clinical case manager, behavioral health

telephonic case manager

pbm client experience manager

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary 
The Pharmacy Benefit Management Client Experience Manager examines sales, account management, and business retention metrics for products and services, in order to support profitable growth and other business objectives. This person controls strategic business plans for accounts and customer relationships, focusing on revenue growth, member retention, and achievement of financial objectives. 
 
What you will do:
Client Support<ul><li>
Perform and support plan changes.</li><li>
Perform ID card facilitation.</li><li>
Complete any necessary reporting (scheduled, ad-hoc).</li><li>
Conduct inbound phone calls.</li><li>
Complete any assigned invoices.</li><li>
Perform any assigned group terminations.</li><li>
Complete documentation requests.</li><li>
Serve as a presence throughout the implementation process.</li><li>
Facilitate and participate in external-facing meetings.</li></ul> 
Member Support<ul><li>
Perform overrides as needed.</li><li>
Oversee prior authorization and accessibility processes.</li><li>
Conduct inbound phone calls.</li><li>
Oversee resolution of claims issues.</li><li>
Perform manual eligibility adds and terminations.</li><li>
Service warranties as assigned.</li></ul> 
Required Qualifications<ul><li>
5+ years of experience in a pharmacy, PBM, or insurance setting.
</li><li>Travel up to 25% of time within the continental United States.</li></ul> 
Preferred Qualifications<ul><li>
Certified Pharmacy Technician.</li><li>
Basic awareness of problem solving and decision-making skills.</li><li>
Previous experience with Salesforce.</li><li>
Bachelor&rsquo;s degree.</li></ul> 
Education<ul><li>
High school diploma or GED.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$46,988.00 - $122,400.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 05/01/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

PBM Client Experience Manager

Medical Mutual

<div>
 <ul>
 <li>
 Medical Mutual employees must submit their applications through MySource.
 </li>
 <li>
 This is a remote-based role, and we are currently seeking candidates located in Ohio.
 
 
 </li>
 </ul>
 Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
 
 
 
 Clinical Pharmacist I
 
 
 
 
 
 Job Summary:
 
 
 
 
 As assigned, supports any of the following pharmacist specialty areas; formulary and policy development, intervention programs for commercial and Medicare programs, partnering with sales team, or health systems liaison. Develops and implements evidence based clinical programs to ensure that members receive the most clinically appropriate medication cost-effectively. Evaluates evidence and applies these principles to patient care.
 
 
 
 
 Responsibilities:
 
 
 
 
 <ul>
 <li>
 Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):
 </li>
 <li>
 Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend.
 </li>
 <li>
 Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.
 </li>
 <li>
 Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives.
 </li>
 <li>
 Contributes with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs.
 </li>
 <li>
 Collaborates with pharmacy team members in the development and implementation of programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups.
 </li>
 <li>
 Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.
 </li>
 <li>
 Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc.
 </li>
 <li>
 Collaborates with pharmacy departments within the Company&rsquo;s strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship.
 </li>
 <li>
 Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).
 </li>
 <li>
 Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals.
 </li>
 <li>
 Builds and maintains and clinical knowledge and knowledge of prescription benefit trends.
 </li>
 <li>
 Performs other duties as assigned.
 
 
 </li>
 </ul>
 
 
 Qualifications:
 
 
 
 
 
 Education and Experience:
 
 
 
 <ul>
 <li>
 Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.
 </li>
 <li>
 Successful completion of internal Clinical Pharmacy Resident program, or 0 to 3 years of experience as a Clinical Pharmacist, or equivalent experience in a managed care pharmacy setting.
 </li>
 <li>
 Medicare/Medicaid experience preferred.
 
 
 </li>
 </ul>
 
 
 Professional Certification(s):
 
 
 
 
 <ul>
 <li>
 Registered Pharmacist with current unrestricted license from the appropriate State Board of Pharmacy.
 </li>
 <li>
 May be required to obtain Ohio State Board of Pharmacy license within 6 months of hire.
 
 
 </li>
 </ul>
 
 
 Technical Skills And Knowledge:
 
 
 
 
 <ul>
 <li>
 Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.
 </li>
 <li>
 Knowledge of medical/pharmacy terminology/coding and specialty drug management.
 </li>
 <li>
 Good clinical acumen.
 </li>
 <li>
 Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.
 </li>
 <li>
 Ability to present clinical information to various internal and external audiences.
 
 
 </li>
 </ul>
 
 Clinical Pharmacist II
 
 
 
 
 
 Responsibilities:
 
 
 
 
 <ul>
 <li>
 Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):
 </li>
 <li>
 Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend.
 </li>
 <li>
 Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.
 </li>
 <li>
 Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives.
 </li>
 <li>
 Interacts with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs.
 </li>
 <li>
 Develops and implements programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups.
 </li>
 <li>
 Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.
 </li>
 <li>
 Promotes the value-add of the Company&rsquo;s pharmacy services with internal and external stakeholders. Develops relationships and partnerships to support health systems engagement or sales efforts.
 </li>
 <li>
 Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc.
 </li>
 <li>
 Collaborates with pharmacy departments within the Company&rsquo;s strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship.
 </li>
 <li>
 Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).
 </li>
 <li>
 Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals.
 </li>
 <li>
 May orient, train, and assist new hires, residents, and junior level Pharmacists. Maintains and shares clinical knowledge and knowledge of prescription benefit trends.
 </li>
 <li>
 Performs other duties as assigned.
 
 
 </li>
 </ul>
 
 
 Education And Experience:
 
 
 
 
 <ul>
 <li>
 Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.
 </li>
 <li>
 3 years of experience as a Clinical Pharmacist or equivalent experience in a managed care pharmacy setting.
 </li>
 <li>
 Medicare/Medicaid experience preferred.
 
 
 </li>
 </ul>
 
 
 Technical Skills And Knowledge:
 
 
 
 
 <ul>
 <li>
 Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.
 </li>
 <li>
 Knowledge of medical/pharmacy terminology/coding and specialty drug management.
 </li>
 <li>
 Good clinical acumen and strategic analysis skills.
 </li>
 <li>
 Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.
 </li>
 <li>
 Ability to present clinical information to various internal and external audiences.
 
 
 </li>
 </ul>
 
 Sr Clinical Pharmacist
 
 
 
 
 
 Job Summary:
 
 
 
 
 Applies a thorough understanding of clinical pharmacy programs including formulary design, prescription benefit trends, and translates complex clinical information into actionable strategies. Administers formulary design and drug policy within the clinical systems of the Pharmacy Benefit Manager (PBM). Keeps apprised of prescription benefit trends and pipeline, ensuring programs are set for success as the landscape of pipeline evolves. Presents, translates, and communicates complex clinical information for diverse group benefit plan audiences.
 
 
 
 
 Responsibilities:
 
 
 
 
 <ul>
 <li>
 Provides clinical support for formulary and policy development in the administration of pharmacy benefits. Identifies new opportunities for drug management, including safety programs, and medical/pharmacy cost savings.
 </li>
 <li>
 Collaborates with Chief Medical Officer, other Physician leadership, and related staff to perform utilization review of drugs to develop drug medical policies, research new drugs for possible utilization, education staff/customers and identify administration of those policies.
 </li>
 <li>
 Interprets standards published by national accrediting bodies, gathers and documents supporting evidence demonstrating compliance with said standards. Collaborates with external delegate(s) and Pharmacy Management department with regard to accreditation standard oversight.
 </li>
 <li>
 Represents the department or division in activities or projects as assigned by management.
 </li>
 <li>
 Provides oversight of PBM or third-party vendors by conducting regular audits of clinical program implementation and operations.
 </li>
 <li>
 Conducts internal and external appeal reviews and works with medical directors to decision cases and complete Independent Review Organization (IRO) submissions.
 </li>
 <li>
 May lead projects for existing staff and acts as a resource to newly hired staff, supporting management with training, assigned projects, and goals.
 </li>
 <li>
 Reviews drug/medical literature, clinical practice guidelines, and available national guidelines to support drug policy development and consultation over various medical and pharmacy clinical programs
 </li>
 <li>
 Orients, trains, and assists new hires, residents, and junior level Pharmacists. Develops and maintains policies and procedures to support team as needed. Maintains and shares knowledge of prescription benefit trends.
 </li>
 <li>
 Performs other duties as assigned.
 
 
 </li>
 </ul>
 
 
 Education And Experience:
 
 
 
 
 <ul>
 <li>
 Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.
 </li>
 <li>
 5 years of experience as a Clinical Pharmacist or equivalent experience in a managed care pharmacy setting.
 
 
 </li>
 </ul>
 
 
 Technical Skills And Knowledge:
 
 
 
 
 <ul>
 <li>
 Comprehensive understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.
 </li>
 <li>
 Knowledge of medical/pharmacy terminology/coding and specialty drug management.
 </li>
 <li>
 Strong clinical acumen and strategic analysis skills.
 </li>
 <li>
 Advanced Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.
 </li>
 <li>
 Ability to present clinical information to various internal and external audiences.
 
 
 </li>
 </ul>
 
 A Great Place To Work:
 
 
 
 Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
 
 
 <ul>
 <li>
 We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
 </li>
 <li>
 Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
 </li>
 <li>
 On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
 </li>
 <li>
 Discounts at many places in and around town, just for being a Medical Mutual team member.
 </li>
 <li>
 The opportunity to earn cash rewards for shopping with our customers.
 </li>
 <li>
 Business casual attire, including jeans.
 
 
 </li>
 </ul>
 
 Excellent Benefits And Compensation:
 
 
 
 <ul>
 <li>
 Employee bonus program.
 </li>
 <li>
 401(k) with company match up to 4% and an additional company contribution.
 </li>
 <li>
 Health Savings Account with a company matching contribution.
 </li>
 <li>
 Excellent medical, dental, vision, life and disability insurance &mdash; insurance is what we do best, and we make affordable coverage for our team a priority.
 </li>
 <li>
 Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
 </li>
 <li>
 Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
 </li>
 <li>
 After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
 
 
 </li>
 </ul>
 
 An Investment In You:
 
 
 
 <ul>
 <li>
 Career development programs and classes.
 </li>
 <li>
 Mentoring and coaching to help you advance in your career.
 </li>
 <li>
 Tuition reimbursement up to $5,250 per year, the IRS maximum.
 </li>
 <li>
 Diverse, inclusive and welcoming culture with Business Resource Groups.
 
 
 </li>
 </ul>
 
 About Medical Mutual:
 
 
 
 Medical Mutual&rsquo;s status as a mutual company means we are owned by our policyholders, not stockholders, so we don&rsquo;t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
 
 
 There&rsquo;s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
 
 
 We&rsquo;re not just one of the largest health insurance companies based in Ohio, we&rsquo;re also the longest running. Founded in 1934, we&rsquo;re proud of our rich history with the communities where we live and work.
 
 
 
 We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
 
 
 
</div>

Clinical Pharmacist - Managed Care

Gainwell Technologies LLC

<div>It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.<div><div><div><h2 class="jobSectionHeader"> 
Summary</h2></div><div>
Gainwell Technologies is seeking a Certified Pharmacy Technician - Remote US to support a high-volume PBM clinical and technical call center environment. In this fully remote role, you will assist with provider inquiries, process prior authorizations, and help ensure timely, accurate resolution of pharmacy-related requests while maintaining compliance with HIPAA, state regulations, and internal quality standards.</div></div><div><div><h2 class="jobSectionHeader">
Your role in our mission</h2></div><div><ul><li>
Process prior authorization requests within required turnaround times and complete approvals when pharmacist review is not needed.</li><li>
Handle provider inquiries efficiently across phone, email, fax, and web-based channels, aiming for first-contact resolution whenever possible.</li><li>
Conduct outbound communication to providers to obtain missing information and support closure of pending prior authorization cases.</li><li>
Accurately document all interactions, decisions, and follow-up actions in the appropriate systems.</li><li>
Follow established workflows, productivity expectations, and quality standards while identifying opportunities for process improvement.</li></ul></div></div><div><div><h2 class="jobSectionHeader">
What we're looking for</h2></div><div><ul><li>
Active Certified Pharmacy Technician (CPhT) certification and/or active Pharmacy Technician registration as required by applicable Board of Pharmacy regulations.</li><li>
At least 2 years of pharmacy technician experience, preferably in retail, hospital, managed care, PBM, insurance, or prior authorization support.</li><li>
Strong knowledge of drug terminology, pharmacy operations, and pharmacy benefit or claims-related processes.</li><li>
Experience working in a fast-paced, metrics-driven environment with strong attention to detail and accuracy.</li><li>
Proficiency in Microsoft Office applications and the ability to quickly learn internal systems and workflows.</li></ul></div></div><div><div><h2 class="jobSectionHeader">
What you should expect in this role</h2></div><div><ul><li>
Fully remote position supporting a high-volume call center operation.</li><li>
Frequent interaction with providers through phone, email, fax, and web portals.</li><li>
Strict adherence to HIPAA, PHI, regulatory, and turnaround-time requirements.</li><li>
Performance expectations tied to productivity, quality, and service metrics.</li><li>
Comprehensive benefits package including medical, dental, vision, 401(k) with company match, paid time off, floating holidays, and wellness programs.</li></ul>
#LI-REMOTE
#LI-JT</div></div></div> 
The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. 
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. 
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.</div>

Certified Pharmacy Technician - Remote US

Gainwell Technologies

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 Gainwell Technologies is seeking a Certified Pharmacy Technician - Remote US to support a high-volume PBM clinical and technical call center environment. In this fully remote role, you will assist with provider inquiries, process prior authorizations, and help ensure timely, accurate resolution of pharmacy-related requests while maintaining compliance with HIPAA, state regulations, and internal quality standards.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Process prior authorization requests within required turnaround times and complete approvals when pharmacist review is not needed.
 </li>
 <li>
 Handle provider inquiries efficiently across phone, email, fax, and web-based channels, aiming for first-contact resolution whenever possible.
 </li>
 <li>
 Conduct outbound communication to providers to obtain missing information and support closure of pending prior authorization cases.
 </li>
 <li>
 Accurately document all interactions, decisions, and follow-up actions in the appropriate systems.
 </li>
 <li>
 Follow established workflows, productivity expectations, and quality standards while identifying opportunities for process improvement.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Active Certified Pharmacy Technician (CPhT) certification and/or active Pharmacy Technician registration as required by applicable Board of Pharmacy regulations.
 </li>
 <li>
 At least 2 years of pharmacy technician experience, preferably in retail, hospital, managed care, PBM, insurance, or prior authorization support.
 </li>
 <li>
 Strong knowledge of drug terminology, pharmacy operations, and pharmacy benefit or claims-related processes.
 </li>
 <li>
 Experience working in a fast-paced, metrics-driven environment with strong attention to detail and accuracy.
 </li>
 <li>
 Proficiency in Microsoft Office applications and the ability to quickly learn internal systems and workflows.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Fully remote position supporting a high-volume call center operation.
 </li>
 <li>
 Frequent interaction with providers through phone, email, fax, and web portals.
 </li>
 <li>
 Strict adherence to HIPAA, PHI, regulatory, and turnaround-time requirements.
 </li>
 <li>
 Performance expectations tied to productivity, quality, and service metrics.
 </li>
 <li>
 Comprehensive benefits package including medical, dental, vision, 401(k) with company match, paid time off, floating holidays, and wellness programs.
 
 
 </li>
 </ul>
 The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
 
 
 We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
 
 
 
 Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
 
 
</div>

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Telephonic Case Manager
<div>PRIMARY PURPOSE OF THE ROLE: While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services.
ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
<ul><li>Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.
</li><li>Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting.
</li><li>Enable our Caring counts&reg; mission supporting injured employees from some of the world&rsquo;s best brands and organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Performs initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems.
</li><li>Effectively communicates and builds relationships with the claims&rsquo; examiner, client, injured worker, attorney and supervisor.
</li><li>Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approach
</li><li>Negotiates treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality.
</li><li>Identifies opportunities to expedite care for cost containment and timely medical recovery.
</li><li>Provides recommendations for alternate clinical resources to support claim resolution.
</li><li>Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
</li></ul>EDUCATION AND LICENSING
Current unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred. 
TAKING CARE OF YOU BY
<ul><li>Offering flexibility and autonomy.
</li><li>Supporting meaningful work that promotes critical thinking and problem solving.
</li><li>Providing on-going learning and professional growth opportunities.
</li><li>Promoting a strong team environment and a culture of support.
</li><li>Recognizing your successes and celebrating your achievements.
</li><li>Thrives when everyone is working towards the same vision/goals.
</li><li>We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.
</li></ul>NEXT STEPS
If your application is selected to advance to the next round, recruiter will be in touch.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $72,000 - $75,000/year. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
#nurse #telephoniccasemanager
</div>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Telephonic Case Manager

UC Health

<div>UC Health is hiring a Full Time Business Intell Analyst
The purpose of this position is to support organizational needs for business intelligence, data reporting, and related metrics to inform decision-making, planning, and continuous improvement across UC Health. Responsibilities revolve around the collection, manipulation and dissemination of data to support the needs of decision-makers at all levels of the organization. This position will need to have a clear understanding of the data and work with key stakeholders in order to validate accurate results and reconcile discrepancies when necessary.
About UC Health
UC Health is an integrated academic health system serving Greater Cincinnati and Northern Kentucky. In partnership with the University of Cincinnati, UC Health combines clinical expertise and compassion with research and teaching&mdash;a combination that provides patients with options for even the most complex situations. Members of UC Health include: UC Medical Center, West Chester Hospital, University of Cincinnati Physicians and UC Health Ambulatory Services (with more than 900 board-certified clinicians and surgeons), Lindner Center of HOPE and several specialized institutes including: UC Gardner Neuroscience Institute and the University of Cincinnati Cancer Center. Many UC Health locations have received national recognition for outstanding quality and patient satisfaction. Learn more at uchealth.com.
Analytics Development and Support:<ul><li>
Supports information requests from inception to delivery, translating client requirements into appropriate reporting objects that tell a story with data including, but not limited to: analytic scorecards, dashboards, and reports.</li><li>
Provides solutions and alternatives to problems/issues including adhoc reports to support offered solutions.</li><li>
Executes reporting design changes according to established procedures.</li><li>
Provides maintenance support for all queries or reports.</li><li>
Provides timely and accurate support to resolve reporting errors and user reported problems.</li><li>
Utilizes and adheres to production support standards and promotion process.</li><li>
Acts as a resource / subject matter expert for the UC Health Departments.</li><li>
Responsible for monitoring data quality of related reporting datasets.</li><li>
Work with data requestor or stakeholder to validate the results.</li><li>
Determines and manages workload priorities.</li></ul>
Coordination:<ul><li>
Assesses and escalates user requests and issues.</li><li>
Works with programming teams on application development.</li></ul>
Testing and Documentation:<ul><li>
Provides documented solution to problems/issues.</li><li>
Performs complete testing of reports and validates application requirements are met.</li></ul>
Project Support:<ul><li>
Provides task level detail for project plans, including suggested schedules.</li><li>
Provides accurate and timely individual status reports.</li><li>
Documents and ensures timely resolution of project issues.</li><li>
Coordinates effectively with team members.</li><li>
Supports the institution&rsquo;s internal and external, strategic and operational reporting needs</li><li>
Informs management of all issues that are impacting or will impact assignment.</li><li>
Assists with regulatory requirements.</li><li>
Assists with external surveys.</li></ul>
Customer Relationship:<ul><li>
Builds consultative relationships, establishing value for the department as a key partner for producing high-quality, actionable information that meets the needs of decision-makers at all levels of the organization.</li><li>
Conveys technical messages in layman terms so that the receiver can understand, regardless of their technical aptitude.</li><li>
Provides consults to end users.</li></ul>
Other duties assigned by Manager:<ul><li>
Provides occasional backup for other duties as needed.</li></ul><ul><li>
Minimum Required: Bachelors Degree - Business Intelligence/Analytics related field.</li><li>
Preferred: Masters Degree - Epic Data (Caboodle / Clarity) certified within six months.</li><li>
Minimum Required: 1 - 2 Years equivalent experience</li><li>
4 years equivalent experience can substitute for a BA/BS degree.</li></ul>
Join our team to BE UC Health. Be Extraordinary. Be Supported. Be Hope. Apply Today!
At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.
As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors. UC Health is an EEO employer.</div>

Business Intell Analyst, Data & Analytics, Full-time, First Shift

Nationwide Mutual Insurance Company

<div>If you&rsquo;re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide&rsquo;s Property and Casualty team could be the place for you! At Nationwide&reg;, &ldquo;on your side&rdquo; goes beyond just words. Our customers and partners are at the center of everything we do and we&rsquo;re looking for associates who are passionate about delivering extraordinary care.
Territory: This role covers the Dayton, OH and surrounding areas.
Ideal Candidate Locations: The ideal candidate will live in Dayton or Springfield, OH.
This is a work-from-home position with day travel to policy locations (on average 3-4 days a week) via company vehicle (personal use, gas and maintenance included). Claims inspections will include onsite and virtual inspection. Depending on claim volume, this role may also support additional territories in a desk adjuster capacity. Occasional overnight travel may be required in this role.
Relocation assistance may be available for qualified candidates who reside more than 50 miles outside of the territory.
Qualifications:<ul><li>
3-5 years of insurance field/property claims handling or adjusting experience</li><li>
Solid experience/proficiency with Xactimate</li><li>
Solid experience writing own estimates and handling claims start to finish</li><li>
Construction background/experience - Residential, Roofing, Remodeling, Water mitigation, etc</li><li>
Strong customer service competency</li><li>
Strong written &amp; verbal communication skills</li></ul>
PLEASE NOTE that CAT duty is a requirement of this role
Benefits Include: Medical, Dental, Vision, 401k with company match, Company-paid Pension plan, Paid time off and more!
#LI-JJ1
#LI-Remote
Job Description Summary
No two property claims are ever the same and each customer has unique needs. Our team thrives on providing the very best service and building lasting, successful relationships with our customers. If you are confident, curious, driven to learn and grow, and have a desire to help people when they most need it, we want to know more about you!
 
 
As a Field Claims Specialist, you'll investigate and resolve moderate to severe property damage claims by phone and face-to-face.
Job Description
Key Responsibilities:<ul><li>
Handles all assigned claims promptly and effectively, with little to no direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures.</li><li>
Determines proper policy coverages and applies appropriate claims practices to resolve cases in alignment with company guidelines.</li><li>
Opens, closes and adjusts reserves according to company practices to ensure reserve adequacy. Adheres to file conferencing notification and authority procedures.</li><li>
Maintains current knowledge of insurance and applicable product/services; court decisions which may impact the claims function; current guidelines; and policy changes and modifications. This may require attending various seminars and training sessions.</li><li>
Maintains current knowledge of local industry repair procedures and local market pricing.</li><li>
Submits severe incident reports, reinsurance reports and other information to claims management as needed.</li><li>
Partners with Special Investigations Unit and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for lawsuit, trial, or subrogation.</li><li>
Initiates and conducts follow-ups through proficient use of claims and other related business systems.</li><li>
Delivers an outstanding customer service experience to all internal, external, current and prospective Nationwide customers. Adheres to high standards of professional conduct while providing delivery of outstanding claim's service.</li></ul>
May perform other responsibilities as assigned.
Reporting Relationships: Reports to Claims Manager. Individual contributor role.
Typical Skills and Experiences:
Education: Undergraduate degree or equivalent experience.
License/Certification/Designation: State licensing where required. Successful completion of required applicable claims certification or training classes. Obtain Xactimate Level 1 certification within a year of start date. Obtain Xactimate Level 2 certification within two years of employment.
Experience: Three to five years of related property claims experience. Experience in a customer service environment, including flexible work schedules and extended work hours preferred.
Knowledge, Abilities and Skills: General knowledge of insurance theory and practices, and contracts and their application. Property estimating and automated claims systems. Demonstrated knowledge of the investigation, consultation and settlement activities used to resolve extensive property damage claims. Proven ability to meet customer needs and provide exemplary meaningful service by guiding customers through the claims process and ensuring a positive customer experience. Analytical and problem-solving skills necessary to make decisions and resolve issues related to application of coverages to submitted claims, application of laws of jurisdiction to investigation facts, and application of policy exclusions and exceptions. Ability to establish repair requirements and cost estimates for property losses. Ability to evaluate and successfully advise on property claims. Organizational skills to prioritize work. Command of written and verbal communication skills to effectively communicate with policyholders, claimants, repairpersons, attorneys, agents and the general public. Ability to efficiently operate a personal computer and related claims and business software. Able to provide leadership to less experienced claims associates. Must be able to safely access and inspect rooftops using a ladder. Must be prepared and capable of conducting physical inspections on rooftops, including first and second story roofs with pitches up to 8/12.
Other criteria, including leadership skills, competencies and experiences may take precedence.
Staffing exceptions to the above must be approved by the business unit executive and HR Business Partner.
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Job Conditions:
Overtime Eligibility: Not Eligible (Exempt)
Working Conditions: Normal office or field claims environment. May require ability to sit and operate phone and personal computer for extended periods of time. Able to make physical inspections of property loss sites; including climb ladders, balance at various heights and rooftops up to 8/12 pitch stoop, bend and/or crawl to inspect vehicles and structures; work outside in all types of weather. Must be willing to work irregular hours and to travel with possible overnight requirements. May be on-call. Must be available to work catastrophes (CAT). Extended and/or non-standard hours as required. Must have a valid driver&rsquo;s license with satisfactory driving record in accordance with Nationwide standards.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
Benefits
We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.
#claims 
NOTE TO EMPLOYMENT AGENCIES:
We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means.
Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule.
The national salary range for Field Claims Specialist II, Property : $62,500.00-$115,500.00
The expected starting salary range for Field Claims Specialist II, Property : $62,500.00 - $93,500.00</div>
 <ul><li>Job Category Claims
</li><li>Position Type Full Time
</li><li>Posted 2026-04-21T18:12:03.196964+00:00
</li><li>Location(s) Ohio
</li><li>Line of Business
</li><li>Entity
</li><li>Recruiter
</li><li>Hiring Manager
</li><li>Experience Level
</li><li>Req ID 097860</li></ul>

Property Claims Adjuster II (Dayton, OH - WFH)

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Property Claims Adjuster II (Dayton, OH - WFH)