FULL_TIME

FEED

OTHER

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.

TriWest Healthcare Alliance

Director, Population Health

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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

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

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

Coordinate with survey field crews, project managers, and engineers to support timely delivery of mapping products. The successful candidate will produce high-quality drawings in support of pipeline survey and engineering deliverables.

HOUR

MAVRX LLC

Drafter / Mapper

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

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

Your level of success will be determined by several factors, including the amount of work you put in, your ability to successfully follow and implement our training and sales system and engage with our lead system, and the insurance needs of the customers in the geographic areas in which you choose to work. By submitting this form, you agree to recurring contact from Symmetry Financial Group LLC and its affiliated companies under common control and their insurance agents via text & live, automated, A.I., or prerecorded calls, including for marketing or recruiting purposes.

The Gray Agency

Remote Insurance Agent (Licensed or Unlicensed)

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Functions on TriWest standing and ad hoc committees as a representative of the Legal department including, but not limited to, committees responsible for TriWest's peer review, quality, and credentialing programs. • Experience advising managed care administrators, health plans, or healthcare providers, • Familiarity with HIPAA, False Claims Act, Stark, Anti-Kickback and other healthcare-related laws & regulations.

Assoc Gen Counsel - Healthcare

Accurately assesses caller requests, answers caller inquires and processes requests while focusing on first call resolution and/or appropriate call escalation protocols. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Customer Service Rep

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.

Transition of Care Coordinator RN/LCSW

Technical Skills: Advanced collaboration, listening, consulting, and conflict resolution skills; experience conducting investigations; in-depth knowledge of TriWest Human Capital policies and procedures; knowledge of Human Resources management concepts; Federal, state, and local employment law; ability to maintain the confidentiality of information and maintain safeguards; presentation skills. Coaches leaders on Triest Human Capital policies and procedures, including employee relations, leadership development, exit interviews, turnover analysis, performance appraisal system, leadership training, and investigations.

Senior Human Capital Generalist

TriWest will prioritize candidates with experience with healthcare regulatory matters, including Medicare and Medicaid and conditions of participation in federal healthcare programs, anti-kickback laws, self-referral laws, HIPAA, and transactional matters for health care providers. Supports the Office of General Counsel in advising and producing attorney work products that support TriWest's healthcare-related departments including, but not limited to, Provider Services, Medical Management, Program Integrity, and Claims.

Healthcare Counsel

Functions as an advocate for the beneficiary by ensuring access to necessary care and maintaining Beneficiary's safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process. Independent Thinking / Self-Initiative: Resourceful critical thinker who is able to prioritize tasks essential to achieving desires outcomes, demonstration a proactive commitment to task completion and the ability to identify and secure necessary resources.

Case Manager

At Touching Hearts At Home Denver , our aides are more than task-takers—they’re trusted partners in each client’s well-being. Personalized Daily Living Assistance – Safely transfer clients, support bathing/grooming, and help with mobility devices.

Touching Hearts At Home Denver

Home Care Aide

We work with independent agents across Houston and all of Texas who are building their own books of business through a system that is already proven and already in motion. It is an independent contractor opportunity where your results are a direct reflection of your effort, your consistency, and your willingness to follow a system that works.

GIA Legacy Planning

Life Insurance Agent- Remote

Teamtailor

If this role is defined as Safety-Sensitive (involving risk of injury or harm to the general public), be aware that subsequent Random Testing and Post-Accident Testing will be conditions of continued employment. This role provides deep, hands-on partnership with operating unit leadership on financial modeling, forecasting, reporting, and strategic decision-making, while staying closely integrated with corporate FP&A processes and consolidated reporting.

YEAR

Vero Networks

FP&A Analyst

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Executive Presentations & Technical Advocacy: Review, refine, and occasionally deliver high-impact technical presentation materials regarding complex system designs to customers, pre-sale, and post-sale engineering leadership. The Manager of Regional MCN Deployments NSA Team - Network Practice Office (NPO) provides leadership, strategic direction, and technical oversight to a team of regional Network Solutions Architects (NSAs).

Motorola Solutions Inc

Manager of Regional MCN Deployments NSA Team - Network Practice Office (NPO)

Works closely with: the Business Systems Manager, Data Architect, Program Manager and Program Director, system integrator engagement leadership, Global Process Owners and Business Owners, Finance and Compliance, ERP administration and integration engineers, and third-party vendors. You will hold end-to-end responsibility for the reports, interfaces, customizations, enhancements & extensions, and forms delivered on the PMS side, for the provisioning and readiness of every Infor application and environment, and for the user access model that governs them.

Particle Measuring Systems Inc

Technical Delivery Architect

You'll help travelers turn their ideas into organized trip plans by researching options, coordinating travel details, maintaining reservation information, and communicating with clients throughout the planning process. Individuals participating in this opportunity have access to resources designed to help them learn and develop within the travel business, including: Remote work capabilities.

Work From Home Jobs in Commerce City, CO

Director, Population Health TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Direct Contracting Manager TriWest Healthcare Alliance

Supervisor, Utilization Management TriWest Healthcare Alliance

Drafter / Mapper MAVRX LLC

Program Integrity Investigator TriWest Healthcare Alliance

TRICARE Customer Service Rep TriWest Healthcare Alliance

Remote Insurance Agent (Licensed or Unlicensed) The Gray Agency

Assoc Gen Counsel - Healthcare TriWest Healthcare Alliance

Customer Service Rep TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

Senior Human Capital Generalist TriWest Healthcare Alliance

Healthcare Counsel TriWest Healthcare Alliance

Case Manager TriWest Healthcare Alliance

Home Care Aide Touching Hearts At Home Denver

Life Insurance Agent- Remote GIA Legacy Planning

FP&A Analyst Vero Networks

Manager of Regional MCN Deployments NSA Team - Network Practice Office (NPO) Motorola Solutions Inc

Technical Delivery Architect Particle Measuring Systems Inc

Remote Travel Planning & Client Services — Independent Opportunity Travelingwithmariah

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