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

equestftpin

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

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

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

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. 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

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

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

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

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

UNKNOWN

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 Policyholder Services Representative

ea_via_bold

Solutions Consultant - SDDC will assist SHI's customers in the post-sales implementation of data center infrastructure automation initiatives (Software-Defined Data Center) as clients move towards modern data center solutions and private clouds. Ability to understand and manage various infrastructure components (firewalls, load balancers, hypervisors, storage, monitoring, security) and use orchestration tools to develop comprehensive technical solutions - Advanced.

YEAR

SHI GmbH

Sr. Solutions Consultant - SDDC

IRecruitee

In the event a recruiter or agency submits a resume or candidate without a previously signed agreement and approved engagement request with Brown and Caldwell, Brown and Caldwell reserves the right to pursue and hire those candidate(s) without any financial obligation to the recruiter or agency. We strive to be the company of choice-to our clients, who benefit from our passion for delivering exceptional quality, and to our employees, present and future, who share our commitment to client service, collaboration, and innovation.

Brown and Caldwell Inc

Project Analyst/Assistant

ADAPTED_NOW

For US based candidates only - The On Target Earnings (OTE, base salary + commissions) for this position ranges from $108,900 - $226,100/year; a candidate’s OTE is determined by various factors including, but not limited to, relevant work experience, skills, certifications and location. With the world's most distributed compute platform from cloud to edge we make it easy for customers to develop and run applications, while we keep experiences closer to users and threats farther away.

Akamai is the global leader in Content Delivery Network (CDN) services, making the Internet fast, reliable and secure for its customers. The company's advanced web performance, mobile performance, cloud security and media delivery solutions are revolutionizing how businesses optimize consumer, enterprise and entertainment experiences for any device, anywhere.

Akamai Technologies, Inc.

Senior Partner Solutions Engineer - US West

Akamai Technologies, Inc

The work • Take requested conversations — no cold lists • Explain benefit options simply • Help clients enroll when it is a fit • Keep a clean follow-up rhythm You get • Remote work • A written process so you are not inventing the job • Coaching from people who have done the work • A path into leadership if you produce You should apply if you are competitive, coachable, and comfortable on camera. 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.

Remote Client Experience 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.

Remote Family Services Coordinator

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.

We are searching for individuals with strong communication skills and customer service who are detail-oriented and like helping clients organize vacations, cruises, hotels, resorts, car rentals, theme park tickets, and a variety of other travel experiences. If you love working with people, enjoy idea of helping others plan memorable trips, have strong communication skills, and want the flexibility of a remote opportunity, we look forward to hearing from you.

Work From Home Jobs in Honolulu, HI

Supervisor, Utilization Management TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Senior Referral Specialist TriWest Healthcare Alliance

Healthcare Operations Specialist- HI TriWest Healthcare Alliance

Autism Care Demonstration Specialist TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Health Coach TriWest Healthcare Alliance

Business Analyst Sr TriWest Healthcare Alliance

Lead Referral Specialist TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Manager, Case Management Special Programs TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Remote Policyholder Services Representative AO Garcia Agency

Sr. Solutions Consultant - SDDC SHI GmbH

Project Analyst/Assistant Brown and Caldwell Inc

Senior Partner Solutions Engineer - US West Akamai Technologies, Inc.

Remote Client Experience Manager AO Garcia Agency

Remote Family Services Coordinator AO Garcia Agency

Data Engineer Sr. TriWest Healthcare Alliance

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