Physician Advisor Salary in State of Maine, USA

Care Management Nurse (Future Opportunities) Remote within WA, OR, ID, UT. Candidates outside of these states will not be considered.Primary Job Purpose The Care Management Nurse provides clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member's care to assess, plan, implement, coordinate, monitor and evaluate care as needed. **Please note this role is a candidate pool, and we are always looking for top talent. We do not always have open positions but we encourage you to submit your resume so you will be considered for all open roles as they become available.**General Functions and Outcomes Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring and evaluation. Assessment: collection of in-depth information about a member's situation and functioning to identify individual needs. Planning: identification of specific objectives, goals, and actions designed to meet the member's needs as identified in the assessment.Implementation: execution of the specific case management activities that will lead to accomplishing the goals set forth in the plan.Coordination: organization, securing, integrating and modifying resources. Monitoring: gathering sufficient information to determine the plan's effectiveness and the evaluation phase should determine the effectiveness of reaching the desired outcomes. Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care. Utilizes evidence-based criteria that incorporates current and validated clinical research findings. Practices within the scope of their license.Consults with physician advisors to ensure clinically appropriate determinations.Serves as a resource to internal and external customers.Collaborates with other departments to resolve claims, quality of care, member or provider issues. Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.Provides consistent and accurate documentation.Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines.Minimum Requirements Knowledge of health insurance industry trends, technology and contractual arrangements.General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.Strong oral, written and interpersonal communication and customer service skills.Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.Strong organization and time management skills with the ability to manage workload independently.Ability to think critically and make decision within individual role and responsibility.Normally to be proficient in the competencies listed above Care Management Nurse would have a/an Associate or Bachelor's Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience. Required Licenses, Certifications, Registration, Etc. Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical careMust have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Master's degree in Behavioral Health preferred for behavioral health care management); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)#LI-RemoteThe expected hiring range for a Care Management Nurse is $38.00 - $41.50 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $33.80 - $55.00 an hour. Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

PURPOSE OF YOUR JOB DESCRIPTION: Assists in planning, developing, and organizing the operations of the Case Management Department regarding the implementation of utilization management, coordination of care activities, quality improvement and case management activities in order to meet the requirement of The Joint Commission, state and local regulatory and/or accrediting agencies. Obtains pre-certification from third party payors as required. Performs all admission/continued stay reviews for appropriateness of acute hospital level, assessing quality of services as the patient moves through the continuum of care. Establishes and implements safe, comprehensive discharge plans to meet individual patient/family needs. Communicates with the interdisciplinary team and community resource representatives in planning for the patient's transition to post-hospital care. DELEGATION OF AUTHORITY: As Case Management, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. JOB FUNCTIONS: Every effort has been made to make your job description as complete as possible. However, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position. PERFORMANCE REQUIREMENT / DUTIES AND RESPONSIBILITIES Assists the Director of Quality Management in planning, developing, organizing, implementing, and evaluating the Case Management program of the Hospital. Develops and implements departmental and interdepartmental policies and procedures relating to Case Management and the Swing Bed Program. Coordinates the Hospital's Swing Bed Program. Performs daily utilization review activities (assesses appropriateness of admission/continued stays.) Completes initial review within one business day of admission and updates continued stay reviews daily. Reviews the medical/surgical treatment plan with third party payors to obtain authorization for pre certification, admission and continued stay. (Communicates in a professional, courteous manner, respecting the third party payors need for treatment plan updates as well as patient confidentiality issues.) Refers those cases that still do not meet Interqual criteria to the Utilization review Physician Advisor for admission or continued stay approval and contacts MASSPRO for Medicare Non-Coverage cases. Distributes Hospital-issued Notices of Non-Coverage to patient or family as indicated. Communicates with the interdisciplinary team in planning for patients post hospital care. Attends biweekly patient care rounds and initiates appropriate referrals to social work, rehabilitation therapy and homecare liaisons as needed. Establishes individual patients discharge plans to provide transition to outpatient or extended care providers. (Elicits the patient/representative participation in the discharge planning process while allowing for individual patient needs including: age appropriateness, language barriers, educational level and sensory deficits in discharge planning discussions.) Coordinates/provides social and practical assistance with environmental problems including financial assistance, discharge planning and referrals to other community agencies. Works closely with the patient/representative and family to identify the appropriate health and social service agencies for continuing care post-hospital. Implements the final discharge plan and notifies the patient's family promptly. Provides the required discharge documentation (patient care referrals, STAT discharge summaries) to community agencies and extended care facilities at the time of discharge in cases requiring post hospital care. Arranges air or ground transportation to other facilities. Completes occurrence screens as part of the Hospital's patient safety program. Educates Medical and Nursing Staffs on Interqual criteria and appropriate documentation for acute hospital care. Pre-screens patients for respite care/swing bed admissions, collaborating with Clinical Coordinator/Nursing Supervisor on appropriateness. Coordinates appeal process for reimbursement denials with Medical Staff, Billing, and Medical Records. Performs other duties as deemed necessary and appropriate or as directed by the Chief Quality Officer. Participates in community planning related to the interests of the facility and the services and needs of the patient and family. Helps facilitate interdisciplinary team meetings on inpatients as needed.Qualifications EDUCATION REQUIREMENTS: • Registered Nurse with previous case management experience required • Successful completion of Case Management Certification Program preferred EXPERIENCE: • Prior work in a community health, home health, or acute care or critical access hospital setting. • Must possess a current, unencumbered license to practice in this state.EEO Statement Martha's Vineyard Hospital and Windemere Nursing & Rehabilitation Center are Equal Opportunity Employers. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.

The Project Manager will be a member of the PMO Team, reporting to the Director of Program Management. The PMO Team leads client software implementation projects and works closely with the Product Management team to identify opportunities and develop solutions. The Project Manager is a critical role within the organization, and is primarily responsible for successfully managing software implementations, from project initiation through project closure. The Project Manager will be working on a variety of interesting projects, and work closely with our clients as well as internal teams (including, but not limited to, Business Analysts, Development, QA, Sales, and Executive Leadership), in a fast paced and dynamic environment. We are looking for a Project Manager that is detail oriented, flexible when faced with change, able to manage multiple tasks and projects, skilled at building relationships with clients and internal team members, thrives in a fast paced work environment, and has a solid understanding of the software development lifecycle. This candidate will have many opportunities to impact business process and company success. This is a highly technical position with accountability for product quality that requires the ability to motivate and mentor cross-functional team members.Essential Duties & Responsibilities:Effectively manage client communications and expectations Own the customer relationship - function as primary point of contact during implementation, and maintain position as trusted advisor to clientsDefine implementation projects, execute tasks, complete deliverables, coordinate staffing, and monitor and report resultsDevelop and deliver trainingAble to function as subject matter expert in order to collect complete and accurate business requirements from clientsWork as a team player and leader in order to effectively coordinate across functional teamsCollaborates with Product Management to balance product vision and voice of customer in order to recommend and deliver best-in-class solutionsPresents project statuses to executive teamWorks closely with Business Analyst to ensure that all documentation accurately reflects client needs and clearly defined for Development and QA teams (i.e. business requirements, user stories, wireframes, functional specifications, test plans, etc)Manages issues, risks and changes using appropriate and agreed upon processesCoordinate estimation of development effortPlan milestones, track progress, prioritize bug reportsCoordinate training for team membersRequirementsPM needs deep technology skill setUnderstands, sFTP, API'sFile formatsUnique GUID'sIntegrationsHTMLSpecialty PharmacyProven, hands-on experience successfully implementing SaaS and/or enterprise software applicationsA working knowledge of pharmaceutical, special pharmacy, hub or related industriesDirect experience in consulting for external clientsIn addition to the qualifications listed above, successful candidates will have the following characteristics:A self-starter who can thrive in a fast-paced environment with minimal direct supervisionHighest ethical standards and personal integrityGood data, business, and financial analysis skillsSuperior communications skills, both verbally and in writingProficiency with MS Office suite, including Word, Excel, Outlook, PowerPoint, ProjectQualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Education and/or Experience Requirements:Passion for making a different in patients' lives and reducing the administrative burden on physician officesBachelor's Degree (preferably in Management Information Systems, Computer Science, Business or related discipline)3-5 years of experience successfully managing complex software projects, including client facing projectsAgile software development experience preferredSpecialty pharmacy industry experience preferredAbility to plan, direct, and deliver outstanding presentationsExcellent written and verbal communication skillsImpeccable organizational skills and attention to detailExceptional interpersonal and teamwork skills. Capable of understanding a broad range of viewpoints and building consensusAbility to multi?task in a fast?paced organizationProven experience at working independently with minimal supervision and as part of a team to complete assignmentsFlexibility and adaptability to rapid changeBenefitsSupportive, progressive, fast-paced environmentCompetitive pay structureMatching 401(k) with immediate vestingMedical, dental, vision, life, & short-term disability insuranceAssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local lawsAll offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background checkIn compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this positionAssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire