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Description The Bilingual Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or..
Description The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness by guiding members/families toward resources appropriate for..
Description The Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal..
Description The Enrollment Representative 3 processes applications from members, enrolls them on company platforms, and transmits enrollment to Center for Medicare and Medicaid Services. Responsibilities Data entry of member updates/provider..
Description of Duties/Qualifications:Pilgrimu2019s is seeking a Production Supervisor (Box Room) for our facility inu00A0Moorefield,u00A0WV.This position is responsible for assuring all procedures are followed in achieving the highest level or productivity..
Description The Senior Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Senior..
Description Are you someone who is passionate about helping Sales Agents learn through facilitation and development? Then we have a job for you! Humana is in search for our next..
Description of Duties/Qualifications:u00A0Pilgrimu2019s is seeking a Production Supervisor for our facility inu00A0Moorefield,u00A0WV.u00A0This position is responsible for assuring all procedures are followed in achieving the highest level or productivity in the..
Description The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal..
Production Supervisoru00A0At Pilgrimu2019s,u00A0Safety Is A Condition, which means the safety of our team members comes first - always.u00A0We have implemented safety measures to prevent the spread of COVID-19. We are..
Pilgrim’s is seeking a Security Manager for our Moorefield, WV location.The Security Supervisor is responsible for providing a safe and secure work environment for all Employees by enforcing company policies..
Description of Duties/Qualifications: Pilgrim’s is seeking a Production Supervisor for our facility in Moorefield, WV. This position is responsible for assuring all procedures are followed in achieving the highest level..
Job Information Humana Telephonic Behavioral Health Care Manager in Charleston West Virginia Description The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to..
Description Humana is continuing to grow nationwide! We have 28 new Bilingual Medicaid Inbound Contact Representative openings that will have the pleasure of taking inbound calls from our Florida Medicaid..
Job Information Humana Bilingual Quality Auditor in Charleston West Virginia Description The Bilingual Quality Auditor/ Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of..
Description The Supervisor, Grievances & Appeals manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal, or further request is..
Description The Bilingual Grievances & Appeals Representative 3 manages client concerns by conducting and responding to complaints, grievances and appeals in a consistent fashion, adhering to all regulatory, accreditation and..
Description . Responsibilities The Process Improvement Lead researches best business practices within and outside the organization to establish benchmark data. This individual collects and analyzes process data to initiate, develop..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor,..
Description The Subrogation Professional II identifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides..
