Medical Coder
Wausau, WI
Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits...

Field Care Coordinator - Alexandria, VA Market
Alexandria, VA
Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs...

Specialty Benefits Small Business Account Executive - NYC
New York, NY
Small Business Sales (1 100) Create and drive strategies for top specialty producing agencies and Brokers Collaborate with Sales Management and/or Health Plan leadership regarding pipeli...

Department Resource Specialist - Hybrid, Phoenix, AZ
Phoenix, AZ
Compile and/or integrate information needed to complete reports and documents Prepare and/or format office documentation (e.g., letters; spreadsheets; reports) needed for various audienc...

Director of Medicare Quality - Remote
Minnetonka, MN
Synthesize and forecast industry trends, customer needs, competitive threats, survey insights, member experience best practices and internal and competitive performance to design industr...

Senior Business Analyst - Remote
Wausau, WI
Analyze, review, forecast and trend complex data Present analysis and recommendations for operational and business review/planning Support short and long term operational/strategic busin...

Physical Therapist Case Manager - Remote
Eden Prairie, MN
Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly cont...

Occupational Therapist Case Manager - Remote
Eden Prairie, MN
Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly cont...

Sr. Clinical Grievances RN - Remote in MST, PST or AZ
Denver, CO
Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions. Document relevant chronology of case review and...

Speech Language Pathologist Case Manager - Remote
Eden Prairie, MN
Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly cont...

Public Sector Field Account Manager - Cypress, CA Hybrid
Cypress, CA
Own the service experience of customers at the field level by working with the assigned team and other matrix partners as required to ensure issues are resolved promptly and accurately m...

VP Clinical Operations National Accounts - Remote
Eden Prairie, MN
Collaborate cross organizationally in the development, proposing and prioritization of customer solutions to reduce trend (programs, processes, benefit design, network, etc.) Works with...

Associate Enrollment Eligibility Representative - National Remote
Dallas, TX
Serve as primary contact as it relates to all enrollment tasks for assigned book of business, which include multiple group customers; maintain satisfied customers by providing superior s...

Medical Director, Clinical Advocacy and Support - Remote
Houston, TX
Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings,...

Senior Financial Analyst - Hartford, CT
Hartford, CT
Compiles financial statements for various Management and Labor customers in prescribed formats by collecting financial data from Peoplesoft General Ledger and other finance data reposito...