UNKNOWN

FEED

Abide by Administrative Expectations as defined by AMR SOPs: Submit expense reports regularly as outlined, enter sales calls in CRM system daily or as indicated by Regional Sales Director, enter company car mileage weekly, maintain company car as required by Fleet Maintenance. · Strategically identify and develop relationships with non-prescribing health care providers that influence decision making in accounts such as CEOs, CFOs, Nurse Navigators, injecting nurses, Medical Assistants, office managers and personnel, etc.

Tolmar Careers

Account Manager Urology/Oncology - (Remote In Territory)

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

AO Garcia Agency

Entry-Level Remote Financial Services Associate

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 Client Consultation Specialist

FULL_TIME

OTHER

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.

TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW

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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

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

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 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

The Director, HS Utilities leads health and safety programs for the company's utility-sector operations, including synthetic gypsum and fly ash processing and other byproduct handling and beneficial-reuse facilities, distinguishing this scope from the cement plant operations covered by the Director, HS Operations roles. This position is a peer to the Director, HS Operations positions within the Health & Safety organization, and is accountable for the day-to-day execution of safety programs at utility and byproduct-handling sites, leading a team of Safety Specialists and Safety Coordinators who provide site-level training, auditing, and incident response support.

Eco Materials

Director - Health & Safety - Remote

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

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

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: Strong knowledge of data warehouse design; data modeling; proficiency with SQL; strong experience with data extraction, transformation, and loading (ETL); working knowledge of report and dashboard development; strong knowledge of SQL Server / Snowflake databases; working knowledge of Oracle databases. • Bachelor's Degree in Business Administration, Computer Science, Mathematics, Engineering, or related field with programming and database systems coursework or equivalent database development experience.

Data Engineer Sr.

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

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

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).

Program Integrity Investigator

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.

Sup, Case Mgmt Sp Prgms Ops

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

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.

Work From Home Jobs in Belton, MO

Account Manager Urology/Oncology - (Remote In Territory) Tolmar Careers

Entry-Level Remote Financial Services Associate AO Garcia Agency

Remote Client Consultation Specialist AO Garcia Agency

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

Direct Contracting Manager TriWest Healthcare Alliance

TRICARE Customer Service Rep TriWest Healthcare Alliance

Director, Population Health TriWest Healthcare Alliance

Lead Referral Specialist TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Director - Health & Safety - Remote Eco Materials

Healthcare Operations Specialist- HI TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Business Analyst Sr TriWest Healthcare Alliance

Data Engineer Sr. TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Supervisor, Utilization Management TriWest Healthcare Alliance

Program Integrity Investigator TriWest Healthcare Alliance

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Autism Care Demonstration Specialist TriWest Healthcare Alliance

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