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Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. A focus of this position is to work in concert with members' physical and behavioral health care providers, outside community partners/agencies and other external and internal partners (e.g., Oregon Health Authority/Ombudsperson, Tri County 911, county case workers, hospital social workers, physical health plan if not CO, dental health plan, NEMT dept, UM dept, Social Determinants Dept, Customer Service, etc.
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Participate in leadership team by actively contributing in decision making, grievance follow up, building and company-wide initiatives and attending leadership team meetings such as stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI) and other meetings as required.
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Utilize a trauma-informed approach to provide member-centric physical and behavioral health care and support. Provide telephonic-based physical and behavioral health care coordination to eligible members and families.
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Codes for all services performed at WHA. Services may include office visits, wellness exams, in office surgeries & procedures, injections, supplies, lab, ultrasound, screening mammography, behavioral health, maternal fetal medicine, inpatient and outpatient hospital services, birth center, and ambulatory surgical center.
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The ideal candidate will have extensive experience in layout and fitting, proficient blueprint reading skills, and hands-on experience in structural welding. Description:We are seeking a skilled Journeyman Fitter/Fabricator to join our team, specializing in structural steel and bridge projects.
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From health and financial benefits to time away and everyday wellness, we give Autodeskers the best, so they can do their best work. + Submit and secure export control checks to the Global Trade Compliance team.
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This position promotes constructive and collaborative labor relations by providing advice, counsel and support to operations management, employees and human resources staff in all aspects of labor relations, including contract administration and interpretation, grievance handling and collective bargaining.
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Under the leadership of our Administrator, employees at Prestige Care Discovery take pride in recognition at a national level for their commitment to the health and well-being of their residents and patients.
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Participates in leadership team by actively contributing in decision making, grievance follow-up, building and company-wide initiatives, and leadership team meetings, such as daily stand up, Managing Acute Care Conditions (MACC), Nutrition at Risk (NAR), Utilization Review (UR), Quality Assurance Performance Improvement (QAPI), and other meetings as required.
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Experience in mathematics (statistics, linear algebra, differential calculus); data visualization (Tableau, Power BI, Qlikview); programming (SQL, Python, R, Java); data analysis (feature engineering, data wrangling, EDA) and machine learning (classification, regression, reinforcement learning, deep learning, clustering, dimensionality reduction.
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This is a combined posting for a Social Worker MSW, Social Worker LCSW, Mental Health Therapist LMFT, and Licensed Professional Counselor. Mental Health Professional (MSW, LCSW, LPC, and LMFT.
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Why join the Prestige Care Family in the Resident Care Manager (RN) - MDS Nurse role and what can we offer you? Cascade Terrace is a skilled nursing and rehabilitation center conveniently located close to all of the Portland hospitals in southeast Portland with easy access to I-205 from Foster Road.
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Under the direction of the Sr. Instrumentation and Controls Engineer, continually improve packaging and processing equipment controls logic for better efficiency and reduced waste.
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The ideal candidate will be a proactive self-starter who is comfortable with ambiguity, excels in a fast-paced environment, and is enthusiastic about growing and sustaining a robust individual giving program through crafting appeals and campaigns to engage supporters.
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Prestige Care is a family of over 75 skilled nursing + post-acute care centers, as well as assisted living and memory care communities in 8 Western states. Why join the Prestige Care Family in the Resident Care Manager (LPN) – MDS Nurse role and what can we offer you.
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grievance and appeals jobs Title: health Company: Association For Community Affiliated Plans in Portland, OR
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