FULL_TIME

FEED

OTHER

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.

TriWest Healthcare Alliance

Direct Contracting Manager

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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

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

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

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

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)

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

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

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

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

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

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

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

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.

UNKNOWN

Collaborate effectively across GSK's highly matrixed sales organization, partnering closely with Organized Provider Account Directors, Reimbursement Managers, and other cross-functional stakeholders to drive aligned execution and business success. This role engages Infectious Disease physicians, as well as hospitalists, pharmacists, case management teams, discharge planners, as well as key decision makers of IDNs (CMO, Pharmacy Directors, P&T Committee members) as needed, to drive sales.

GSK, Plc.

Hospital Senior Account Manager, Anti-Infectives - Phoenix, AZ / El Paso, TX

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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 Originator - Remote

If you are a data entry clerk, administrative assistant, receptionist, warehouse or factory worker, driver, medical assistant, nurse, call centre employee or anyone who is looking for a flexible part time remote work from home job, this is a great position to supplement your income. We need participants on the following topics: Child Related (individuals with children 18 yrs or younger).

Apex Focus Group

Remote Research Panel Assistant - Up to $750/Week

IRecruitee

In this 100% work-from-home role, you will assist clients with travel-related questions, provide trip support, and ensure a smooth, stress-free experience from start to finish. This position is ideal for someone who enjoys helping people, is highly organized, and is excited about working remotely in the travel industry.

Almaaventurera

Remote Travel Customer Representative

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In this fully remote role, you will serve as a key point of contact for travelers, providing support before, during, and after their trips to ensure a smooth and positive experience. This role is ideal for someone with strong customer service skills who enjoys helping others, staying organized, and working independently in a remote environment.

Work From Home Jobs in Rio Rancho, NM

Direct Contracting Manager TriWest Healthcare Alliance

Senior Human Capital Generalist TriWest Healthcare Alliance

Customer Service Rep TriWest Healthcare Alliance

Supervisor, Utilization Management TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

Healthcare Counsel TriWest Healthcare Alliance

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

Assoc Gen Counsel - Healthcare TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

TRICARE Customer Service Rep TriWest Healthcare Alliance

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

Case Manager TriWest Healthcare Alliance

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

Dir, Provider Network Strategy TriWest Healthcare Alliance

Data Engineer Sr. TriWest Healthcare Alliance

Hospital Senior Account Manager, Anti-Infectives - Phoenix, AZ / El Paso, TX GSK, Plc.

Licensed Mortgage Loan Originator - Remote Amerisave Mortgage

Remote Research Panel Assistant - Up to $750/Week Apex Focus Group

Remote Travel Customer Representative Almaaventurera

Remote Client Support Representative Almaaventurera

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