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Work closely with clients and claimants Provide outstanding claims handling and customer service Coordinate and direct all outside service providers including legal counsel, occupational medical providers and all other ancillary cost containment service providers Manage reserves on claim files Analyze and investigate claims and report findings and recommendations to insured Meet and maintain all r
Posted Today
Supervisor, Medical Management (Non Clinical) (1113875) Position Purpose Supervise the day to day operations of the medical review unit Oversee changes to medical review unit functions and performance in relation to company mission, philosophy objectives and policies Assist senior management with budgets and forecast for strategic planning and key initiatives. Balance current and future needs effe
Posted 1 day ago
Grievance & Appeals Coordinator I (1114217) Position Purpose Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain f
Posted 1 day ago
Supervisor, Medical Management (Non Clinical) Supervisor, Medical Management (Non Clinical) (1113875) Position Purpose Supervise the day to day operations of the medical review unit Oversee changes to medical review unit functions and performance in relation to company mission, philosophy objectives and policies Assist senior management with budgets and forecast for strategic planning and key init
Posted 1 day ago
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the
Posted 1 day ago
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 1 day ago
Duties Summary About the Position This is an Hydropower Office Assistant (OA) position GS 0303 06 with the USACE Little Rock District, Operations Division. This position is located in Little Rock AR. This position is exclusively represented by Local 2219 IBEW, AFL CIO. Responsibilities Develop and implement procedures to support, supply management, budget and personnel management Explain data to f
Posted 3 days ago
Program Specialist I Social Work LPN or RN (1113783) Position Purpose Identify special needs members through the completion of health screens and other resources Work with community outreach/member advocates to coordinate member care Educate providers and community resources on program components and available support services Educate members with special needs to foster compliance with program an
Posted 16 days ago
Program Specialist I Social Work LPN or RN Program Specialist I Social Work LPN or RN (1113783) Position Purpose Identify special needs members through the completion of health screens and other resources Work with community outreach/member advocates to coordinate member care Educate providers and community resources on program components and available support services Educate members with special
Posted 17 days ago
Responsible for following a filing system and organizing records, such as letters, legal documents, case files, correspondence, invoices and memoranda according to that system. The File Clerk will close files, box, maintain filing list, and transport them to storage. This person may perform other duties, such as mail, faxing, using a copy machine. Responsible for being the back up for the Law Offi
Posted 17 days ago
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to
Posted 21 days ago
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to
Posted 21 days ago
Health Net
- Little Rock, AR
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 24 days ago
Centene Corporation
- Little Rock, AR / Fayetteville, AR / Monticello, AR / 2 more...
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 24 days ago
Health Net
- Little Rock, AR
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 1 month ago
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