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Current working knowledge of chronic care management, discharge planning, utilization management, case management, performance improvement and/or managed care reimbursement. Experience with Medicare Advantage, Value-based care, and/or Managed Care desirable.
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Minimum 2 years "telephonic" Case Management experience with a Managed Care Company preferred. Managed Care experience preferred. The "Telephonic" Nurse Case Manager II is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
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Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care.
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The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines, determined the viability of the appeal, and manage the appeal process.
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Join our team of Financial Services Representative where you ll have dedicated time to focus on growth and career development, while you support our customers taking inbound calls while preparing for a future as the official face of Fidelity in our Investor Centers.
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ASM Global, the leader in privately managed public assembly facilities, has an excellent and immediate opening for a Journeyman Electrician at NRG Park in Houston, Texas. Demonstrate knowledge of practices and procedures related to event set-up and conversions, typical methods and techniques for cleaning and maintaining the facility and proper use and care of hand power tools.
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Demonstrate knowledge of practices and procedures related to event set-up and Requisition Conversions, typical methods and techniques for cleaning and maintaining the equipment and proper use and care of hand power tools.
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NET Core ASP.NET, MVC, Entity framework, Unity, o JQuery, knockout, Angular, JS libraries, CSS Bootstraps, Visual Studio 2017, REST, LINQ, ArcGIS, ESRI, SQL Server, Dynatrace, o Cloud Managed SQL, Big data/data lakes.
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Job Summary: Under the direct supervision of the Pre-Op/PACU manager, the PACU nurse is responsible for implementing all physician orders, providing for the continuity and quality of nursing care for all patients, with continual evaluation of the patients.
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Embarking on a career with Hanger allows you to continue in this endeavor but elevates you as a champion of the orthotic and prosthetic market by providing superior patient care, outcomes, service and value.
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Baylor St. Lukes Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more.
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The Fire Captain oversees activities including fire suppression, emergency medical incidents, hazardous materials spills and other emergency incident calls and supervises a fire crew to ensure safety.
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The company offers a personalized Open XDR approach to Managed Detection and Response, advanced Threat Hunting, Digital Risk Protection, Phishing Response, and Incident Response services, helping customers mature their security program efficiently and effectively based on their unique risks and business needs.
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Assist in individual tax returns, equalization calculations, and miscellaneous tax forms for inbound expatriate employees and foreign investors, ensuring accuracy and compliance with tax regulations.
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Handling inbound Customer Service calls, assisting with an assortment of questions from website assistance, escrow to processing payoffs. The Performing Loan Consultant will handle inbound customer service related calls, as well as, contact homeowners across the country to collect past-due mortgage payments, identify their issues, and develop practical payment solutions that help them get current in their mortgage payments.
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inbound calls managed care jobs Title: customer service in Houston, Dearborn-heights, Michigan
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