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Utilization Management Claims Specialist

C0661780 459b 43e5 8562 8ca6e7a191c8 9200139169330 2 · Hopkinton, MA, US, Hopkinton, MA · Active · $65,000–$75,000 / year · ADP Workforce Now Recruiting

Job facts

FieldValue
CompanyC0661780 459b 43e5 8562 8ca6e7a191c8 9200139169330 2
TitleUtilization Management Claims Specialist
Normalized title-
Department / team-
LocationHopkinton, MA, United States
Work model-
Employment typeFull Time
Salary$65,000–$75,000 / year
Statusactive
ATS providerADP Workforce Now Recruiting
Posted / first seen2026-06-22 / 2026-06-23
Changed / last seen2026-06-23 / 2026-06-23

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ATS provider jobsActive postings observed through ADP Workforce Now Recruiting.Open
Provider filtered searchThe same provider as a filtered job collection.Open
City jobsActive postings in Hopkinton.Open
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Linked records

CompanyC0661780 459b 43e5 8562 8ca6e7a191c8 9200139169330 2
Source4395ac6d-9f1a-49cd-ab53-97cb5ca597fa
ATS providerADP Workforce Now Recruiting

Description

Join the VitalCore Team in Massachusetts! We're people who are fueled by passion, not by profit. VitalCore Health Strategies, (VCHS), an industry leader in Correctional Healthcare, has an opening for a Full-Time Utilization Management Claims Specialist at our Regional Office in Hopkinton, MA! Looking for a rewarding career in the field of healthcare? At VitalCore we pride ourselves on retaining and acquiring hardworking ethical individuals who are committed to providing quality services. Join our team and experience first-hand how VitalCore Health Strategies promotes a positive work environment that is based on respect and appreciation of the hard work and dedication of our staff. UTILIZATION MANAGEMENT CLAIMS SPECIALIST BENEFITS: Holiday Pay: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day, and Christmas Day Medical Dental Vision Health Savings Account Dependent Care Flexible Spending Account Life Insurance Short Term/Long Term Disability Identity Theft Protection Pet Insurance Employee Assistance Program and Discount Center 401K & Plan Matching PTO UTILIZATION MANAGEMENT CLAIMS SPECIALIST POSITION SUMMARY: The Utilization Management Claims Specialist is responsible for reviewing and evaluating off-site healthcare service claims for accuracy, completeness, and compliance with organizational and contractual policies and regulatory guidelines. UTILIZATION MANAGEMENT CLAIMS SPECIALIST ESSENTIAL FUNCTIONS: Ensure the accurate flow of medical information between patients, external providers, and third-party payers. Enter, research, and analyze data to ensure accuracy and support reimbursement processes. Identify potential billing errors, duplicate claims, fraud, waste, or abuse and escalate concerns as appropriate. Utilize established criteria to conduct preliminary reviews for services requiring prior authorization. Assess the need for additional information to support service authorization decisions. Maintain accurate records of claim reviews, determinations, and related correspondence. Collaborate with clinical and administrative teams to support efficient claims processing and quality outcomes. Process requests for authorization reviews and data verification in a timely and efficient manner. Adhere to departmental and organizational policies and procedures, as well as all applicable regulatory, contractual, and compliance requirements. Maintain proficiency in Microsoft Office applications, including Excel, and other required technology platforms. Demonstrate strong customer service skills, including effective communication, patience, empathy, and professionalism. Apply problem-solving and critical thinking skills to resolve issues and support decision-making Maintain knowledge of CPT and ICD coding requirements. Interpret and apply medical coding, reimbursement policies, and utilization management guidelines. Work effectively both independently and collaboratively within a team environment. Safeguard patient confidentiality and comply with all HIPAA requirements. Perform other duties as assigned. UTILIZATION MANAGEMENT CLAIMS SPECIALIST MINIMUM REQUIREMENTS: Associate’s degree or equivalent experience – Bachelor’s degree preferred. Has an active certification in Medical Coding or equivalent experience. 5+ years professional work experience in healthcare, managed care, or insurance preferred. Education, training, or experience as a medical coder, medical billing, or insurance coordinator require Demonstrate proficiency in the English language, including reading, writing, speaking, and comprehension skills. Function as a supportive team member by contributing to a collaborative and positive team environment. Exercise sound judgment and make independent decisions when appropriate. Interact professionally and tactfully with staff, family members, visitors, government agencies, and the general public. Exhibit leadership and supervisory skills while working effectively and harmoniously with others. Maintain a safe and professional work environment and perform duties in a manner that does not pose a direct threat to the health or safety of others in the workplace. VitalCore Health Strategies is an equal opportunity employer and is committed to creating and maintaining an inclusive workplace in which all employees have an opportunity to participate and contribute to the success of the business and are valued for their skills, experience, and unique perspectives. Full-Time Day Shift

Full job record

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Org IDdd41eeff-7b26-49d5-a4d8-18414d966c00
Source ID4395ac6d-9f1a-49cd-ab53-97cb5ca597fa
Board ID4395ac6d-9f1a-49cd-ab53-97cb5ca597fa
Provideradp_workforcenow
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TitleUtilization Management Claims Specialist
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First Seen At2026-06-23 13:01:20Z
Last Seen At2026-06-23 13:01:20Z
Last Checked At2026-06-23 13:01:20Z
Last Changed At2026-06-23 13:01:20Z
Inactive At—
Source Posted At2026-06-22 17:19:00Z
Source Updated At—
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Extensions
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We&#39;re people who are fueled by passion, not by profit.<br><br></strong></span><div id=\"isPasted\" style='margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: \"Segoe UI\", \"Segoe UI Web\", Arial, Verdana, sans-serif; font-size: 12px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-style: initial; text-decoration-color: initial;'><p lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; font-weight: normal; font-style: normal; vertical-align: baseline; font-kerning: none; background-color: rgb(255, 255, 255); color: windowtext; text-align: left; text-indent: 0px;\"><span data-contrast=\"none\" lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; outline: transparent solid 1px; color: rgb(0, 0, 0); background-color: rgb(255, 255, 255); font-size: 14px; line-height: 12px; font-family: arial, sans-serif; font-variant-ligatures: none !important;\"><span style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;\">VitalCore&nbsp;Health Strategies, (VCHS), an industry leader in Correctional Healthcare,&nbsp;has an opening for a</span></span><span data-contrast=\"none\" lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); font-size: 14px; line-height: 12px; font-family: arial, sans-serif; font-variant-ligatures: none !important;\"><span style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;\"> <u><strong>Full-Time Utilization Management Claims Specialist at our&nbsp;Regional Office in Hopkinton, MA!</strong></u></span></span></p></div><div style='margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: \"Segoe UI\", \"Segoe UI Web\", Arial, Verdana, sans-serif; font-size: 12px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-style: initial; text-decoration-color: initial;'><p lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; font-weight: normal; font-style: normal; vertical-align: baseline; font-kerning: none; background-color: rgb(255, 255, 255); color: windowtext; text-align: left; text-indent: 0px;\"><span style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\"><br></span></p><p lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; font-weight: normal; font-style: normal; vertical-align: baseline; font-kerning: none; background-color: rgb(255, 255, 255); color: windowtext; text-align: left; text-indent: 0px;\"><span data-contrast=\"none\" lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); font-size: 14px; line-height: 12px; font-family: arial, sans-serif; font-weight: bold; font-variant-ligatures: none !important;\"><span style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;\">Looking for a rewarding career in the field of healthcare?</span></span><span data-ccp-props='{\"201341983\":0,\"335559738\":240,\"335559739\":225,\"335559740\":240}' style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 14px; line-height: 12px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">&nbsp;</span></p><p lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; font-weight: normal; font-style: normal; vertical-align: baseline; font-kerning: none; background-color: rgb(255, 255, 255); color: windowtext; 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padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;\">At </span><span style='margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-repeat: repeat-x; background-position: left bottom; background-image: var(--urlSpellingErrorV2,url(\"data:image/svg+xml;base64,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\")); border-bottom: 1px solid transparent;'>VitalCore</span><span style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;\"> we pride ourselves on retaining and acquiring hardworking ethical individuals who are committed to providing quality services. Join our team and experience first-hand how </span><span style='margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-repeat: repeat-x; background-position: left bottom; background-image: var(--urlSpellingErrorV2,url(\"data:image/svg+xml;base64,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\")); border-bottom: 1px solid transparent;'>VitalCore</span><span style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;\"> Health Strategies promotes a positive work environment that is based on respect and appreciation of the hard work and dedication of our staff.</span></span></span><span data-ccp-props='{\"201341983\":0,\"335559738\":240,\"335559739\":225,\"335559740\":240}' style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 14px; line-height: 12px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\"><span data-ccp-props='{\"201341983\":0,\"335559738\":240,\"335559739\":225,\"335559740\":240}' style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: pre-wrap; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial; line-height: 12px;\"> </span>&nbsp;</span></p><p lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; font-weight: normal; font-style: normal; vertical-align: baseline; font-kerning: none; background-color: rgb(255, 255, 255); color: windowtext; text-align: left; text-indent: 0px;\"><br></p><p><br></p><p id=\"isPasted\"><span data-ccp-props='{\"201341983\":0,\"335559738\":240,\"335559739\":225,\"335559740\":240}' style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 14px; line-height: 12px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\" id=\"isPasted\"><strong>UTILIZATION MANAGEMENT CLAIMS SPECIALIST</strong></span><span style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\"><strong>&nbsp;BENEFITS:&nbsp;</strong></span></p><ul><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Holiday Pay: New Year&rsquo;s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran&rsquo;s Day, Thanksgiving Day, and Christmas Day&nbsp;</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Medical</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Dental</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Vision</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Health Savings Account</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Dependent Care Flexible Spending Account</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Life Insurance&nbsp;</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Short Term/Long Term Disability&nbsp;</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Identity Theft Protection&nbsp;</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Pet Insurance&nbsp;</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">Employee Assistance Program and Discount Center&nbsp;</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">401K &amp; Plan Matching</li><li style=\"font-size: 14px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\">PTO</li></ul><p><br></p><p><strong><span style=\"font-size: 16px;\">UTILIZATION MANAGEMENT CLAIMS SPECIALIST POSITION SUMMARY:</span></strong></p><p style='color: rgb(0, 0, 0); font-family: \"Times New Roman\"; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; line-height: 1;' data-pasted=\"true\">The Utilization Management Claims Specialist is responsible for reviewing and evaluating off-site healthcare service claims for accuracy, completeness, and compliance with organizational and contractual policies and regulatory guidelines.</p><p><br></p><p><span style=\"font-size: 14px;\"><strong id=\"isPasted\"><span style=\"font-size: 16px;\">UTILIZATION MANAGEMENT CLAIMS SPECIALIST ESSENTIAL FUNCTIONS:</span></strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Ensure the accurate flow of medical information between patients, external providers, and third-party payers.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Enter, research, and analyze data to ensure accuracy and support reimbursement processes.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Identify potential billing errors, duplicate claims, fraud, waste, or abuse and escalate concerns as appropriate.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Utilize established criteria to conduct preliminary reviews for services requiring prior authorization.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Assess the need for additional information to support service authorization decisions.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Maintain accurate records of claim reviews, determinations, and related correspondence.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Collaborate with clinical and administrative teams to support efficient claims processing and quality outcomes.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Process requests for authorization reviews and data verification in a timely and efficient manner.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Adhere to departmental and organizational policies and procedures, as well as all applicable regulatory, contractual, and compliance requirements.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Maintain proficiency in Microsoft Office applications, including Excel, and other required technology platforms.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Demonstrate strong customer service skills, including effective communication, patience, empathy, and professionalism.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Apply problem-solving and critical thinking skills to resolve issues and support decision-making</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Maintain knowledge of CPT and ICD coding requirements.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Interpret and apply medical coding, reimbursement policies, and utilization management guidelines.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Work effectively both independently and collaboratively within a team environment.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Safeguard patient confidentiality and comply with all HIPAA requirements.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Perform other duties as assigned.</li></ul><p><span style=\"font-size: 14px;\"><span style=\"font-size: 16px;\"><span style=\"font-size: 16px;\"><br></span></span></span></p><p lang=\"EN-US\" style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; font-weight: normal; font-style: normal; vertical-align: baseline; font-kerning: none; background-color: rgb(255, 255, 255); color: windowtext; text-align: left; text-indent: 0px;\"><span data-ccp-props='{\"201341983\":0,\"335559738\":240,\"335559739\":225,\"335559740\":240}' style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 14px; line-height: 12px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\" id=\"isPasted\"><strong>UTILIZATION MANAGEMENT CLAIMS&nbsp;SPECIALIST</strong></span><span data-ccp-props='{\"201341983\":0,\"335559738\":240,\"335559739\":225,\"335559740\":240}' style=\"margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 14px; line-height: 12px; font-family: arial, sans-serif; color: rgb(0, 0, 0);\"><strong>&nbsp;MINIMUM REQUIREMENTS:</strong></span></p><ul><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Associate&rsquo;s degree or equivalent experience &ndash; Bachelor&rsquo;s degree preferred.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Has an active certification in Medical Coding or equivalent experience.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>5+ years professional work experience in healthcare, managed care, or insurance preferred.</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'>Education, training, or experience as a medical coder, medical billing, or insurance coordinator require</li><li style='font-family: \"times new roman\", serif; font-size: 16px;'><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\">Demonstrate proficiency in the English language, including reading, writing, speaking, and comprehension skills.&nbsp;</span></li><li style='font-family: \"times new roman\", serif; font-size: 16px;'><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\">Function as a supportive team member by contributing to a collaborative and positive team environment.&nbsp;</span></li><li style='font-family: \"times new roman\", serif; font-size: 16px;'><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\">Exercise sound judgment and make independent decisions when appropriate.&nbsp;</span></li><li style='font-family: \"times new roman\", serif; font-size: 16px;'><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\">Interact professionally and tactfully with staff, family members, visitors, government agencies, and the general public.</span></li><li style='font-family: \"times new roman\", serif; font-size: 16px;'><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\"><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\">Exhibit leadership and supervisory skills while working effectively and harmoniously with others.&nbsp;</span></span></li><li style='font-family: \"times new roman\", serif; font-size: 16px;'><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\"><span style=\"color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important;\" data-pasted=\"true\">Maintain a safe and professional work environment and perform duties in a manner that does not pose a direct threat to the health or safety of others in the workplace.</span></span></li></ul><p><br></p><p><span style=\"color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 14px;\">VitalCore Health Strategies is an equal opportunity employer and is committed to creating and maintaining an inclusive workplace in which all employees have an opportunity to participate and contribute to the success of the business and are valued for their skills, experience, and unique perspectives.<br></span></p><p><br></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div>\n<br/>Full-Time<br/>Day Shift",
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