FULL_TIME

FEED

OTHER

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.

TriWest Healthcare Alliance

TRICARE Customer Service Rep

equestftpin

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

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

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

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

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

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

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

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

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

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

Lead Referral Specialist

UNKNOWN

With our proprietary Ultrasound-on-Chip technology, we're democratizing healthcare by shifting ultrasound from the expensive, stationary systems of the past to the connected, mobile, and software-enabled platforms of today. Immediately reporting any suspected or actual security incidents, including phishing attempts, malware infections, or unauthorized access, following the established incident response procedure.

Butterfly Network

Regional Vice President I, Sales - Southeast

GreenHouseAPI

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. 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

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

We work with independent agents across the US who are building their own books of business through a system that is already proven and already in motion. Warm inbound leads system in place — you talk to people who already raised their hand for coverage, so there is no cold calling.

GIA Legacy Planning

Licensed Insurance Agent - Remote

Teamtailor

Ability to perform the physical aspects of the role, including extending and reaching with hands and arms, using hands and fingers to handle, squeeze, twist and manipulate objects, controls and tools; plus occasionally climbing, balancing, bending, stooping, kneeling or crouching; and lifting, moving, and carrying up to 60 pounds. An innovation leader in every industry we serve since 1983, our team members help pet owners worldwide keep their companion animals healthy and happy, ensure safe drinking water for billions, and help farmers protect livestock and poultry from disease.

Work From Home Jobs in Mount Pleasant, SC

TRICARE Customer Service Rep TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

Program Integrity Investigator TriWest Healthcare Alliance

Supervisor, Referral Management TriWest Healthcare Alliance

Director, Population Health TriWest Healthcare Alliance

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Direct Contracting Manager TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Healthcare Operations Specialist- HI TriWest Healthcare Alliance

Provider Program Manager TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Lead Referral Specialist TriWest Healthcare Alliance

Regional Vice President I, Sales - Southeast Butterfly Network

PH Communications Specialist TriWest Healthcare Alliance

Business Analyst Sr TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Manager, Case Management Special Programs TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Licensed Insurance Agent - Remote GIA Legacy Planning

Field Support Representative Diagnostic Imaging Southeast Idexx

Similar Job Searches

Stand out to leading employers.