Skip to main content

New Jobs in the US

12 Jobs Found

Job Summary: The Network Contract Specialist develops the provider network (physicians, hospitals, dental, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Network Contract Spec...
The primary role of the Quality Assurance Coordinator is to develop and follow Quality Monitoring Guidelines to provide a detailed description of the call quality performance requirements. The Quality Assurance Coordinator is responsible in monitoring all lines of Member Services business as designated. Key Responsibilities Oversee day to day operations set forth by the Department Management Mem...
JOB SUMMARY: The Supervisor of Case Management is responsible for the day to day operations within the Case Management department. This position is responsible for the development of Case Management (CM/DM) Processes. The Supervisor of Case Management reports directly to the Director of Case Management/Disease Management and interfaces with provider's families and physicians as well as health plan...
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a tea...
We are currently recruiting medical case managers to work with members who need assistance with the immediate and ongoing care of their complicated illnesses, or who are experiencing a care transition back to their residence. Our medical case managers also document interactions with and on behalf of the member, including, but not limited to: care plans, progress notes, assessments, and author...
JOB SUMMARY: The Transition of Care Coordinator is responsible for the medical management and care planning for all members referred to case management. Manage members who require a comprehensive approach to immediate and/or ongoing care of their complicated and/or catastrophic medical illness. Gather information for medical, social, environmental and functional needs as related to care planning....
JOB SUMMARY: The Maternal Health Manager develops implements, manages, and tracks the Maternal/Child Health program. This position oversees the activities related to the delivery of the Maternal Health Program in accordance with established policies and procedures. Job responsibility: Assure department efficiency and effectiveness •Provide information for the preparation of the annual departmen...
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a tea...
JOB SUMMARY: The Claims Adjuster researches and resolves outstanding claims payment/denial issues, including but not limited to: voids, refund, over/underpayment, audit results and provider inquiries through the claims adjustment queue; provides high level complex claims resolution to providers. Answers escalated provider calls that are in need of assistance and timely and accurate claim resolutio...
Medical Director – Prior Authorization Health Choice is currently recruiting for a Medical Director to serve as a key member of our medical management team. The Medical Director will work in collaboration with an engaged team of Medical Directors to conduct physician review activities for medical management programs, with a special focus on prior authorization. The Medical Director will also act ...
The Utilization Claims Review Nurse reviews and analyzes medical record and claims data, utilizing and applying Interqual Acute/Sub-acute Care Criteria and DRG coding practices to determine if inpatient admissions, observation stays, and ancillary services meet criteria. This position also maintains current information on regulatory guidelines as they pertain to acute and sub-acute levels of ...
The Encounters Specialist ensures that 100% of all encounters submitted to AHCCCS are accepted, processed and proper reimbursement is sent back to the health plan. This position also documents and reports inappropriate adjudication trends to facilitate additional staff training, examines AHCCCS pend and denial reports for processing inaccuracies, and reviews and works the TI portal to resolve any ...