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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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

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

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

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: In-depth knowledge of all application functionality, security, development, and system administration; knowledge of relevant technology, tools and middleware; proficient change agent; knowledge of the agile methodology and software maintenance and support. • Develops and maintains ongoing relationships with hardware, software, consultant, and employee resource vendors to insure that TriWest systems are adequately supported and external opportunities are understood and considered in the planning process.

Manager, Data Engineering (Master Data Management) MDM

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.

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

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

Develop compelling proposal content that clearly articulates TriWest's unique capabilities, market expertise, provider relationships, analytical capabilities, and demonstrated ability to build and maintain networks that meet complex customer requirements. The Director of Network Strategy is responsible for developing and executing TriWest's enterprise strategy for network adequacy and network optimization across its VA Community Care Network (CCN) and TRICARE programs.

Dir, Provider Network Strategy

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

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

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

The Training Specialist is responsible for delivering high-quality training programs to TriWest employees and external stakeholders, including beneficiaries, Providers, and DHA employees. • Assist with training department-specific needs, including compliance with the department policies and procedures, maintaining required training documentation, participating in process improvement meetings, and other duties as appropriate and requested.

Training Specialist

UNKNOWN

This role works closely with executive leadership andhiring managers to understand business needs, develop effective hiring strategies, and deliver high-quality candidates who support both immediate and long-term organizational goals. This role is responsible for proactively identifying and engaging both active and passive candidates, building strong talent pipelines, and providing market insights that help leaders make informed hiring decisions.

YEAR

Clean Energy & Infrastructure Services

Executive Recruiter, Corporate

IRecruitee

In addition, candidate introductions or resumes can only be submitted to our internal talent acquisition recruiting team if a signed vendor agreement is already on file and the third-party recruiter or agency has received formal instructions from our internal talent acquisition team to submit candidates for a particular job posting. SOLV Energy is a leading provider of infrastructure services to the power industry, designing, building and maintaining utility scale solar, battery storage and high voltage substation projects nationwide.

SOLV Energy LLC

Senior Wage Compliance Specialist (Remote)

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Business Operations Coordinator (Remote)

In addition, candidate introductions or resumes can only be submitted to our internal talent acquisition recruiting team if a signed vendor agreement is already on file and the third-party recruiter or agency has received formal instructions from our internal talent acquisition team to submit candidates for a particular job posting. Job Description Summary: We are seeking an experienced and dynamic Business Development Account Manager to lead our pursuit and acquisition of EPC (Engineer, Procure, Construct) contracts for utility-scale solar and energy storage projects across the United States.

Business Development Account Manager (Remote)

Represent Testing & Commissioning during EPC contract reviews focused on commissioning and quality exhibits, specifications, owner requirements, SOW, and vendor scopes to identify commissioning obligations, deliverables, acceptance criteria, milestones, and interfaces. Drive and own Commissioning exhibit during contract negotiation process and review commissioning exhibits, scope language, assumptions, clarifications, and exclusions; coordinate proposed revisions and resolution of conflicting or incomplete requirements with Business Development, the SOLV Preconstruction team, Project Management, and Contracts/Legal.

Senior Commissioning Manager Preconstruction (Remote)

This role focuses on working closely with Project engineering team on engineering design deliverables, track both internal and external design comments, RFI management, assist engineering team in finalizing Bill of Materials and overall project document management. In addition, candidate introductions or resumes can only be submitted to our internal talent acquisition recruiting team if a signed vendor agreement is already on file and the third-party recruiter or agency has received formal instructions from our internal talent acquisition team to submit candidates for a particular job posting.

Work From Home Jobs in Fargo, ND

Supervisor, Utilization Management TriWest Healthcare Alliance

TRICARE Customer Service Rep TriWest Healthcare Alliance

Program Integrity Investigator TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

Direct Contracting Manager TriWest Healthcare Alliance

Manager, Data Engineering (Master Data Management) MDM TriWest Healthcare Alliance

Data Engineer Sr. TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Customer Service Rep TriWest Healthcare Alliance

Dir, Provider Network Strategy TriWest Healthcare Alliance

Assoc Gen Counsel - Healthcare TriWest Healthcare Alliance

Case Manager TriWest Healthcare Alliance

Healthcare Counsel TriWest Healthcare Alliance

Training Specialist TriWest Healthcare Alliance

Executive Recruiter, Corporate Clean Energy & Infrastructure Services

Senior Wage Compliance Specialist (Remote) SOLV Energy LLC

Business Operations Coordinator (Remote) SOLV Energy LLC

Business Development Account Manager (Remote) SOLV Energy LLC

Senior Commissioning Manager Preconstruction (Remote) SOLV Energy LLC

Energy Storage Preconstruction Project Engineer (Remote) SOLV Energy LLC

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