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.

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

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

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

UNKNOWN

Also, we are unable to accept substance abuse counselors, school counselors, registered nurses, career counselors, Christian counselors, and business coaches (unless they have an additional license as a mental health counselor). BetterHelp is one of the world's largest online therapy platforms for mental health professionals who want to focus on client care — not admin or overhead.

BetterHelp is the largest online counseling platform worldwide. We change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.

BetterHelp

Licensed Marriage and Family Therapist - Remote

GreenHouseAPI

Also, we are unable to accept substance abuse counselors, school counselors, registered nurses, career counselors, Christian counselors, and business coaches (unless they have an additional license as a mental health counselor). Competitive hourly compensation with an estimated range between $43 to $59 per hour for live sessions* Therapists can now earn up to 33% more per session for insurance clients.

HOUR

Licensed Clinical Social Worker- Remote

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

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 . 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

100% Remote Client Relations Advisor

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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

Licensed Professional Counselor - Remote

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

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.

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

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

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

Estimates are derived from modeled assumptions regarding the number of completed visits per hour, CPT code mix, and utilization of add-on codes (such as 90833) when clinically appropriate and properly documented. Competitive earning potential: Estimated effective hourly earnings of $119–$242 per hour *, based on modeled assumptions for a 60-minute period that may include patient visits and applicable CPT codes.

Psychiatrist (MD/DO)

Company: ClaimsPro LP - International Programs GroupProperty Claims Examiner - REMOTE - Little Rock, Arkansas, United States IPG works in the contiguous 48 states, Hawaii, and Puerto Rico handling a variety of claims including, but not limited to auto physical damage, inland marine cargo, dealers' open lot, property damage (commercial and homeowners) and general liability. Reporting to a Claims Supervisor, the Claims Examiner is responsible for investigating and settling property and first party claims and third-party claims, with an emphasis on strong communication and customer service, while utilizing state specific guidelines.

ClaimsPro LP

Property Claims Examiner - REMOTE - Little Rock, Arkansas, United States

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

Work From Home Jobs in Conway, AR

Supervisor, Utilization Management TriWest Healthcare Alliance

Data Engineer Sr. TriWest Healthcare Alliance

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Business Analyst Sr TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Manager, Case Management Special Programs TriWest Healthcare Alliance

Licensed Marriage and Family Therapist - Remote BetterHelp

Licensed Clinical Social Worker- Remote BetterHelp

Provider Program Manager TriWest Healthcare Alliance

100% Remote Client Relations Advisor AO Garcia Agency

Clinical Quality Support Specialist TriWest Healthcare Alliance

Licensed Professional Counselor - Remote BetterHelp

Supervisor, Referral Management TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Healthcare Operations Specialist- HI TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Health Coach TriWest Healthcare Alliance

Psychiatrist (MD/DO) BetterHelp

Property Claims Examiner - REMOTE - Little Rock, Arkansas, United States ClaimsPro LP

Remote Team Lead - Client Services AO Garcia Agency

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