3,795 jobs found

Aetna Description: **Office Based - Plantation FL** Exciting opportunity join Aetna and our Medicaid Compliance team as Sr Compliance Lead. This is an expert level position that applies specialized expertise in compliance, business, analytical and communication skills to support, manage and help develop compliance strategies, programs and processes to promote compliant and ethical behavior, meet regulatory obligations and prevent, detect and mitigate compliance risks working specifically with our FL Medicaid and CHIP plans. 63316 Fundamental Components: Leads, implements, and maintains an effective Compliance program, including, but not limited to, risk assessment, auditing and monitoring, maintaining effective compliance policies and procedures, and effective communication and training. Prepares highly complex regulatory reports, filings and follow-ups, and manages highly complex regulatory review and audit activities. Independently manages multiple highly complex regulatory interactions including drafting regulatory correspondence, responding to regulatory inquiries and negotiating resolution of regulatory matters requiring a sophisticated understanding of business processes and regulatory requirements. Leads highly complex compliance business process reviews, corrective actions and other projects involving internal and external constituents. Independently develops strategy, processes, forms and related materials to meet the most complex regulatory and legal requirements. Builds and maintains positive, productive relationships with internal and external constituents at the most senior and regulatory organizational levels, and is able to remove significant barriers, drive decision-making and influence ethical and compliant outcomes at all organizational levels necessary to accomplish goals. Applies expert industry and compliance knowledge to lead highly complex matters involving established compliance system and operations, including processes for implementation of laws and regulations, support of the Company's Privacy Office on privacy issues, monitoring of compliance issues, and handling of the most complex complaints. Independently identifies and assesses the most complex compliance issues and risks, engages appropriate enterprise resources, supports internal and external constituents in the development and monitoring of effective corrective action, error prevention and risk mitigation plans and related activities and communications. This may include the development of new or updated policies and processes. Appropriately informs and escalates matters to senior management. Independently collects facts and utilizes strong analytical capabilities to recommend appropriate actions on the most complex matters and effectively communicates status and results in a concise and timely manner. Responds to the most complex requests for information within area of responsibility from internal and external constituents. Acts as resource and subject matter expert for colleagues and effectively guides teams to accomplish complex goals. Identifies shifting strategic priorities and leads the implementation of both tactical and strategic solutions. Other components relevant to the specific role. Background Experience: 8+ years' experience in a regulatory compliance position in healthcare, insurance or financial services or work experience in a relevant business area Experience leading complex projects. Bachelor's degree and advanced degree desired or certification or equivalent experience. Additional Job Information: The Medicaid Sr. Compliance Lead position promotes and enforces compliance with state/federal laws and regulations and related-company policies (including the Aetna Code of Conduct) affecting Aetna businesses and encouraging high business standards in order to advance company objectives, benefit the company's customers, employees and shareholders, and protect the company's reputation. This is full-time office-based position in Overland Park, KS. Responsibilities include: auditing, investigating, training/education and enforcement, ongoing consultation on compliance issues impacting businesses, interfacing with industry groups and regulators on compliance with laws and regulators, monitoring and reporting on adherence to compliance controls, recommending and helping businesses to implement compliance controls. Fundamental Components: This role will work closely with the CEO, as well as, members of the legal department building successful relationships with stakeholders, client, state/federal authorities and other parties as necessary. Oversees compliance activities in support of a large or complex business group and/or manages teams responsible for managing audits and other regulatory exams, inquiries or reporting. Works closely with management to drive compliance as a core competency and integrate compliance into business plans, scorecards, metrics and processes; removes barriers to implementation. This is partnership with the health plan to focus on understanding scope of business and partner with plan to achieve business needs while maintaining compliance. Assures the timely implementation of all state and federal legislation and regulations applicable to assigned business areas. Ensures that compliance risks are addressed and corrective actions are taken, as appropriate; Assists business units with development and promulgation of appropriate compliance controls/corrective actions. Oversees or ensures the development of policies and procedures needed in response to new or existing laws or Company policies. Monitors ongoing compliance with the policies and procedures within the business group Conducts investigations of compliance deviations or failures. Promotes compliance reviews and risk assessments Promotes and enforces Aetna's Code of Conduct and Integrity The Aetna Way Promotes compliance awareness, education and training Assists with communicating the Company's business conduct, integrity and compliance messages Identifies and analyzes significant legislative initiatives and impact on business operations Establishes education programs and provides and/or promotes continuing training & education Assures compliance direction is aligned with segment business strategies Develops standards of performance and related metrics. BACKGROUND/EXPERIENCE desired: 5+ years experience in a regulatory compliance position in managed care healthcare, insurance or financial services. -Bachelor's degree and 5 or more years of relevant experience preferred OR Education: Bachelor's degree in Public Policy, Government Affairs, Business or Public Administration or equivalent; Masters or Law degree or equivalent experience preferred. EDUCATION The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience; Master's preferred. Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Aetna Description: Responsible for developing and implementing sales strategies to identify, cultivate and generate new sales of a product and/or service to individuals or groups of individuals via presentations in their homes or community meetings in assigned business segment, product or geography. 62777 Fundamental Components: Contacts prospective individual members to generate new sales of company products or services via in-home or community based presentations. Builds strategic partnerships with assigned producers and customers to achieve profitable growth and cross-sell objectives for assigned business or customer segments, products and assigned geographiesFollows up on new sale leads from marketing, referrals and own prospecting lead generation activities.Qualifies prospective members and assist with enrollment and educates prospective clients on product, pricing and services.Coordinates sales materials, testimonials and subject matter expert involvement in support of the successful delivery of constituent presentations.Ensures product, pricing and services meet client's needs while meeting Aetna revenue growth and profit objectives.Manages/coordinates the integration of client's and Aetna's internal organizations and partners cross-functionally to complete sales, installation, and servicing.Coordinates internal teams to provide required materials for the sales process, including RFP responses, working with underwriting, network, specialists, product & others. Required to communicate with internal and external parties telephonically and/or in person. May require travel to offsite locations for in-person meetings. Background Experience: 2-5 years of industry and sales experience depending on business segment being supported and the products and services being sold Bachelor's Degree or equivalent work experienceLicense as required by state law Functional Skills: Sales & Service - Individual sales Education: Insurance - Life, Health and Variable Annuity License Potential Telework Position: No Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Aetna Description: JOIN OUR GROWING TEAM Do you want to make a difference as a Field Case Manager in your local community? Let us show you how you can expand your professional experience as a CRC, CCM, CRRN, COHN, and CDMS. We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers' Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members. The Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Territory Ft Lauderdale, Miami, FL, Florida 63692 Fundamental Components: Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician's office to provide ongoing case management services.Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.Prepares all required documentation of case work activities as appropriate.Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.Provides educational and prevention information for best medical outcomes.Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.Testifies as required to substantiate any relevant case work or reports.Conducts an evaluation of members/clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member's/client's overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work. Please note that we do offer mileage reimbursement for local travel. As a Workers' Compensation Field Case Manager, you will be offered: Autonomy Productivity incentives Monday-Friday schedule Reimbursement for mileage, tolls, parking, licensure and certification Laptop, iPhone & printer/fax/scanner all in one. All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU's to maintain licensure. Continuing Education credits are available/provided for RN and a various industry certifications too. Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Background Experience: 5 years clinical practice experience (required for NCM role only). 3 years case management experience (required for NCM role, preferred for all other areas). Effective computer skills including navigating multiple systems and keyboarding Job-specific technical knowledge, (e.g., knowledge of workers compensation and disability industry for workers' compensation case managers or case management). Ability to travel within a designated geographic area for in-person case management activities Excellent analytical and problem solving skills Bilingual preferred Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. Ability to work independently (may require working from home). Knowledge of laws and regulations governing delivery of rehabilitation services. Effective communications, organizational, and interpersonal skills. CERTIFICATION Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is required. Certified Case Manager is preferred. LICENSE Registered Nurse with active state license in good standing in the state where job duties are performed is required EDUCATION Bachelor degree in a closely-related field, or an equivalent combination of formal education and recent, related experience; preference will be given to applicants with a Master's degree Functional Skills: Nursing - Case Management, Nursing - Disability, Nursing - Medical-Surgical Care Technology Experience: Desktop Tool - Microsoft Word Education: Medical - Certified Rehabilitation Counselor (CRC), Nursing - Certified Case Manager (CCM), Nursing - Certified Disability Management Specialist (CDMS), Nursing - CRRN - Certified Rehabilitation Registered Potential Telework Position: Yes Percent of Travel Required: 50 - 75% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Aetna Description: This is an in-office position in the Jacksonville, FL office. The Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. 63498 Fundamental Components: Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician's office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.Prepares all required documentation of case work activities as appropriate.Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes.Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.Testifies as required to substantiate any relevant case work or reports.Conducts an evaluation of members/clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member's/client's overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. Background Experience: RN licensure required 5+ years clinical practice experience required 1+ years case management, home health, OR discharge planning experience required Effective computer skills including navigating multiple systems and keyboarding Excellent analytical and problem solving skills Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications Effective communications, organizational, and interpersonal skills Certified Case Manager is preferred Education: Nursing - Registered Nurse Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Aetna Description: The clinical pharmacy advisor supports a new and innovative member centric clinical care program for Aetna Medicaid, the Pharmacy Medication Management Program. The Pharmacy Medication Management Program (PMMP) integrates clinical pharmacists with the local Medicaid health plan clinical care team to improve medication utilization and member outcomes. The PMMP clinical pharmacist is responsible for leading pharmacy-based clinical initiatives and supporting the work of clinical care teams serving high risk Medicaid members. The PMMP clinical pharmacist will be responsible for assisting in the development and implementation of Pharmacy Medication Management Programs as well as independently administering clinical pharmacy initiatives. Seeking Pharmacists in the following areas: SAN DIEGO, CA PRINCETON, NJ FT LAUDERDALE ,FL Schedule is standard business hours Monday-Friday. 63018 Fundamental Components: * Collaborate with health plan associates (including pharmacy director, care managers, medical directors, provider relations, quality management, and others as necessary) to identify high priority member and provider populations in order to perform clinical pharmacy interventions and improve member outcomes * Review and evaluate pharmacy and medical claims data with plan associates to identify members and prescribers requiring clinical pharmacy interventions * Assist in the development of member and provider facing tools, resources, and educational outreach material * Perform targeted Academic Detailing interventions with external providers to encourage the appropriate prescribing of medications * Serve as the health plan PMMP brand ambassador to drive engagement and utilization of the available programs * Independently complete accurate and comprehensive medication reviews and perform the corresponding member, care manager, and provider outreach as necessary * Serve as the medication expert for health plan clinical care activities Background Experience: In-depth knowledge and experience in managed care / managed pharmacy / competitive environment. 3 years clinical pharmacy experience or equivalent is required. Understanding HEDIS and other quality programs and processes is preferred Proficiency in Microsoft Office Suite applications Local travel is required LICENSE REQUIRED Current unrestricted Pharmacist state license required active and unrestricted. Education: Pharmacy - Registered Pharmacist Potential Telework Position: Yes Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

PARSONS We areseeking a CEI Inspector for road/highway/bridge construction projectsin the JacksonvilleFlorida area. We offer excellent benefits, competitive salaries, overtime, and a great backlog of work ! Responsibilities include: Receive general supervision from the Senior Inspector who reviews work while in progress. Readand interpret plans, specifications, and shop drawings. Perform field inspection of contractor's operations toensure compliance with contract documents. Perform sampling and testing of component materials and completed work in accordance with appropriate standards and procedures. Prepare daily reports to document contractor work operations. Enter daily reports in Site Manager and testing results into Materials Acceptance and Certification (MAC) database. Field measure installed quantities and perform supporting standard mathematical calculations. Requirements: Local Candidates in theFlorida regionpreferred. No relocation offered. High School degree and minimum of two years of Road or Bridge construction inspection experience. We will also consider candidates with Associates Degrees in Civil Engineering and EIT, with no experience, that are interested in getting into Road/Bridge Construction. Prefer FDOT experience, but will consider candidates with other DOT experience Prefer candidate to possesscurrent FDOT CTQP certificates and Intermediate Temporary Traffic Control (MOT) certification as well as possess working knowledge of FDOT specifications. If you do not possess these certs, you must be ableto obtain the required certifications within one year of employment.(We will pay for the training and certification). Skills/ Competencies : Must be able to read and interpret plans and specifications and be familiar with construction-related processes related to the area of assignment. Knowledge of English grammar and composition, the ability to communicate clearly both orally and in writing; to follow oral and written instructions and prepare written diaries and reports. Capability to perform basic math calculation in order to prepare simple engineering calculations, graphs and charts. Familiarity with basic computer usage, knowledge of Microsoft Office, Project Management Software and internet search engines (like Google or equivalent) required. Ability to comply with requirements as applicable to the project based on client and industry standards. Must have basic understanding of scheduling, and the ability to review progress pay estimates and extra work bills. Must be able to recognize hazardous work conditions. Ability to work with others is required. Requires ability to climb ladders, inspect work above ground, and work in confined spaces. Requires ability to lift up to 50 lbs (i.e. lifting materials used for testing of concrete, AC, etc.). _ Ready for action? We're looking for the kind of people who see this opportunity and don't hesitate to act. Parsons is a leader in the world of Technical Services and Engineering. We hire people with a broad set of technical skills who have proven experience tackling some of the greatest challenges. Take your next step and apply today. Parsons is a digitally enabled solutions provider focused on the defense, security, and infrastructure markets. With nearly 75 years of experience, Parsons is uniquely qualified to deliver cyber/converged security, technology-based intellectual property, and other innovative services to federal, regional, and local government agencies, as well as to private industrial customers worldwide. Parsons is an equal opportunity, drug-free employer committed to diversity in the workplace. Minority/Female/Disabled/Protected Veteran/LGBT. For more about Parsons, visit parsons.com and follow us on Facebook , Twitter , LinkedIn , and YouTube .

PARSONS If you are an electrician looking to join team and jump start your career, Parsons may be the place for you! We are currently seeking a maintenance electrician to support our efforts. It's time to make your skills as an electrician work for you! Qualifications: 6+ years of experience in the electrical construction industry Construction, safety, and quality training/certifications a plus MS Office experience and computer proficiency required Must be able to repetitively lift up to 50 pounds Must be willing to travel 100% throughout the United States and its territories Must be willing to work overtime when required Valid driver license and ability to pass a motor vehicle record check required Must have, or be able to obtain, a satisfactory DOT medical examination Must be able to pass a preemployment drug test Must be able to meet customer security requirements (moderate to high risk) _ Ready for action? We're looking for the kind of people who see this opportunity and don't hesitate to act. Parsons is a leader in the world of Technical Services and Engineering. We hire people with a broad set of technical skills who have proven experience tackling some of the greatest challenges. Take your next step and apply today. Parsons is a digitally enabled solutions provider focused on the defense, security, and infrastructure markets. With nearly 75 years of experience, Parsons is uniquely qualified to deliver cyber/converged security, technology-based intellectual property, and other innovative services to federal, regional, and local government agencies, as well as to private industrial customers worldwide. Parsons is an equal opportunity, drug-free employer committed to diversity in the workplace. Minority/Female/Disabled/Protected Veteran/LGBT. For more about Parsons, visit parsons.com and follow us on Facebook , Twitter , LinkedIn , and YouTube .