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1 - 10 of 54 matches in 0.009 seconds
Operations Account Rep - Chicago, IL - 1907264 (6976470)
Last Updated: 2019-11-11
Employer: Wellcare Health Plans
Location: Chicago, IL

Description

Serves as an account representative with facility (institutional) and provider groups maximizing their ability to interact with WellCare. Manages education and issues related to claims, reimbursement, authorizations and referrals. Responsible for onsite interaction as necessary with high maintenance providers/strategic providers.

Report to: Senior Manager, Ops Account Management

Department: Ops-National…

Claim Technician (6976426)
Last Updated: 2019-11-11
Employer: Health Care Service Corporation
Location: Rockford, IL

Description:

Job Purpose:Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits and resolving pended claims.Required Job Qualifications:
*

  • High School diploma or GED.

*

  • Data entry and/or typing experience.

*

  • Clear and concise written and verbal communication skills.

*

  • Experience processing…
Strategic Sourcing Analyst II (6974555)
Last Updated: 2019-11-09
Employer: Health Care Service Corporation
Location: Chicago, IL

Description:

SUMMARY:
Strategic member of a high performing sourcing team, responsible for Market Assessments, RFIs, and RFPs for Independent Medical Review and Clinical Software . Sourcing Analyst will also be responsible for contract negotiations and contract compliance. Analysts are expected to have excellent project management and time efficiency skills…

Primary Nurse Case Administrator I (6972369)
Last Updated: 2019-11-08
Employer: Health Care Service Corporation
Location: Chicago, IL

Description:

We are the Health Care Management division of HCSC – a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health…

Contract Specialist (6972324)
Last Updated: 2019-11-08
Employer: Health Care Service Corporation
Location: Chicago, IL

Description:

BASIC FUNCTION:
This position is responsible for drafting and maintaining contract templates, issuing account-specific documents; participating in the peer review process.

*JOB REQUIREMENTS: Knowledge of health insurance contract and claim administration agreement development and financial agreement development.

  • Knowledge of health products and procedures, contract requirements and underwriting…
Medical Management Specialist I - Govenment Progra (6972129)
Last Updated: 2019-11-08
Employer: Health Care Service Corporation
Location: Belleville, IL

Description:

We are the Health Care Management division of HCSC – a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health…

Care Coordinator UM/CM I - Government Programs (6972127)
Last Updated: 2019-11-08
Employer: Health Care Service Corporation
Location: Downers Grove, IL

Description:

We are the Health Care Management division of HCSC – a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health…

Med Management Accreditation & Audit Coordinator - (6971605)
Last Updated: 2019-11-08
Employer: Health Care Service Corporation
Location: Chicago, IL

Description:

We are the Health Care Management division of HCSC – a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health…

Healthcare Quality Auditor (HEDIS and quality impr (6971595)
Last Updated: 2019-11-08
Employer: Health Care Service Corporation
Location: Chicago, IL

Description:

BASIC FUNCTION:
This position is responsible for reviewing medical records and abstracting and overreading data for quality improvement projects (HEDIS like measures) and HEDIS. This position collaborates internally and externally with stakeholders to drive improvement in quality outcomes and performance. The Quality Management Specialist (QMS

Clinical Delegation Coordinator (RN) (6969405)
Last Updated: 2019-11-07
Employer: Health Care Service Corporation
Location: Chicago, IL

Description:

Job Purpose:

This position is responsible for leading, coordinating and participating in clinical delegation oversight audits of HCSC’s vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements. The position also develops audit tools based on state and federal regulations, conducts the reviews…

Legend

  • Registered Apprenticeship