pm. This is a 40 hour per week position. Due to the nature of the Call Center and the Behavioral Health Crisis line, the job may require some holiday work throughout the year.</div><div></div><div><b><br>
GENERAL STATEMENT OF JOB</b></div><div>
This position is within the Member and Recipient Services Department at Vaya Health. The Member and Recipient Services Clinician is responsible for providing an array of functions to assist consumers in receiving clinically appropriate assessments and services. Telephone calls come to the unit via a 1-800 number from members, recipients, families, agencies, organizations, professionals and others within Vaya&rsquo;s catchment area. The Behavioral Health Crisis service line operates 24 hours per day, seven days per week, 365 days per year and the employee is subject to working holidays and holiday rotation as deemed necessary by the business.</div><div></div><div><br>
The primary purpose of the position is to provide telephone screening and triage for callers and families who are seeking mental health, substance abuse, or developmental disability services. The unit assesses the nature of the caller&rsquo;s situation, determines the urgency of the caller&rsquo;s need, and makes a referral to the most appropriate service available based on the caller&rsquo;s location and insurance plan.</div><div></div><div><br>
Duties include linking callers to needed services within clinically appropriate time frames, including telephonic clinical triage and referral which includes a determination of need for urgent or emergent services. In addition to providing clinical support the position will also directly handle any telephonic requests for services at times of heavy call volume.</div><div></div><div><br>
The employee works productively and efficiently with a wide variety of consumers, families, agencies, professionals, law enforcement and others in the community. Callers may be in distress or in emergency or crisis situations requiring speedy assessment and intervention. Some callers are at risk to harm themselves or others and this risk must be accurately assessed. The high volume of calls requires the employee to balance the need to do a careful and accurate telephone assessment of the consumer&rsquo;s need and situation, with the need to be efficient in the use of time to complete the screening and triage interaction. The employee develops and maintains the knowledge and skills necessary to accurately assess and refer consumers from all disability areas, and also maintains a good working knowledge of resources available throughout Vaya&rsquo;s entire catchment area.</div><div></div><div><br>
Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.</div><div></div><div><b><br>
ESSENTIAL JOB FUNCTIONS</b></div><div><b>
Handle telephonic requests for services, respond to member and recipient calls, and provide requested information:</b></div><div>
Member and Recipient Svcs Clinician perform clinical screening, triage and referral to callers needing services, answer and provide disposition to service request calls at times of heavy call volume, and handle crisis calls in the Member and Recipient Services Call Center. Member and Recipient Svcs Clinicians triage calls for urgency and facilitate access to crisis services when risk indicators are present. Where safety is at risk, the employee initiates immediate intervention via law enforcement or emergency medical assistance. Member and Recipient Svcs Clinicians will provide information and educate callers about the involuntary commitment process, as appropriate based on assessment of risk.</div><div></div><div><br>
The employee provides brief crisis interventions and/or support when indicated to facilitate the assessment process, encourages compliance, addresses safety issues, etc. Clinical functions are performed by the Member and Recipient Services Clinicians.</div><div></div><div><br>
Member &amp; Recipient Svcs Clinician will inquire about the caller&rsquo;s needs, determine clinical urgency, review and confirm member and recipient eligibility, collect necessary demographic information, offer choice of available providers based upon the consumers request and service needs, and schedule appointments within established access time standards.</div><div></div><div><br>
The Member &amp; Recipient Svcs Clinician will inform a Member Services Manager and/or appropriate Network Development staff of gaps and needs associated with trends that are detected within the services system for timely analysis and resolution.</div><div></div><div><br>
For information calls, this position will provide information about Vaya, the Vaya provider network, community resources, and about Medicaid services in the State of NC. Member &amp; Recipient Svcs Clinician shall receive extensive training on customer services skills such as the use of appropriate tone, cadence, inflection, and choice of recovery oriented and/or person-centered wording. All Member and Recipient Services Representatives must adhere to NCMT Call Grading Rubric provided by NCDHHS.</div><div></div><div><br>
This position requires a high degree of communication skills and professionalism with various parties- members, recipients, providers, vendors, community organizations, legal guardians, and more. The Member and Recipient Svcs Clinician will complete warm transfers and linkages to a variety of different parties to assist the caller with correct linkage.</div><div></div><div><b><br>
Documentation in the electronic information system:</b></div><div>
The Member &amp; Recipient Svcs Clinician completes call notes, forms, reports and other documentation as required. The Member and Recipient Services Clinician will complete required documentation at the time of call. This position requires a high degree of technical skills with utilization of multiple systems/logins throughout a phone call.</div><div></div><div><b><br>
Specialized projects and reviews:</b></div><div>
The Member &amp; Recipient Svcs Clinician will assist in specialized Member Services Departmental projects as requested by the Member and Recipient Services Managers or Directors, and/or the Vice President of Member and Recipient Services.</div><div></div><div><b><br>
Other duties as assigned.</b></div><div></div><p><b><br>
KNOWLEDGE, SKILLS, &amp; ABILITIES</b></p><div><ul><li>
A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts. Problem solving, negotiation, arbitration and conflict resolution skills are essential to balance the needs of both internal and external customers.</li><li>
Mastery of utilization review principles to resume continuity of care and clinical evaluations as needed for appropriate provision of intensive, crisis services and other levels of care to ensure linkage to correct services;</li><li>
Knowledge of documentation and clinical protocols for utilization purposes.</li><li>
Knowledge of linage, authorization and level of care determinations, assisting providers with creative problem solving to suggest alternative approaches to care.</li><li>
Clinical knowledge of managed systems of mental health and substance abuse. Knowledge of managed behavioral care practices.</li><li>
Ability to collaborate with providers and other agencies.</li><li>
Clinical knowledge of mental health and substance abuse treatment as a basis for clinical triage and referral decisions</li><li>
Comprehensive knowledge of resources and the ability to use a personal workstation.</li></ul></div><div></div><div><br>
Knowledge of databases and data entry is essential. A degree alone does not prepare an applicant for this position. Experience providing mental health, substance abuse, or intellectual/ developmental disabilities services are essential. This employee should have knowledge of individual and group dynamics, and will learn de-escalation of telephonic situations, and a thorough knowledge risk indicators. Considerable knowledge of governmental and private organizations and resources in the community is beneficial. Considerable knowledge of the laws, regulations, and policies that govern MCO operations is beneficial. Skill in establishing rapport with staff/consumers in discussing their issues in a sensitive, supportive and nonjudgmental way is necessary. Ability to establish and maintain effective working relationships with community members and provider agency staff is necessary.</div><div></div><div><br>
Other skills or abilities require are as follows:</div><div><ul><li>
Knowledge of behavioral health principles, techniques, and practices, and their applications to complex treatment and service provision.</li><li>
Considerable knowledge of person-centered and recovery philosophies.</li><li>
Familiarity with mental health, developmental disability and substance abuse disorders.</li><li>
The ability to remain professionally responsive in an ethical and sensitive manner to individual&rsquo;s needs throughout the course of the work day/shift.</li><li>
The ability to work responsibility and effectively with others for a timely resolution of the caller&rsquo;s needs.</li><li>
The ability to interact professionally and effectively with persons who are upset and who disagree.</li><li>
Knowledge of the laws, regulations, and policies which govern human services and utilization management.</li><li>
The ability to express ideas clearly and concisely orally and in writing, and to plan and execute work effectively and efficiently.</li><li>
The ability to utilize complex telephone and computer systems, and to read and document information electronically.</li></ul></div><div></div><div><b><br>
EDUCATION &amp; EXPERIENCE REQUIREMENTS</b></div><div>
Master&rsquo;s degree in a Human Services field (such as Psychology, Social Work, etc.) and at least two (2) years of post-degree-progressive experience providing services in the population served <b><i>OR</i></b> graduation from a State accredited school of nursing and two years of experience in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform the work; or an equivalent combination of education and experience.</div><div></div><div><br>
Must possess a current and valid professional license or certificate in North Carolina; or possess a current and valid license or certificate from another state or be certified by the national accrediting body appropriate to their profession. (URAC HCC 5)</div><div></div><div><br>
Experience in the public mental health field and a thorough understanding of the services available in the catchment area is highly desired due to the complexity of the work of the organization. Prior experience in a Call Center environment in Behavioral Healthcare would be valuable for this employee.</div><div></div><div><br>
A degree alone does not prepare an applicant for this position. Experience providing mental health or substance abuse services are essential.</div><div></div><div><br>
No experience can be substituted for the formal degree.</div><div></div><div><b><br>
Licensure/Certification Required:</b></div><div>
Must possess a current, active, unrestricted professional license or certification from North Carolina in a Human Services field (such as Psychology, Social Work, Counseling, Marriage and Family Therapy, Addictions, etc.). Acceptable licenses include Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Clinical Addictions Specialist (LCAS), Doctor of Psychology (Psy. D.), PhD. Psychologist, Licensed Marriage and Family Therapist (LMFT) or Licensed Psychological Associate (LPA). For RN candidates, the employee must have a current, active, unrestricted professional license to practice as a registered Nurse in North Carolina by the NC Board of Nursing.</div><div></div><div><b><br>
PHYSICAL REQUIREMENTS</b></div><ul><li>
Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.</li><li>
Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.</li><li>
Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.</li></ul><div></div><div><br>
<b>RESIDENCY REQUIREMENT:</b> The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.</div><div></div><div><b><br>
SALARY: </b>Depending on qualifications &amp; experience of candidate. This position is exempt and is not eligible for overtime compensation.</div><div></div><div><b><br>
DEADLINE FOR APPLICATION:</b> Open Until Filled</div><div></div><div><b><br>
APPLY:</b> Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.</div><div></div><div><br>
Vaya Health is an equal opportunity employer.</div></div><div></div>

Member & Recipient Services Clinician (Sun-Wed, Remote NC)

Southern Scripts

<p></p><div><h1 class="jobSectionHeader"><b>Clinical Member Services Agent</b></h1><h1 class="jobSectionHeader"><b>
Role and Responsibilities</b></h1><p>
The clinical member services agent (CMSA) is responsible for providing effective customer service for all internal and external customers by using excellent, in-depth knowledge of company products and programs as well as communicating effectively with team members within the clinical department. The CMSA will work in conjunction with the member service agent to assist in clinical situations and resolutions.</p><ul><li>
Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. Confer with customers by telephone to provide information about Rx claims processing.</li><li>
Understanding of Pharmacy terms and formularies as a certified Pharmacy Technician (CPhT).</li><li>
Keep detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.</li><li>
Follow-up to ensure that appropriate changes were made to resolve customers' problems.</li><li>
Refer unresolved customer grievances to designated departments for further investigation.</li><li>
Review Rx insurance policy terms to determine whether a claim is covered for employer group.</li><li>
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.</li><li>
Resolve customers' service or billing complaints.</li><li>
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.</li><li>
Abide by all obligations under HIPAA related to Protected Health Information (PHI).</li><li>
If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.</li><li>
Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.</li><li>
Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.</li></ul><h1 class="jobSectionHeader"><b>
Required Skills and Competencies</b></h1><ul><li>
Interacting with Computers &mdash; Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.</li><li>
Communicating with Supervisors, Peers, or Subordinates &mdash; Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.</li><li>
Getting Information &mdash; Observing, receiving, and otherwise obtaining information from all relevant sources.</li><li>
Communicating with Persons Outside Organization &mdash; Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.</li><li>
Processing Information &mdash; Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.</li><li>
Resolving Conflicts and Negotiating with Others &mdash; Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.</li><li>
Updating and Using Relevant Knowledge &mdash; Keeping up-to-date technically and applying new knowledge to your job.</li><li>
Organizing, Planning, and Prioritizing Work &mdash; Developing specific goals and plans to prioritize, organize, and accomplish your work.</li><li>
Performing Administrative Activities &mdash; Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.</li><li>
Making Decisions and Solving Problems &mdash; Analyzing information and evaluating results to choose the best solution and solve problems.</li><li>
Customer and Client Focus.</li><li>
Problem Solving and Analysis.</li><li>
Time Management.</li><li>
Communication Proficiency.</li><li>
Teamwork Orientation.</li><li>
Technical Capacity.</li><li>
Multitasking</li><li>
Competencies as a Certified Pharmacy Technician (CPhT).</li></ul><h1 class="jobSectionHeader"><b>
What We Have to Offer</b></h1><ul><li>
Medical, Dental, Vision Insurance</li><li>
Disability and Life Insurance</li><li>
Employee Assistance Program</li><li>
Remote work options</li><li>
Generous Paid-Time Off</li><li>
Annual Reviews and Development Plans</li><li>
Retirement Plan with company match, immediately 100% vested</li></ul><h1 class="jobSectionHeader"><b>
Position Type and Expected Hours of Work</b></h1><p>
This is a full-time, hourly position. Days and hours of work vary on shift assigned. The Call Center hours of operation are Monday &ndash; Friday 6a &ndash; 10p, Saturday 8a &ndash; 6p, and Sunday 8a-5p. On-Call responsibilities are on a rotation basis.</p><p>
This position reports to the Contact Center Supervisor.</p><h1 class="jobSectionHeader"><b>
Travel</b></h1><p>
Minimal travel expected for this position to Natchitoches, Louisiana for training and development.</p><h1 class="jobSectionHeader"><b>
Qualifications and Education Requirements</b></h1><ul><li>
High School or equivalent.</li><li>
Customer service experience.</li><li>
Certified Pharmacy Technician Certification (CPhT) with experience in a pharmacy setting.</li><li>
Computer experience.</li></ul><p></p><p><br>
Liviniti, LLC and all entities provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.</p><p>
Liviniti expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/V/D</p></div><p></p>

Clinical Member Services Agent

Northern Light Health

<div><p><b>Northern Light A.R. Gould
</b></p><p><b>Department: </b>Sleep Medicine Clinic
</p><p><b>Position is located: </b>Northern Light Health Center Fort Fairfield
</p><p><b>Work Type: </b>Full Time
</p><p><b>Hours Per Week: </b>40.00
</p><p><b>Work Schedule: </b>8:00 AM to 4:30 PM
</p><p><b>Summary </b>:
</p><p></p><p>Manages the daily operations of the Medical Group Practice. The manager provides leadership of daily operations of the unit, ensuring that policies, procedures, finances, operations, and practices are consistent with the organizational goals and strategic initiatives. Is responsible for personnel management, assuring adequate access is available for patients, performance improvement, quality patient care, and assuring the department meets regulatory requirements. In collaboration with the physician dyad leader, works on growth and strategic initiatives to improve care, access, and services offered. The selected manager must be able to work collaboratively with others, lead business operations, and have familiarity with medical coding, billing practices, public relations, HR rules, and customer service. Strong business acumen and exceptional communication skills are required.
</p><p><b>Responsibilities:
</b></p><p></p><p>Plans, allocates, and assigns duties and programs to the administrative and clinical staff. Monitors activities and operations to ensure that practice successfully meet objectives. Standardizes procedures and initiates changes when necessary. Constantly reviews administrative and operational procedures to strive for more efficient ways to conduct business and improve patient relations and experience. Responsible for the development, adherence and implementation of the departmental capital and operating budgets, including assisting with coding and billing audits. Responsible for compliance with applicable Joint Commission. State, and other regulations. Responsible for the oversight of training and ongoing education of staff. Is responsible for the development, implementation, revision, and reporting of Performance Improvement activities. Assists and provides support to front line staff, including coverage as needed. Other duties
</p><p><b>Other Information </b>:
</p><p></p><p><b>Competencies and Skills<br>
</b><br>
</p><p></p><ul><li>Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
</li><li>Acts Strategically: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.
</li><li>Adobe Acrobat
</li><li>Applies Business Acumen:Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.
</li><li>Arithmetic
</li><li>Electronic medical record software.
</li><li>Cyber Security
</li><li>Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
</li><li>Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
</li><li>Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.
</li><li>Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
</li><li>Exercises Sound Judgment &amp; Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
</li><li>Fosters Innovation: Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.
</li><li>Influences and Inspires: Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.
</li><li>Human Capital, Supply Chain and Financial Software.
</li><li>Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
</li><li>Word processing, spreadsheets, data entry, database experience and other computer related skills.
</li><li>Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.
</li><li>Presentation software with the ability to create presentations with the ability to incorporate animation, audio, video, time delays, as well as designing themes and variants with animations and effects.
</li><li>MS Teams
</li><li>Word process application with the ability to create and edit documents, format, use tables, apply footnoting, create table of contents and mail merge techniques.
</li><li>Multi-line phone, scanner, photocopier, fax, and internet.
</li><li>OneNote
</li><li>Promotes Health and Safety: Promotes a healthy and safe environment for patients, employees and visitors. Advocates and models healthy physical and mental health behaviors even in challenging circumstances. Sets high quality standards and strives for continuous improvement and quality assurance by reporting and encouraging others to report near misses and safety issues.
</li><li>Provides Patient-Centered Care: Demonstrates understanding of patient care quality and service as organizational priority. Proactively supports change to improve patient experience and results. Exhibits the ability and willingness to find out what the patient wants and needs and to act accordingly, taking the organizational and outside resources into account. Cooperates, collaborates, communicates, and integrates care within and between teams to ensure that care is continuous and reliable.
</li><li>Public Speaking
</li><li>Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability .
</li><li>Seeks Process Improvement &amp; Applies System Thinking: Possesses and gains insight into situations, problems and processes. Understands the interconnection between organizational elements. Deconstructs problems and systematically investigates the various components. Considers the impact of actions on the entire process/system. Detects problems and opportunities, recognizes important information, and links various data to trace potential causes and relevant details.
</li><li>Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.
</li><li>Siemens Clinical software.
</li><li>Business intelligence and data analysis software.
</li><li>Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.
</li><li>Zoom
</li><li>Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
</li><li>Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
</li><li>Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
</li><li>Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
</li></ul><p></p><p><b>Education<br>
</b><br>
</p><p></p><ul><li>Required Bachelor's Degree
</li></ul><p><b>Required Experience<br>
</b><br>
</p><p></p><ul><li>1 year/years of Leadership Experience
</li><li>3 year/years of Relevant Work Experience
</li></ul><p><b>Working Conditions
</b></p><p></p><ul><li>Potential exposure to abusive and/or aggressive people.
</li><li>Potential exposure to diseases or infections.
</li><li>Work with computers, typing, reading or writing.
</li><li>Work beyond the regularly scheduled hours.
</li>Lifting, moving and loading less than 20 pounds.<br>
<li>
</li></ul><p></p><br>
<p>Northern Light AR Gould Hospital is an acute care hospital located near the Canadian border in Presque Isle, Maine. This is the largest city and economic hub of Aroostook County &ndash; Maine&rsquo;s northernmost county, with a geographic area larger than the states of Maryland and Rhode Island combined. When you're not enjoying year-round outdoor activities, you will be working with supportive colleagues in a facility that offers a surprising range of comprehensive services given its rural location.
</p><p>AR Gould provides emergency, primary, and specialty care. In addition to traditional acute care, our inpatient units also include acute rehabilitation and a women and children&rsquo;s unit. It is the only healthcare facility in the region to offer certain life-saving specialty services, such as radiation therapy, a cardiac catheterization lab, and a dialysis center.
</p><p>The hospital is a member of Northern Light Health, an integrated statewide health system that is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our state.
</p><p></p><p>The University of Maine at Presque Isle, Northern Maine Community College, the Maine School of Science and Mathematics magnet school, and quality local public schools all provide opportunities for academic enrichment. Lakes, rivers, and woodlands are legendary and well-known to hunters, anglers, and outdoor recreationalists. The local airport provides year-round easy access and daily commercial airline service to Newark, New Jersey.<br>
</p><p></p><br>
<br>
<p>ARG, Presque Isle, Aroostook County, Maine, TAMC, Northern Maine, Rural Health Care</p></div>

Mgr- Sleep Medicine Services

Physicians Data Trust

<div><p><b>Primary Purpose:</b></p><p>
Data input of referral authorization requests received from the Organization's Contracted Providers; generate member notifications as directed.</p><p><b>
Principal Duties and Responsibilities (* = essential functions):</b></p><ul><li>
Verifies eligibility and benefits for each referral. *</li><li>
Performs data entry of referral authorization requests for primary care visits, specialty consults, diagnostic/outpatient procedures, and admissions approved by the Medical Director. *</li><li>
Tracks and monitors progress of referral requests, responding to requests for additional information to assist the medical director's staff in making a decision. *</li><li>
Primary telephone call process for incoming calls into the Utilization Management Department. *</li><li>
Provides referral and authorization notifications to providers as directed. *</li><li>
Organizes and maintains electronic and hard copy filing systems for authorizations/referrals as directed.</li><li>
Prepares assigned correspondence and reports and complies with statistical data as directed.</li><li>
Tracks all types of references on the computer system on a hard copy log and compiles statistics monthly.</li><li>
Supports and facilitates teamwork within the department/group and the organization.</li><li>
Obtains CPT procedure codes and ICD-10 diagnosis codes from referring providers to assist with the determination of approval/denial.</li><li>
Ensures that network providers are utilized.</li><li>
Handles incoming calls from physicians, ancillary providers, and patients regarding referral authorization requests.</li><li>
Review file for completeness of required documentation, including but not limited to confirmation of receipt of notification copies of written notification correspondence with members and providers.</li><li>
Monitors and facilitates requisition requests for home health DME and other services in accordance with benefit guidelines.</li><li>
Coordinates all out-of-network outpatient specialist referrals with the Medical Director.</li><li>
Generates all required letters and notifications to patients and providers regarding referral authorizations, medical approval, and medical denial within established timeframes in accordance with policies, procedures, and contractual requirements.</li><li>
Provide the requested information during the appeals process.</li><li>
To organize and act promptly on pending denial files/cases to maintain designated turnaround times and physician communication.</li><li>
To provide information to licensed nursing staff regarding referrals that are 'not a covered benefit' and facilitate denial letters.</li><li>
To organize, manage, and prioritize workload effectively to process authorization request forms within the established time frame. *</li><li>
To refer appropriate authorization request forms to the IPA case manager based on established criteria.</li><li>
To educate and inform physicians and their office staff of any changes to the referral process, network changes, or other information about the referral process.</li><li>
Assist other departments in creating denial documentation during the appeals process.</li><li>
Document denial and denial rationale in data management systems. *</li><li>
Maintains/updates all required reporting for referrals/authorizations.</li><li>
Complete other duties and special projects as assigned.</li><li>
Ensure all required work is completed on time by the end of each shift.</li><li>
Participates in scheduled departmental/group meetings.</li><li>
Represents the department/group and organization professionally and positively.</li><li>
To perform other duties as assigned.</li></ul><p>
Job Specifications (KSAs):</p><ul><li>
Six months of experience in the medical field, either in a hospital, clinical, or insurance setting, that includes experience with computers.</li><li>
The ability to read, write, and speak English and perform other basic educational skills, as is generally obtained by completing High school or a GED equivalent.</li><li>
Bilingual English/Spanish preferred.</li><li>
Clear and accurate knowledge of medical terminology; managed care experience and knowledge preferred.</li><li>
Working knowledge &amp; expertise of ICD-10 &amp; CPT-4 codes.</li><li>
Demonstrated computer literacy. Excel experience helpful.</li><li>
Excellent communication skills in both oral and written modes, as well as superior telephone etiquette.</li><li>
Excellent Customer Service experience and proficiency required.</li></ul><p>
Pay Range $18 - $27.00 hourly DOE.</p></div><p></p>

Clinical Services UM Coordinator

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