UNKNOWN

FEED

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. You are paired with a growing team, given tools and mentorship, and expected to enroll and support clients who asked for guidance.

AO Garcia Agency

100% Remote Client Relations Specialist

ea_via_bold

FULL_TIME

OTHER

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).

TriWest Healthcare Alliance

Program Integrity Investigator

equestftpin

This role drives process simplification, oversees integration of financial and technology frameworks, and partners with stakeholders to deliver clear, efficient, and scalable allocation solutions. The Director, Financial Reporting & Allocation Strategy leads the enterprise-wide allocation strategy, ensuring transparency, accuracy, and compliance across management and legal entities.

YEAR

Reinsurance Group of America Inc

Director, Expense Allocation & Legal Entity Reporting (open to remote)

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: Knowledge of and/or experience with Adobe Creative Suite (Photoshop, Illustrator, and Acrobat) as well as Microsoft Office; Extensive knowledge of hand-coding HTML, CSS, JavaScript (including jQuery), NET (C#); Extensive knowledge of developing and testing Section 508 compliance, Knowledge of web design editing software including Microsoft Visual Studio and Adobe Dreamweaver; Proficient in PC operating systems. Consults with Communications and IT staff on architecture issues as required; consults with client departments on project issues and offers training to departments as needed to help ensure TriWest's policy on 508 compliance is enforced.

Front-End Web Developer

MCI organically grows, acquires, and operates companies that have synergistic products and services portfolios, including but not limited to Automated Contact Center Solutions (ACCS), customer contact management, IT Services (IT Schedule 70), and Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse North American client partners across the following MCI brands: MCI BPO, MCI BPOaaS, MarketForce, GravisApps, Gravis Marketing, MarchEast, Mass Markets, MCI Federal Services (MFS), OnBrand24, The Sydney Call Center, Valor Intelligent Processing (VIP), BYC Aqua, EastWest BPO, TeleTechnology, and Vinculum.

MCI LC

Full Time Call Center Representative (Urgently Hiring)

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

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 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: 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

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

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

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

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

Works closely with the Regional Sales Office, Implementation Manager, and internal support resources in order to develop an effective and efficient strategy and workflow for new and existing business. As the lead of a team of professionals, they will deliver on our promises, fully leverage the power of our service capabilities to exceed expectations and problem solve for custom client needs.

Matrix Absence Management, Inc.

National Client Executive Central Region

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

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

Lead Referral Specialist

Senior 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.

Work From Home Jobs in Menomonee Falls, WI

100% Remote Client Relations Specialist AO Garcia Agency

Program Integrity Investigator TriWest Healthcare Alliance

Director, Expense Allocation & Legal Entity Reporting (open to remote) Reinsurance Group of America Inc

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

Front-End Web Developer TriWest Healthcare Alliance

Full Time Call Center Representative (Urgently Hiring) MCI LC

Health Coach TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Supervisor, Utilization Management TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Senior Human Capital Generalist TriWest Healthcare Alliance

National Client Executive Central Region Matrix Absence Management, Inc.

Director, Population Health TriWest Healthcare Alliance

Direct Contracting Manager TriWest Healthcare Alliance

Lead Referral Specialist TriWest Healthcare Alliance

Senior Referral Specialist TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Similar Job Searches

Stand out to leading employers.