Access resources to assist with special health care needs. Assist caregivers with day to day processes. Scheduling appointments every 90 days or as needed . Arrange for transportation when required. Identify any gaps in care or health care needs. Coordinate moving from member from one setting to another including being discharged from the hospital. Assess eligibility for

Seeking a Care Review Clinician I ( LCSW, LPC, or RN. If RN, must have a Virginia or compact license ) to work with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities. The position is remote. The work scheduled is Tue Sat, 8 00am 5 00pm. Essential Functions Review provider re

Seeking an Enrollment Representative to enter referrals, handle inbound and outbound calls, review long term services with prospects, additional duties as assigned. This is a remote position however candidates MUST reside in NY. The w ork schedule is 9 00 AM 5 30 PM EST . Essential Functions Receive referrals from referral sources. Verify prospective members eligibility.

Job Title Customer Service Advocate I Location Remote (Indiana) Hours 11am 8pm Monday Friday (Eastern Standard Time Zone) Job Description Serves as the first line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers. Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and persona

Access resources to assist with special health care needs. Assist caregivers with day to day processes. Scheduling appointments every 90 days or as needed . Arrange for transportation when required. Identify any gaps in care or health care needs. Coordinate moving from member from one setting to another including being discharged from the hospital. Assess eligibility for

The Clinical Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states. Essential Functions Responsible for the completion of clinical appeals and state hearings from all states Review and complete all provider clinical appeals within required timeframes. Review and complete member clinical appeals within required timeframes. Re

The Quality Assurance Analyst works closely with higher level staff and/or management to outline general objectives and boundaries that this individual will follow to meet the requirements of the agency. Unusual problems or deviations from guidelines or practice are discussed with the manager at the discretion of this role. Work is reviewed for attainment of objectives an

Access resources to assist with special health care needs. Assist caregivers with day to day processes. Scheduling appointments every 90 days or as needed . Arrange for transportation when required. Identify any gaps in care or health care needs. Coordinate moving from member from one setting to another including being discharged from the hospital. Assess eligibility for

Works with members, providers, and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on

A customer service representative, or CSR, will act as a liaison, provide services information, and resolve any emerging problems that our customer accounts might face with accuracy and efficiency. The best CSRs are genuinely excited to help customers. They're patient, empathetic, and passionately communicative. They love to talk. Customer service representatives can put

PME is looking for a Healthcare Case Manager I (RN, LCSW, LMSW) experienced in Case Management working with complex medical and mental illness cases. The position will require field visits 3 days a week and the rest will be from home. Schedule M F 8 30am 5 00pm CST. MUST live in within 30 minutes of ARLINGTON HEIGHTS, BARTLETT, HANOVER PARK, BARRINGTON, ELGIN, MOUNT PROSP

Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims. Analyzes problems and provides information/solutions. Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database. Thoroughly documents inquiry outcomes for accura

Seeking an RN Care Manager II to p rovide Care Management duties to include telephonic outreach to members, assess members for complex medical needs, develop and update care plans, assess members current health , resource utilization , assess progress to goals , assist member with coordinating services and appointments , provide member education, assist with access to com

Data Capture Specialist is responsible for the accurate capture of the alphabetic, numeric, or symbolic data from electronic images and/or source documents according to the custom developed software application including repair of incorrect data resulting from OCR process (optical character recognition results). Pay Rate $14.85hr (Weekly Pay) Work Schedule Monday (9 00 am