FULL_TIME

FEED

OTHER

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.

TriWest Healthcare Alliance

Senior Referral Specialist

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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

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

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

Lead 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

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

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

UNKNOWN

Scope of Responsibilities/Expectations: Collaborate closely with business stakeholders and the enterprise architecture team to translate business requirements into scalable technical solutions across Oracle EBS, CPQ, and Oracle Fusion Cloud applications. Coordinate closely with external vendors and internal business leads to ensure successful implementation, ongoing operations, and alignment of project deliverables.

YEAR

Motorola Solutions Inc

Fusion Technical Lead (US Remote)

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 Family Benefits Planner

ea_via_bold

Dodge Construction Network (Dodge) is seeking a Construction Information Specialist for our Midwest-South region that will be responsible for leading the acquisition, evaluation, and validation of high-value commercial construction project intelligence through strategic engagement with industry stakeholders, including contractors, construction managers, owners, architects, and public agencies. 5+ years of experience in the commercial construction industry, with deep knowledge of the construction ecosystem (contractors, owners, architects, subcontractors, project lifecycle, bid and award processes) and the ability to evaluate complex project information within a business context.

Dodge Construction Network

Construction Information Specialist (Midwest-South)

Provide decisions for UW and claims based on solid medical knowledge consistent with current guidelines, demonstrate ability to incorporate new medical knowledge into guideline updates and enhancements, includes advanced proficiency in ECG interpretation. In this role, you will integrate evidence-based medical knowledge with insurance principles to assess mortality and morbidity risk, influence underwriting decisions, evaluate claims, and shape forward-looking risk management strategies.

Securian Financial Group, Inc.

Medical Director (Remote)

Advise clients on SAP S/4HANA, SAP Cloud ERP Public Edition, SAP Cloud ERP Private Edition, RISE with SAP Methodology / Journey, SAP Business AI, Generative AI, Data & Analytics, Automation, and SAP BTP. We Are: Accenture's Commercial Client Success organization helps clients realize measurable business value from their investments by connecting strategy, sales, solutioning, and delivery.

Accenture Plc

SAP Solution Architect Manager

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 Benefits Advisor

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. We hire for • On-time follow-up • Clean video presence • Fast learning on tools • Respect for the client Apply now.

Remote Member Experience Representative

Hexagon's Manufacturing Intelligence business area delivers solutions that leverage data from design and engineering through production and metrology to help manufacturers make smarter, data-driven decisions and improve performance across the product lifecycle. Successful interns will gain hands-on experience in technical customer support, software applications, and product demonstrations, with the opportunity to transition into a full-time Application Engineer role after graduation.

Hexagon AB

Application Engineer Intern- Waukesha, WI, Services

Works closely with the Regional Sales Office, Implementation Manager, and internal support resources in order to develop an effective and efficient strategy and workflow for new and existing business. As the lead of a team of professionals, they will deliver on our promises, fully leverage the power of our service capabilities to exceed expectations and problem solve for custom client needs.

Matrix Absence Management, Inc.

National Client Executive Central Region

The Principal Technical Program Manager will own the strategy, definition, and roadmap across the following core areas, with an emphasis on the Computer Vision Platform: Platform Product Strategy & Roadmap: Define the vision, strategy and roadmap for the Computer Vision Platform, ensuring alignment with Motorola Solutions' overall product portfolio and strategic business goals. We are industry leaders in video security and analytics, with solutions deployed in more than 120 countries across diverse environments such as school campuses, transportation systems, healthcare centers, public venues, critical infrastructure, prisons, factories, casinos, airports, financial institutions, government facilities, and retailers.

Principal Technical Program Manager - Computer Vision

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 .

Remote Jobs in Racine, WI

Senior Referral Specialist TriWest Healthcare Alliance

Provider Program Manager TriWest Healthcare Alliance

Supervisor, Referral Management TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Lead Referral Specialist TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Manager, Case Management Special Programs TriWest Healthcare Alliance

Health Coach TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Fusion Technical Lead (US Remote) Motorola Solutions Inc

Remote Family Benefits Planner AO Garcia Agency

Construction Information Specialist (Midwest-South) Dodge Construction Network

Medical Director (Remote) Securian Financial Group, Inc.

SAP Solution Architect Manager Accenture Plc

Remote Benefits Advisor AO Garcia Agency

Remote Member Experience Representative AO Garcia Agency

Application Engineer Intern- Waukesha, WI, Services Hexagon AB

National Client Executive Central Region Matrix Absence Management, Inc.

Principal Technical Program Manager - Computer Vision Motorola Solutions Inc

Remote Member Services Specialist AO Garcia Agency

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