Care Model Advisor in United States

Become a part of our caring community The Dental Recontracting Professional initiates, negotiates, and executes dental provider contracts and agreements for an organization that provides dental insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This is a VSP role - work specific hours to meet business needs on a limited term basis. The project is expected to go through mid-2027. The Dental Recontracting Professional - VSP will recontract Humana contracted dentists to our new agreement and as needed will communicates contract terms, payment structures, and reimbursement rates to providers. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures and work special projects as needed. This role is Variable Staffing Pool (VSP), Variable Staffing Pool Humana associates work specific hours to meet business needs on a limited term basis. The project is expected to go through mid-2027. This role is also eligible for limited benefits. Use your skills to make an impact Required Qualifications 2 - 5 years of experience negotiating managed care contracts with physician, hospital and/or other provider contracts and/or working with insurance in a dental office Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures a

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Account Manager is responsible for managing and supporting an assigned segment of one of Aetna International's largest and most complex global client relationships. This role serves as the primary point of contact for a defined group of client stakeholders within designated geographic regions, providing strategic account management, operational support, and consultative guidance to ensure a high level of service and client satisfaction. Operating within a highly customized service environment supporting globally distributed populations, the Account Manager partners closely with client contacts, internal business partners, and external vendors to resolve complex issues, drive service improvements, and execute account strategies aligned with client objectives and organizational goals. The successful candidate will balance strategic relationship management with day-to-day operational support, while navigating complex healthcare and administrative challenges across multiple regions, cultures, and time zones. Key Responsibilities Serve as the primary account management contact for assigned client stakeholders within designated geographic regions, building trusted relationships and ensuring a high level of client satisfaction. Provide proactive account management support aligned with client objectives,

Become a part of our caring community The Care Coaching Assistant 2 (Transition Coordination Support Staff) employs a variety of strategies and techniques to support a member's wellness state by coordinating services and resources. The Care Coaching Assistant may support multiple responsibilities including Transitions. You/applicant/employee typically focuses decisions on interpretation of area/department policy and methods for completing assignments. Work within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works. Follow standard practices that allow for some opportunity for interpretation/deviation or independent. Position Responsibilities: Contribute to administration of care coordination, for transitions and custodial prevention teams. Provide non-clinical support to the assessment and evaluation of members' needs and requirements. This support helps achieve and/or maintain an optimal wellness state by guiding members/families toward resources appropriate for their care and wellbeing. Additionally, it facilitates interaction with these resources. Perform varied activities and moderately complex administrative/operational/customer support assignments. Perform computations. Typically work on semi-routine assignments. Use your skills to make an impact Required Qualifications Less than 3 years of technical experience Must reside in the State of Indiana Proficiency in Microsoft Word, Excel and Outlook Excellent verbal and written communication skills Must Reside in the State of Indiana Preferred Qualifications Clerical support background in a healthcare environment Associate or Bachelor's Degree </

Become a part of our caring community The Transition Coordinator (Care Coach 2) evaluates member's needs and requirements. This evaluation aims to achieve and/or maintain an optimal wellness state. The Coordinator does this by guiding members/families toward resources and facilitating interaction with them. These resources are appropriate for the care and wellbeing of members. The Care Coach 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Position Responsibilities: Support the ongoing member transitions in and out of the Indiana Medicaid programs, the Contractor's enrollment, and among care settings. Complete transitions and assists with the planning and preparation for them, and the follow-up care after. Works with the Member Advocate Coordinator and other member-focused departments of the plan. This collaboration ensures continuity and coordination of care and member and provider communication through the initial transition, ongoing benefit plan, and MCE transfers. Ensure the transfer and receipt of all outstanding prior authorization decisions, utilization management data, and clinical information such as prevention and wellness programs(s), care management and complex case management notes. Help with transitions from the custodial setting to the home and community-based setting. We ask that you have telephonic and in-person meetings within an assigned region. The purpose of these meetings is to work with various stakeholders, including long-term care members, hospital/rehab staff discharge planners, family members/POA's, PCP's, and other healthcare professionals. The ultimate goal is to prevent custodial placements whenever possible. Assess and evaluate member's needs to establish a member specific car

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: This is an individual contributor role. As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the OhioRISE Network. This executes, services and may negotiate contracts with local market providers in accordance with company and program standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives. Key Responsibilities: Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships and partners in the development of business strategy and programs to support the operational plans. Collaborates cross-functionally to ensure resolution of escalated issues or

Become a part of our caring community The Field Service Coordinator (Care Coach 1) assesses and evaluates member's needs and requirements. This is done to achieve and/or maintain optimal wellness state by guiding members/families toward resources appropriate for their care and wellbeing. The Service Coordinator work assignments are often straightforward and of moderate complexity. Your role will involve meeting members in their location, spending quality time assessing their needs and barriers and then connecting our members with quality services to promote their ultimate well-being and guide health outcomes. Responsibilities include: Administer ongoing long-term services and support (LTSS) related assessments through person-centered thinking approaches. Contacts members both telephonically and/or in-person to establish goals and priorities. This involves evaluating resources, developing a plan of care, and identifying LTSS providers and community partnerships. The goal is to provide a combination of services and supports that best meet the needs and goals of the member and caregiver through person-centered thinking approaches. Development and modification of Service Plan and involve applicable members of the care team in care planning (Informal caregiver coach, PCP) Support members through navigation of their LTSS and related environmental and social needs Use available information about member to prevent the need for administration of duplicative assessments. Focus on supporting members or caregivers in accessing long-term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs. Assist members in maintaining Medicaid eligibility Collaborate with Medical Director/Geriatrician/Care Coordinator as deemed necessary to ensure cohesive, holist

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary We are seeking an experienced actuarial professional to support Medicaid managed care pricing evaluation, financial performance management, and strategic decision-making. This role requires a strong combination of actuarial expertise, business acumen, technical proficiency, and leadership capability. The successful candidate will serve as a key partner to market leadership, finance, and operational stakeholders while providing guidance and oversight to actuarial analysts supporting complex Medicaid markets. This position is ideal for an actuary with strong project management skills who can balance short-term deliverables and ad hoc requests with long-term strategic initiatives, thrive in a dynamic environment, and independently develop analyses to address emerging business questions. Medicaid Pricing and Actuarial Analysis • Lead actuarial evaluation of state capitation pricing and forecasting for Medicaid managed care programs. • Evaluate and interpret complex state rate-setting methodologies, risk adjustment programs, acuity adjustments, and regulatory requirements. • Assess revenue, medical cost, utilization, and margin drivers to identify emerging trends and business risks. • Summarize and communicate actuarial analysis for business leadership. Strategic Business Support • Partner with market, product, finance, and operations tea

Become a part of our caring community The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to team members for review depending on case findings. Educate providers on utilization and medical management processes. Enter and maintain relevant clinical information in various medical management systems. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications 2&#43; years of RN experience Active RN license in the state of Indiana Ability to be licensed in multiple states without restrictions Previous experience in utilization management, case management, discharge planning and/or home health or rehab Proficient with MS Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Preferred Qualifications Bachelor's degree MCO experience Health Plan experience working with large carriers Previous Medicare/Medicaid experience Outpatient or home health experience in Utilization Manageme

Role Summary Pfizer Commercial Oncology is introducing the world to the next era of cancer care. With a growing portfolio of novel therapies, industry-leading R&D, and a goal of delivering eight breakthroughs by 2030 across major cancer types, we're translating cutting-edge science into market-shaping impact. Here, you'll partner with exceptional colleagues across scientific, medical, and manufacturing teams, backed by advanced digital and AI-enabled infrastructure and the authority to accelerate medicines from discovery to delivery. Guided by our values of courage, excellence, equity, and joy, you'll have the opportunity to stretch your skills and build a career that evolves with you—across teams, roles, and the Pfizer enterprise. Join us to make history — for patients, for their families, for the future. The Senior Oncology Account Specialist (SOAS) will have a variety of responsibilities, ranging from promoting Pfizer’s product portfolio to health care providers and specialists, to educating members of the healthcare community regarding the appropriate use of Pfizer products, to calling on accounts and organized customers to help improve patients’ experience with Pfizer products, as well as the overall quality of patient care delivered. The SOAS plays a critical role in increasing Pfizer’s brand with high-value target customers by linking an insightful assessment of the account and/or business landscape with a strong understanding of Pfizer’s products and resources. BASIC QUALIFICATIONS BA/BS Degree from an accredited institution BA/BS Degree from an accredited institution OR an associate’s degree with 8&#43; years of experience; OR a high school diploma (or equivalent) with 10&#43; years of relevant experience. Ability to travel domestically and stay overnight as necessary Valid US driver’s license and driving record in compliance with company

ROLE SUMMARY Pfizer Commercial Oncology is introducing the world to the next era of cancer care. With a growing portfolio of novel therapies, industry-leading R&D, and a goal of delivering eight breakthroughs by 2030 across major cancer types, we're translating cutting-edge science into market-shaping impact. Here, you'll partner with exceptional colleagues across scientific, medical, and manufacturing teams, backed by advanced digital and AI-enabled infrastructure and the authority to accelerate medicines from discovery to delivery. Guided by our values of courage, excellence, equity, and joy, you'll have the opportunity to stretch your skills and build a career that evolves with you—across teams, roles, and the Pfizer enterprise. Join us to make history — for patients, for their families, for the future. At Pfizer Oncology, we are committed to “Outdo Cancer” by advancing transformative medicines wherever we can make a profound difference in the lives of patients. Today, Pfizer Oncology has an industry leading pipeline that includes the combined legacy Pfizer and Seagen portfolio across breast, genitourinary (GU) including both prostate and bladder, hematology-oncology and thoracic therapeutic areas. The primary purpose of this position will be to provide comprehensive day-to-day administrative support to the US Prostate Franchise Lead and to support the overall Franchise business. The Administrative Assistant will report to the US Prostate Vice President. In this role, the Administrative Assistant will be responsible for (but not limited to) heavy calendar management, coordination of meetings and events, development of agendas and meeting reports, slide development for select meetings, and requests and assembly of briefing materials, arranging travel and expense report preparation. As a working professional, he/she will be expected to handle tasks independently and in a proactive manner. <

Work Flexibility: Hybrid or Onsite Join Stryker’s Global Robotics Customer Care team and support the engineering processes that help maintain and improve service operations for the Mako robotic system and related technologies. This role offers the opportunity to contribute to process development, product lifecycle activities, and continuous improvement initiatives within a regulated medical technology environment. The Process Engineer will support repair, upgrade, and service processes while collaborating across functions to ensure quality, compliance, and operational efficiency. What You Will Do Support new product and process introductions by executing engineering activities and maintaining required documentation in accordance with established development procedures. Lead process and procedure updates related to product launches, product integrations, process improvements, and audit readiness activities. Identify and implement continuous improvement initiatives that enhance service operations, process efficiency, quality, and customer experience metrics. Conduct process investigations, experimental testing, equipment analysis, and validation activities to support repair and upgrade operations. Train service personnel on new processes and procedures while ensuring compliance with quality, safety, and regulated industry requirements. What You Will Need Required: Bachelor’s degree in Engineering or a related technical field. Minimum 0 years of relevant engineering experience. Ability to read and interpret engineering drawings. Working knowledge of geometrical dimensioning and tolerancing (GD&T). Preferred: Minimum 1 year of experience in process engineering, manufacturing engineering, service engineering, or a related field.</

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Preference for those residing in mountain or pacific time zones. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sit

Become a part of our caring community As a Medical Assistant you will be the first contact for patient care, responsible for administrative responsibilities in addition to patient care. Working onsite in a clinical environment and reporting to the Center Administrator you will perform varied activities and moderately complex administrative, operational, and customer support assignments. Location Address CenterWell Senior Primary Care office located at: 4886 N Dowlen Rd., Beaumont, TX., 77708 You will be reporting to the: Supervisor, Center Administration Job Responsibilities As a Medical Assistant you will perform clinical tasks such as: You will perform pre-visit planning based on patient visit type You will obtain and record medical history and vital signs You will room patients and assist healthcare providers with medical procedures and treatments You will perform specimen collection and point of care testing You will prepare and administer medication under the direction of healthcare provider You will ensure accurate documentation in the electronic health record (HER) and electronic medical record (EMR) systems, including documentation of HEDIS and Stars quality measures Required Qualifications An active Certified Medical Assistant/CMA or Registered Medical Assistant/RMA certification from one of the following organizations: AAH, AAMA, AMT, ARMA, MedCa, NAHP, NAHT, NCCT, or NHA Successful completion of MA school/training program or a Certified/Registered Medical Assistant or 5&#43; years of experience and approval from Provider High school diploma or equivalent 1&#43; years of MA experience Phlebotomy experience Medication/vaccine administration ex

Beacon Biosignals is transforming precision medicine for the brain, from clinical development to clinical care. For Life Sciences partners, we offer the leading at-home EEG platform for clinical development of novel therapeutics for neurological, psychiatric, and sleep disorders. Our Diagnostics business is building the most comprehensive at-home platform for precision diagnostics, combining EEG and cardiopulmonary signals to deliver reimbursable assessments for sleep and central nervous system disorders. Together, we're changing the way patients are diagnosed and treated for any disorder that affects brain physiology. What you will be doing: Beacon Biosignals is on a mission to revolutionize precision medicine for the brain. We are the leading at-home EEG platform supporting clinical development of novel therapeutics for neurological, psychiatric, and sleep disorders. Our FDA 510(k)-cleared Dreem EEG headband and AI algorithms enable quantitative biomarker discovery and implementation. Beacon’s Clinico-EEG database contains EEG data from nearly 100,000 patients, and our cloud-native analytics platform powers large-scale RWD/RWE retrospective and predictive studies. Beacon Biosignals is changing the way that patients are treated for any disorder that affects brain physiology. The Sleep Study Support Specialist will work within the SleepView Direct department and report to the Manager, Services. This is a second-shift position that is primarily work-from-home, with occasional on-site meetings as needed. The Sleep Study Support Specialist plays an important role in delivering a positive patient and customer experience by providing timely, accurate, and compassionate support throughout the sleep testing process. This position requires strong communication skills, attention to detail, sound judgment, and the ability to effectively manage multiple priorities while working both independently and as part of a cross-functional team. What success lo

Beacon Biosignals is transforming precision medicine for the brain, from clinical development to clinical care. For Life Sciences partners, we offer the leading at-home EEG platform for clinical development of novel therapeutics for neurological, psychiatric, and sleep disorders. Our Diagnostics business is building the most comprehensive at-home platform for precision diagnostics, combining EEG and cardiopulmonary signals to deliver reimbursable assessments for sleep and central nervous system disorders. Together, we're changing the way patients are diagnosed and treated for any disorder that affects brain physiology. What you will be doing: Beacon Biosignals is on a mission to revolutionize precision medicine for the brain. We are the leading at-home EEG platform supporting clinical development of novel therapeutics for neurological, psychiatric, and sleep disorders. Our FDA 510(k)-cleared Dreem EEG headband and AI algorithms enable quantitative biomarker discovery and implementation. Beacon’s Clinico-EEG database contains EEG data from nearly 100,000 patients, and our cloud-native analytics platform powers large-scale RWD/RWE retrospective and predictive studies. Beacon Biosignals is changing the way that patients are treated for any disorder that affects brain physiology. The Services Specialist will work within the SleepView Direct department and report to the Manager, Services. This is a first-shift position that is primarily work-from-home, with occasional on-site meetings as needed. The Services Specialist plays an important role in delivering a positive patient and customer experience by providing timely, accurate, and compassionate support throughout the sleep testing process. This position requires strong communication skills, attention to detail, sound judgment, and the ability to effectively manage multiple priorities while working both independently and as part of a cross-functional team. What success looks like: Provide profe