FULL_TIME

FEED

OTHER

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.

TriWest Healthcare Alliance

Director, Population Health

equestftpin

UNKNOWN

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.

YEAR

Matrix Absence Management, Inc.

National Client Executive Central Region

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

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

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

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

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

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

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

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

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

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.

Manager, Referral Management

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

Senior Building Mechanical Engineer (HVAC) - Water / Wastewater

Provide decisions for UW and claims based on solid medical knowledge consistent with current guidelines, demonstrate ability to incorporate new medical knowledge into guideline updates and enhancements, includes advanced proficiency in ECG interpretation. In this role, you will integrate evidence-based medical knowledge with insurance principles to assess mortality and morbidity risk, influence underwriting decisions, evaluate claims, and shape forward-looking risk management strategies.

Securian Financial Group, Inc.

Medical Director (Remote)

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. We hire for • On-time follow-up • Clean video presence • Fast learning on tools • Respect for the client Apply now.

AO Garcia Agency

Remote Member Experience Representative

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Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic. Preferred Certification/Licensure(s): Certification in coding and/or healthcare compliance strongly preferred (RHIA, RHIT, CPC, CCS-P, CHC).

Medical College of Wisconsin

Manager II Coding Practice Services

Plans and coordinates end-to-end testing across directly and indirectly integrated solutions, ensuring test plans, test cases, results, defects, and approvals are properly completed and documented. Serves as a subject-matter expert and trusted advisor for SAP Sales and Distribution, Order-to-Cash processes, pricing, payment card solutions, EDI, and third-party ordering integrations.

Ideas and ideals. That's life at Toro. Be a part of a company that delivers a surprising array of products for markets around the globe. You play a role to help customers make the outdoors more beautiful and functional…from the world's top golf courses, Super Bowl stadiums, public venues like Walt Disney World® and the Indianapolis Motor Speedway®, beautiful mountainous vineyards…all the way to some of the best-looking yards in your own neighborhood. Watch your ideas grow in a place where you can put down roots…with a culture founded on lasting values that guide how we treat one another and our customers. At The Toro Company, you'll find a world of opportunities to work hard and contribute your best. And the freedom to take time for the people and pursuits that make life richer. Contribute your ideas and share our ideals. That's life at Toro. Headquartered in Bloomington, MN, The Toro Company (<a href="http://phx.corporate-ir.net/phoenix.z ?c=62289&p=irol-irhome" target="_blank">TTC</a>) delivers innovation around the globe through a surprising array of products. For nearly 100 years, our ideas have transformed the way professionals and homeowners create beautiful outdoor environments. An excellent reputation, strong brands, ethical business practices, and a culture founded on trust and respect are ideals shared by our employees. With annual revenue of approximately $1.8 billion, Toro consistently delivers strong financial performance and market leadership. More than 4,400 global employees form a strong community with a world of opportunities to learn and contribute. We are proud to be an Equal Opportunity Employer.

The Toro Company

Lead Business Systems Analyst (Remote) - The Toro Company

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.

Work From Home Jobs in West Allis, WI

Director, Population Health TriWest Healthcare Alliance

National Client Executive Central Region Matrix Absence Management, Inc.

Supervisor, Utilization Management TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

Sup, Case Mgmt Sp Prgms Ops TriWest Healthcare Alliance

Business Analyst Sr TriWest Healthcare Alliance

Clinical Quality Support Specialist TriWest Healthcare Alliance

Provider Program Manager TriWest Healthcare Alliance

Autism Care Demonstration Specialist TriWest Healthcare Alliance

Health Coach TriWest Healthcare Alliance

Referral Specialist TriWest Healthcare Alliance

PH Communications Specialist TriWest Healthcare Alliance

Senior Referral Specialist TriWest Healthcare Alliance

Manager, Referral Management TriWest Healthcare Alliance

Senior Building Mechanical Engineer (HVAC) - Water / Wastewater Brown and Caldwell Inc

Medical Director (Remote) Securian Financial Group, Inc.

Remote Member Experience Representative AO Garcia Agency

Manager II Coding Practice Services Medical College of Wisconsin

Lead Business Systems Analyst (Remote) - The Toro Company The Toro Company

Front-End Web Developer TriWest Healthcare Alliance

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