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

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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.

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

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

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

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

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: 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

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

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

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

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

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

UNKNOWN

OneSignal is looking for a detail-oriented Billing Operations Consultant to support our Finance team with day-to-day billing, accounts receivable, commission administration, and other operational tasks. The ideal candidate has experience in SaaS billing operations, is comfortable working with subscription and usage-based billing models, and can manage recurring responsibilities independently.

HOUR

Lilomi Inc

Billings Operations Consultant

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 Leadership Development Associate

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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. Requirements • Communication that is clear and human • Discipline without a supervisor in the hallway • Openness to a proven process • Interest in benefits conversations, not just “sales energy” Apply today.

Remote Family Benefits Representative

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

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.

Work From Home Jobs in Billings, MT

Supervisor, Utilization Management TriWest Healthcare Alliance

Data Engineer Sr. TriWest Healthcare Alliance

Autism Care Demonstration Specialist TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Business Analyst Sr TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Lead Referral Specialist TriWest Healthcare Alliance

Supervisor, Referral Management TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Manager, Case Management Special Programs TriWest Healthcare Alliance

Senior Referral Specialist TriWest Healthcare Alliance

Healthcare Operations Specialist- HI TriWest Healthcare Alliance

Provider Program Manager TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Health Coach TriWest Healthcare Alliance

Billings Operations Consultant Lilomi Inc

Remote Leadership Development Associate AO Garcia Agency

Remote Family Benefits Representative AO Garcia Agency

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

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