Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G
Customer Service Rep - Remote (Must live near McAllen, TX) Maximus is currently seeking Customer Service Representatives to support the Federal Emergency Management Agency (FEMA). FEMAs mission is to help people before, during, and after disasters. In
Bilingual Customer Service Rep - Remote (Must Live Near McAllen, TX) Maximus is currently seeking Bilingual Spanish Customer Service Representatives to support the Federal Emergency Management Agency (FEMA). FEMAs mission is to help people before, during, and
Bilingual Mandarin or Cantonese Customer Service Representative Essential Duties and Responsibilities: Answer incoming calls from consumers including the general public, prospective enrollees and people assisting enrollees or acting on their behalf in accordance with all performance
Bilingual Customer Service Representative - Remote in Oklahoma City Work/Life Balance Support - Flexibility tailored to your needs! Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally,
RN Clinical Assessor - (Hybrid Remote - Waldo/Kennebec County, Maine) Essential Duties and Responsibilities: - Responsible for completing medical and/or behavioral health assessments within contract requirements - Conducts on-site, video call and/or telephonic assessments to determine
Customer Service Representative (Remote - Albany, NY) Essential Duties and Responsibilities: - Answer incoming calls from consumers including the general public, prospective enrollees and people assisting enrollees or acting on their behalf in accordance with all
Bilingual Spanish Customer Service Representative Essential Duties and Responsibilities: Answer incoming calls from consumers including the general public, prospective enrollees and people assisting enrollees or acting on their behalf in accordance with all performance standards, policy
RN Clinical Assessor - (Hybrid Remote - Cumberland County, Maine) Essential Duties and Responsibilities: - Responsible for completing medical and/or behavioral health assessments within contract requirements - Conducts on-site, video call and/or telephonic assessments to determine
Marketing Creative Director Position is Remote (US or Canada) No agencies please Maximus is a mission-driven consumer performance medicine telehealth company that provides men and women with content, community, and clinical support to optimize their health, wellness,
Key Responsibilities 1. Jointly monitor operational and clinical performance across PIP & WCA with support from Head of Assurance & Audit using site and individual MI to spot trends, risks and development needs; create and execute
Essential Duties and Responsibilities: - Lead the development and implementation of advanced sourcing and category management strategies through the RFx process. - Oversee the negotiation and development of contracts with new suppliers and/or renegotiate existing contracts
Essential Duties and Responsibilities: - Organize project teams, assign individual responsibilities, develop project schedules, and determine resource requirements. - Oversee all facets of project operations. - Deploy resources to address all operational needs. - Make informed
Essential Duties and Responsibilities: - Provides customer service for basic and routine inquiries and problems via multiple possible channels (i.e. telephone, emails, web chats, or written letters). - Calls are predominantly routine, but may require deviation
Essential Duties and Responsibilities: - Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. - Issue approvals, denials or recommendations based on contract
Essential Duties and Responsibilities: - Facilitate and prepare all planning activities and artifacts for complex initiatives including project scope statements, work breakdown structure, and detailed project schedule. - Monitor schedule progress, and implement corrective measures as
Essential Duties and Responsibilities: - Update facility billing information. - Request claims and processing payment. - Ensure VES payments have been posted. - Confirm zero balances on patients accounts. - Mail zero balance letters to veterans
Essential Duties and Responsibilities: - Facilitate the development of cross-line-of-business solutions by combining knowledge of business capabilities, value streams, and business processes. Consult with technical subject matter experts to develop technical solutions and advise on options,
Do good. Be great as a nurse. Are you a Registered Nurse, Nurse Practitioner or Registered Mental Health Nurse seeking professional growth, flexible working and a better work-life balance? About the role As a Nurse Functional
Essential Duties and Responsibilities: - Responsible for database administration, data consolidation, data analysis and management reporting. - Design database reports based on the requestors requirements in support of key business strategies. - Perform queries, data extraction,