FULL_TIME

FEED

OTHER

Complies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).

TriWest Healthcare Alliance

Program Integrity Investigator

equestftpin

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

Bachelor's degree in Business, Engineering, Communications, or a related technical discipline and a minimum of 10 years of successful sales leadership experience in unmanned systems, tactical or public safety communications, C4ISR, electronic warfare, or defense/public safety technology; or Associate's degree with a minimum of 12 years; or High School Diploma/GED with a minimum of 14 years. In this key leadership role, you will lead a high-performing team of Sales Directors responsible for driving B2B "design-win" revenue across major defense primes, uncrewed system manufacturers (UAS, UGV, USV, loitering munitions), systems integrators, and C-UAS platform builders.

YEAR

Motorola Solutions Inc

Senior Sales Director, Original Equipment Manufacturer (OEM) & Defense Primes

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. Bring • Communication skill • Self-management • Team habits • A spine — integrity is not optional .

AO Garcia Agency

Remote Member Services Specialist

Remote Insurance Enrollment Representative

Remote Client Consultation Specialist

Maxion Research invites people in Honolulu, HI to join an online research panel and be considered for optional surveys, interviews, focus groups, and product-feedback studies. Research activities may include completing online questionnaires, joining remote discussions, testing concepts, or sharing opinions about products and services.

Maxion Corp

Online Research Panel Participant - Honolulu, HI

ea_via_bold

This person will build the market from the front: serving as the technical voice in design meetings, the problem-solver on job sites, and the relationship every building owner and contractor remembers for future projects. We are looking for an engineer or technical salesperson in the MEP world who wants to move out of the office and into a career combining technical work, sales, and business development.

the job This

Territory Manager - Hawaii & Guam

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. You are paired with a growing team, given tools and mentorship, and expected to enroll and support clients who asked for guidance.

Virtual - Member Care Representative

This role is responsible for influencing capability requirements, strengthening advocacy within major modernization and advanced battle management programs, and driving long-term strategic engagement across AFLCMC, Space Systems Command, operational wings, and mission partners, while also providing supervisory responsibility overseeing the strategic program pursuits of the USAF BD Director. From pure line-of-sight to extreme non-line-of-sight, Silvus radios form a self-healing, self-forming mesh network, enabling secure and reliable connectivity, including video and high-bandwidth data.

Market Development Executive, United States Air Force & Space Force

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: 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

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.

Lead Referral 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

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

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

Referral Specialist

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.

Remote Jobs in Hawaii

Program Integrity Investigator TriWest Healthcare Alliance

Direct Contracting Manager TriWest Healthcare Alliance

Senior Sales Director, Original Equipment Manufacturer (OEM) & Defense Primes Motorola Solutions Inc

Remote Member Services Specialist AO Garcia Agency

Remote Insurance Enrollment Representative AO Garcia Agency

Remote Client Consultation Specialist AO Garcia Agency

Online Research Panel Participant - Honolulu, HI Maxion Corp

Territory Manager - Hawaii & Guam the job This

Virtual - Member Care Representative AO Garcia Agency

Market Development Executive, United States Air Force & Space Force Motorola Solutions Inc

Business Analyst Sr TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Lead Referral 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

Autism Care Demonstration Specialist TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Supervisor, Referral Management TriWest Healthcare Alliance

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