FULL_TIME

FEED

OTHER

Technical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.

TriWest Healthcare Alliance

Supervisor, Utilization Management

equestftpin

The Transition of Care Coordinator provides clinical oversight and coordination for beneficiaries moving between levels of care, supports discharge planning, conducts post-discharge follow up, completes assessments and reassessments as needed, identifies barriers to care, and reviews and processes authorization and referral requests according to policy. Technical Skills: Thorough knowledge of internal policies and procedures, utilization management principles, managed care concepts, medical terminology, and medical management system, clinical decision support tools, International Classification of Diseases, and Current Procedural Terminology.

Transition of Care Coordinator RN/LCSW

Accurately and professionally answer health care inquiries and provide resolutions to TRICARE beneficiaries & providers over the phone, chat, email or other written correspondence. • Effectively and professionally answer customer inquiries by taking ownership of issues, utilizing sound judgement and the tools at your disposal to resolve customer issues on the initial contact.

TRICARE Customer Service Rep

This leader will collaborate with data management to utilize predictive and prescriptive analytics to stratify our beneficiary population for inclusion in multiple Medical Management programs; direct staff and interventions that will improve beneficiary health outcomes including HEDIS scores; develop and implement clinical programs to optimize Condition/Disease Management strategies and goals; and collaborate with leadership to enhance the overall healthcare education and knowledge of our beneficiaries using multiple platforms and experiences. Technical Skills: Advanced knowledge of managed care principles; working knowledge of medical necessity review criteria, LOS, ICD, CPT, HCPCs and American Dental Coding required; quality management training/experience; extensive experience with relational databases and statistical analysis.

Director, Population Health

Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region.

Direct Contracting Manager

UNKNOWN

Client Fulfillment: As a client advisor you will have access to our technology driven CRM to connect with clients who have requested a consultation, the automation will set a virtual appointment from home or anywhere to help them apply for the best plan for their needs. You may qualify for an agency contract, which gives you full ownership of your permanent residual income stream Expectations: This position is remote and combines the freedom and tax benefits of being an independent contractor, with the ongoing support and coaching from our team of experts who will help you every step of the way.

Griffin Agency

Build a Business, Not Just a Résumé

ea_via_bold

Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries.

HOUR

CorVel is a leader of risk and healthcare management solutions to employers, third party administrators, insurance companies and government agencies. We are publicly traded (NASDAQ:CRVL) and annual revenues exceeded $493 million in FY2015. Our continued customer growth is a testament to our financial stability and our significant investments in new systems and technologies allows us to continue to deliver industry-leading solutions to the marketplace. CorVel has approximately 3,500 associates who serve more than 2,000 customers through a national branch office network covering all 50 states.

CorVel Corp

Bill Review Analyst II

Our comprehensive clinical and operational leadership team will support your transition into our medical practice with a comprehensive onboarding program along with support from industry leading clinical experts in post-acute medicine. TeamHealth is seeking a quality-driven nurse practitioner to join our call solutions remote telephonic clinical call coverage team for weekend day coverage.

TeamHealth was founded in 1979 with a vision of developing the best teams of healthcare professionals. With the relentless pursuit to advance patient care through strong leadership, innovation and teamwork, we're proud to say that 33 years later we have made great strides towards our goals.

The impressive growth of TeamHealth should come as no surprise to hospitals and clinicians aware of our reputation for efficiency and commitment to excellence and collaboration.

Originally founded to provide emergency department administrative and staffing services, TeamHealth is one of the nation's largest providers of hospital-based clinical outsourcing in multiple departments, including Anesthesia, Hospital Medicine, in addition to Emergency Medicine. Although we are a national organization, our operating philosophy is essentially the same as when we started. TeamHealth is committed to a patient-centric model of healthcare delivery with hospitals, physician groups and TeamHealth working collaboratively to deliver compassionate, effective, efficient and safe patient care.

Team Health Holdings Inc

Remote Call Post-Acute Nurse Practitioner

Oversees, manages and analyzes activities associated with asset business systems to ensure company, customer, and US Government assets accountable to the company, or within its possession, are managed in accordance with applicable regulations and policies to achieve best value and operational excellence. In order to comply with the requirements of the ITAR and/or the EAR, applicants must qualify as a U.S. person under the ITAR and the EAR, or a person to be approved for an export license by the governing agency whose technology comes under its jurisdiction.

YEAR

Who We Are
Based in California, AeroVironment (AVAV) is a global leader in unmanned aircraft systems (UAS) and tactical missile systems. Founded in 1971 by celebrated physicist and engineer, Dr. Paul MacCready, we&rsquo;ve been at the leading edge of technical innovation for more than 45 years. Be a part of the team that developed the world&rsquo;s most widely used military drones and created the first submarine-launched reconnaissance drone, and has seven innovative vehicles that are part of the Smithsonian Institution&rsquo;s permanent collection in Washington, DC.
Join us today in developing the next generation of small UAS and tactical missile systems that will deliver more actionable intelligence to our customers so they can proceed with certainty &ndash; and succeed.
We offer our employees&nbsp;full medical, dental, vision benefits all&nbsp;beginning&nbsp;day 1 of employment.&nbsp; &nbsp;For more details visit: <a href="http://www.myavbenefits.com">www.myavbenefits.com</a> Paid time&nbsp;off:&nbsp;&nbsp;2 weeks vacation, plus paid company holiday shut down Dec. 25 - Jan 1. 9/80 work schedule: every other Friday off! A fun and collaborative work environment encouraging personal growth and creative innovation;&nbsp;AV is a tech start-up with stability.

Aerovironment

Property And Asset Analyst III

This is a client-facing role focused on helping customers understand, and select appropriate financial protection solutions for their family and assets. We are an independent insurance agency seekingInsurance Sales Representative(Remote) to work with individuals and families who have requested information about coverage options.

Unlock Potential 360

Insurance Sales Representative - Remote

Zoho

This role focuses on helping clients understand their options and guiding them through the process using a step-by-step pathway. We are hiring a remote Client Account Specialist to assist clients who have requested information about life and financial protection coverage.

Client Account Specialist - Remote

Ensures accuracy and completion of authorization data from customer information, medical records, referral/authorization forms, Military Treatment Facility electronic transmission and other documents into medical management system. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Referral Specialist

Performs clinical research necessary to establish evidence-based clinical content guidelines, uses technical and medical writing capabilities to create content to support targeted population campaigns, population wellness portals and activity, support accreditation and contractual requirements, beneficiary educational and other work as needed. • Supports Medical Management projects and non-clinical resources such as project managers as a subject matter expert in evidence-based clinical criteria for building assessments, care plans, interventions and other clinically-based tools and programs.

PH Communications Specialist

Technical Skills: Knowledge of TRICARE policies and procedures, Case Management, Utilization Management, Managed Care concepts, Behavioral Health practices and principles, Medicaid and Medicare eligibility requirements and benefits, community resources, alternative funding programs, medical management systems, and protected health information; proficiency with the use of medical necessity criteria to evaluate care requests; working knowledge of medical coding. Problem Solving / Analysis: Thorough knowledge of health care delivery, UM, CM, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations.

Manager, Case Management Special Programs

Orders/receives medical records for Potential Quality Issues (PQI and CQM Department activities according to desk procedures, conducts follow-up telephone calls to providers, and completes other processes to resolve missing documents. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Clinical Quality Support Specialist

This work includes data entry and task processing in medical management and customer relationship management (CRM) systems, and making and receiving telephone calls, including participation in outreach campaigns. The Healthcare Operations Specialist provides non-clinical support to TriWest healthcare operations teams, supporting the access to care our military community deserves.

Healthcare Operations Specialist- HI

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. The position collaborates to ensure relevant analysis and complete, timely reporting is provided to meet TriWest business needs and Government's Healthcare requirements.

Business Analyst Sr

Technical Skills: Thorough knowledge of TRICARE policies and procedures, data collection and reporting, TriWest Care Radius medical management systems, and Referral Management Specialists function. • Two or more years of supervisory experience Managed care and operational experience in medical management systems, including referral management/prior authorization, or utilization management.

Supervisor, Referral Management

Technical Skills: Knowledge of TRICARE program and benefits; managed care program concepts and health care delivery processes; management reporting tools and medical management systems; legal, regulatory requirements, and HIPAA privacy regulations. Under the direction of the Director of Referral Management, the Manager will lead and guide non-clinical staff in processes that maintain accuracy, efficiency, and timeliness for all network and military referral requests.

Manager, Referral Management

Develops effective collaborative relationships with TriWest's inter and intra-departmental stakeholders and other SMEs, C-Suite executives, and other leaders in Operations, Health Care Services, Provider Network, and IT to ensure that TriWest meets contractual requirements and fulfills organizational objectives. The Provider Program Manager ensures that strategic, enterprise-wide programs are well defined, planned, tracked, and communicated in a consistent manner; is responsible for collaborating with C-Suite executives and other stakeholders; and is responsible for deliverables that meet defined requirements and for utilizing project management best practices.

Remote Jobs in Albuquerque, NM

Supervisor, Utilization Management TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

TRICARE Customer Service Rep TriWest Healthcare Alliance

Director, Population Health TriWest Healthcare Alliance

Direct Contracting Manager TriWest Healthcare Alliance

Build a Business, Not Just a Résumé Griffin Agency

Bill Review Analyst II CorVel Corp

Remote Call Post-Acute Nurse Practitioner Team Health Holdings Inc

Property And Asset Analyst III Aerovironment

Insurance Sales Representative - Remote Unlock Potential 360

Client Account Specialist - Remote Unlock Potential 360

Referral Specialist TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Manager, Case Management Special Programs TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Healthcare Operations Specialist- HI TriWest Healthcare Alliance

Business Analyst Sr TriWest Healthcare Alliance

Supervisor, Referral Management TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Provider Program Manager TriWest Healthcare Alliance

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