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VNA Albany is seeking a Registered Nurse (RN) Home Health Educator for a nursing job in Rensselaer, New York. Job Description & Requirements • Specialty: Educator, • Discipline: RN, • Duration: Ongoing, • 40 hours per week, • Shift: 8 hours • Responsible for field orientation for RN/LPN staff with a strong concentration on clinical skill., • In cooperation with Clinical managers, facilitate the transition of new staff to their respective roles within the agency during orientation and ongoing as needed., • Provides focused education to staff needing additional instruction and sets up timelines for meeting established objectives., • Assists in the planning and development of new orientation programs, including protocols and policies., • Participates on Agency and community committees as assigned., • Ensures compliance with State and Federal rules and regulations regarding clinical practices., • Provided direct hands-on patient care as needed., • Performs chart/order review and focused audits as requested., • Perform RN telephonic visits as needed., • Complete back-office workflow as needed., • Cover telehealth alerts and related tasks., • Performs related tasks as assigned and requested. Requirements: • NYS RN License, • Valid Driver's License, • Home Health Experience, • Must be willing to travel throughout the assigned counties. VNA of Albany provided the following inclusive hiring information: We are an equal opportunity employer and consider all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. VNA Albany Job ID #1002-Mentor. About VNA Albany The VNA of Albany is a Medicare and Medicaid certified non-for-profit home health care agency, governed by a board of directors composed of community members. The agency provides skilled nursing, rehabilitation services, and medical social work to residents in 11 counties of Northeastern New York. The VNA of Albany makes home care visits to over 3,000 patients each year. We are proud to be New York State’s oldest provider of home health care services and the fifth oldest home health agency in the United States. VNA holds a 4-star rating in both Patient Satisfaction and Quality of Care, thanks to our amazing team of skilled professionals who are dedicated to delivering quality care to the community we serve. Benefits • Holiday Pay, • 403b retirement plan, • Wellness and fitness programs, • Employee assistance programs, • Dental benefits, • Vision benefits, • Discount program, • Guaranteed Hours, • Sick pay, • Mileage reimbursement, • Medical benefits, • Life insurance, • Sign-On bonus

VNA Albany is seeking a Registered Nurse (RN) Home Health Case Management for a nursing job in Albany, New York. Job Description & Requirements • Specialty: Case Management, • Discipline: RN, • Duration: Ongoing, • 40 hours per week, • Shift: 8 hours Job Summary: • Assesses patient's physical, mental, emotional, socioeconomic, financial, spiritual, cultural, and environmental factors, which affect health status and the person's ability to cope with illness and/or disability., • Identifies patient problems based on assessment and works with the patient and caregivers to develop, implement, revise and evaluate a plan for care including other disciplines and community services considering resources available to the patient. Makes appropriate referrals in consultation with the primary Medical Practitioner. Serves as case manager., • Provides direct nursing skills under the direction of an authorized Medical Practitioner including health teaching, health counseling, and patient care (i.e. infusion therapy, wound care, collection of laboratory tests, medication orders, medication administration, and reconciliation etc.)., • Provides health education specific to the needs of the patient and caregivers to enable them to reach their maximum level of independence and well being during the episode of care. This education takes into consideration their ability to learn, their cultural/spiritual background and their motivation to learn. Evaluates and documents the effectiveness of teaching methods and patient/caregiver response to teaching., • Evaluates the patient's responses to care and treatment, documents and reports significant changes to the primary Medical Practitioner., • Utilizes Standard Precautions and appropriate infection control techniques to prevent/control transmission of infection to patients or staff., • Maintains the confidentiality of patient medical and financial information. Protects patient records from loss, damage and unauthorized access., • Provides instruction, training, guidance and timely supervision to LPN's, HHA's. Coordinates care of the patient with LPN’s and HHA's in case conferences, establishes the HHA’s and LPN’s plan of care and makes revisions as appropriate., • Maintains timely, accurate documentation of patient care, communication, medical orders, referrals, progress summaries, supplies requisitions and all other patient care related paperwork. Completes admission paperwork within the same business day, but no later than 12 midnight of the visit day. Completes OASIS assessments based on requirements. Provides 24-hour nursing coverage of patients by participation in on-call, weekend, holiday and shift rotation as needed., • Maintains own professional competence through participation in continuing education and other appropriate learning experiences including current research and literature in the nursing practice., • Assists with the orientation and/or guidance of new staff members, students, Board members and other selected individuals., • Maintains awareness of and follows Agency policies and procedures., • Contributes to the attainment of Agency goals and objectives. Consistently meets productivity standards set by the Department., • Contributes to the improvement activities of the Agency by participation in Performance Improvement activities and in identification of activities/resources requiring updating and/or further research., • Performs related tasks as requested. Requirements: • Current NY State R.N. License, • Driver’s License & Reliable Transportation, • A minimum of 1 year of recent experience in geriatric care, • Must be willing to travel throughout the assigned county, • Home Care experience (Preferred) VNA of Albany provided the following inclusive hiring information: We are an equal opportunity employer and consider all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. VNA Albany Job ID #1002-2. About VNA Albany The VNA of Albany is a Medicare and Medicaid certified non-for-profit home health care agency, governed by a board of directors composed of community members. The agency provides skilled nursing, rehabilitation services, and medical social work to residents in 11 counties of Northeastern New York. The VNA of Albany makes home care visits to over 3,000 patients each year. We are proud to be New York State’s oldest provider of home health care services and the fifth oldest home health agency in the United States. VNA holds a 4-star rating in both Patient Satisfaction and Quality of Care, thanks to our amazing team of skilled professionals who are dedicated to delivering quality care to the community we serve. Benefits • Holiday Pay, • 403b retirement plan, • Wellness and fitness programs, • Employee assistance programs, • Dental benefits, • Vision benefits, • Discount program, • Guaranteed Hours, • Sick pay, • Mileage reimbursement, • Medical benefits, • Life insurance, • Sign-On bonus

NYSTEC is a nonprofit technology consulting company, advising agencies, organizations, institutions, and businesses since 1996. We're independent and vendor-neutral, so we have our clients' best interests at heart. At NYSTEC, we know that we succeed when individuals and teams flourish personally and professionally, so our benefits and perks support that mindset. As a senior consultant - privacy analyst in the Cybersecurity and Data Privacy practice area, you will collaborate with team members to support our clients in today's rapidly evolving privacy landscape. In the privacy space, NYSTEC is considered a trusted advisor, providing subject matter expertise and connecting the dots for our clients. Serving as a privacy analyst, your day-to-day role as a NYSTEC consultant will support the New York State Department of Health. You must have a passion for data privacy and regulatory compliance and a deep knowledge of the Health Insurance Portability and Accountability Act (HIPAA), as well as New York State and federal privacy laws and regulations. You will work independently and with teams to develop solutions to complex problems. • Review policies, regulations, or proposals against existing NYS or federal requirements, • Manage the day-to-day legal and policy requests assigned, • Evaluate proposed activities, including references to applicable laws or regulations, • Create project work plans for long-term or multi-step initiatives, • Manage data use and business associate agreements, • Facilitate meetings with stakeholders from across our client community, • Analyze business needs balanced against privacy requirements and best practices, • Collaborate as part of a team to oversee and implement privacy- and security-related best practices for NYSTEC clients, • Excellent analytic capabilities and exemplary skills in developing and managing stakeholder relationships, • Exceptional privacy knowledge and experience, • General information security knowledge, • New York State and federal health policy experience, • Exceptional written and verbal communications and interpersonal skills and the ability to manage and develop key relationships with colleagues and clients through collaborative thinking and a strong customer focus, • Proficiency with the Microsoft Office Suite of applications, • Experience and demonstrated comfort level in verbal, written, and in-person communications, • Security and privacy certifications from accredited organizations, such as the International Information System Security Certification Consortium (ISC2) or the International Association of Privacy Professionals (IAPP), • Knowledge of the New York State Medicaid program and its systems, data, and uses, • Expertise in public health, health information, or security and privacy policies and standards, such as National Institute of Standards and Technology (NIST) 800-53 and the Centers for Medicare & Medicaid (CMS) Acceptable Risk Safeguards (ARS), • Masters degree, • Bachelor's degree and five years of related experience in privacy, law, or healthcare policy, • An equivalent combination of advanced education, training, and experience will be considered The target base salary for this position is $84,497.00 to $109,846.00 per year. When determining compensation, we analyze and carefully consider several factors, including skill set, experience, location, and job-related qualifications. It is NYSTEC's policy to provide equal employment opportunity (EEO) to all individuals, regardless of actual or perceived race, color, creed, religion, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), age, national origin, ancestry, citizenship status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, military service and veteran status, sexual orientation, marital status, or any other characteristic protected by local, state, or federal laws and ordinances. NYSTEC is strongly committed to this policy and believes in the concept and spirit of the law. Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please contact ___ if you require a reasonable accommodation to apply for or to perform this job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Applicants must be authorized to work in the United States without the need for visa sponsorship now or in the future. Learn more about NYSTEC by visiting ___. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the ___ notice from the Department of Labor.

VNA Albany is seeking a LPN / LVN Home Health for a job in Albany, New York. Job Description & Requirements • Specialty: Home Health, • Discipline: LPN / LVN, • Duration: Ongoing, • 40 hours per week, • Shift: 8 hours Job Summary: • Provide health education, according to the teaching plan established by the RN, • Provide routine LPN nursing care as outlined in the nursing care plan and within the scope of practice for an LPN, • Document those services rendered to the patient, changes noted in the patient's condition and/or family and home situations, • Take vital signs and collect routine patient data, • Recognize high-risk situations and make appropriate referrals, • Follow infection control policies for a safe environment, • Strong computer skills and the ability to use the Agency's EMR program., • Strong interpersonal, organizational, time management, and written and verbal communication skills, • Able to work independently and complete paperwork accurately and in a timely fashion, • Must comply with privacy & HIPAA laws. Must be respectful of the patients' rights & treat a client & their belongings with dignity & respect, • Ability to lift a minimum of 50 lbs. and move patients, • Extensive knowledge of basic health care procedures, • Knowledge in measuring and administering medication, • Valid NYS LPN License, • Driver’s License & Reliable Transportation, • Community health experience preferred, • Must be willing to travel throughout the assigned county VNA of Albany provided the following inclusive hiring information: We are an equal opportunity employer and consider all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. VNA Albany Job ID #1001-2. About VNA Albany The VNA of Albany is a Medicare and Medicaid certified non-for-profit home health care agency, governed by a board of directors composed of community members. The agency provides skilled nursing, rehabilitation services, and medical social work to residents in 11 counties of Northeastern New York. The VNA of Albany makes home care visits to over 3,000 patients each year. We are proud to be New York State’s oldest provider of home health care services and the fifth oldest home health agency in the United States. VNA holds a 4-star rating in both Patient Satisfaction and Quality of Care, thanks to our amazing team of skilled professionals who are dedicated to delivering quality care to the community we serve. Benefits • Holiday Pay, • 403b retirement plan, • Wellness and fitness programs, • Employee assistance programs, • Dental benefits, • Vision benefits, • Discount program, • Guaranteed Hours, • Sick pay, • Mileage reimbursement, • Medical benefits, • Life insurance, • Sign-On bonus

Capital District Psychiatric Center (CDPC), an Office of Mental Health (OMH) Joint Commission accredited hospital, is recruiting an Assistant Director of Nursing 1 Psychiatric (ADON) to oversee Quality, Education, and Training for all Nursing Staff. Under the direction of the Director of Nursing 3 (DON) the ADON for Quality, Education, and Training is responsible for developing and monitoring the nursing department training curriculum and competencies, including: • Monitoring the provision of nursing services to ensure quality care and compliance with nursing philosophy, objectives, policies, and standards in accordance with agency standards., • Providing nursing-specific technical assistance, guidance, and consultation to facility staff and providers., • Participating in nursing recruitment and retention efforts., • Conducting new nurse orientation and participating in training and development of inpatient and outpatient nursing staff., • Performing quality assurance activities such as performance improvement initiatives, corrective actions, reports and recommend modifications related to the nursing aspects of care, policies, and/or procedures., • Collaborating with Outpatient and Inpatient ADONs in coordination of patient’s transition to discharge., • Assisting in preparing for regulatory site visits and surveys., • Overseeing Nursing Education Programs for all nursing services., • Developing and assigning training classes that ensure competencies and staff development. About CDPC CDPC provides inpatient and outpatient treatment and rehabilitation to adults who have been diagnosed with serious mental illness, outpatient treatment services for children and adolescents diagnosed with serious emotional disturbances and operates adult community residences in the Albany/Capital District area. CDPC is committed to supporting underserved individuals, organizations, and communities along with activities and initiatives to reduce disparities in access, quality, and treatment for underserved populations. Minimum Qualifications: • Possession of a license and current registration as a registered professional nurse in New York State; and, • Four years of post-licensure professional clinical nursing experience* working with individuals, at least 50% of whom have been diagnosed with mental illness, addiction, or substance use disorder. One year of this experience must be at a supervisory level. *An associate's degree can substitute for two years of specialized experience; a bachelor’s degree can substitute for four years of experience; a master’s degree in a related field can substitute for five years of experience; and a doctorate in a related field can substitute for six years of experience. If you would like to join the CDPC Nursing Team and contribute to a workforce dedicated to public service, we offer a generous benefits package including: • Competitive Salaries, • Tuition Assistance programs, • NYS medical, dental, and vision insurance, • Excellent opportunities for advancement and professional growth, • Paid time off including vacation, holidays, personal, & sick leave, • NYS Retirement programs The Mission of the New York State Office of Mental Health (OMH) is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. OMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, OMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring OMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. OMH is an equal opportunity/affirmative action employer. Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at . In order to be hired and to maintain your employment, candidates cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists. If appointed and subsequently listed as an excluded individual or entity on any of these lists, you may be terminated from your employment. If appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid. If you are appointed and you lose the ability to bill through Medicare and Medicaid, you may be terminated from your employment. Background checks are required.

Capital District Psychiatric Center (CDPC), an Office of Mental Health (OMH) Joint Commission accredited facility, is currently recruiting overnight Licensed Social Workers for their Crisis Intervention Unit (CIU). Overnight shift is from 11:00 pm to 7:30 am with a rotating weekend schedule. The CIU provides 24-hour crisis response to children, adolescents, and adults in the Capital Region. Individuals can be referred by a mobile crisis team, law enforcement, outpatient clinics, local hospitals, or individuals can self-present in a time of crisis. Licensed Social Workers will collaborate with a multidisciplinary team to triage and assess individuals in a psychiatric emergency room setting including: • Completing psychiatric assessments with a Physician to determine if the individual would benefit from inpatient psychiatric hospitalization., • Providing verbal de-escalation and participating in interventions as needed., • Triaging phone calls and providing telephonic crisis response., • Securing inpatient bed for individuals in need and facilitating transfers., • Working with insurance companies to gain preauthorization for inpatient hospitalization., • Connecting individuals to outpatient services at the time of discharge., • Assisting in training and orientation of new staff and/or interns. If you would like to join the CDPC Team and contribute to a workforce dedicated to public service, we offer a generous benefits package including: • Competitive Salaries, • Shift differential pay for evening, nights, and weekends, • NYS medical, dental, & vision insurance, • NYS retirement program- Pension and Deferred Compensation, • Access to tuition assistance programs, • Paid time off – 13 paid vacation days in the first year, 5 paid personal days, 13 paid holidays, & paid sick leave, • Excellent opportunities for advancement & professional growth Minimum Qualifications: Licensed and currently registered as a Licensed Master Social Worker or Licensed Clinical Social Worker in New York. Additional Notes: The Mission of the New York State Office of Mental Health (OMH) is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. OMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, OMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring OMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. OMH is an equal opportunity/affirmative action employer. Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at . In order to be hired and to maintain your employment, candidates cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists. If appointed and subsequently listed as an excluded individual or entity on any of these lists, you may be terminated from your employment. If appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid. If you are appointed and you lose the ability to bill through Medicare and Medicaid, you may be terminated from your employment. Background checks are required.

VNA Albany is seeking a Home Health Physical Therapist for a job in Albany, New York. Job Description & Requirements • Specialty: Physical Therapist, • Discipline: Therapy, • Duration: Ongoing, • 40 hours per week, • Shift: 8 hours Job Summary: • Performs comprehensive assessment of patient status (including physical and functional deficits and strengths) and the home environment, as well as evaluation of patient problems, needs, resources, and rehabilitation potential, through the use of appropriate tests and measures., • Assesses patient’s physical, mental, emotional, socioeconomic, financial, spiritual, cultural, and environmental factors, which affect health status and the person’s ability to cope with illness and/or disability., • Identifies patient problems based on assessment and works with the patient and caregivers to develop, implement, revise and evaluate a plan for care including other disciplines and community services considering resources available to the patient. Makes appropriate referrals in consultation with the primary Medical Practitioner., • Assists patients and families in obtaining needed assistive devices and equipment., • Identifies those cases or components of the therapy plan of care, which may be delegated to allied personnel and provides instruction, training, guidance and timely supervision/evaluation of PTAs and HHAs. Coordinates care of the patient with PTAs/HHAs in case conferences, establishes the aide plan of care and makes revisions as appropriate., • Evaluates the patient’s responses to care and treatment, documents and reports significant changes to the primary Medical Practitioner., • Acts as consultant, teaches, and demonstrates application of therapy techniques to patients, family members, nurses, and/or home health aides and/or PTA’s., • Instructs, supervises, and assists patients in programs such as, but not limited to: exercises, muscle reeducation, functional training, orthotic and prosthetic training, and cardiopulmonary conditioning., • Provides health education specific to the needs of the patient and caregivers to enable them to reach their maximum level of independence and well being during the episode of care. This education takes into consideration their ability to learn, their cultural/spiritual background and their motivation to learn. Evaluates and documents the effectiveness of teaching methods and patient/caregiver response to teaching., • Participates in patient centered conferences and team meetings., • Utilizes standard precautions and appropriate infection control techniques to prevent/control transmission of infection to patients or staff., • Serves as case manager, coordinates and communicates plan of care with appropriate disciplines/community resources., • Maintains the confidentiality of patient medical and financial information. Protects patient records from loss, damage and unauthorized access., • Maintains timely, accurate documentation of patient care, communication, medical orders, referrals, progress summaries, supplies requisitions and all other patient care related paperwork. Completes agency and clinical documentation within agency identified time frames. Completes OASIS Assessments based on requirements., • Maintains own professional competence through participation in continuing education and other appropriate learning experiences including current research and literature in the physical therapy practice., • Assists with the orientation and/or guidance of new staff members, students, Board members and other selected individuals., • Maintains awareness of and follows agency policies and procedures. May assist in the formulation/revision of policies related to their practice., • Demonstrates and supports customer service standards., • Consistently meets productivity standards set by the Department., • Contributes to the improvement activities of the Agency by participation in Performance Improvement activities and in identification of activities/resources requiring updating and/or further research., • Performs related tasks as requested/required. Requirements: • Current NY State P.T. License, • Driver’s License & Reliable Transportation, • A minimum of 1 year of recent experience in geriatric care, • Home Care experience (Preferred), • Must be willing to travel throughout the assigned county VNA of Albany provided the following inclusive hiring information: We are an equal opportunity employer and consider all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. VNA Albany Job ID #1004-2. About VNA Albany The VNA of Albany is a Medicare and Medicaid certified non-for-profit home health care agency, governed by a board of directors composed of community members. The agency provides skilled nursing, rehabilitation services, and medical social work to residents in 11 counties of Northeastern New York. The VNA of Albany makes home care visits to over 3,000 patients each year. We are proud to be New York State’s oldest provider of home health care services and the fifth oldest home health agency in the United States. VNA holds a 4-star rating in both Patient Satisfaction and Quality of Care, thanks to our amazing team of skilled professionals who are dedicated to delivering quality care to the community we serve. Benefits • Holiday Pay, • 403b retirement plan, • Wellness and fitness programs, • Employee assistance programs, • Dental benefits, • Vision benefits, • Discount program, • Guaranteed Hours, • Sick pay, • Mileage reimbursement, • Medical benefits, • Life insurance, • Sign-On bonus

VNA Albany is seeking a Home Health Occupational Therapist for a job in Albany, New York. Job Description & Requirements • Specialty: Occupational Therapist, • Discipline: Therapy, • Duration: Ongoing, • 40 hours per week, • Shift: 8 hours Job Summary: • Performs comprehensive evaluation and assessment of patient’s activities of daily living (ADL) abilities, upper extremity function, sensory/motor skills, home environment, psychosocial needs, and rehabilitation potential by the application of appropriate diagnostic and evaluative tests. Evaluates need for appropriate assistive/adaptive, orthotic devices., • Instructs, supervises, and assists patients in the performance of therapy procedures, including (but not limited to) functional and sensory-perceptual exercises, activities of daily living, homemaking and work/skill activities, joint protection, work simplification techniques, infant stimulations and child development programs. Evaluates, fabricates, and/or obtains and adjusts, orthotic devices, assistive devices and needed adaptations., • Provides health education specific to the needs of the patient and caregivers to enable them to reach their maximum level of independence and well-being during the episode of care. This education takes into consideration their ability to learn, their cultural/spiritual background and their motivation to learn. Evaluates and documents the effectiveness of teaching methods and patient/caregiver response to teaching., • Participates in patient centered conferences & team meetings., • Utilizes standard precautions and appropriate infection control techniques to prevent/control transmission of infection to patients or staff., • Serves as case manager, coordinates and communicates plan of care with appropriate disciplines/community resources., • Maintains the confidentiality of patient medical and financial information. Protects patient records from loss, damage and unauthorized access., • Maintains timely, accurate documentation of patient care, communication, medical orders, referrals, progress summaries, supplies requisitions and all other patient care related paperwork. Completes agency and clinical documentation within identified time frames. Completes OASIS Assessments based on requirements., • Maintains own professional competence through participation in continuing education and other appropriate learning experiences including current research and literature in the occupational therapy practice., • Assists with the orientation and/or guidance of new staff members, students, Board members and other selected individuals., • Maintains awareness of and follows agency policies and procedures. May assist in the formulation/revision of policies related to their practice., • Demonstrates support of customer service standards., • Consistently meets productivity standards set by the Department., • Contributes to the quality improvement activities of the agency by participation in Performance Improvement activities and in identification of activities/resources requiring updating and/or further research., • Performs related tasks as requested/required., • Assesses patient’s physical, mental, emotional, socioeconomic, financial, spiritual, cultural, and environmental factors, which affect health status and the person’s ability to cope with illness and/or disability., • Identifies patient problems based on assessment and works with the patient and caregivers to develop, implement, revise and evaluate a plan for care including other disciplines and community services considering resources available to the patient. Makes appropriate referrals in consultation with the primary Medical Practitioner., • Assist patients and families in obtaining needed assistive devices and equipment., • Identifies those cases or components of the therapy plan of care that may be delegated to allied personnel and provides instruction, training, guidance and timely supervision/evaluation of COTAs and HHAs. Coordinates care of the patient with PTAs/HHAs in case conferences, establishes the Aide plan of care and makes revisions as appropriate., • Evaluates the patient’s responses to care and treatment, documents and reports significant changes to the primary Medical Practitioner., • Acts as a consultant, teacher, and demonstrates application of therapy techniques to patients, family members, nurses, and/or home health aides and/or COTA’s. Requirements: • Current NY State O.T. License, • Driver’s License & Reliable Transportation, • A minimum of 1 year of recent experience in geriatric care, • Home Care experience (Preferred), • Must be willing to travel throughout the assigned county VNA of Albany provided the following inclusive hiring information: We are an equal opportunity employer and consider all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. VNA Albany Job ID #1003-2. About VNA Albany The VNA of Albany is a Medicare and Medicaid certified non-for-profit home health care agency, governed by a board of directors composed of community members. The agency provides skilled nursing, rehabilitation services, and medical social work to residents in 11 counties of Northeastern New York. The VNA of Albany makes home care visits to over 3,000 patients each year. We are proud to be New York State’s oldest provider of home health care services and the fifth oldest home health agency in the United States. VNA holds a 4-star rating in both Patient Satisfaction and Quality of Care, thanks to our amazing team of skilled professionals who are dedicated to delivering quality care to the community we serve. Benefits • Holiday Pay, • 403b retirement plan, • Wellness and fitness programs, • Employee assistance programs, • Dental benefits, • Vision benefits, • Discount program, • Guaranteed Hours, • Sick pay, • Mileage reimbursement, • Medical benefits, • Life insurance, • Sign-On bonus

Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential Accountabilities: Level I • Handles behavioral health member clinical management programs., • Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable., • Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,, • Maintains confidentiality and conducts information management procedures per corporate and departmental policy., • Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews., • Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services., • Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals., • Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena., • Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits., • Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment., • Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources., • Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist, • Accepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable., • Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications., • Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care., • May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA)., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Handles all member clinical condition management programs., • Offers process improvement suggestions and participates in the solutions of more complex issues/activities., • Mentors junior staff and assists with coaching whenever necessary., • Consistently meets/exceeds all productivity and performance metrics, including positive results of audits., • Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health., • Manages more complex assignments and/or larger caseloads., • Displays leadership skills and serves as a positive role model to others in the department., • Participates in the orientation of new staff. Level III (in addition to Level II Accountabilities): • Process Management and Documentation - o Identifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies. o Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions. o Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department. • Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems., • Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers., • Provides backup for the Supervisor/Manager, whenever necessary by: o Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care. o Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing. o Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. • Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Active NYS RN license required with three years' behavioral health experience; or LMSW; or LCSW; or LMHC., • Minimum of three years of clinical experience required. Case Management experience preferred., • Must demonstrate proficiency with the Microsoft Office Suite., • Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred., • Strong written and verbal communication skills., • Ability to multitask and balance priorities., • Must demonstrate ability to work independently on a daily basis., • Deliver efficient, effective, and seamless care to members., • For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB. Level II (in addition to Level I Qualifications) • A minimum of 2 years in case management position., • Case Management Certification preferred, • Delivers efficient, effective, and seamless care to members., • Demonstrates ability to escalate to management, as necessary., • Demonstrates proficiency in all related technology and documentation requirements., • Consistently meets or exceeds all performance metrics. Level III (in addition to Level II Qualifications) • Must have been in a current Case Management position or similar subject matter expert for at least 5 years., • Case Management Certification required, • Broad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems., • Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues., • Ability to lead the training of new staff., • Demonstrated presentation skills. Physical Requirements: • Ability to travel and work long hours on a computer., • May require flexible hours to meet needs of member discussions. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: E2: Minimum: $62,400 - Maximum: $ 96,081 Level II: E3: Minimum: $62,400 - Maximum: $ 106,929 Level III: E4: Minimum: $65,346 - Maximum: $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Based on the scope of the role & business needs, we're exclusively seeking candidates who reside in the Albany/Capital Region. Summary: The Medicare Broker Account Executive will be responsible for building and maintaining strong relationships with Medicare brokers to drive the sales and growth of our Medicare products This involves close collaboration with Field Marketing Organizations (FMO), General Agents, and Individual Agents to ensure compliance with all relevant policies and procedures. This role will require a strategic approach to broker engagement, sales support, and market development. The ideal candidate will have a deep understanding of Medicare products, comprehensive understanding of Medicare sales dynamics, excellent interpersonal skills, and the ability to foster positive broker relationships. Essential Accountabilities: Broker Relationship Management: • Develops and maintains strong relationships with all levels of the Medicare brokers distribution hierarchy to enhance their engagement and productivity., • Acts as the primary point of contact for brokers, addressing inquiries, resolving issues, and providing ongoing support., • Conducts regular in-person and virtual meetings with brokers to ensure optimal external agent effectiveness through coaching, performance review, addressing concerns, and discussing strategies for growth and retention objectives. Sales Support and Training: • Develops professional presentations related to proposals and projects for both internal and external audiences., • Delivers comprehensive training and support to brokers on our Medicare products, sales techniques, and compliance requirements so that selling methods conform to our brands directed approach to consultative selling and always support the optimal matching of products to the needs of beneficiaries through a proper suitability assessment., • Assists brokers in developing effective sales strategies and marketing plans to drive enrollment and retention., • Ensures brokers are well-equipped with the latest product information, marketing materials, and regulatory updates., • Constructs and implement processes to manage and track agent resources, productivity, and quality. Market Development: • Identifies and recruits new brokers to expand our market presence and drive sales growth., • Analyzes market trends and competitor activities to identify opportunities for product development and market expansion., • Collaborates with internal teams to develop and implement targeted marketing campaigns and initiatives., • Attends conferences and reviews marketplace trends to identify sales and growth opportunities. Compliance and Reporting: • Ensures all broker activities comply with CMS regulations and company policies and procedures., • Prevents, detects, and resolves the instances of conduct that do not conform to federal (CMS) and state law, and federal and state health care program requirements, as well as ethical and business policies of the organization., • Prepares and presents regular reports on broker activities, sales performance, and market insights., • Monitors and reports on broker performance, sales metrics, and market trends to senior management., • Develops corrective action plans for performance and process management improvement., • Ensures that all appointed Agents have approved selling materials and that all Agents have thorough understanding of CMS Medicare Marketing Guidelines. Collaboration and Communication: • Work closely with internal teams, including retail sales, marketing, compliance, and product development, to support broker needs and drive business goals., • Communicate effectively with brokers to ensure alignment on objectives, expectations, and performance goals., • Facilitates recurring meetings to review account status and operational effectiveness., • Foster a collaborative environment that promotes knowledge sharing and continuous improvement., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Minimum Qualifications: • Bachelor's Degree in business, Marketing, Healthcare Administration, or a relevant field with five or more years of experience in sales, account management, or broker relations preferably within the Medicare or health insurance industry. In lieu of degree, a minimum of ten years' Medicare/Insurance Sales experience., • Valid NYS Accident and Health License within six months of employment required. Employees without a license are not eligible for any sales incentive awards or contests. Any sales made while not licensed are not eligible for incentive compensation., • In-depth knowledge of Medicare products, regulations, and market dynamics., • Strong analytical skills with the ability to interpret sales data and market trends., • Self -motivated and highly organized with a proven track record of building and maintaining strong relationships with brokers or sales partners., • Excellent communication, presentation, and negotiation skills., • Ability to work independently and manage multiple priorities in a fast-paced environment., • Demonstrated training skills., • Proficiency in Microsoft Office Suite and CRM software., • Ability to travel at least 60% of the time. Physical Requirements: • Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer., • Ability to travel across the Health Plan service region for meetings and/or trainings as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Minimum: $71,880 - Maximum: $129,384 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential Accountabilities: Level I • Handles physical health member clinical management programs., • Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable., • Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,, • Maintains confidentiality and conducts information management procedures per corporate and departmental policy., • Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews., • Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services., • Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals., • Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena., • Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits., • Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment., • Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources., • Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist, • Accepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable., • Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications., • Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care., • May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA)., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • May participate in the orientation of new staff., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) • Handles all member clinical condition management programs., • Offers process improvement suggestions and participates in the solutions of more complex issues/activities., • Mentors junior staff and assists with coaching whenever necessary., • Consistently meets/exceeds all productivity and performance metrics, including positive results of audits., • Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health., • Manages more complex assignments and/or larger caseloads., • Displays leadership skills and serves as a positive role model to others in the department., • Participates in the orientation of new staff. Level III (in addition to Level II Essential Accountabilities) • Process Management and Documentation, • Identifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies., • Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions., • Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department., • Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems., • Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers., • Provides backup for the Supervisor/Manager, whenever necessary by:, • Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care., • Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing., • Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group., • Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Associates degree required. Bachelor's degree preferred., • Active NYS RN or Registered Dietician or Physical Therapist licensure required., • Minimum of three years of clinical experience required. Case Management experience preferred., • Must demonstrate proficiency with the Microsoft Office Suite., • Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred., • Strong written and verbal communication skills., • Ability to multitask and balance priorities., • Must demonstrate ability to work independently on a daily basis., • Deliver efficient, effective, and seamless care to members., • For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB. Level II (in addition to Level I Qualifications) • A minimum of 2 years in case management position., • Case Management Certification preferred., • Delivers efficient, effective, and seamless care to members., • Demonstrates ability to escalate to management, as necessary., • Demonstrates proficiency in all related technology and documentation requirements., • Consistently meets or exceeds all performance metrics. Level III (in addition to Level II Qualifications) • Must have been in a current Case Management position or similar subject matter expert for at least 5 years., • Case Management Certification required, • Broad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems., • Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues., • Ability to lead the training of new staff., • Demonstrated presentation skills. Physical Requirements: • Ability to travel and work long hours on a computer., • May require flexible hours to meet needs of member discussions. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: E2: Minimum: $62,400 - Maximum: $ 96,081 Level II: E3: Minimum: $62,400 - Maximum: $ 106,929 Level III: E4: Minimum: $65,346 - Maximum: $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: The COBRA & Premium Billing Administrator responds to and resolves written, telephone, and personal inquiries from clients and/or subscribers concerning policies and procedures in a professional and efficient manner. This position coordinates and monitors daily activities for COBRA and Third-Party Premium Billing Administration to ensure regulatory requirements & established standards and deadlines are met. Essential Accountabilities: Client Team • Serves as a point of contact for clients and brokers in relation to the day-to-day operational tasks including, but not limited to, responding to client and broker inquiries/requests; scheduling, facilitating, and delivering client reporting; processing member refund requests; managing open enrollment requests; monitoring member grace periods, managing member payment requests, reviewing and reporting on member payment status., • Responds to client/broker inquiries on a timely basis within department service standards. Notifies and educates clients of any rules or regulation changes., • Conducts webinar demonstrations and supports client and broker training of the software system and portal functionality., • Manages the rate renewal process for assigned clients., • Participates in client and broker requested conference calls. File Team and Enrollment • Responsible for the processing of the inbound and outbound departmental file exchanges within the services standards. Files are primarily membership files that require adding, updating, or deleting subscriber group data within the software system. Responsible for processing any identified error or no-load files., • Responsible for the coordination and execution of the daily carrier file for member coverage reinstatements, changes, and terminations., • Coordinates and collaborates will the LBS EDI team to proactively identify and resolve any file errors., • Communicate with client, broker, or vendor(s) to resolve file related processing issues., • Supports the process of establishing and testing new client files., • Monitors and documents each respective carrier preferred eligibility process., • Works with Carriers to assure all billing activities meet the needs of the client and the carrier. Level I • Maintains knowledge of rules, regulations, policies, and benefits governing COBRA and Premium Billing., • Administers group plans in accordance with all appropriate regulations and process all activity within service time standards., • Supports customer service team in answering or researching member inquiries. Researches, interprets, and responds to inquiries in a professional and efficient manner using problem solving skills., • Processes member requests not facilitated through software vendor, including but not limited to member payments, banking forms, enrollment and termination forms., • Assists in system and release testing and troubleshooting., • Performs departmental and team functions according to established desk level procedures (DLP). Participates in the development, updating, and monitoring of DLP., • Participates in ongoing training to further knowledge of regulations, software systems, policies and procedures, and develops skills to accurately fulfill requirements of the job., • Consistently meets the established departmental and team productivity metrics. Successfully satisfies the assigned tasks and standards of the inter-departmental team assignments., • Maintain current knowledge of LBS policy and procedures., • Consistently demonstrates high standards of integrity by supporting the Lifetime Benefit Solution's mission and values, adhering to the Corporate Code of Conduct and, leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs functions as assigned by management. Level II (in addition to Level I Accountabilities) • Performs advanced research and resolution of inquiries and adjustments on behalf of clients, brokers or carriers., • Assists in resolution of escalated or systematic issues. Proactively identifies error trends., • Assists in client audits and data comparisons., • Services strategic accounts as well complex COBRA and Premium Billing accounts., • Serves as a resource to other team members. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I • High School diploma or equivalent. Associate degree in business administration or related field preferred., • Two or more years of related experience., • Knowledge of COBRA rules and regulations preferred., • General understanding of medical, dental, vision, and Medicare benefits., • Excellent problem solving, reasoning, and organizational skills. Ability to manage multiple projects., • PC experience including knowledge of Microsoft Word and Excel., • Excellent oral and written communication skills., • Ability to communicate effectively while working collaboratively and maintaining positive relationships with clients., • Ability to work in a team environment as well as independently. Level II (in addition to Level I Qualifications) • Four or more years of experience working in COBRA and Premium Billing industry., • Strong knowledge of COBRA and Premium Billing rules and regulations., • Demonstrated problem solving and ability to resolve complex inquiries or escalated situations., • Advanced knowledge of departmental software system and Excel. Physical Requirements: • Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time., • The ability to hear, understand, and speak clearly while using a phone, with or without a headset. One Mission. One Vision. One I.D.E.A. One you. Together we can create a better I.D.E.A. for our communities. At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity. We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply. OUR COMPANY CULTURE: Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Minimum: $20/hr - Maximum: $26.90/hr The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: Under the general direction of the Assigned Management, and in accordance with sound and ethical procedures, objectives and controls, a Network Services Analyst analyzes and evaluates the composition and characteristics of Health Plan provider networks. This position also is responsible for the development of consistent payment methodologies and negotiates allowances for out of area/out of network non-par claims. In the course of this work, the Analyst will be required to work closely with others to assemble and produce documentation and informational materials that will guide Senior Management in making strategic network specific business decisions. Essential Primary Responsibilities/Accountabilities: All Levels - Manages and supports various projects with implications for all lines of business. These projects arise in response to shifts in marketplace dynamics, changes in the delivery of healthcare services, or the emergence of new products. Responsibilities include, but are not limited to: * Differentiates claim types and navigates through the various claims platforms. * Uses pricing tools and efficiency in the varying payment methodologies. * Gathers data from a variety of sources; updates and maintains a variety of; prepares financial reports, statements and analysis for management review. * Performs assigned analysis and/or assists in complex analysis for supervisory review, creates models and makes recommendations based on the analysis completed. * Assists in the determination of the impact of various business options for strategic planning and other financial decisions. * Assists in accumulation and evaluation of data from outside sources to negotiate pricing for out of area/network services. Develops letter of agreement then notifies claims department that service has been priced. * Responsible for the development and analyses of supporting financial schedules, including preparation of worksheets, maintenance of appropriate backup and documentation for internal control and auditing purposes. * Supports and maintains contracting and relationship responsibilities associated the utilization of the Blue and non-Blue national/regional provider network(s), including development and maintenance of vendor contracts, tracking of open issues, leading team efforts to matrix manage open network issues relative to prospective employer groups, tracking and status reporting for senior management. * Creates and maintains network tracking reports by product and by region, including threatened resignation reports, specialty inventory reporting, provider specific product participation reporting, assessing analytics to identify potential network gaps and recommendations for change. * Supports product development initiatives such as development of networks to service Safety Net and Medicare products. This includes development of reports on products, network strategies, status reporting on activity, financial information preparation for negotiators. * Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct. * Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. * Regular and reliable attendance is expected and required. * Performs other functions as assigned by management. * Regular and reliable attendance is expected and required. Level II - performs similar functions as the Network Services Analyst I and can be differentiated by the following: * Works with larger, more complex, higher visibility accounts that have been escalated. Develops and maintains more complex vendor contracts. * Identify root cause of problems; develop potential options and likely outcomes of each option; Recommend optimal option. * Model financial impact of change to reimbursement methodology on an individual claim basis; Articulates impact of changing from one reimbursement methodology to an alternate. * Analyzes, identifies and recommends improvements to the claims process and inventories such as triaging misrouted cases, conducting cost and quality analyses. * Maintains appropriate backup and documentation to ensure regulatory compliance is being met. * Demonstrates adherence to internal controls surrounding regulatory compliance and have ability to explain same. Level III - performs similar functions as the Network Services Analyst I & II and can be differentiated by the following: * Facilitates cross-functional workgroups and internal meetings to present recommendations and lead workgroup to determine best course of action to implement corrections to system or process improvement opportunities. Presents information clearly. * Discusses complex out of network claims with providers and recommends solutions. Tracks unusual and/or outstanding claims. * Identifies trends and opportunities with network management/negotiators, etc.; presents findings and recommendations to management. * Works with key stakeholders to create improvements as either a dedicated resource or with overall division processes to ensure end to end continuity. * Analyzes and interprets complex records/documentation; reviews and assesses validity of financial estimates from a variety of sources against stated business objectives. * Acts in a consultative capacity to management at all levels of assigned organization unit to provide professional technical expertise in the determination of suitable approaches to reimbursement concerns. * Applies principles of total quality management, team leadership, facilitates peer review activities on a consistent, ongoing basis to identify and remove barriers to increased productivity, quality, cost effectiveness, and timeliness of operations and customer satisfaction. * Designs and develops reports which illustrate integrated solutions to meet business needs or enhance performance. * Reviews and approves project cost/benefit analyses prior to presentation to company management. * Acts as a mentor to the team by setting, and striving to achieve high levels of professional competence. Leads by example. Minimum Qualifications: NOTE: This description includes multiple levels of classification. The levels of classifications are differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making and in some cases, becoming a resource to others. New hires will be placed in the level for which they are most qualified based on their experience, credentials and skills. Level I * Bachelor's degree in Health Care Administration, Business, Finance or relevant field with a minimum of four years health care/business experience in an analytical function, plus a minimum of one year of business user experience including negotiation, research, analysis and working with outside customers. * In lieu of degree, a minimum of eight years health care/business experience in an analytical function including a minimum of one year of business user experience including negotiation, research, analysis and working with outside customers. * Ability to read and understand contractual language - weave through it and be able to negotiate on layman's terms. * Strong analytical, written and oral communication, organizational and time management skills. * Proficiency in Microsoft Office suite. * Ability to work with the various levels of internal management and external audiences. Level II - requires similar minimum qualifications as level I, as well as: * A minimum of five years health care experience in an analytical function, plus a minimum of one year of business user experience including negotiation, research, analysis and working with outside customers. * Excellent written and oral communications skills in addition to strong organizational and time management skills are required. * Strength in spreadsheet, data base, word processing and Microsoft Office products. * Ability to present and communicate complex issues with fluency and expertise. * Must be able to interact comfortably with all levels of management. * Relationship building skills required Level III - requires similar minimum qualifications as level I & II, as well as: * A minimum of seven years health care analytical experience, plus a minimum of two years of business user experience including negotiation, research, analysis and working with outside customers. * Ability to identify trends and opportunities with network management/negotiators, etc.; presents findings and recommendations. * Demonstrated leadership, decision-making and team building skills. * In addition to solid oral and written skills, must have solid presentation skills. * Certification preferred in Lean Six Sigma Green Belt. * Excellent presentation skills. Physical Requirements: * Use of computers and phone * Ability to have limited travel In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade E2: Minimum $62,400 - Maximum $96,081 Level II: Grade E3: Minimum $62,400 - Maximum $106,929 Level III: Grade E4: Minimum $65,346 - Maximum $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: This position is responsible for coordinating, integrating, and monitoring the utilization of behavioral health (BH) or physical health (PH) services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as required, to meet departmental time frames. Per department needs, may be responsible for additional hours. Essential Accountabilities: Level I • Performs pre-service, concurrent and post-service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs., • Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care delivery processes. Ensures compliance with corporate and departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director., • Utilizes appropriate communication techniques with members and providers to obtain clinical information, assesses medical necessity of services, advocating for members in obtaining needed services, as appropriate, interacts with the treating physician or other providers of care., • Collaborates with hospital, home care, care management, and other providers effectively to ensure that clinical needs are met and that there are no gaps in care., • Acts as a resource and liaison to the provider community in conjunction with Provider Relations, explaining processes for accessing Health Plan to perform medical review, obtains case or disease management support, or otherwise interacts with Health Plan programs and services., • Makes accurate and consistent interpretation of required clinical criteria, medical policy, contract benefits, and State and Federal Mandates., • May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and Corporate Medical Policies., • Accountable for meeting departmental guidelines for timeliness, production and metrics and meeting requirements established for audits to ensure adherence to regulatory and departmental policy/procedures., • Maintains compliance with all regulatory and accrediting standards. Keeps abreast of changes and responsible for implementation and monitoring of requirements., • Assists with training and special projects, as assigned., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Offers process improvement suggestions and participates in the solutions of more complex issues/activities., • Mentors staff and assists with coaching, as necessary., • Provides consistent positive results on audits., • Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health., • Manages more complex assignments; cross-trained to review various levels of care and/or services., • Participate in committees and lead when required. Level III (in addition to Level II Accountabilities) • Displays leadership and serves as a positive role model to others in the department., • Identifies, recommends and assesses new processes to improve productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department., • Assists in updating departmental policies, procedures, and desk level procedures relative to the functions., • Expert and resource for escalations - Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems., • Mentor (to others in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to Utilization Management staff, members and providers., • Provides backup for the Supervisor, whenever necessary. Participates in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care., • Assists Medical Director (MD) in projects as needed. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Associates degree and active NYS RN license required. Bachelors degree preferred., • Minimum of three (3) years of clinical experience required. Utilization Management experience preferred., • Must demonstrate proficiency with the Microsoft Office Suite., • Demonstrates general understanding of coding standards., • Maintains current and working knowledge of Utilization Management Standards., • Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred., • Strong written and verbal communication skills., • Ability to multitask and balance priorities., • Must demonstrate ability to work independently on a daily basis., • Deliver efficient, effective, and seamless care to members. Associates degree and active NYS RN license required. Bachelors degree preferred. Level II (in addition to Level I Qualifications) • Minimum of 2 years in utilization management position., • Demonstrates ability to escalate to management, as necessary., • Demonstrates proficiency in all related technology., • Ability to take on broader responsibilities., • Ability to participate in training of new staff. Level III (in addition to Level II Qualifications) • Must have been in a utilization management position or similar subject matter expert for at least 5 years., • Broad understanding of multiple areas (i.e. UM and CM). Incumbent is required to know multiple functional areas and supporting systems., • Expert in Utilization Management and ability to handle complex assignments, challenging situations and highly visible issues., • Ability to lead the training of new staff., • Demonstrated presentation skills. Physical Requirements: • Ability to independently travel within regions., • Ability to work at a computer for prolonged periods of time. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): E2: $62,400 - $96,081 E3: $62,400 - $106,929 E4: $65,346 - $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Trinity Health - 315 South Manning Boulevard - Responsibilities: Perform outpatient and inpatient registration and insurance verification; Collect patient financial liability payments; Ensure patients meet financial requirements including Medicare medical necessity, payer pre-certifications & referr

Trinity Health - 600 Northern Boulevard - Responsibilities: Perform outpatient and/or inpatient registration and insurance verification functions; Collect patient financial liability payments; Ensure patients meet financial requirements including Medicare medical necessity, payer pre-certifications

Become a part of our caring community The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing Home Health, SNF, DME, dual Medicare/Medicaid requests. The Medical Director reviews and determines whether healthcare services provided by other healthcare professionals align with national guidelines, CMS requirements, Humana policies, clinical standards, and applicable contracts. The Medical Director evaluates the medical necessity of healthcare services, ensuring decisions comply with regulatory and organizational standards. The role requires interpreting clinical guidelines, CMS policies, and Medicare requirements, and applying them consistently. All work at OneHome is conducted within a framework of regulatory compliance. This secures compliance with all requirements set by federal and state laws. Medical Directors review clinical cases for Medicare and Medicaid members, report to the Lead Medical Director, and work within defined timelines and departmental expectations. Role Responsibilities: * Review clinical cases and determine medical necessity of services for Medicare and Medicaid members * Ensure compliance with review policies, procedures, and regulatory standards * Apply clinical guidelines, CMS policies, and Medicare/Medicare Advantage/Medicaid requirements * Identify opportunities for medical management operational improvements * Participate in call rotations, including weekend coverage and after-hours coverage * Contribute to an engaged, collaborative team culture that supports organizational excellence * Deliver exceptional consumer experiences * Support Home Solutions and other activities as assigned by the OneHome leadership Use your skills to make an impact Required Qualifications * MD or DO degree * Current, active and ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABPS). National Board of Physicians & Surgeons (NBPAS) certification is not accepted * Current and unrestricted state license in at least one state and willing to obtain other medical licenses, as required, for various states in region of assignment * No sanctions from Federal or State Governmental organizations * 5 years of direct clinical patient care experience post residency or fellowship * The ability to pass credentialing requirements * Intermediate to advanced skills utilizing Microsoft Office and Internet navigation * Strong verbal and written communication skills, with the ability to analyze information and interpret data clearly and accurately * Adaptable and willing to learn new technologies to enhance workflow efficiency Preferred Qualifications * Experience in an inpatient and/or outpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age) * Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care, Surgery or hospital based clinical specialists Additional Information * Workstyle: remote work at home * Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM, call rotations, including weekend coverage and after-hours coverage * Training: 10 weeks of onboarding, no time off and training is in Eastern Standard Time (EST) Work At Home Guidance To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: * At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required. * Satellite, cellular and microwave connection can be used only if approved by leadership. * Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. * Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our .

Cardinal Health Sonexus Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient markers of success. We're continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Together, we can get life-changing therapies to patients who need them-faster. Location - Fully remote, open to candidates in various time zones across the country (with expectation that individual can work within our standard business hours, 8:00am Central - 5:00pm Central) Responsibilities * First point of contact on inbound calls and determines needs and handles accordingly * Creates and completes accurate applications for enrollment with a sense of urgency * Scrutinizes forms and supporting documentation thoroughly for any missing information or new information to be added to the database * Conducts outbound correspondence when necessary to help support the needs of the patient and/or program * Provides detailed activity notes as to what appropriate action is needed for the Benefit Investigation processing * Working alongside teammates to best support the needs of the patient population o Will transfer caller to appropriate team member (when applicable) * Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance * Update internal treatment plan statuses and external pharmacy treatment statuses * Maintain accurate and detailed notations for every interaction using the appropriate database for the inquiry * Self-audit intake activities to ensure accuracy and efficiency for the program * Make all outbound calls to patient and/or provider to discuss any missing information and/or benefit related information * Notify patients, physicians, practitioners, and or clinics of any financial responsibility of services provided as applicable * Assess patient's financial ability to afford therapy and provide hand on guidance to appropriate financial assistance * Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals, etc. All avenues to obtain coverage for the product must be fully exhausted * Track any payer/plan issues and report any changes, updates, or trends to management * Search insurance options and explain various programs to the patient while helping them to select the best coverage option for their situation * Handle all escalations based upon region and ensure proper communication of the resolution within required timeframe agreed upon by the client * Serve as a liaison between client sales force and applicable party * Mediate situations in which parties disagree and facilitate a positive outcome * Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties * Responsible for reporting any payer issues by region with the appropriate team * Log and maintain a reconciliation report for all Field requests to send to client at their designated preferred date range * Support team with call overflow and intake when needed * As needed conduct research associated with issues regarding the payer, physician's office, and pharmacy to resolve issues swiftly Qualifications * Ideally targeting individuals with a background in healthcare (such as medical assistant, working in medical claims/billing, pharmacy technician, clinician in a doctor's office, etc) or with insurance verification - highly preferred * Ideally targeting individuals with a high level of attention to detail, eagerness to learn, willingness to collaborate and communicate effectively * Ability to work in an environment that involves a high volume of varying tasks (must be willing to be flexible and wear a lot of different hats, without getting overwhelmed), required * Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers' policies and guidelines for coverage, preferred * Knowledge of DME, MAC practices, preferred * Prior understanding of Medical, Supplemental, and pharmacy insurance benefit practices, preferred * Intermediate to advanced computer skills and proficiency in Microsoft Office including but not limited to Word, Outlook, and preferred Excel capabilities * Bilingual, preferred What is expected of you and others at this level * Investigate and resolve patient/physician inquiries and concerns in a timely manner * Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate * Must be able to manage multiple concurrent assignments. * Must communicate clearly and effectively in both a written and verbal format * Proactive follow-up with various contacts to ensure patient access to therapy * Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments * In-depth knowledge in technical or specialty area * Applies advanced skills to resolve complex problems independently * May modify process to resolve situations * Works independently within established procedures; may receive general guidance on new assignments * May provide general guidance or technical assistance to less experienced team members * Adaptable and Flexible * Self-Motivated and Dependable * Problem Solving * Strong customer support skills and professional experience working with medical providers * Team Spirited * Punctual and Efficient * Great work attitude Anticipated hourly range: $21.50 per hour - $27.70 per hour Bonus eligible: No Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being. * Medical, dental and vision coverage * Paid time off plan * Health savings account (HSA) * 401k savings plan * Access to wages before pay day with myFlexPay * Flexible spending accounts (FSAs) * Short- and long-term disability coverage * Work-Life resources * Paid parental leave * Healthy lifestyle programs Application window anticipated to close: 7/4/2026 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply. Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law. To read and review this privacy notice click here ()

Employment Type: Full time Shift: Day Shift Description: Athletic Trainer / DME Coordinator - Outpatient Orthopedics Office - Latham, NY - FT If you are looking for a Durable Medical Equipment coordinator position specializing in Orthopedics, this could be your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places. This position is based out of 1182 Troy Schenectady Road, Latham, NY. . Position Highlights: * Quality of Life: Where career opportunities and quality of life converge * Advancement: Strong orientation program, generous tuition allowance and career development * Office Hours: Monday - Friday What you will do: Under the supervision of the physician, provides direct care and performs selected functions for orthopedic patients of all ages in accordance with established policies and procedures. Position may require working at either campus or alternate sites. The DME Coordinator will be responsible for managing the inventory, fitting, training, and billing of orthopedic DME supplies, as well as applying and removing casts and splints. Responsibilities: The DME Coordinator's tasks include, but are not limited to, the following: * Prepare examination rooms for patient visits, ensuring cleanliness and readiness. * Fit and educate patients on the use of orthopedic DME, including braces, walkers, boots, and supports. * Maintain appropriate inventory levels and reorder supplies as needed while consistently reviewing market value for best cost. * Maintain strong relationships with outside vendors and within the trinity system. * Ensure accurate documentation of DME dispensed in the patient medical record. * Verify insurance coverage and obtain pre-authorization when required. * Work with billing staff to ensure accurate coding and charge capture for DME while performing quarterly audits. * Maintain compliance with Medicare and third-party payer regulations regarding DME. * Apply, remove, and adjust orthopedic casts, splints and braces under physician direction. * Educate patients and caregivers on proper cast care, precautions, and follow-up instructions. * Monitor and report any complications related to bracing or casting. * Sterilize instruments and dispose of contaminated supplies to maintain hygienic standards. * Deliver equipment to the patient's hospital room if required and provide education on equipment usage, fall risk prevention, financial obligations and provide all appropriate documentation for patient review and signature. What you will need: Education: High school diploma or GED; Completion of an accredited program associated with license (LPN, RN, ATC, Orthopedic R.S.A) License in the applicable state(s) of engagement. Preferred Qualifications: Training or experience in Orthopedics Pay Range : $22.25 - $ 32.30 Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran

Become a part of our caring community Humana is a leading health and well-being company focused on helping our patients, members, and customers achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. At Humana, we are committed to creating a meaningful work environment where everyone belongs. Our environment is one in which every employee can bring their whole self to work to do their best work. Celebrating diverse backgrounds is at the heart of our corporate values, and we believe that our inclusive, diverse culture has a direct and positive impact on our customers and their healthcare experiences. Our brokerage business is poised to advance the industry in how digital can be used to drive customer acquisition in the Medicare Advantage space. Within this business area, we are aggressively driving new digital capabilities for our eCommerce website, creating new ways of working, and employing next-gen technology to revolutionize how Medicare Advantage is sold. This role is part of this expanding Digital organization and is critical in our growth plans. Key Accountabilities The Product Owner maximizes value of product created by an Agile team and will serve as the team's primary contact for information, work prioritization, and decision-making. Key accountabilities include: * Drive the ecommerce website's product vision, roadmap, and backlog, aligning with business objectives and customer need. * Partnering with Engineering, Design, Content and partners in Product to define the vision for this specific team * Creating a product roadmap based on the aligned vision * Managing the product backlog and prioritizing it based on changing requirements * Define and prioritize epics, features, and user stories (grooming and refining them) with clear acceptance criteria, prioritizing user needs and conversion-driving experiences. * Working with the UX/Design team to ensure user-centered designs and experiences are created. * Monitoring and evaluating product progress at each stage of the process to report on status and ensure timely delivery * Participating in Scrum meetings and product sprints * Establish and review key performance metrics on a regular cadence to ensure the digital experience is performing at an optimal level and identifying if improvements are needed. Partner with the analytics team. * Performing user acceptance testing and accepting user stories before releasing to ensure the final product is meeting all requirements defined in the acceptance criteria. * Continually develop A/B tests to drive learning and ensure the best possible, data-informed, user experience. Use your skills to make an impact Required Skills Commercially focused (eCommerce) Have a strong commercial focus, finding the intersection of customer desires, value to the business, and technology feasibility, with the primary goal of driving customer value and website conversion to grow the insurance eCommerce business. Value Determination and Prioritization Have excellent skills for assessing value and understanding feasibility to determine how to sequence the product backlog. This includes prioritization at multiple altitudes including epic, feature and story roadmaps and backlogs. Curiosity and Empathy Curiosity and a human-centered approach will drive the Product Owner to find relevant data and turn it into information that can help improve their products. They will be consumer-obsessed and driven to have proven solutions to consumer problems before adding work to the product roadmap. Data Obsessed Digital product owners have an advantage over product owners who oversee physical products. They can track how people use their products and learn what's working and what isn't. Digital product owners must become skilled at reading and interpreting these product analytics. Because they must leverage these insights into the ability to improve their products. Required Qualifications * 5+ years of experience in product, with direct experience as a Product Owner to include: * • Owning, prioritizing and managing a backlog, • Writing and refining clear user stories, • Working with Design, Content and Development to bring these experiences alive, • Conducting UAT 3+ years of experience managing eCommerce websites * Strong experience working in Agile/Scrum environments * An analytical and metrics-driven work style, with direct experience working with eCommerce analytics tools (Adobe, Google, others) and KPIs * An entrepreneurial work style, you're a self-starter that's comfortable in a startup environment * Deep user empathy and strong user experience sensibility * Excellent written and verbal communication skills * Comfort in a fast-paced and dynamic environment * Natural leadership instincts with proven ability to innovate and influence Preferred Qualifications Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 05-12-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ? Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our .

Become a part of our caring community With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. Humana's MarketPoint organization is looking for 10 Customer Success Agents to join the Customer Success Team working remote. Humana's Customer Success Agents are our members' trusted partners in navigating healthcare. In this role, you'll provide guidance and solutions to ensure a positive member experience, from explaining plan benefits to resolving issues around disenrollment or dual eligibility. You'll work cross-functionally with care teams, sales agents, and customer service to support and retain members throughout their healthcare journey. ***This position requires you to have a current and valid Health Insurance License in your current state of residence. You will not qualify for this position without a Health Insurance License. Key Role Functions * Deliver a high level of professionalism and empathy with every inbound and outbound consumer phone interaction * Actively listens to identify member needs and suggest available plans, resources, and/or service, which may include enrollments into other plans * Simplify and clearly explain plan benefits, claims, and coverage communications. * Ask thoughtful questions to uncover social determinants of health and broader member needs * Support member retention and engagement goals by educating and guiding members through complex decisions Use your skills to make an impact Required Qualifications * Active resident Health insurance license for your state of residence (based on the resident state's Department of Insurance requirements) * Flexibility - Ability to work a flexible schedule, including overtime, nights and weekends as needed to meet business demands (see additional details below under Work At Home Requirements) * 2+ years of experience working in a virtual environment * 2+ years professional experience in navigating multiple computer tools/systems/screens * 2+ years of experience in Medicare customer service experience or Medicare sales (virtual/telephonic preferred) * Demonstrated ability to understand and explain Medicare benefits and address the unique needs of Medicare and dual-eligible members Preferred Qualifications * Bilingual in English/Spanish a PLUS (Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing) * Bachelor's degree * Prior call center experience * Prior success in Medicare Product Sales or member retention roles * Prior Sales (any industry) experience * Experience navigating Salesforce CRM or similar customer relationship management systems * Proven ability to collaborate cross-functionally to resolve complex member issues Additional Information * Department Hours - Shift could fall between the business hours of 7:00 am to 11:00 pm local time. Hours are subject to change based on business needs and likely to include a weekend day during peak season (October-March) * Training Hours - Training will start day one of employment and run the first 6 weeks with a schedule of 10 am to 6:30 pm EST. Attendance is mandatory and vital for success * Language Proficiency Testing: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: * At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wired cable or DSL connection is suggested * Satellite, cellular and microwave connection can be used only if approved by leadership * Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. * Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. * Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: * Health benefits effective day 1 * Paid time off, holidays, volunteer time and jury duty pay * Recognition pay * 401(k) retirement savings plan with employer match * Tuition assistance * Scholarships for eligible dependents * Parental and caregiver leave * Employee charity matching program * Network Resource Groups (NRGs) * Career development opportunities Our Hiring Process As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $48,900 - $66,200 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ? Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our .

JOB DESCRIPTION Job Summary Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed. * Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met. * Assesses clinical staff regarding appropriate clinical decision-making. * Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership. * Ensures auditing approaches follow a Molina standard in approach and tool use. * Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications. * Adheres to departmental standards, policies and protocols. * Maintains detailed records of auditing results. * Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results. * Meets minimum production standards related to clinical auditing. * May conduct staff trainings as needed. - Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct. Required Qualifications * At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and restricted in state of practice. * Strong attention to detail and organizational skills. * Strong analytical and problem-solving skills. * Ability to work in a cross-functional, professional environment. * Ability to work on a team and independently. * Excellent verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $33.4 - $67.97 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Company : Highmark Inc. Job Description : JOB SUMMARY This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. ESSENTIAL RESPONSIBILITIES * Communicate effectively with physician and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner. * Interact with staff to implement processes and problem solves. * Respond to drug benefit design inquires or exception requests and evaluate/direct daily workflow within the department. * Prioritize requests for drug authorizations or denials. * Review of prior authorization criteria for drug products. * Recommend staffing adjustments necessary to appropriately maintain a level of high efficiency/productivity. * Ensure adherence to call center turn around time requirements associated with DPW/CMS regulations. * Take necessary steps to perform a complete and accurate evaluation of all non-formulary drug exception requests prior to approval, authorization or claim override. * Search member claim history profile and recommend formulary alternatives wherever feasible. * Contact physician network provider to obtain necessary and/or additional information when necessary. * Consult with staff clinical pharmacist for guidance and assistance as necessary. * Document all authorizations and denials completely, accurately, and in accordance with timelines as defined by state and federal regulations to insure appropriate notification issuance to prescribing physician and impacted member. * Populate all authorization and denial information fields within the OnBase information system. * Enter all authorizations into the Argus IPNS information system to allow claim adjudication. * Complete other assigned duties as specified. * Identify and report improper coordination of benefit billing practices through paid clams review. * Participate as pharmacy representative in onsite member appeals and grievances sessions. * Serve as a resource for technical staff. * Other duties as assigned or requested. QUALIFICATIONS: Minimum * High school diploma or GED * Experience in pharmacy prescription claims processing/submission/payment. Preferred * Associate degree * Pharmacy technician certification certificate * Experience working in a managed care medication formulary management environment * Working knowledge of retail pharmacy and/or third party prescription procession * Strong background and understanding of medications and formulary terminology * Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being familiar with applicable federal rules/regulations that remain consistent throughout the nation Skills * Excellent computer skills such as working knowledge of Microsoft Outlook, Word, OnBase * Excellent interpersonal, communication and attentive listening skills * Strong organizational skills, detail oriented * Demonstrated excellence in communication skills * Demonstrated ability to work well with others * Demonstrated ability to work in a fast paced, multi-task environment SCOPE OF RESPONSIBILITY Does this role supervise/manage other employees? No WORK ENVIRONMENT Is Travel Required? No Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $19.01 Pay Range Maximum: $24.19 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J276611

Registered Nurse Independently performs the duties below: • Conducts nursing assessments; and obtains, records, and updates individuals' health information and vital signs, using standard instruments and procedures., • Prepares, implements, and modifies nursing care plans; prepares individuals for and/or assists with examinations and treatments; and administers medications and nursing procedures to individuals, as prescribed., • Observes, monitors, and records individuals' symptoms, conditions, and care, including diet and physical activity; and identifies and reports individuals' responses to medication or changes in health status., • Serves as the nursing representative on a treatment team; provides information on nursing needs; and consults and coordinates with treatment teams and other health care disciplines to assess, plan, implement, or evaluate individuals' care., • Makes clinical rounds to assess individuals' nursing care needs and observe and participate in the provision of nursing services., • Provides health teaching, counseling, and education to individuals, families, and other groups; and develops health improvement programs., • Implements infection control protocols and procedures and provides related consultation and instruction to staff., • Maintains and updates charts, records, and other documentation, consistent with agency, State, and federal requirements; and may collect data and perform related activities to support medical research., • Delegates responsibility for appropriate nursing activities, skills, and/or procedures to nursing and direct care staff; and makes clinical rounds to assess individuals' nursing care needs and observe and evaluate the provision of nursing services., • Acts as liaison to outside agencies and providers to ensure continuity of care and the necessary follow-up for individuals; advocates for individuals' needs; and may provide instruction to providers on individuals' discharge plans. Must have a license and a current registration as a registered professional nurse in New York State. Additional Comments: This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). HELPS Program titles may be filled via a non-competitive appointment. This means that you do not need to take an exam to qualify, but you do need to meet the minimum qualifications of the title. At a future date (within one year of permanent appointment), employees hired under NY HELPS are expected to have their permanent non-competitive employment status converted to permanent competitive status. You will not have to take an exam to gain permanent competitive status. • Please note that starting salary for this title reflects the increased hiring salary and geographic pay differential. Posted Hiring Salary includes the sum of the statutory hiring rate for PS&T Grade 18 ($66,951), Increased Hiring Salary ($9,196), and Geographic Pay Differential ($20,000). Geographic Pay Differential is added to the job rate ($85,138)., • If you are currently a New York State employee serving in a permanent competitive qualifying title and eligible for a transfer via Section 70.1 of the Civil Service Law, you may be appointed to this title as a permanent competitive employee., • The assignment of PS&T employees will be made in accordance with any agreed upon Memorandum of Understanding between PEF and the local DDSO regarding the posting of job vacancies., • Preference will be given to OPWDD employees impacted by closures. If you are being impacted by closure, please indicate this on your resume., • All OPWDD employees must be eligible and maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining eligibility., • Employees on long term leave can bid on positions but must be able to report to work within fourteen (14) days and be able to perform the essential functions of their positions with or without reasonable accommodation (RA)., • Savings programs such as the U.S. Savings Bond and the College Savings Plan., • Voluntary pre-tax savings programs such as Health Care Spending Account and the Dependent Care Advantage Account offer employees options to pay for uncovered health care expenses or dependent care expenses., • Access to the Employee Assistance Program (EAP) an assessment and referral service that connects employees with local service providers and support services to address their personal needs., • Life insurance and Disability insurance., • The New York State Deferred Compensation Plan is a voluntary retirement plan that offers employees the option to invest a part of their salaries for retirement on a tax-deferred basis., • Paid Holidays and Leave: • Thirteen (13) paid holidays each year., • Thirteen (13) days of paid vacation leave initially., • Five (5) days paid personal leave each year., • Thirteen (13) days of paid sick leave each year (PEF/CSEA), which may carry over from year to year., • Up to three (3) days professional leave each year to participate in professional development events. • Health Care Coverage: Employees and their eligible dependents can choose from a variety of affordable health insurance programs. Employees are provided family dental and vision plans at no extra cost. • Paid Parental Leave: Paid Parental Leave allows eligible employees to take up to 12 weeks of paid leave at full pay for each qualifying event. A qualifying event is defined as the birth of a child or placement of a child for adoption or foster care. • Retirement Program: Participate in The NYS Employees' Retirement System (ERS), which is recognized as one of the best-managed and best-funded public retirement systems in the nation. • Professional Development and Education and Training: NYS offers training programs and tuition assistance to eligible employees to maintain and increase their professional skills and prepare them for promotional opportunities. For more information, please visit . • OPWDD is an Equal Opportunity/Affirmative Action employer dedicated to creating and sustaining a culture of inclusion. We believe that we are most effective in managing and improving our service system with a diverse team of employees. With such a large workforce, we rely on the collective individual differences, life experiences, knowledge, self-expression, ideas and talent that our employees bring to their work. This speaks to our culture and is a key part of our successes. As we continuously recruit people for our team, we welcome the unique contributions that applicants bring in terms of their education, culture, ethnicity, race, sex, gender identity and expression, nation of origin, age, languages spoken, veteran's status, color, religion, disability, sexual orientation and beliefs.

VNA Albany is seeking a Registered Nurse (RN) Home Health Quality Assurance for a nursing job in Albany, New York. Job Description & Requirements • Specialty: Quality Assurance, • Discipline: RN, • Duration: Ongoing, • 40 hours per week, • Shift: 8 hours • Develops and leads the agency QAPI program. Chairs the QAPI leadership team., • Gathers and collects clinical data for QAPI analysis., • Oversees and monitors the actions of QAPI teams, ensuring performance improvement plans are developed and executed. Provides consultation to teams., • Develops reports for the Professional Advisory Council., • Develops and implement monitoring processes to ensure compliance with agency policy, professional standards, and state and federal regulations., • Conducts ongoing clinical record audits aligned with the quality plan and identified areas of risk. Reports same to the QAPI Leadership team., • Collaborates in providing strategy related to clinical practices and enhancing the patient experience., • Collaborates with clinical leadership on developing and monitor quality goals., • Monitors result against performance targets for key metrics and meet with Executive Director of Clinical Operations to review findings and provide recommendations for improvement., • Ensures compliance with key metrics for all workflows, including but not limited to missed visits, timeliness of documentation, and appropriate Nursing and Therapy supervisory visits based on regulatory metrics., • Works with clinical management to follow up on all patient Incident reports. Tracks and incorporates reporting in the QAPI process to identify ways to reduce risk., • Collaborates with the Manager of Education and Director of Corporate Compliance to identify training needs and activities for staff that focus on accurate and appropriate evidence-based practice principles, existing tools and guidelines, and regulatory principles., • Monitors variances/discrepancies to metrics with clinical management and provides insight as needed. Works collaboratively to find solutions to improve performance., • Performs as a Clinical Manager on assigned weekends as part of a rotation with other managers., • Provides backup to Clinical Managers and clinical workflow as necessary., • Participates in special projects and performs other duties as required Requirements: • NYS RN License, • Prior experience in Quality Assurance, • Home Health experience (Preferred), • Drivers License / Reliable Transportation VNA of Albany provided the following inclusive hiring information: We are an equal opportunity employer and consider all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. VNA Albany Job ID #1006-QA. About VNA Albany The VNA of Albany is a Medicare and Medicaid certified non-for-profit home health care agency, governed by a board of directors composed of community members. The agency provides skilled nursing, rehabilitation services, and medical social work to residents in 11 counties of Northeastern New York. The VNA of Albany makes home care visits to over 3,000 patients each year. We are proud to be New York State’s oldest provider of home health care services and the fifth oldest home health agency in the United States. VNA holds a 4-star rating in both Patient Satisfaction and Quality of Care, thanks to our amazing team of skilled professionals who are dedicated to delivering quality care to the community we serve. Why Vivian Health? Be sure to apply via Vivian Health to increase your chances of landing your perfect job. Just complete your Vivian Health profileonce, and get access to thousands of opportunities across the country. Then keep up to date with your job application process and conversations with our easy to use app. Benefits • Holiday Pay, • 403b retirement plan, • Wellness and fitness programs, • Employee assistance programs, • Dental benefits, • Vision benefits, • Discount program, • Guaranteed Hours, • Sick pay, • Mileage reimbursement, • Medical benefits, • Life insurance

Duties Description A Dietitian 2 would be a member of an interdisciplinary team and provide Medical Nutrition Therapy which may include consulting with physicians on nutrition support requests; planning and supervising the preparation of special diets and menus; maintaining safe and sanitary conditions; and training or assisting individuals, families and staff to plan specialized and therapeutic nutrition care plans. The Dietitian 2 may have oversight responsibility in the service of food; assist in the instruction of students or nutrition interns in Medical Nutrition Therapy and food preparation techniques, supervise dietetic interns and technicians; and/or supervise a small food preparation service unit. Minimum Qualifications Candidates from outside and within State Service may be considered for hire under the Hiring for Emergency Limited Placement - Statewide (NY HELPS) program as a Dietitian 2 if they have: Current registration with the Commission on Dietetic Registration (CDR) as a Registered Dietitian (RD) or New York State Education Department (NYSED) certification in dietetics-nutrition and have completed a minimum of an additional 400 hours of supervised dietetics practice under the supervision of a RD. OR Candidates from within State service may be considered for transfer to a competitive class position if they have one year of permanent competitive or 55-b/55-c service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Additional Comments All OMH employees receive a generous benefits package including: • NYS medical, dental, & vision insurance, • Access to tuition assistance programs, • Excellent opportunities for advancement & professional growth, • Paid time off - 13 paid vacation days in the first year, 5 paid personal days, 13 paid holidays, & paid sick leave, • NYS Retirement programs Background checks will be required. Notes: 1. If you fail to maintain your license and/or registration once you are appointed, action will be taken to remove you from the position., 2. In order to be eligible for appointment and to maintain employment, you cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program). If you are appointed and subsequently listed as an excluded individual or entity on any of these lists (or excluded from any other Federal or Federally assisted program), you may be terminated from your employment., 3. If appointed you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid. If you are appointed and you lose the ability to bill through Medicare and Medicaid, you may be terminated from your employment. Some positions may require additional credentials or a background check to verify your identity. Name Human Resources Telephone Fax 518-549-6611 Email Address Address Street Capital District Psychiatric Center 75 New Scotland Avenue City Albany State NY Zip Code 12208 Notes on Applying Indicate the Title and Location of the position you are applying for. Please complete the Office of Mental Health Employment Application and submit it with your other application materials. The Mission of the New York State Office of Mental Health is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. OMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, OMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring OMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. OMH is an equal opportunity/affirmative action employer.

Job Description Capital District Psychiatric Center (CDPC), an Office of Mental Health (OMH) Joint Commission accredited facility, is recruiting Board Certified or Board Eligible Psychiatrists to serve as the Clinical Leads of multidisciplinary treatment teams. As a Psychiatrist at CDPC, you will provide comprehensive, patient centered and recovery focused treatments to individuals with mental illness 18 year of age or older; including: • Conducting comprehensive psychiatric assessments and patient admissions, • Creating treatment plans including medication management, • Obtaining and reviewing appropriate laboratory tests and consulting with members of treatment team as needed, • Providing individual and group psychotherapy, • Supervising Psychiatric Residents and Fellows Minimum Qualifications - Candidates from outside or within State Service can be considered for hire under the Hiring for Emergency Limited Placement – Statewide (HELPS) program if they have a license and current registration to practice medicine in New York State and have certification in psychiatry approved by the American Board of Psychiatry and Neurology (ABPN). OR Candidates from within State Service can be considered for a competitive class appointment if they have one year of permanent competitive or 55-b/55-c service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Psychiatrist 1: License and current registration to practice medicine in New York State, and completion of a training program in psychiatry approved by the ABPN. Psychiatrist 2: License and current registration to practice medicine in New York State, and certification in psychiatry approved by the ABPN. Additional Comments - Psychiatrists at OMH facilities are eligible for: • Psychiatrist Loan Repayment Program offering up to $120,000, • Supplemental income of up to 50% of salary by volunteering to provide evening, night, and weekend coverage, • Defense and Indemnification Protection- broader in scope than typical medical malpractice coverage, • OMH sponsored Continuing Medical Education (CME) Program All OMH employees receive a generous benefits package including: • Excellent opportunities for advancement & professional growth, • Generous paid time off, • NYS medical, dental, & vision insurance, • NYS Retirement programs – NYS Pension and Deferred Compensation Background checks will be required. PSYCHIATRIST 1: $273,549.00 PSYCHIATRIST 2: $285,735.00 NOTE: 1. In order to be eligible for appointment and to maintain employment, you cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program). If you are appointed and subsequently listed as an excluded individual or entity on any of these lists (or excluded from any other Federal or federally assisted program), you may be terminated from your employment., 2. If appointed you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid. If you are appointed and you lose the ability to bill through Medicare and Medicaid, you may be terminated from your employment.

Job DescriptionSenior AuditorEmployment Type: Full-Time, ExperiencedDepartment: Financial CGS is seeking a highly skilled Senior Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection. The ideal candidate will develop, coordinate, and draft technical audit guidelines, is proficient in a variety of accounting systems, and practices excellent cross-functional communication throughout investigations. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success:-Management experience helpful; experience in litigation environment, experience working with automated litigation support helpful. -Conduct financial analysis by reviewing bank records, wire transfers, ledgers, and other financial documentation.-Conduct open-source intelligence and database research on individuals, business entities, and assets.-Analyze large and complex healthcare claims datasets to identify fraud, waste, and abuse patterns.-Design and run SQL queries, models, and data algorithms to detect anomalous billing trends and patterns.-Extract and manipulate federal health claims data using CMS tools such as OnePI, STARS, Business Objects, and other related platforms.-Prepare analytical summaries, memoranda, charts, and data visualizations to support case development and litigation.-Summarize transaction histories and flag suspicious activities for follow-up.-Evaluate allegations of fraud and provide recommendations to [assistant client attorneys] for determination.-Based on fraud data, assist with development of investigative plans including identifying areas of investigative focus.-Work collaboratively with attorneys and investigators to refine leads and develop investigative strategies.-Deliver oral briefings and written reports to [assistant client attorneys] on findings from healthcare data analytics.-Support development of internal best practices and workflows for healthcare fraud detection." Required Skills: -Undergraduate degree minimum, CPA/MBA equivalent.-Must be a Certified Public Accountant. -MBA or equivalent in accounting or directly related field. -Thorough knowledge of generally accepted accounting principles and generally accepted auditing standards. -Minimum of five years’ experience as an auditor; minimum three years specialized experience in the specific subject matter area involved - for example, Medicare billing and claims systems, or DoD inventory systems. -Extensive working knowledge of appropriate accounting and financial analysis ADP systems and applications. -Excellent oral and written communication skills. -Must be a United States citizenMust be able to obtain a Public Trust security clearance Our Commitment:Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package.- Health, Dental, and Vision- Life Insurance- 401k- Flexible Spending Account (Health, Dependent Care, and Commuter)- Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board: For more information about CGS please visit: or contact:Email: #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Job DescriptionGet to Know Rivia Mind At Rivia Mind, we believe great mental health care begins with a human connection. Where We Are: We are a psychiatrist-owned mental health practice rooted in New York City, serving individuals across New York, New Jersey, Connecticut, Florida, and Massachusetts through both virtual and hybrid appointments. How We Support: With a Whole-Person Lens, we provide compassionate, science-based care that honors the full complexity of a person's biology, psychology, and life circumstances. We go beyond symptom management with an interdisciplinary care model grounded in collaboration, personalization, and delivered with warmth, respect, and clinical integrity. We bring a high-touch, human-centered approach to every aspect of care, from clinical treatment to operational coordination. Click Here to learn more about our services. Thrive Together: 🌟 Our shared North Star unites us to provide the best patient experience. At Rivia Mind, we cultivate a collegial culture rooted in: • A foundation of shared values and reciprocal support, • A mindset of curiosity, learning, and growth, • Participate in Rivia Mind supervision groups, trainings, and attend department and organization meetings, such as:, • Weekly Group Supervision (1 Hour), • Case and peer discussion, knowledge sharing, guidance, etc., • Weekly 1:1 Supervisor/Supervisee meetings (1 Hour), • Weekly Education Meeting (1 Hour), • Mental Health Topics & Presentations, Guest Speakers, Training, etc., • Comprehensive, multi-part Orientation/Onboarding, • Setting the Therapeutic Frame, • Standards of Practice, • EMR and Care Processes, • Psychotherapy Modality Courses & Review MeetingsWork Location: Remote or Hybrid (NYC, Manhattan)Application Window: Until May 12th, 2026Anticipated Start Date: August - September# of Openings: 3Employment Status: Full TimeExemption Status: Exempt W-2Department: PsychotherapySupervisor: Director of Psychotherapy and SupervisorsSupervisees: NoneJob Responsibilities & Qualifications, • Provide excellent quality clinical care on a consistent basis that exemplifies Rivia Mind's culture, values, and guiding principles, • Service and maintain a weekly average standard of 31 patients across self-pay, insurance, and Medicare, • Maintain a consistent weekly patient care schedule in alignment with Rivia Mind's standard productivity expectations., • Follow Care Model practices that emphasize continuity of care, high-frequency follow-up appointments, and effective calendar management., • Conduct comprehensive intake evaluations and develop curated patient-centered treatment plans, • Provide appropriate Psychotherapy practices that leverage various modalities (CBT, DBT, motivational interviewing, etc.), • Provide clinical support & counseling to diverse patient populations in a telehealth environment, • Coach patients on how to manage ongoing health conditions and provide therapy to help patients make positive behavior changes, • Counsel and provide crisis intervention for patients, including assessment and treatment of emotional and behavioral problems, • Comply with clinical standards and adhere to timely and thorough session note documentation, • Promote a friendly work culture that encourages a fun, collaborative, and co-learning environment that benefits individuals' well-being, self-improvement, and potential, • Perform other related role and team function duties as assigned by department and group leadersLicensure/Certification Requirements, • Active New York State License (LMSW/MHC-LP), • Candidates must be license-eligible or hold an active associate-level license or permit (e.g., LMSW, LSW, LAC, MHC or equivalent),, • OR–have up to 2 years of post-licensure experience (not independently licensed)., • Where applicable, completion of the required licensure examination is preferred., • At least one (1) year of experience practicing Psychotherapy (Practicum clinical experience applies), • Outpatient experience preferred, • Long-term therapy care model experience preferred, • Additional Language Fluency is a plus, • Experience or desire to work with Couples is a plus, • Multi-Disciplinary Teamwork, • Proficient with utilizing diverse technology platforms and systems (Google Suite, company-wide platforms/software and EHR platforms when applicable) At Rivia Mind, we know that providing exceptional care starts with caring for our team. That's why we offer a comprehensive, thoughtfully designed benefits package that supports your health, financial wellness, growth, and overall well-being—so you can thrive in work and life. Learn more here. • 3 weeks of front-loaded PTO + Milestone Increases, • Annual office closure (Dec 25–Jan 1) + 7 additional paid holidays, • Annual Impact Days for volunteering or professional development, • Annual Continuing Education (CE) Stipend + Flexible Benefit Reimbursement, • Medical, dental, and vision insurance — with EAP and additional wellness programs, • Voluntary benefits, HSA, DCA, FSA (based on plan), transit & parking options, • 401(k) with employer match, • Referral bonus potential, • Our operating hours are M-F: 8 am to 6 pm, but we do allow a schedule to have a start as early as 7 am, and end as late as 9 pm M-F, and between 9 am - 5 pm Saturday. All Eastern Time Zone., • Include at least four(4)+ hours within your schedule, which should be after 5 pm on a weekday or have hours on the weekend., • On-call is not required, but checking and responding to time-sensitive emails on unscheduled days is required unless on PTO. Location Eligibility: At this time, we are only able to consider applicants whose primary residence is in one of the following states within the United States of America: Connecticut, Florida, Massachusetts, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Texas. Because this is not a solely on-site role, your primary residence must remain in one of these approved states. Please note that residing outside of these states—even temporarily—may result in employment eligibility issues, tax implications, or other regulatory concerns. If your location changes or you're based elsewhere, we encourage you to stay connected for future openings. Equal Opportunity Employer: Rivia Mind is an Equal Employment Opportunity Employer. It is the policy of Rivia Mind to provide equal employment opportunities without regard to race, color, ancestry, religion, sex, gender identity or expression, pregnancy, age, ethnic or national origin, immigration or citizenship status, hair, weight, height, disability, marital status, veteran status, sexual orientation, genetic information/GINA, political affiliation or activity, or any other protected characteristic under applicable law. It is also the policy of Rivia Mind that qualified individuals with disabilities receive equal opportunity regarding job application procedures, hiring, and all aspects of the employment process. Rivia Mind is committed to the full inclusion of all qualified individuals. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of Rivia Mind to provide reasonable accommodations when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, pre-employment testing, to otherwise participate in the selection process, to perform the essential job functions, and/or to receive other benefits and privileges of employment, please contact us directly. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Rivia Mind participates in E-Verify to confirm the identity and employment eligibility of newly hired employees. Right to Work Poster, and E-Verify Poster Applicants must be authorized to work in the United States. We are unable to sponsor work visas at this time. This is in accordance with applicable federal, state, and local laws, including Title VII of the Civil Rights Act, the Americans with Disabilities Act, the Age Discrimination in Employment Act, and the Genetic Information Nondiscrimination Act. If you need assistance or accommodation due to a disability during the application process, please contact our Talent Acquisition team at .

Job Description Tesis Laboratory is seeking a billing professional. Remote work is available. This position is responsible for all molecular genetic laboratory billing and revenue cycle management, thorough insurance benefit investigation of new referrals, a small assignment of collections with a variety of payers, authorization requests, and claim submission. ESSENTIAL DUTIES: • Accurately interprets patient insurance, prescription, and other health-related documentation., • Conducts medical insurance verification and investigations for commercial and government payors., • Communicates with insurance companies, patients, providers, and prescribers to coordinate reimbursement and access solution., • Reviews unpaid accounts to determine status and taking appropriate action to ensure payment., • Reviews all claims for compliance and completeness for claims submissions., • Researches available alternative funding options to reduce patient's financial burden, • Always maintains a high degree of confidentiality due to access to sensitive information., • Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department., • Works with customers and affiliates on reporting, best practice, and strategic planning to optimize growth within a compliant environment., • Reviews and designs KPI to ensure proper financial performance of assigned Laboratory clients., • Follows all Medicare, Medicaid, and HIPAA regulations and requirements., • High school diploma or equivalent is required; Undergraduate degree is preferred., • Experience in Genetic Lab Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment is required., • Computer proficiency -- MS Office and Web-enabled applications strongly preferred, • Customer service skills required., • Understanding of the requirements of Medicaid, Medicare, and Insurance billing for genetic laboratories in all MAC’s is required., • 5 years’ experience with Laboratory medical billing., • 3 years minimum with Cancer Genomics billing., • 1 year with R & D of molecular genetics panels., • Certified Medical coder or biller with AHIMA or affiliated organization., • Experience with managing clients and/or employees preferred.

Job DescriptionJob Title: Epic Tapestry Analyst Job Summary: The Epic Tapestry Analyst is responsible for the build, configuration, implementation, and support of the Epic Tapestry (Managed Care/Payer) module. This role partners with payer operations, revenue cycle, contracting, and IT teams to ensure accurate benefits, authorizations, claims adjudication, and payer workflows. Key Responsibilities: • Configure and maintain Epic Tapestry (Payer/Managed Care) application components., • Build and support benefit plans, products, packages, coverage rules, and authorizations., • Configure claims adjudication logic, reimbursement rules, and payment policies., • Support payer contracts, fee schedules, and coordination of benefits (COB)., • Analyze payer requirements and translate them into Epic system build and workflows., • Perform unit, integrated, and user acceptance testing (UAT); resolve defects., • Collaborate with Revenue Cycle, Enrollment, Claims, and Provider Contracting teams., • Support integrations with Epic HB, PB, Clearinghouses, and external payer systems., • Monitor adjudication errors, work queues, and reports; recommend system improvements., • Provide go-live, postgo-live, and production support., • Create and maintain build, workflow, test scripts, and training documentation., • Ensure compliance with CMS, Medicaid, Medicare, and HIPAA regulations. Required Skills & Qualifications: • Epic Tapestry certification or proficiency (required or strongly preferred)., • 3+ years of experience working with Epic Tapestry or payer systems., • Strong knowledge of payer operations, benefits, claims processing, and authorizations., • Experience with Medicare, Medicaid, and commercial insurance plans., • Understanding of reimbursement methodologies and provider payment models., • Strong analytical, troubleshooting, and communication skills. Preferred Qualifications: • Experience with Epic Resolute HB/PB integrations., • Knowledge of reporting tools such as Clarity, Caboodle, or Reporting Workbench., • Previous Epic implementation or payer-system optimization experience., • Healthcare payer or managed care organization background.

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