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Summary:

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
• Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
• Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
• Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
• Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
• Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines.
• Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
• Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
• Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
• Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate. 
• Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
• Must be able to take after hour calls to meet business requirements as needed.

Job Requirements:

Education/Skills

• Graduate of an accredited school of vocational nursing or equivalent required
• Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred

Experience

• 3 – 5 years of nursing experience preferred
• Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
• General computer knowledge and capability to use computers required

Licenses, Registrations, or Certifications

• LVN license in the state of employment or compact required
• RN license in state of employment or compact preferred

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Job Description

Key Responsibilities/Duties - what you will be doing (top five):

• Develops and manages the 2-4-year product strategy for a set of product lines and/or geographic regions. Lead product- specific, cross-functional teams responsible for assessing/implementing new/revised or enhanced product designs and programs.
• Meet with internal and external stakeholders/customers including market teams, brokers, accounts, vendors, and government agencies to incorporate voice of the customer in product roadmap.
• Develop new products and features, product enhancements, line extensions, portfolio revisions, and product discontinuation as needed to achieve market position, membership goals, and profitability targets.
• Synthesize product line financial modeling and analysis into actionable tactics. Assess market and competitive positioning in support of expansion strategies.
• Monitor and report on-going performance of product portfolio(s) including profitability, customer satisfaction, membership growth/retention, and operational performance. Develop course correction proposals, as needed, based on metrics.
• Collaborate with other teams in the development of product collateral, marketing, and communications initiatives and in conducting internal and/or external trainings. Map and manage the customer experience.
• Manage vendor relationships as part of the product line.
• Other duties and projects as assigned.
  

Qualifications - what you need to perform the job

Certification and Licensure

Education

• Required: Bachelor's degree in a related field
• Preferred: Master's degree

Experience

• Required: 5-7 years of related work experience
• Preferred: 5-7 years of product management, strategic planning, project management, marketing, or healthcare sales experience.
• Direct experience with Stop Loss and/or Level Monthly Funding highly desired.
  

Skill Requirements

• Effective and strategic leader who can use strong analytic and problem-solving skills to facilitate cross- functional teams.
• Excellent interpersonal and collaboration skills; ability to influence at all levels of the organization.
• Proven organization, facilitation, and conflict management skills
• Ability to function effectively in a fast paced, rapidly changing environment.
• Resilient, collaborative, flexible, innovative.
• Excellent oral, written and presentation skills.
  

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact

As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home. 

It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

Showing Up Somatus Strong

We foster an inclusive work environment that promotes collaboration and innovation at every level. Our values bring our mission to life and serve as the DNA for every decision we make:

• Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.
• Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.
• Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests.
• Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions. 
• Tenacity: We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners.

Showing Up for You

We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including:

• Subsidized, personal healthcare coverage (medical, dental vision)
• Flexible PTO
• Professional Development, CEU, and Tuition Reimbursement
• Curated Wellness Benefits supporting teammates physical and mental well-being
• Community engagement opportunities
• And more!

As a Vice President of Business Development, you will drive new logo growth and sales pipeline development while playing a key role in the continued growth of the company. You will support strategic initiatives working with health plans, employer groups, ACOs, hospitals and health systems, provider groups, and other healthcare organizations.  

• Build, own, and maintain a robust pipeline of qualified opportunities by cultivating executive-level relationships with payors, ACOs, Health Systems, and other strategic partners 

• Work closely with company leadership to lead and coordinate complex deal execution and strategy in a fast-paced, competitive, and entrepreneurial environment 

• Deliver measurable revenue and membership growth by rapidly advancing opportunities through all stages of the sales pipeline to contract execution 

• Represent the company at industry events and client meetings to promote thought leadership, and drive new business opportunities 

• Develop effective outbound content and thought leadership in partnership with the marketing team 

• Stay up to date on knowledge of industry trends, market intelligence, and state/federal regulations and programs 

• Lead proposal writing efforts to demonstrate company capabilities and secure new business opportunities 

• Provide real-time pipeline and relationship updates, forecast accuracy, and growth reporting to executive leadership with a focus on transparency, urgency, and outcomes 

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

• 7-10 years of relevant experience in business development, enterprise sales, consulting, or commercial role working with health plans, provider groups, or other healthcare organizations 

• Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization, including executive and C-level 

• Commercial acumen and a proven track record of driving new business development and creatively structuring agreements 

• Ability to connect with diverse constituents and stakeholders across cross-functional teams (leadership, marketing, account management, new product development, data and analytics, market operations, finance and clinical) 

• Demonstrated success driving new revenue growth and closing favorable deals with national and regional payors, ACOs, and other risk-bearing entities 

• Experience developing compelling presentations using Microsoft PowerPoint 

• Salesforce experience  

• Travel to HQ in McLean, Virginia and client locations 

Health Plan IT Director

Onsite | Dallas, Texas

We are seeking an experienced IT Applications Manager to lead health plan-focused application development and support within our payer organization in Dallas, TX.

This role oversees mission-critical insurance systems supporting eligibility, utilization management, care management, pharmacy, and related payer operations. This is not a hospital IT role — we are seeking a leader with direct health plan / insurance-side experience. The ideal candidate brings strong payer application knowledge, a data-driven mindset, and proven success leading teams in delivering projects on time and within scope.

What You’ll Do

• Lead and manage a team of IT professionals supporting health plan applications
• Oversee application development, integration, enhancement, and production support
• Partner closely with business stakeholders to translate operational needs into technical solutions
• Provide architectural input and solution design guidance (non-coding leadership role)
• Manage vendor relationships, including third-party system implementations (e.g., pharmacy platforms)
• Ensure strong process control, documentation, and system governance
• Drive project execution with strong focus on timelines, accountability, and quality
• Collaborate with enterprise IT teams to ensure cohesive system integration
• Maintain compliance with HIPAA and healthcare data privacy standards

What We’re Looking For

• 5+ years of IT leadership experience within a health plan / payer organization
• Direct experience supporting insurance-side systems (eligibility, UM, care management, pharmacy)
• Strong background in data-driven application environments
• Experience overseeing vendor implementations and system integrations
• Demonstrated ability to lead cross-functional projects and meet deadlines
• Strong documentation, process management, and operational discipline
• Experience managing teams of 10+ FTEs
• Working knowledge of SQL and application environments (technical fluency required; coding not required)
• Bachelor’s degree in Computer Science or related field

Join the team leading the next evolution of virtual care.

At Teladoc Health, you are empowered to bring your true self to work while helping millions of people live their healthiest lives.

Here you will be part of a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth. Together, we're transforming how better health happens.

Summary of Position

Under the general direction of the Health Plan Management leadership, the Health Plan Management Associate will work closely with the Health Plan team to support key initiatives for a select group of Health Plan clients that result in exceptional service and attentiveness to client needs.

The Health Plan Management Associate must be a reliable selfstarter who thrives in a fastpaced, challenging environment, maintains a positive attitude, and demonstrates strong attention to detail and multitasking abilities.

Essential Duties and Responsibilities

• Acts in a support role for a book of business within the HP management team supporting Health Plan Managers with their accounts.
• Internal and external coordination, tracking of requests, and driving resolution of issues across various internal and external teams, building strong relationships along the way.
• Performance Guarantee and Service Level Agreement Tracking
• Tracking & submission of security audit/inquiries.
• Provide regular status reporting to track project/tasks progress against goals, objectives, and timelines.
• Develop and own a project management tracking system that enables efficient monitoring of key tasks and ensures consistent followthrough.
• Maintaining Health Plan Partner playbook.
• Coordinating and monitoring Marketing activities, triaging issues as required.
• Other requests to support the overall Health Plan book of business.

The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs.

Supervisory Responsibilities

No

Required Qualifications

• A Bachelor's degree from a four-year college or university.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint) and Outlook.
• Possesses excellent communication and presentation skills, both verbal and written.
• Must work collaboratively with all team members and cross-departmentally.
• Occasional travel may be required for internal and client facing meetings.

Summary:

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuity of services. The Care Coordinator is responsible for making telephonic outreaches to members attributed to our value-based contacts. They support the ACO and CIN network providers and practices in successfully meeting quality improvement initiatives, monitoring standards of care and managing high risk multi morbidity patient populations across CHRISTUS Health ministries. The role focuses on improving quality care gaps, promoting preventive care, and improving patient outcomes.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Mentor, train and support the team of care coordinators, ensuring high-quality care and adherence to best practices. Assist with work assignments and development of new work processes as needed. Coordinate and assist with associate onboarding. Create education material for training.
• Monitor and ensure compliance with all regulatory requirements, organizational policies, standing delegated orders and protocols.
• Identify quality gaps and risk adjustment gaps. Participate in Quality Improvement Programs as indicated. Attend learning sessions and share information learned with team members. Assist in the development of tools, education, and workflow processes to assist the network in meeting CMS, ACO, documentation, and payor quality initiatives.
• Conducts internal review audits to facilitate feedback for documentation and efficiency of the care coordination team.
• Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings.
• Monitor value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance.
• Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements.
• Communicate resources and services available to patients through the continuum of care.
• Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness. Conduct in-person and virtual meetings with practice managers, staff, providers and managers to communicate program goals, results, and provide education.
• Document relevant, comprehensive information and data using standard assessment tools. Maintain patient chart compliance through proper documentation and updated: preventative screenings, medical history, medication, and immunizations.
• Unburden primary care providers by placing approved orders for labs and other screenings as per the Standing Delegated orders.
• Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Utilizing clinical judgment and problem-solving skills to coordinate appropriate care with physicians and Nurse Navigation.
• Prepare and maintain Transitions of Care and Care Management reports and provide periodic updates to network leaders.
• Must have strong leadership, exceptional oral communication skills, strong organizational and analytical skills, ability to adapt to change and motivate a team.
• Must have a strong ability to multi-task and coordinate multiple projects.
• Perform other duties as assigned.

Job Requirements:

Education/Skills
• High School Diploma required.

Experience
• Minimum of 3 years of clinical or home health experience required.
• 5 years supporting value-based care programs, accountable care organizations, or HEDIS
• Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred.
• Knowledge of physician office practice operations and 3 years of experience in a physician practice is preferred.
• Proficiency in keyboarding and EHR systems, primarily Epic.

Licenses, Registrations, or Certifications
• LVN/ LPN in the state of employment and/or compact licensure required.

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time

Summary:

The Radiology Technologist will perform a wide variety of routine and advanced imaging procedures, will provide support for other imaging technologists as needed, and help to facilitate smooth and efficient patient flow. The technologist will demonstrate flexibility by working other shifts and/or at other campuses as needed or required. The technologist must be able to troubleshoot basic maintenance, participate in QA, and resolve issues related to image processing and the image archiving system. Expectation to participate in ongoing education, safety, and technical advances within their scope of licensure. The Technologist will adhere to, and maintain, the expected imaging competencies as outlined by management. Behavior and communication skills must align with the organization's mission, values, and culture.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Demonstrates adherence to the Core Values of CHRISTUS Health.
• Maintains consistency with Administrative and Departmental policies with appropriate behavior, dress, attitude, attendance, confidentiality, professionalism, and reliability.
• Promotes staff growth, development, and employee engagement by collaborating with management, coworkers, and physicians to create an optimal work environment.
• Promotes exceptional physician satisfaction by providing meaningful assistance to radiologists and referring physicians.
• Performs all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.
• Appropriately adapt assigned patient assessment, treatment, and/or care methods to accommodate the unique physical, psychosocial, cultural, spiritual, age-specific, and other developmental needs of each patient served.
• Ensures compliance with all policies, procedures, and standards of care as deemed appropriate by State and Federal agencies, the hospital, and other regulatory entities.
• Performs examinations/procedures as needed to assist in patient throughput within the scope of the Manager’s license(s), certification(s), and/or documented competencies.
• Demonstrates flexibility by working other shifts and at other campuses as needed or required.
• Ensures completed exams are scanned and stored correctly in PACS.
• Ability to follow PACS downtime procedures as a PACS Superuser and escalate any problem(s) or issue(s) to the PACS administrator or Designee if needed.
• Troubleshoots and reports any equipment malfunctions to the Director/Manager and/or Biomedical personnel; does appropriate follow-up.
• Performs other duties as assigned.

Job Requirements:

Education/Skills

• Graduate of an accredited school of Radiology Technology or other accepted and approved equivalent required

Experience

• 1 year of experience in a hospital preferred
• Basic computer experience required

Licenses, Registrations, or Certifications

• Radiography (R) by ARRT is required
• State Licensure required
  • Texas: MRT by TMB
  • Louisiana: LRT (R) or (F) by LSRTBE
  • New Mexico: RRT by MIRTP NMED
• BLS required

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time

Overview
Are you passionate about making a positive impact on people's lives? Do you thrive in a collaborative environment where you can be part of an interdisciplinary team dedicated to restoring the health and well-being of clients? Look no further – VNS Health Personal Care is seeking compassionate and skilled Certified Home Health Aides like you

What You Will Do

• Provide personal care and support, including ambulation, transfers, ostomy care, and assistance with medical equipment and self-administered medication.
• Monitor vital signs, observe and report client conditions, and adhere to infection control practices.
• Assist with personal hygiene, nutrition, fluid intake, and light housekeeping.
• Ensures client rights and confidentiality.

Qualifications

• Satisfactory completion of New York State Health Department approved HHA Training Program or Equivalency.
• Sixth (6) grade reading comprehension level. 
• Writing and math skill level to the extent necessary for the successful and safe performance of required job functions. 
• Must be at least eighteen (18) years of age.

Physical Requirements

• Full range of body motion, including handling and lifting adult clients. 
• Standing and walking for extensive periods, as well as bending and climbing stairs. 
• Commonly lifts, carries, and maneuvers items weighing more than 50 lbs.

Compensation:

• $19.50 - $22.00 per hour