FULL_TIME

FEED

OTHER

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.

TriWest Healthcare Alliance

Clinical Quality Support Specialist

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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

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.

Provider Program Manager

In support of TRICARE beneficiaries enrolled in the Autism Care Demonstration (ACD), the Autism Services Navigator (ASN) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services for TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD). • Current unrestricted licensure in an appropriate state or territory of the United States, as a Licensed Independent Clinical Social Worker (LICSW), Licensed Clinical Social Worker (LCSW), Registered Nurse, or other licensed mental health professionals who possess a Certification in Case Management (CCM).

Autism Services Navigator

The ACD Specialist lends administrative support to beneficiaries, clinical staff, and providers in support of the Autism Care Demonstration (ACD) The ACD is a benefit program for eligible TRICARE beneficiaries who have an Autism Spectrum Disorder (ASD) diagnosis, and provides a set of services not available under basic TRICARE benefits. Independent Thinking / Self-Initiative: Critical thinker with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without considerable direction and to find necessary resources.

Autism Care Demonstration Specialist

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.

Senior Referral 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

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

Lead Referral Specialist

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. This role spans many specialties such as Nutrition, Exercise Physiology, Clinical/Nursing, Respiratory Therapy, Counseling and Pharmacy and will spend time addressing individual health and lifestyle concerns of our beneficiaries.

Health Coach

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.

Supervisor, Utilization Management

UNKNOWN

Daily work • Speak with people who asked for information • Map needs to available protection options • Run a simple enrollment flow • Build and service a client list Provided • Pre-qualified warm leads • Step-by-step onboarding • Remote tools • Flexible hours • Ongoing mentorship Good fit Self-starters who like helping families and can handle a performance environment. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information.

AO Garcia Agency

Remote Client Benefits Consultant

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. What comes with the seat • No cold calling • Qualified-interest pipeline • Performance-based advancement • Full training • Current tech stack • Work from home Traits that work here Driven.

Remote Appointment Setter

To verify education is being used to meet and/or support the required minimum qualifications/competencies, you must fill in the Education section of the application If you have not obtained a degree, please indicate the number of units completed Copies of transcripts are required to verify educational credentials used to meet or support the minimum qualifications/competencies for a position and are required with each application (Unofficial is okay; please ensure the institution/URL name is listed on the transcripts) Transcripts can be attached at the time of application or provided at the time of interview; if not, transcripts will be required before employment. If you have currently or previously been appointed to a flexibly staffed position, please ensure your work experience within a flexibly staffed position indicates the actual dates employed at each level Ensure your time and any subsequent flex promotion(s) are documented as a separate position This is required as minimum qualifications require experience at a particular level in which the lower level may not be considered If this information is not accurately reflected in your application, this may cause the processing of your application for consideration to be delayed.

HOUR

State of Alaska

Education Associate 3 (PCN 051668)

If utilizing this education you must show that the education credentials have been submitted to a private organization that specializes in interpretation of foreign educational credentials and that such education has been deemed to be at least equivalent to that gained in conventional U.S. education programs; or an accredited U.S. state university reports the other institution as one whose transcript is given full value, or full value is given in subject areas applicable to the curricula at the state university. [Please rate your level of proficiency in Oral and Written Communication: Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral and written presentations; listens to others, attends to nonverbal cues, and responds appropriately.

Administrative Officer 1 (PCN 250494)

The required experience includes work such as Oil and Gas Auditor 4 or a Corporate Income Tax Auditor 4. Special Note: "Professional experience" means work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the professions principles, concepts, theories, and practices; and is performed with the power or right to decide or act according to ones own judgment. If utilizing this education, you must show that the education credentials have been submitted to a private organization that specializes in the interpretation of foreign educational credentials and that such education has been deemed to be at least equivalent to that gained in conventional U.S. education programs or an accredited U.S. state university reports the other institution as one whose transcript is given full value, or full value is given in subject areas applicable to the curricula at the state university.

Revenue Appeals Officer 1/2 (PCN 048045)

Professionalism is defined by its key behaviors including being accountable for actions and assigned projects; practicing efficient work habits to effectively manage time and workload; clearly communicating and expressing thoughts and ideas in writing and in person; possessing the ability to understand how non-verbal communication impacts the workplace; working effectively as part of a team to achieve productive outcomes; and consistently demonstrating, emotional intelligence, integrity, and ethical behavior. If utilizing this education, you must show that the education credentials have been submitted to a private organization that specializes in the interpretation of foreign educational credentials and that such education has been deemed to be at least equivalent to that gained in conventional U.S. education programs or an accredited U.S. state university reports the other institution as one whose transcript is given full value, or full value is given in subject areas applicable to the curricula at the state university.

Tax Auditor 4 (Lead Auditor PCN 043266M)

This leader will report to the Manager of Case Management Special Programs under the overall Case Management Special Programs umbrella, specifically supporting TRICARE beneficiaries seeking benefits under Extended Care Health Option (ECHO) and Autism Care Demonstration (ACD). Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues, tactics, and strategies.

Remote Jobs in Anchorage, AK

Clinical Quality Support Specialist TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Manager, Case Management Special Programs TriWest Healthcare Alliance

Provider Program Manager TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Autism Care Demonstration Specialist TriWest Healthcare Alliance

Senior Referral Specialist TriWest Healthcare Alliance

Healthcare Operations Specialist- HI TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Lead Referral Specialist TriWest Healthcare Alliance

Health Coach TriWest Healthcare Alliance

Supervisor, Utilization Management TriWest Healthcare Alliance

Remote Client Benefits Consultant AO Garcia Agency

Remote Appointment Setter AO Garcia Agency

Education Associate 3 (PCN 051668) State of Alaska

Administrative Officer 1 (PCN 250494) State of Alaska

Revenue Appeals Officer 1/2 (PCN 048045) State of Alaska

Tax Auditor 4 (Lead Auditor PCN 043266M) State of Alaska

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Education Specialist 2 (PCN 057730 & 057732) State of Alaska

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