FULL_TIME

FEED

OTHER

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.

TriWest Healthcare Alliance

Customer Service Rep

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4 years of experience with scheduling software, workforce management software or equivalent, and telephony systems, or 2 years of TriWest experience as a Workforce or Performance Reporting Analyst or Contact Center Supervisor with scheduling software, workforce management software or equivalent, and telephony systems. 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.

Workforce Analyst Sr - TRICARE

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

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

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

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

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

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.

Director, Population Health

UNKNOWN

As an Account Manager for Keiko Pacheco - State Farm Agent, you are vital to our daily business operations and customers’ success. You help grow our agency through meaningful customer relations and acting as a liaison between customer needs and agent office departments.

Keiko Pacheco - State Farm Agent

Account Manager - State Farm Agent Team Member

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

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

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

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

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: 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

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

Experience in case management, care coordination or discharge planning in an acute, ambulatory or specialty disease management program settings in a healthcare system or managed care organization (MCO). The DM nurse will partner with the interdisciplinary care team to identify appropriate care to prevent complications related to chronic conditions and minimize the risk of potential exacerbation through the use of evidence-based condition-specific education and coaching.

RN Disease Manager (Behavioral Health Experience Required)

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

AmeriSave offers top-tier tech, aggressive commissions, and the ability to delight your clients with our streamlined processes and speedy turn times. Why AmeriSave: As one of the top-rated lenders in the nation, our mission is to deliver beneficial, responsible home and personal lending solutions with unwavering integrity, dedication and excellence.

HOUR

Amerisave Mortgage

Licensed Mortgage Loan Officer - Remote

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The role includes preferred drug list (PDL) implementation and maintenance activities, pharmacy reporting, management of state pharmacy relationship, active engagement at pharmacy related meetings with internal and external stakeholders as the pharmacy subject matter expert, key contact for pharmacy to internal and external stakeholders, developing and executing pharmacy strategy, ensuring pharmacy benefit compliance, communicating pharmacy trends and value proposition, developing and executing on affordability initiatives, supporting clinical and quality initiatives. Position is Plan Pharmacy Director, a dedicated resource and key staff of the UnitedHealthcare Community Plan of Hawaii health plan; that is accountable for setting the strategic direction, operational execution, oversight and financial impact analysis of pharmacy program priorities for the health plan.

YEAR

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.

What we do

Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.

<a href="https://www.youtube.com/watch?v=5PbNyi2IDkY">https://www.youtube.com/watch?v=5PbNyi2IDkY</a> 

Caring. Connecting. Growing together. 

Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. <a href="https://careers.unitedhealthgroup.com/culture/what-we-offer/">Learn more about what we offer.</a> 

• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. <a href="https://careers.unitedhealthgroup.com/culture/">Learn more about our culture.</a> 

• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. <a href="https://careers.unitedhealthgroup.com/career-areas/">Discover all the ways you can learn, grow and develop.</a>

Work From Home Jobs in Kapolei, HI

Customer Service Rep TriWest Healthcare Alliance

Workforce Analyst Sr - TRICARE TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Healthcare Counsel TriWest Healthcare Alliance

TRICARE Customer Service Rep TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Program Integrity Investigator TriWest Healthcare Alliance

Director, Population Health TriWest Healthcare Alliance

Account Manager - State Farm Agent Team Member Keiko Pacheco - State Farm Agent

Assoc Gen Counsel - Healthcare TriWest Healthcare Alliance

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Senior Human Capital Generalist TriWest Healthcare Alliance

Dir, Provider Network Strategy TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

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

Case Manager TriWest Healthcare Alliance

RN Disease Manager (Behavioral Health Experience Required) TriWest Healthcare Alliance

Training Specialist TriWest Healthcare Alliance

Licensed Mortgage Loan Officer - Remote Amerisave Mortgage

Account Consultant Pharmacist - Remote In HI Only UnitedHealth Group Inc.

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