UAS Certified RN licensed in the state of NY. Conduct face to face assessments of members' functional status, medical, behavioral, psychosocial and community resource needs. Provides the Interdisciplinary Care Team (ICT) with assessment information and acts as facilitator to ensure that members' needs are met. Develop an ICP/PCSP based on members' clinical, behavioral, an

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

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

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

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

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

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

Professional Management Enterprises, inc. is looking for an entry level Technical Writer. Their role is to employ their technical knowledge to research, document, and present detailed information in easy to interpret guides, help manuals, white papers, templates, web pages, videos, journal articles, etc. The Technical Writer will transform complex information into concise

The Community Well Care Coordination Manager must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordination Manager must, at a minimum, be a registered nurse or simil

The trainer is responsible for facilitation of a range of training content, primarily for Indiana early childhood education professionals and program leaders, SPARK IN staff/partners, and for broader external audiences. This position is remote in Indiana, with travel to provide training coverage . Essential Duties & Responsibilities Supports the implementation of technica

Educate individuals on the importance of nutrition, safety, and overall good health. Provide knowledge and advice through our triage line. Engage callers to assess and de escalate uneasy situations in the least restrictive manner to ensure caller safety over the phone. Report to assigned supervisor and actively seek consultation whenever necessary or requested by supervis

ESSENTIAL DUTIES MAY INCLUDE Following policy in critical incidents preventing injury, escape, or property damage. Maintains confidentiality. Incumbent supervises the daily work of students and evaluates the achievement of individual student knowledge. Operates all job related equipment. Collaborates with other departments in order to enhance the learning environment of s