8 jobs found

Remote Opportunity within the US SUMMARY  The Nurse Case Manager (NCM) is responsible for applying medical knowledge in reviewing workers’ compensation claims to assess, evaluate, plan, implement and oversee the treatment appropriateness for occupational injuries based upon evidence based guidelines.  The NCM utilizes clinical knowledge to evaluate the medical and disability needs of an injured worker against relevant policies, facilitate coordination of the patient’s medical treatment and timely return to work. The NCM engages the claimant and physician(s) in providing proactive medical and disability management, working collaboratively with claim handlers in providing focused claim resolution and return to work driven outcomes.  The case management process requires a focus on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to effectively ensure optimal outcomes. RESPONSIBILITIES/TASKS: The nurse...

Summary: The Senior Principal Architect (Data) is a new role within the Data and Analytics organization that will have the opportunity to define and build the data architecture practice for the enterprise. He or she acts as a consultant seeking to optimize the overall process the organization follows from data ingestion to final product. It will provide overall direction, guidance, definition and facilitation for the development of architecture required to meet product strategies and goals including our journey to the cloud. The role will identify, support, and analyze business drivers, modern data platforms, technology strategies, and current technology environment, and is adept at using large data sets to find opportunities for product and process optimization and using models to test the effectiveness of different courses of action. They must have strong experience using a variety of data management tools, evaluating and implementing models, using/creating algorithms and...

SUMMARY:  The Senior Analyst is an analytical role responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. RESPONSIBILITIES/TASKS:  Develops and improves workflows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality. Identifies and/or analyzes business problems and devise procedures for solutions to the problems. Effectively leads projects in order to produce desired results. Recommends and assists with implementing standard policies and procedures.  Assures that corporate compliance is communicated, implemented, and monitored on an ongoing basis. Participates in systems testing, develops procedures/controls, and provides recommendations for the ongoing improvement of the updated process. Assists personnel (both internal and external) by answering questions, supplying information, and training. Represent...

SUMMARY : The Certified MRA Coder II will perform Prospective Review and CDI Opportunity Review to assists healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation.  HCC coder will conduct audits to abstract data not submitted by providers and initiate opportunities to improve clinical documentation. Increase accuracy, completeness and compliance with clinical condition documentation to enable providers to deliver quality of care. RESPONSIBILITIES/TASKS:  Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System.  Performs on-site medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.  Ensure diagnosis codes are supported by the documentation and...

The Supports Coordinator (SC) uses person-centered principals to perform comprehensive assessments to determine health care and social needs of applicants and eligibility for enrollment to the MI Choice Waiver Program. Assess medical, functional, psychological, financial, and environmental needs of applicants. Coordinates support services to assist participants in developing a person-centered long-term care (LTC) plan. The SC may be expected to cover the entire six-county region of the MI Choice program area as needed. Community based staff schedule will accommodate daytime, evening and weekend hours as required. Models AAA1-B values and mission. BENEFITS: The Area Agency on Aging 1-B in Southfield has outstanding benefits for this position that include: Choice of 3 excellent low cost Medical Plans Fitness and Wellness programs Dental, Vision, Short and Long-Term Disability Excellent PTO package (accruing up to 4 weeks in first year) We recognize 10...

Want to join a stable, growing national company that provides solutions to our clients that help them grow their business in any economic climate? If so, then Valpak Media wants to talk to you about an opportunity on our outside sales team! Consult with local and regional dining and entertainment businesses, home services, retail, auto and more, to help get their message and offers out to homes and devices in the neighborhoods they serve. Our PAK is made up of highly motivated sellers who love UNCAPPED commissions and the flexibility to run their own book of business. Our PAK stands out because we offer the opportunity to provide complete marketing solutions to business owners who want to talk to you. Valpak connects consumers with local businesses via targeted direct mail products that are integrated with cutting-edge digital campaigns. Our iconic Blue Envelope & Custom Postcards mail to over 41 million homes each month. Our Advanced...

Job description SAS Global Corporation is seeking a motivated sales professional to add to our team! The target sales area includes New York, NY, Boston, MA, Portland, ME, Philadelphia, PA, Cincinatti, OH, Louisville, KY, Nashville, TN, and Indianapolis, IN. POSITION SUMMARY: The Product Sales Specialist plays a key role in increasing revenue by managing and negotiating with clients, generating leads, qualifying prospects, and managing sales of products and services. This individual specializes in the sale of fabricated components within the industries of mining, cement plants, asphalt and coal-fired power utility high wear areas. These sales opportunities may consist of wear materials such as chrome carbide (overlay) plate, AR plate, aftermarket pulverized parts, chute systems, crushers, combustion tuning/testing services, fabricated design and builds, and many other high wear areas. TASKS AND RESPONSIBILITIES: · Engages in strategies to increase sales in...