Become a part of our caring community The Field Care Manager Nurse 2 assesses and evaluates members needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate
Job Description Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy
AgileEngine is an Inc. 5000 company that creates award-winning software for Fortune 500 brands and trailblazing startups across 17+ industries. We rank among the leaders in areas like application development and AI/ML, and our people-first culture
Summary We are currently hiring for a Payment Integrity Nurse – Medicare Advantage to join BlueCross BlueShield of South Carolina. In this role as an Payment Integrity Nurse, you will monitor/implement quality improvement/management activities, conduct specific
ABOUT GREYSTAR Greystar is a leading, fully integrated global real estate platform offering expertise in property management, investment management, development, and construction services in institutional-quality rental housing. Headquartered in Charleston, South Carolina, Greystar manages and operates
Job Description: At Sparklight and Cable One, we keep our customers and associates connected to what matters most. For our associates, that means: a thriving and rewarding career, respect for the communities where they live and
LOCATIONRemote Work-at-Home POSITION OVERVIEW MCI is one of the fastest-growing tech-enabled business services companies in the USA, with a strong call center footprint and operations that extend across multiple countries. We deliver Customer Experience (CX), Business
LOCATIONRemote Work-at-Home POSITION OVERVIEW MCI is one of the fastest-growing tech-enabled business services companies in the USA, with a strong call center footprint and operations that extend across multiple countries. We deliver Customer Experience (CX), Business
Remote Prior Authorization Pharmacist Work From Home in Managed Care A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe and effective therapies. This
Business Analyst - Clinical Analyst & Coding Specialist Sunshine Enterprise USA is retained by our valued client to search and recruit for the following executive opening: Business Analyst - Clinical Analyst & Coding Specialist Location: Fully
Regional Payor Contracting Associate Fundamental Clinical & Operational Services, LLC is searching for an experienced Regional Payor Contracting Associate to focus on MCO and payor contracting for multiple client skilled nursing facilities and Behavioral Health Hospital
Inspire Health. Serve With Compassion. Be The Difference. Performs operational and financial analysis to evaluate assigned projects in support of managed care operations, services, and initiatives. Performs proactive servicing of contracts and analysis of contract performance to include
Market Chief Medical Officer (CMO) At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come
Denial Management Specialist The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager. * Only applicants from the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana,