Nurse Resident - Licensed Practical Nurse jobs in East Montpelier

Clinical UM Nurse 2

Become a part of our caring community and help us put health firstThe Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. 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.Use your skills to make an impactRequired QualificationsLicensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non compact licensure3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience requiredPrior clinical experience preferably in an acute care, skilled or rehabilitation clinical settingComprehensive knowledge of Microsoft Word, Outlook and ExcelAbility to work independently under general instructions and with a teamMust have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is requiredMust be passionate about contributing to an organization focused on continuously improving consumer experiencesMust be willing to be in weekend rotation and possible holiday coverage.Preferred Qualifications3 or more years experience in a high-volume community or mail order pharmacy practice environmentPrevious experience in utilization managementEducation: BSN or Bachelor's degree in a related fieldHealth Plan experiencePrevious Medicare/Medicaid Experience a plusCall center or triage experienceBilingual is a plusTravel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Pay RangeThe 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.$71,100 - $97,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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: 06-18-2025About usAbout Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.Equal Opportunity EmployerIt 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.Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources

Work Life Balance

Patient Nurse Case Manager- Central Region

Otsuka America Pharmaceutical Inc. East Montpelier, VT

Job DescriptionThe Patient Nurse Case Manager (PNCM) is a dynamic, field-based role that serves as a crucial educator for patients. This position helps to execute against a “patient empowerment” care model, and combines the responsibilities of patient disease-state and education, injection training support, and access management to provide comprehensive support throughout the patient journey. The PNCM is an empathetic and trusted resource, responsible for engaging with the patient community, and addressing barriers to treatment adherence.Key ResponsibilitiesDevelop and execute regional patient engagement plans that align with commercial priorities, in collaboration with Patient AdvocacyEducate patients and caregivers in 1:1 sessions about disease state, how to understand their bodies and navigate their lifestyle to manage their disease, and recommending advocacy programsConduct comprehensive assessments of individual patient needs inclusive of understanding of their disease state, if they are “injection naïve” and their comfort with their support systemBuild and maintain relationships with patients and their caregivers to promote patient empowermentServe as the primary point of contact for resolving issues impacting treatment initiation and ongoing therapyCoordinate with cross-functional teams to ensure compliant and effective patient outreach and supportTrack and communicate progress on data-driven performance objectives to leadership and stakeholdersQualificationsMinimum RequirementsBachelor's degreeNursing degree5+ years of business experience in the healthcare or biotech industryExperience engaging with patients and caregivers, preferably in the relevant therapy areaFamiliarity with legal and regulatory components of the pharmaceutical and biotech industries (e.g., FDA regulations, Anti-Kickback Statute, HIPAA)Valid driver's license and ability to travel 60-80% of the time, including evenings and weekendsPreferred QualificationsAdvanced degree in a related fieldBackground in advocacy, counseling, nursing, or social workCase management experience in the specific therapy areaBilingual skills, particularly SpanishKey SkillsExceptional empathy and active listening abilitiesExcellent written and verbal communicationProblem-solving and critical thinking capabilitiesAbility to influence without authority and collaborate across teamsAdaptability and positive attitude in a fast-paced environmentSuperior organizational and time management skillsCustomer service focus and professionalismPhysical RequirementsThis role requires the ability to travel by various means of transportation, work comfortably in clinical settings, use computers and communication devices, engage in complex problem-solving, and maintain general availability during standard business hours. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.Join our team and make a meaningful impact on patients' lives by combining education, advocacy, and access support in this rewarding role!CompetenciesAccountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business.Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders.Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals.Empowered Development - Play an active role in professional development as a business imperative.Minimum $146,955.00 - Maximum $210,100.00, plus incentive opportunity: The range shown represents a typical pay range or starting salary for candidates hired to perform the work. Other elements may be used to determine actual salary such as the candidate’s job experience, specific skills, and comparison to internal incumbents currently in role. This information is provided to applicants in accordance with states and local laws.Company benefits : Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.Come discover more about Otsuka and our benefit offerings; https://www.otsuka-us.com/careers-join-otsuka .Disclaimer:This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request ([email protected]) .Statement Regarding Job Recruiting Fraud ScamsAt Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf.Please understand, Otsuka will never ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment.Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters.To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website https://vhr-otsuka.wd1.myworkdayjobs.com/en-US/External .Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka’s call center at: 800-363-5670. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: https://www.ic3.gov , or your local authorities.Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. (“Otsuka”) does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka’s application portal without a valid written search agreement in place for the position will be considered Otsuka’s sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.

High salary

Coordinator, Individualized Care, Pharmacy Services

Lensa East Montpelier, VT

1 day ago Be among the first 25 applicants Lensa is the leading career site for job seekers at every stage of their career. Our client, Cardinal Health, is seeking professionals in East Montpelier, VT. Apply via Lensa today! 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. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products. Together, we can get life-changing therapies to patients who need them—faster. Responsibilities Responsible for handling inbound calls, with ability to determine needs and provide one call resolution. Manage workload of inbound faxes (if applicable) Investigate and resolve patient/physician inquiries and concerns in a timely manner Enter detailed information into company proprietary software while conversing via telephone Place outbound phone calls for patient follow ups, confirmations or to obtain missing information Interact with the patient referral sources to process new applicants Follow up with other internal team members regarding next steps Communicate with external constituents including physician offices and pharmacies Ability to identify, document and submit Adverse Events during customer contact or via received documentation Qualifications Minimum high school diploma or GED Certified Pharmacy Technician, preferred 1+ years’ experience in fast paced call center environment Basic computer knowledge, Microsoft systems, telephony Strong communication/customer service skills Ability to be an independent worker and self-directed Ability to sit for long periods of time in a cubicle setting Demonstrate superior customer support talents Ability to prioritize multiple, concurrent assignments and work with a sense of urgency Ability to work any schedule between 7am-5pm M-F What is expected of you and others at this level Applies acquired job skills and company policies and procedures to complete standard tasks Works on routine assignments that require basic problem resolution Refers to policies and past practices for guidance Receives general direction on standard work; receives detailed instruction on new assignments Consults with supervisor or senior peers on complex and unusual problems TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 5:00pm CST REMOTE DETAILS: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable . Download speed of 15Mbps (megabyte per second) Upload speed of 5Mbps (megabyte per second) Ping Rate Maximum of 30ms (milliseconds) Hardwired to the router Surge protector with Network Line Protection for CAH issued equipment Anticipated hourly range: $17.80 per hour - $21 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: 06/29/2024 *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 (https://www.cardinalhealth.com/content/dam/corp/email/documents/corp/cardinal-health-online-application-privacy-policy.pdf) Seniority level Seniority level Entry level Employment type Employment type Full-time Job function Job function Other Industries IT Services and IT Consulting Referrals increase your chances of interviewing at Lensa by 2x Get notified about new Care Coordinator jobs in East Montpelier, VT . Clinic Coordinator - Hardwick/Morrisville locations RN Care Coordinator - Infectious Disease Clinic Chronic Care Manager (Remote - Compact States) Administrative Assistant - Full or Part - Time Administrative Assistant - Norwich University Motor Vehicle Direct Client Service Specialist I - Temporary High School Assistant Principal / Dean of Students NON-COMPACT STATE - PT Remote CCM/RTM Care Management Nurse (CA) Judicial Assistant - Clerical, Administrative Assistant (LS) Pediatric High-Tech RN and Palliative Care Coordinator Travel Certified Nursing Aide, CNA to Montana VT- Registered Nurse -Hospice/Clinical Coordinator, Days/Nights+Wknds(8-Hour Shifts),**Must have Clinical/Administrative Experience** - Barre VT- Registered Nurse -Hospice/Clinical Coordinator, Days/NightsWknds(8-Hour Shifts),Must have Clinical/Administrative Experience - Barre We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr

Caregiver Experience Lead (Remote)

Lensa East Montpelier, VT

1 day ago Be among the first 25 applicants Lensa is the leading career site for job seekers at every stage of their career. Our client, Sharecare, is seeking professionals. Apply via Lensa today! Job Description Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com . Job Summary We are seeking a dedicated and proactive Caregiver Experience Lead to join our team. This role is integral in ensuring the success of our employee support call center, driving performance improvements, and fostering a positive and efficient work environment for our employees. The Employee Experience Lead will manage a team of call center agents, handle high-level employee escalations, and work closely with internal teams to enhance operational processes. Additionally, this role will be responsible for managing network reports, aiding in employee engagement initiatives, and assisting with training-related activities. Essential Job Functions Call Center Management: Lead and manage the employee support call center, ensuring the team provides high-quality assistance to employees. Train, mentor, and develop call center agents, ensuring consistent performance and professional growth. Act as the main point of contact for the call center team, addressing their needs and ensuring smooth operations. Handle high-level employee escalations, working to resolve complex issues with urgency and care. Continuously assess and improve call center performance, identifying areas for improvement and implementing effective solutions. Streamline and optimize escalation processes to ensure quick and effective resolution. Provide regular performance reports on call center metrics and updates to senior leadership. Collaborate with the Operations team to address challenges and improve the overall employee support experience. Network Reporting & Analysis Retrieve and analyze network data, ensuring accurate employee tracking against required metrics (e.g., employee count per desired time). Prepare and present network adequacy reports for new or upcoming programs, ensuring teams are prepared and aligned with workforce needs. Collaborate with cross-functional teams to ensure data is accurately presented and actionable. Engagement And Training Assist in the development and execution of employee engagement and training initiatives. Specific Skills/ Attributes Proven experience in managing call center operations or a similar customer service/support environment. Strong leadership and team management skills Exceptional communication skills, with the ability to effectively manage escalations and communicate with all levels of the organization. Ability to translate data into actionable insights. Ability to collaborate cross-functionally with operations, HR, and other teams to achieve organizational goals. Highly organized with the ability to manage multiple tasks and priorities effectively. Strong problem-solving skills and a results-driven mindset. A proactive and positive approach to employee experience. Qualifications Bachelor’s degree or equivalent experience required 1-3 years of experience in the caregiver industry 1-3 years of experience working in or with a call center Strong experience with building reports, analyzing, and presenting data Strong experience with technology and understanding workflows Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor. Seniority level Seniority level Mid-Senior level Employment type Employment type Full-time Job function Job function Other Industries IT Services and IT Consulting Referrals increase your chances of interviewing at Lensa by 2x Get notified about new Caregiver jobs in East Montpelier, VT . Vermont, United States $48,900.00-$66,200.00 2 weeks ago Vermont, United States $300,000.00-$350,000.00 1 week ago Staff Psychiatric Nurse Practitioner- Vermont Vermont, United States $180,000.00-$215,000.00 1 week ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr

Complex Claim Major Case Specialist

Travelers Insurance East Montpelier, VT

Who Are We?Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.Job CategoryClaimCompensation OverviewThe annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.Salary Range$111,600.00 - $184,200.00Target Openings1What Is the Opportunity?Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling and superior customer service throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required.As of the date of this posting, Travelers anticipates that this posting will remain open until September 11, 2025.What Will You Do?CLAIM HANDLING:Directly handle assigned severe claims when Travelers has coverage of $2 million or greater and file exposure is between $2 million and $3 million.Full damage value for average claim (without regard to coverage or liability defenses): $2 million to several million dollars, amounting to a typical inventory of claims with FDV of over a multi-million dollar value.Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.Work with Manager on use of Claim Coverage Counsel as needed.Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.Complete outside investigation as needed per case specifics.Travels frequently inclusive of claim office visits, court appearances, mediations, etc.Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts.Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.Maintain claim files and document claim file activities in accordance with established procedures.Develop and employ creative resolution strategies.Responsible for prompt and proper disposition of all claims within delegated authority.Negotiate disposition of claims with insureds and claimants or their legal representatives.Recognize and implement alternate means of resolution.Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.Utilize evaluation documentation tools in accordance with department guidelines.Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis. Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure.Establish and maintain proper indemnity and expense reserves.COMMUNICATIONS/INFLUENCE:Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.Recommend appropriate cases for discussion at roundtable.Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.Apply the Company's claim quality management protocols, and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance.OTHER ACCOUNTABILITIES:Apply litigation management through the selection of counsel, evaluation.Perform other duties as assigned.What Will Our Ideal Candidate Have?Bachelor's Degree preferred.6-7 years experience handling serious injury and complex liability claims preferred.Extensive working level knowledge and skill in various business line products.Excellent negotiation and customer service skills.Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management skills.Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims.Able to make independent decisions on most assigned cases without involvement of supervisor.Openness to the ideas and expertise of others and actively solicits input and shares ideas.Thorough understanding of commercial lines products, policy language, exclusions, ISO forms and effective claims handling practices.Demonstrated strong coaching, influence and persuasion skills.Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.Can adapt to and support cultural change.Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information.Analytical Thinking - AdvancedJudgment/Decision Making - AdvancedCommunication - AdvancedNegotiation - AdvancedInsurance Contract Knowledge - AdvancedPrinciples of Investigation - AdvancedValue Determination - AdvancedSettlement Techniques - AdvancedLitigation Management - AdvancedMedical Terminology and Procedural Knowledge - AdvancedWhat is a Must Have?3 years bodily injury litigation claim handling experience or 5 year of litigation experience required.High School Degree or GED requiredIn order to perform the essential job functions of this job, acquisition and maintenance of Property/Casualty Adjuster License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job.What Is in It for You?Health Insurance : Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.Employment PracticesTravelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ([email protected]) so we may assist you.Travelers reserves the right to fill this position at a level above or below the level included in this posting.To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/ .

Senior Accreditation Professional

Humana East Montpelier, VT

Become a part of our caring community and help us put health firstWe are seeking a Senior Accreditation Professional who will work in a team environment on Humana’s health plan accreditations, performing complex tasks related to compliance with accreditation standards across multiple operational areas within Humana.Role Responsibilities:Serves as subject matter expert on National Committee for Quality Assurance (NCQA) Health Plan Accreditation Credentialing (CR) requirements and advising stakeholders on compliance.Works closely with operational areas to prepare documentation for submission to NCQA.Advises operational leaders and frontline associates in developing functional strategies for compliance with accreditation standards.Self-directed, exercises independent judgement and decision-making on complex issues regarding job duties and related tasks, and works under minimal supervision.Uses independent judgement requiring analysis of variable factors and determining the best course of action.Use your skills to make an impactRequired QualificationsBachelor's degree.Three (3) years of experience in NCQA Health Plan Accreditation with a focus on Credentialing Accreditation.Prior experience participating in NCQA virtual or onsite surveys.Commitment to continuous process improvement.Exceptional analytical and critical thinking skills, including problem solving and proficiency in executing solutions.Exceptional attention to detail.Demonstrated excellent time management skills with proven ability to be flexible, adapt to changing environment, handle multiple tasks and deadlines and manage multiple priorities.Exceptional verbal and written communication skills.Demonstrated successful relationship building.Experience working with cross-functional business areas.Preferred QualificationsCredentials Verification Organization (CVO) Certification.Registered Nurse or Behavioral Health professional.Advanced degree in a healthcare-related field.Managed care, Medicaid health plan experience.Additional InformationWorkstyle: This is a remote position with some travel.Schedule: Monday through Friday; 8:00 AM – 5:00 PM Eastern Standard Time (EST). Must be able to accommodate work schedules and meetings in both Central and Eastern time zones.Travel: Up to 5% travel – typically, 3-5 times annually possibly outside of your state of residence for team engagement meetings, onsite audits, and trainings.WAH Internet StatementTo 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 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.Interview FormatAs part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Pay RangeThe 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.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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: 09-04-2025About usHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt 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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

AVP, Complex Claim Liability Specialist-Business Torts Life Sciences

Travelers Insurance East Montpelier, VT

Who Are We?Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.Job CategoryClaimCompensation OverviewThe annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.Salary Range$129,200.00 - $213,200.00Target Openings1What Is the Opportunity?Investigate, evaluate, reserve, negotiate and resolve the company's most severe and/or complex Life Science medical products, clinical trial and pharmaceutical bodily injury claims, as well as General Liability Coverage B claims and E&O claims involving Life Sciences insureds, in multiple jurisdictions, in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in indemnity & expense management. Promptly manage claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management, negotiating and resolution. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required.What Will You Do?CLAIM HANDLING:Directly handle assigned severe/complex Life Science medical products, clinical trial and pharmaceutical bodily injury claims, as well as General Liability Coverage B claims and E&O claims involving Life Sciences insureds.Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.Directly investigate each claim through prompt and strategically appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.Complete outside investigation as needed per case specifics.Actively engage in the identification, selection and direction of appropriate internal and./or external resources for specific activities required to effectively evaluate claims, such as Subro, Risk Control, nurse consultants, the Travelers Lab, Claim Legal, and fire or fraud investigators and other experts.Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.Utilize diary management system to ensure that all claims are handled timely.At required time intervals, evaluate liability & damages exposure.Establish and maintain proper indemnity & expense reserves.Share experience and deep knowledge of creative resolution techniques to improve the claim results of others.Apply the Company's claim quality management protocols, Best Practices and metrics to all claims; document the rationale for any departure from applicable protocols and metrics.Develop and employ creative resolution strategies.Effectively and efficiently manage both allocated and unallocated loss adjustment expensesEvaluate all claims for recovery potential; directly handle recovery efforts and/or engage and direct Company resources for recovery efforts.Responsible for prompt and proper disposition of all claims within delegated authority. Negotiate disposition of claims with insureds and claimants or their legal representatives.Ensure that the right resources are being applied to each claim to achieve the best result at the most optimal cost.LEADERSHIP:Actively provide mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.COMMUNICATION/INFLUENCE:Consult with Manager on use of Claim Coverage Counsel as needed.Provide guidance to underwriting business partners with respect to the accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims.Recommend appropriate cases for discussion at roundtable.Attend and or present at roundtables/authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.Represent the company as a technical resource, attend legal proceedings as needed, act within established professional guidelines as well as applicable state lawsObtain and evaluate current information regarding trends in the law; digest and communicate this information to other Company departments and divisions to assist in underwriting and management decisions.Assist underwriting business partners in marketing efforts and account stewardship.Conduct contract reviews to assist in underwriting of E&O exposures.Conduct reviews of other carriers’ Medical Products policies on Life Sciences accounts where Travelers is not writing the products coverage.Assist if development of Life Sciences coverage forms and endorsements and conduct coverage training for underwriters.OTHER ACCOUNTABILITIES:Apply expert litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.Recognize and implement alternate means of resolution.Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy our customers.Track and control legal expenses to assure cost-effective resolution.Develop and employ innovative techniques to manage expense and outcome when independent counsel is engaged.Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.Closely monitor independent counsel to ensure quality product.Actively participate in periodic file quality reviews.Appropriately deal with information that is considered personal and confidential.Fulfill specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquiries from agents and brokers.Perform other duties as assigned.What Will Our Ideal Candidate Have?Law degree preferred.5-7 years medical products and/or pharmaceutical litigation or claim handling experience.Advanced level knowledge in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills.Position requires a proficiency in oral and written communications.Advanced communications skills are required to understand, interpret and convey highly technical information in simple terms to others.Thorough understanding of product lines, objectives of claim management, and legal theory issues involving claim resolution. Familiarity with commercial lines/personal lines products, policy language, exclusions, ISO forms, effective claims handling practices.Extensive experience handling large exposure and/or complex liability claimsFamiliarity with commercial lines products, policy language, exclusions, ISO forms, effective claims handling practices.Thorough understanding of the litigation process, relevant case and statutory law.Ability to recognize, analyze and advise on complex coverage, liability and damage issues.Expert written and verbal communication skills to understand, synthesize, interpret and convey complex data.Create and manage positive working relationships with business and marketing partners.Ability to analyze and effectively respond to human resource issues.Utilize technology as a strategic tool.Ability to make independent decisions up to $1,000,000 without involvement of supervisor.Competencies:Leading the Business - Drive Results.Leads Change - Executes Business Strategy.Leading Others - Attract Top Talent, Maximize Individual Performance, Holds Others Accountable, Aligns Rewards, Creates and Sustains a Dynamic Workplace.Leading Self-Emotional Intelligence - Demonstrates Self-Awareness, Initiative and accountability, Applies Critical Thinking, Communications Effectively & Influences Others, Exhibits Courage, Conviction & Credibility.What is a Must Have?High School Degree or GED required.5 years bodily injury litigation claim handling experience or 10 years litigation experience required.In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job.What Is in It for You?Health Insurance : Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.Employment PracticesTravelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ([email protected]) so we may assist you.Travelers reserves the right to fill this position at a level above or below the level included in this posting.To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/ .

RN Consultant Sr - Professional Liability

Sedgwick East Montpelier, VT

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top CompaniesCertified as a Great Place to Work®Fortune Best Workplaces in Financial Services & InsuranceRN Consultant Sr - Professional LiabilityPrior Legal Nurse Consulting expereince highly preferred in order to be considered.PRIMARY PURPOSE : To handle complex or high exposure claim issues; to provide medical knowledge of the health care system and health care issues; to independently investigate, analyze and evaluate medical malpractice claims for self-insured and commercially insured clients; to provide information needed to clients as needed to determine liability issues and exposure; and to assist in identification of risk management issues to decrease liability exposure and associated legal costs.ESSENTIAL FUNCTIONS and RESPONSIBILITIESHandles complex or high exposure claim issues; advises and leads Nurse Consultant - PL colleagues.Receives requests for investigation; reviews and develops action plans and investigates cases accordingly.Collects data from Company and clients to document and communicate results as appropriate.Prepares reports summarizing medical records and interviews; outlines issues related to summary reports; and provides analysis and recommendations for further claims handling.Interviews practitioners involved in medical malpractice claims at hospital facilities weekly as needed.Participates in follow-up review and investigation as directed and assists in discovery requests as needed.ADDITIONAL FUNCTIONS and RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).Travels as required.QUALIFICATIONSEducation & LicensingBachelor's degree from an accredited college or university preferred. RN license required. LNC (Legal Nurse Consultant) Certification or training preferred.ExperienceFive (5) years related clinical nursing experience and two (2) years nurse consultant experience required. General or Professional Liability investigation related experience preferred.Skills & KnowledgeTechnical claims knowledge of medical malpractice claims procedures and practicesExcellent oral and written communication, including presentation skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsExcellent interpersonal skillsAbility to work in a team environmentAbility to meet or exceed Performance CompetenciesWORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations.Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlinesPhysical : Computer keyboarding, travel as requiredAuditory/Visual : Hearing, vision and talkingThe statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000-$90,000 A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

New York RN Case Manager

Public Consulting Group East Montpelier, VT

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com .PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be responsible for assisting enrollees of a publicly administered Medical Fund on behalf of a state agency. The Case Manager will be charged with helping program recipients, family members, and caretakers navigate healthcare benefits offered through this Fund. The Case Manager will also be responsible for utilizing a case management software system on a day-to-day basis. The purpose of the Fund is to provide a funding source for future health care costs associated with birth‐related neurological injuries.The Case Manager will also assist in development of program policies and procedures, and program improvement processes. The Fund operations include, performing assessments, providing case management services, assisting families and program recipients through prior approval of certain healthcare services, and collaborating with the claim’s administration team. Successful candidates will be accountable for the full patient care cycle.Responsibilities:• Responsible for helping program recipients, family members, and caretakers navigate healthcare benefits• Assists in the development of program policies and procedures• Responsible for the full patient care cycle.• Assesses, plans, implements, monitors and evaluates actions required to meet the client’s health and human services needed.• Coordinates and provides care that is safe, timely, effective, efficient, equitable, and client-centered• Handles case assignments, draft service plans, review case progress, and manages ongoing care needs• Travels within the State to conduct periodic in-person assessments• Facilitates multiple care aspects (case coordination, information sharing, etc.)• Helps patients make informed decisions by acting as their advocate regarding their clinical status and treatment options• Develops effective working relations and cooperate with the medical team throughout the entire case management process• Interacts with patients to keep track of their progress and to ensure satisfaction• Document all care activity via case management software system• Promotes quality and cost-effective interventions and outcomes• Assesses and addresses motivational and psychosocial issues• Adheres to professional standards as outlined by protocols, rules and regulationsDuties and ResponsibilitiesResponsible for helping program recipients, family members, and caretakers navigate healthcare benefitsAssists in the development of program policies and proceduresResponsible for the full patient care cycle.Assesses, plans, implements, monitors and evaluates actions required to meet the client’s health and human services needed.Coordinates and provides care that is safe, timely, effective, efficient, equitable, and client-centeredHandles case assignments, draft service plans, review case progress and determine case closureTravels within the State to conduct periodic in person assessmentsFacilitates multiple care aspects (case coordination, information sharing, etc.)Helps patients make informed decisions by acting as their advocate regarding their clinical status and treatment optionsDevelops effective working relations and cooperate with medical team throughout the entire case management processInteracts with patients to keep track of their progress and to ensure satisfactionRecords case information, complete accurately all necessary forms and produce statistical reports Promotes quality and cost-effective interventions and outcomesAssesses and addresses motivational and psychosocial issuesAdheres to professional standards as outlined by protocols, rules and regulationsRequired SkillsExcellent communication, interpersonal and client-facing skills.Ability to work independently and on a team.Proven working experience in case management, including as a nurse, medical, mental health care manager or a related jobExcellent knowledge of case management principles, healthcare management and reimbursementPrevious experience with psychological aspects of careEffective communication skillsExcellent organizational and time management skillsFamiliarity with professional and technical emerging knowledgeProblem solving skills and ability to multi-taskCompassionate with teamwork skillsThe above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of personnel so classified.QualificationsBS degree in related healthcare field preferredExperience working with pediatrics; Experience or educational training in health or social services, preferably including work experience or a practicum that involved the performance of assessments and the development of case management plans.Current license, certification or registration as a Registered Nurse or Social WorkerWorking ConditionsOffice SettingCompensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role: $75,000-$105,000.#LI-AH1#LI-remoteCompensation:Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role below. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.EEO Statement:Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

Best Match

LNA, Licensed Nursing Assistant, Hospice, Full Time

BAYADA Home Health Care East Montpelier, VT

BAYADA Home Health Care is currently seeking an experienced Nurses Aide, LNA for a full-time opportunity to complete Hospice visits to clients located throughout Chittenden and Washington counties As a hospice LNA, you will be an integral member of a multi-disciplinary hospice team that provides home health aide, skilled nursing and palliative care to clients, affording them the opportunity to receive the care required to remain at home.Offering flexible schedules, 1:1 patient ratio, and comprehensive benefits package!Must have access to reliable transportation.BAYADA offers:BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit and employee assistance programTo learn more about BAYADA Benefits, click hereWeekly payFlexible scheduling to fit your lifestyleShort commute times - we try to match you to opportunities near your homePositive work environment and the tools you need to do your jobScholarship programsA stable working environment - we invest in our care teamPaid time off24 / 7 on call clinical manager supportFeel confident, safe, and supported with PPE supplies, comprehensive infection prevention protocol, daily pre-screens, and close monitoring of the COVID-19 outbreak.A Licensed Nurses Aide must: Have at least one year of work experienceMust be listed on the VT Aide Registry, active and in good standing.Demonstrate an ability to read, write, and effectively communicate in EnglishPass the BAYADA Competency Evaluation ExaminationHave a criminal background check completedMeet all state requirementsEnjoy being part of a team that cares and a company that believes in leading with our valuesJob Responsibilities for LNA: Activities of daily livingLight housekeepingBathingGroomingToiletingNail careRange of motion / exercisesTransfers / use of mechanical lifting devicesOral feedingVital sign checks: temperature, pulse, respirationHome Management Tasks: laundry, meal preparation, bed making etc.Assisting with ambulationMedication assistanceAs an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates.BAYADA is celebrating 50 years of compassion, excellence, and reliability. Learn more about our 50th anniversary celebration and how you can join in here.BAYADA Home Health Care, Inc., and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.

Senior Integrated Clinical Pharmacist Bilingual

CenterWell East Montpelier, VT

Become a part of our caring community and help us put health firstWe are seeking an ambitious and goal-oriented Clinical Pharmacist with over 5 years of experience to join our primary care organization. The successful candidate will play a critical role in improving patient outcomes through effective medication management, patient education, and collaboration with our healthcare team. The role requires strong critical thinking skills and the ability to use clinical judgment to make informed decisions about patient care. Must be able to work Eastern Time Zone hours 8-5pm and have an unrestricted and active practicing pharmacist Fl license. Chronic Disease Management experience and averaging 10 patients per day is highly desired.Role Specific Responsibilities (executed in person and/or virtual)Utilize evidence-based medicine and clinical judgment to evaluate the suitability of pharmacotherapy for high-risk patients with chronic conditions, including but not limited to diabetes, hypertension, heart failure and COPDExecute clinical protocols as allowed per organization and state regulatory agenciesOptimization of drug coverage benefits for appropriate care and reduced costs (preferred formulary products, lower cost alternatives and home delivery pharmacy)Collaborate with physicians, nurses, and other healthcare professionals to optimize patient careParticipate in high-risk rounds with a multi-disciplinary team, utilizing highly effective communication skills to discuss patient progress and adjust treatment plans as necessaryExcellent patient counseling skills and the ability to communicate complex medical information to patients and healthcare providersDisease state education for patients on appropriate use of medications and self-managementEngage in quality improvement initiatives aimed at enhancing medication safety and efficacyPost-discharge medication reconciliation for high-risk transition of care patientsDocument all activity within clinic EMR and other required pharmacy or clinical management systemsSupport CMS Stars and HEDIS quality measures for successful clinic performanceMaintain accurate and thorough documentation of clinical interventions and patient care activitiesConduct in-service education and training sessions for healthcare staff as well as develop and disseminate educational materials related to pharmacotherapyStay current with advancements in pharmacotherapy and clinical guidelines.Provide consultation to healthcare providers on complex medication management issuesUse your skills to make an impactRequired QualificationsActive and unrestricted pharmacist license within the state of Florida.Willingness to become licensed in additional states as needed for market supportPharm.D. or other advanced pharmacy degree5+ years’ experience as a practicing pharmacistExcellent organization and communication (verbal and written) skillsAbility to work in a team environment and support common goalsStrong attention to detail; able to concentrate without distraction in a fast-paced environmentAbility to prioritize multiple tasks, anticipate and solve problemsIntermediate level or higher competency with MS Office programs such as Word, Excel and Power PointPreferred QualificationsClinical residency in ambulatory care or similar disciplineBoard certification in geriatric pharmacy or pharmacotherapyFamiliarity with electronic medical record (EMR) systemsDemonstrated ability to identify and implement solutions for improved efficiencies and outcomes2+ years working in an ambulatory care/primary practice settingMultilingual (preferably English/Spanish)Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Pay RangeThe 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.$115,200 - $158,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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: 06-26-2025About usAbout CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.Equal Opportunity EmployerIt 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.Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources

Accounting Manager -Insurance Statutory Accounting

GE Aerospace East Montpelier, VT

Job Description SummaryThis role is for a specialist in technical, statutory Insuranc accounting. ERAC, Employers Reassurance Corporation and a corporate holding of GE Aerospace. We are a reinsurance company supporting the long-term care insurance, structure settlements and Life along with other insurance productsResponsible for driving technical accounting compliance, financial and operational internal controls, process simplification, and operational excellence to deliver accurate actual financial reporting and analysis. Interprets simple internal and external business challenges and recommends best practices to improve products, processes or services. Stays informed of industry trends that may influence work. This role is available remote anywhere US or in our Overland Park, KS location.Job DescriptionRoles and ResponsibilitiesResponsible for providing guidance to the Finance teams and the organization on statutory accounting, filings and regulatory requirements. Assist financial reporting teams as required to ensure all statutory filings are completed timely, efficiently and in compliance with state regulatory requirements.Developing expertise within function. Growing reputation within the organization. Includes roles that are experts in their discipline, providing professional or thought leadership. Influences policy and ensures delivery within own function, linking with other functions of the organization.Lead or support functional teams or projects with moderate resource requirements, risk, and/or complexity (e.g., NAIC’s Principles-Based Bond Definition and Group Capital Calculation). Presents business solutions to leaders in functional area.Communicates complex messages and negotiates mainly internally with others to adopt a different point of view. Influences peers to act and may negotiate with external partners, vendors, or customers.Leads others to find creative solutions to address complex problems that may impact the organization. Has the ability to evaluate quality of information received and questions conflicting data for analysis. Uses multiple internal and external resources outside of own function to help arrive at a decision.Required QualificationsMaster's degree from an accredited university or collegeStrong knowledge of statutory and insurance regulatory requirements a must.Prior technical controllership and insurance industry experience, with Life & Health insurance productsExperience in preparing statutory financial statements and working with auditorsDesired CharacteristicsAbility to analyze relevant facts and formulate technical accounting positions, considering statutory & regulatory guidance, insurance industry practices, etc.Excellent communication skills, with the ability to collaborate effectivelyAbility to quickly learn and adapt to company-specific processesThe base pay range for this position is $124.5 to 180,000 USD Annual. The specific pay offered may be influenced by a variety of factors, including the candidate’s experience, education, and skill set. This position is also eligible for an annual discretionary bonus based on a percentage of your base salary/ commission based on the plan. This posting is expected to close on May 1, 2025 Healthcare benefits include medical, dental, vision, and prescription drug coverage; access to a Health Coach, a 24/7 nurse-based resource; and access to the Employee Assistance Program, providing 24/7 confidential assessment, counseling and referral services. Retirement benefits include the GE Retirement Savings Plan, a tax-advantaged 401(k) savings opportunity with company matching contributions and company retirement contributions, as well as access to Fidelity resources and planning consultants. Other benefits include tuition assistance, adoption assistance, paid parental leave, disability insurance, life insurance, and paid time-off for vacation or illness.General Electric Company, Ropcor, Inc., their successors, and in some cases their affiliates, each sponsor certain employee benefit plans or programs ( i.e ., is a “Sponsor”). Each Sponsor reserves the right to terminate, amend, suspend, replace, or modify its benefit plans and programs at any time and for any reason, in its sole discretion. No individual has a vested right to any benefit under a Sponsor’s welfare benefit plan or program. This document does not create a contract of employment with any individual.Additional InformationGE Aerospace offers a great work environment, professional development, challenging careers, and competitive compensation. GE Aerospace is an Equal Opportunity Employer (https://www.eeoc.gov/sites/default/files/2022-10/22-088_EEOC_KnowYourRights_10_20.pdf) . Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law.GE Aerospace will only employ those who are legally authorized to work in the United States for this opening. Any offer of employment is conditioned upon the successful completion of a drug screen (as applicable).Relocation Assistance Provided: No#LI-Remote - This is a remote positionGE Aerospace is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law.

Telephonic Case Manager

Sedgwick East Montpelier, VT

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top CompaniesCertified as a Great Place to Work®Fortune Best Workplaces in Financial Services & InsuranceTelephonic Case ManagerPRIMARY PURPOSE OF THE ROLE: While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services.ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury.Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment.Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting.Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations.Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more.Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.ESSENTIAL RESPONSIBLITIES MAY INCLUDEPerforms initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems.Effectively communicates and builds relationships with the claims’ examiner, client, injured worker, attorney and supervisor.Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approachNegotiates treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality.Identifies opportunities to expedite care for cost containment and timely medical recovery.Provides recommendations for alternate clinical resources to support claim resolution.Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.EDUCATION AND LICENSINGCurrent unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.TAKING CARE OF YOU BYOffering flexibility and autonomy.Supporting meaningful work that promotes critical thinking and problem solving.Providing on-going learning and professional growth opportunities.Promoting a strong team environment and a culture of support.Recognizing your successes and celebrating your achievements.Thrives when everyone is working towards the same vision/goals.We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.NEXT STEPSIf your application is selected to advance to the next round, recruiter will be in touch.#nurse #telephoniccasemanagerAs required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $73,000 - $75,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.“Always accepting applications.”Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

Best Match

Western Zone Pulmonary Sales Specialist

FUJIFILM Corporation East Montpelier, VT

Position OverviewThe Western Zone Pulmonary Sales Specialist is a key member of the Fujifilm Endoscopy sales team that is responsible for driving awareness, market share, and revenue growth across Fujifilm's Pulmonary product line. This includes flexible scopes, Endobronchial Ultrasound (EBUS), and all other pulmonary franchise offerings. The role is accountable for business development, strategic partnerships with Key Opinion Leaders (KOLs), and collaboration with the existing Fujifilm Endoscopy sales and clinical specialist teams to ensure successful demonstrations and customer satisfaction. Reporting directly to the Regional Sales Leader, the Zone Pulmonary Sales Specialist plays a pivotal role in expanding Fujifilm's presence in the pulmonary space.To best serve the territory, prefer candidates currently located in the Western US region.Company OverviewAt FUJIFILM Healthcare Americas Corporation, we’re on a mission to innovate for a healthier world, and we need passionate, driven people like you to help us get there. Our cutting-edge healthcare solutions span diagnostic imaging, enterprise imaging, endoscopic and surgical imaging, as well as in-vitro diagnostics.But we don’t stop at healthcare; our Non-Destructive Testing (NDT) team harnesses advanced radiography solutions to keep transportation infrastructure, aerospace, and oil and gas assets safe and running smoothly.Ready to innovate, collaborate, and make a difference? Join us and bring your big ideas to life while working in a dynamic, flexible environment that fuels your creativity and drive.Our headquarters is in Lexington, Massachusetts, an inspiring healthcare research hub in a historic town.Fujifilm is globally headquartered in Tokyo with over 70,000 employees across four key business segments of healthcare, electronics, business innovation, and imaging. We are guided and united by our Group Purpose of “giving our world more smiles.” Visit: https://www.fujifilm.com/us/en/about/region/careersJob DescriptionDuties and Responsibilities:Business Development and Sales:Drive sales revenue and market share growth within the pulmonary product line across the assigned zone.Identify and pursue new business opportunities through strategic planning and engagement with prospective customers.Develop and implement targeted business plans to achieve sales objectives and overall market share growth goals.Lead and support pulmonary product demonstrations in collaboration with the clinical specialist team.Pulmonary Market Expertise:Serve as a subject matter expert on Fujifilm's pulmonary product portfolio, including flexible scopes and EBUS.Educate customers on product benefits, clinical applications, and proper usage to establish Fujifilm as a trusted pulmonary partner.Maintain a deep understanding of competitor products, positioning, and market dynamics to effectively differentiate Fujifilm's offerings.KOL and Stakeholder Engagement:Build and maintain relationships with Key Opinion Leaders (KOLs), clinicians, and other stakeholders in the pulmonary community.Actively seek opportunities to collaborate with KOLs to enhance Fujifilm’s market presence and reputation.Partner with key stakeholders to develop and execute strategies for expanding pulmonary product adoption in targeted accounts.Team Collaboration and Support:Work closely with the Fujifilm Endoscopy Account Executives and Clinical Sales Specialists to identify opportunities, support demonstrations, and grow market share.Provide training and expertise to internal sales teams on the pulmonary product line to enhance their effectiveness in driving sales.Ensure seamless integration of pulmonary solutions into broader sales strategies and customer workflows.Administrative and Reporting Duties:Maintain accurate records of sales activities, customer interactions, and KOL engagements via SFDC.Provide regular updates to the Regional Sales Leader on pipeline progress, sales forecasts, and market trends.Collaborate with product development and marketing teams to provide customer feedback and identify areas for product improvement or innovation.Qualifications:Bachelor’s degree in marketing, business, life sciences, or related field.5+ years of sales experience in the medical device or healthcare industry, with pulmonary / thoracic experience strongly preferred.Demonstrated ability to independently manage a large territory and drive sales growth in a highly competitive environment.Strong interpersonal and communication skills with the ability to build relationships with diverse customer stakeholders, including physicians, nurses, and hospital administrators.Proven experience in KOL engagement and business development within a specialized market segment.Technical proficiency with medical equipment, particularly pulmonary devices, and the ability to effectively train customers on their use.Strong organizational skills, with the ability to manage multiple priorities and projects simultaneously.Physical Requirements:The position requires the ability to perform the following physical demands and/or have the listed capabilities:Ability to sit and use hands/fingers to manipulate equipment or keyboards for prolonged periods.Capability to stand, talk, and hear during customer interactions and presentations.Ability to lift and carry medical equipment weighing up to 50 pounds as required.Travel:Willingness to travel up to 75% of the time, including overnight and occasional weekend travel as required to meet business needs.In the event that COVID-19 vaccine mandates issued by the federal government, or by state or local government become effective and enforceable, the Company will require that the successful candidate hired for positions covered under relevant government vaccine mandate(s) be fully vaccinated against COVID-19, absent being granted an accommodation due to medical or sincerely held religious belief or other legally required exemption.EEO InformationFujifilm is committed to providing equal opportunities in hiring, promotion and advancement, compensation, benefits, and training regardless of nationality, age, gender, sexual orientation or gender identity, race, ethnicity, religion, political creed, ideology, national, or social origin, disability, veteran status, etc.ADA InformationIf you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to our HR Department ([email protected] or (330) 425-1313).Job Locations US-RemotePosted Date 2 weeks ago (6/2/2025 12:44 PM)Requisition ID 2025-32971Category SalesCompany (Portal Searching) FUJIFILM Healthcare Americas Corporation

VP, Centerwell PCO, IPA CMO

CenterWell East Montpelier, VT

Become a part of our caring community and help us put health firstThe Primary Care Organization (PCO), is looking for high potential candidates who are looking to accelerate their career development and contribute to driving disruption in the health care industry. The PCO provides primary care medical group practice with centers in Florida, Arizona, Georgia, Kansas, Louisiana, Missouri, Nevada, Missouri, North Carolina, South Carolina, Texas, Mississippi, Indiana, Kentucky, Tennessee, Louisiana, and more. The PCO has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience.At PCO we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.PCO-IPAOur Independent Practice Association business consists of 182 affiliate organizations, 13,000 providers taking care of 75,000 patients across 4 states and growing every day! We are opening in 3 additional markets this year. The IPA was recently centralized into its own business unit, and we are very excited to invest in and grow this business so that it can be the growth engine for the Centwell and Conviva business going forward. This is an incredibly exciting opportunity to help shape the future of this business at a critical stage in our growth!The IPA Chief Medical Officer (CMO) is an entrepreneurial & experienced physician leader committed to the principles of comprehensive primary care and unlocking the power of value-based care for patients at national scale. S/he will be a proven clinician, leader, and strategist capable of driving the highest standards of care, building high-performance care teams, developing clinical leadership talent, and quantifiably improving outcomes and performance across multiple geographies.The IPA CMO will develop and support the MSO’s National Clinical Vision and Strategy, directly lead a team of regional & area medical directors and serve as dyad partner to National Operations Leader across the nation where CenterWell and/or Conviva serve patients. The IPA CMO will report to the SVP, Chief MSO & Medical Business Leader for the Primary Care Organization. This role will also have. Dotted line to the SVP, CMO PCO to be tighly connected to the rest of the clinical organization. This role requires travel to markets (up to 50%) to meet with national and regional teams and should be based in one of our current or upcoming CenterWell or Conviva markets.Use your skills to make an impactResponsibilitiesDrive Clinical Excellence in Culture & PerformanceBuild a best-in-class culture of engaged clinicians, focused on patient-focused care and clinical excellence, where doing the right thing for patients and team-based care within a value-based care framework, drives success and prideDrive patient outcomes and population impact across regions for optimal results, across patient care experience & engagement, disease prevalence, quality/STARS, efficiency of care, and improved clinical outcomes and utilization.Identify and act on opportunities to better manage & coordinate with high-quality specialist, hospital, and community partners to serve patient needs and deepen our impactPractice ~10% clinically within your home market, to maintain clinical skills and familiarity with our seniors’ needs and the daily environment of our cliniciansBuild & Sustain High-Quality Primary Care Teams & LeadershipAttract, coach, and develop regional clinical leaders in the principles and activities of value-based care, team leadership, and driving clinical excellence & performanceEnsure appropriate, timely recruiting and onboarding of high-quality primary care clinicians to serve our seniors, supporting regional leaders and functional leaders in developing high-quality pipelines and ensuring 100% staffing for patient needsContinuously improve teamwork and collaboration at the regional and center levels to shift the needle in population outcomes.Launch and lead a Clinical Advisory workgroup that include a physician from each of the regions.Effectively Partner as Dyad Clinical LeaderPartner cohesively with National Operations Leader as a leadership dyad for the region across all dimensions of success, building an effective and collaborative working relationship where patient-first culture and clinically-led decision-making drives growth, clinical excellence, performance & outcomesWork with National Operations Leader, Regional Market presidents, regional dyads, and shared service leaders to design new programs, optimize initiatives, drive continuous improvement in operations, patient care, and outcomesCollaborate with National Operations Leader, Regional Market Presidents regional dyads, and shared service leaders to support organic and inorganic patient growth, through strategies to improve our patient value proposition and experience of care, market expansion, acquisitions, and IPA relationships to ensure clinical integration and effectivenessNational Leadership & InnovationIn partnership with the Chief Management Services Officer, Chief Medical Officer and Primary Care Organization leadership, lead the organization’s national clinical focus in one or more key areas, as assigned, such as care model development, clinical operations, quality & clinical excellence, and technology enablement & analytics to advance our clinical team, care model, and patient care operationsChannel the voices of our patients and teams to build awareness of the Primary Care Organization regionally and nationally, through research/publications around our care model and population impact, strengthening our presence with best-in-class clinical talent recruiting channels such as top-tier training programs and schools, and speaking opportunitiesEffectively identify and act on opportunities to bring Humana’s enterprise capabilities and programs to bear to support the Primary Care Organization, our patients, and our teams in delivering world-class care and outcomesRequired QualificationsExpertise in value-based care, especially Medicare Advantage, with familiarity of HEDIS/STARS, medical risk adjustment, and clinical programming in primary care, complex care, or adjacent areasDeep knowledge of principles & operations of team-based care modelsProven convener of high-quality clinical talent and ability to develop next-generation clinical leadersExperience identifying & implementing clinician-led strategies to improve outcomes & performanceExceptional interpersonal and influencing skills. The attitude and experience to strengthen a patient-centered culture that is clinically ledStrategic problem-solver with examples of driving change initiatives with measurable impact on patient care and outcomesUnderstanding of health plan frameworks in Medicare Advantage and managed care that affect patient care and population management, such as quality management, utilization management, network management, and payment frameworks (e.g. capitation, partial risk, direct contracting)Population health minded physician with an understanding of, and supportive of independent physician practices.A passion for serving high-risk seniors in achieving their best health and outcomes and the clinical experience to bring deep knowledge of patient needs & the communities we serveSeven plus years of experience as a practicing physician, and five plus years of strategic clinical leadership experience at a regional or national levelGraduate of accredited MD or DO program of accredited universityActive Board Certification in Family Medicine, Internal Medicine or Geriatric Medicine with continued certification throughout employmentCurrent, unrestricted medical licensure in applicable state(s) and willingness to be licensed in additional states, as required by the organizationRequired to live within commuting distance to PCO Center to allow for practicing as a provider ~10% of the time.Preferred QualificationsExperience leading in an IPA/MSO modelMulti-site clinic start-up experienceExpectations:Flexibility to travel as needed (up to 50% travel)Healthcare is not just about health anymore. It is about caring for family, friends, finances, and personal life goals. It is about living life fully. At Humana’s Primary Care Organization (PCO) we want to help people everywhere, including our associates, live their best life. At Humana’s PCO, we are seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Application Deadline: 06-29-2025About usAbout CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.Equal Opportunity EmployerIt 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.Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources

Health Coach - Remote

Lensa East Montpelier, VT

22 hours ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. Lensa is the leading career site for job seekers at every stage of their career. Our client, Sharecare, is seeking professionals. Apply via Lensa today! Job Description Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visitwww.sharecare.com. Job Summary Start Date: Monday, June 9th, 2025 Shift: Monday - Friday: Must be open to any shift between the hours of 10:30am – 8pm CST. It is required to work every fourth Saturday from 8:00am-4:30pm CST Training: Training will be a duration of 6 weeks from 8am – 4:30pm CST Due to the structured training schedule, new hires are unable to miss any days of training. Compensation: Hourly Rate: $21.50 or $25 including certification through NBC-HWC or CHES only The Health Coach is part of a multi-disciplinary team that is responsible for improving both the individual health and wellness of program participants and the overall health status of a client's population. The Health Coach is an integral part of an overall client specific Health and Care Support Team that engages and supports members with improving lifestyles and behaviors that put them "at risk" of developing chronic or disease conditions. The Health Coach looks to be a positive change agent in helping members alter behaviors that lead to better health and reduction / elimination of identified risk factors. A Health Coach is supervised by an Operations Coach Manager. Essential Job Functions Participating in the following types of telephonic calls: Engagement (inbound and outbound)- contacting eligible participants to inform them of the program offering and enroll them in the program Coaching (inbound and outbound)- providing individualized behavior change coaching to reduce or eliminate high risk behaviors and encourage adoption of habits that are conducive to a higher quality of life Chase (outbound)- reaching out to members who are enrolled in coaching, but do not have a scheduled call Coordinate delivery of services and care with other members of a multi-disciplinary care team, including nurses, pharmacists and external vendors. Support operational aspects of the assigned area to meet the organization's customer requirements, which can include multiple customers. Adhere to a schedule and caseload to support success and connectivity of member interaction. Caseloads may be a 1:1 model or team based. This is determined by the business/client need. Participate in daily and monthly meetings for updates and to present findings and insight Note and track the members' progress and efficacy of program Specific Skills/ Attributes Effective interpersonal and communication skills required Understand directions and communicate/respond to inquiries Enthusiastically inspires members to change behaviors and to see possibilities Ability to learn to coach effectively using motivational interviewing Flexibility to work any shift (typically an evening shift) or change shifts based on business needs. This also includes availability to work rotating Saturdays Qualifications Bachelor's degree in health-related field required (i.e., Psychology, Nutrition, Exercise Science, etc.) 2+ years prior health coaching experience may substitute for a degree 1 -2 years of related experience required; experience in a customer service role preferred Experience with benchmarks and contact center metrics preferred, including adherence to schedule Proficiency in computer data entry and Microsoft Office Ability to coordinate telephonic communication with program participants while simultaneously navigating software platform and entering data, for extended periods of time Knowledge ability to quickly learn information around lifestyle related topics such as: smoking cessation, weight management, nutrition, exercise, stress reduction and sleep desired Ability to work independently and prioritize a moderate workload with minimal supervision Adaptability to schedule changes on an as-need basis Ability to multitask with members and operationally with managers and support staff Hard-wired internet connection is necessary as WIFI is not permitted Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor. Seniority level Seniority level Entry level Employment type Employment type Full-time Job function Job function Health Care Provider Industries IT Services and IT Consulting Referrals increase your chances of interviewing at Lensa by 2x Sign in to set job alerts for “Health Coach” roles. We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr