Medical & Health category and Insurance industry jobs

OB/GYN Service Line Director Our client has engaged the THOR Group to assist them in hiring an OB/GYN Service Line Director. If you are a Registered Nurse with supervisory experience interested in furthering your career in an innovative organization and have a passion for leading a professional team in their provision of high quality patient care and growing a service line, this could be just the ...
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AmeriHealth, NJ is looking for a Case Manager for our Cranbury, NJ office. POSITION SUMMARY: Through the Commit2Wellness program, the Case Manager collaborates on care plan development and coordination with members and physicians by screening, triaging, assessing, planning, facilitating, monitoring and giving input when adjustment is necessary and advocating for the member on an individual basis. ...
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Responsible for implementing and maintaining an effective Member Medical Necessity, Facility, Administrative and Provider Appeals Program for AmeriHealth New Jersey members with commercial lines of business. This includes program development, implementation and maintenance of all appeal processing to assure compliance with all Federal, State and accrediting organizations’ mandates. Responsible for...
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Responsible for safely and effectively transitioning Molina members from acute or inpatient care to lower levels of care and/or home in a cost efficient manner. Provides assessment, planning, implementation, coordination, monitoring, and evaluation of services for Molina members as they transition care and follows them for at least 30 days. Conducts an onsite hospital discharge visit and a post-di...
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Job Summary Responsible for health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina member's progress and services to ensure consistent cost effective care that complies with Molina policy and...
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Description Major Job Responsibilities: Translate Business Strategy into an Actionable Business Plan: Responsible for creating the business plan to carry out divisional goals and strategy. Influence/provides input to Senior Leadership regarding the feasibility of business vision and goals. Conducts risk assessments and devises actionable steps to mitigate risks. Works with Service Organization Lea...
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Solid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference. SUMMARY: Serve as technical resource to provide proactive medic...
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Solid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference. SUMMARY: Serve as technical resource to provide proactive medic...
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Solid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference. SUMMARY: Office based telephonic medical case management with e...
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Reporting to the Director, Ancillary Services, theThe Manager, Ancillary Services reports directly to and is responsible for staff and daily activities of the department. The Manager is responsible for recruiting, contracting and maintaining a network of long term care ancillary providers for all lines of business for Healthfirst in New York and New Jersey. The Manager also serves as the key conta...
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JOB RESPONSIBILITIES: Under limited supervision, this position is responsible for providing the best possible care to all participants at our facilities. This will include working with participants in an outpatient, acute hospital and lower level of care settings to help guide them through the continuum of care. This position will assess, plan, implement, coordinate, monitor, and evaluate care opt...
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Duties include assigned A/R report, billing phone calls, collections, claims, insurance follow up, charge review and payment posting. 3 or more years experience is required in a medical billing office setting along with very strong organizational skills. Must also have a strong knowledge of email, Excel, Word type software. All applicants will be tested at their scheduled interviews....
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Position Description: 1.Provide daily utilization oversight and external communication with network physicians and hospitals. The candidate must be driven and results oriented with a high degree of motivation to coordinate effective and efficient care. Proven leadership skills are required. 2.Ensure that Windsor Health Group (WHG) leads the industry in innovative health management strategies and i...
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Physician Assistant - Las Vegas, Nevada What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any oth...
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The Manager of Case Management and Wellness will be responsible for the day to day oversight of the Case Management and Wellness Department. Additionally, the Manager may perform health and wellness coaching, disease management and case management functions for members in specific employer groups across New Jersey as needed. The Manager will actively engage employer group members both telephonical...
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Remote position, not telephonic, must provide 10 home visits and live in the El Paso area Provides case management services to members with chronic or complex conditions including: Proactively identifies members that may qualify for potential case management services. Conducts assessment of member needs by collecting in-depth information from Molina's information system, the member, member's famil...
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This is a Remote position (home office)-not telephonic and requires 10 home visits per week. Must live in the El Paso area. Provides case management services to members with chronic or complex conditions including: Proactively identifies members that may qualify for potential case management services. Conducts assessment of member needs by collecting in-depth information from Molina's information ...
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Liberty Mutual Insurance “Helping people live safer, more secure lives” since 1912, Boston-based Liberty Mutual Insurance is a diversified global insurer and third largest property and casualty insurer in the U.S. based on A.M. Best Company’s report of 2010 net written premium. Liberty Mutual also ranks 82nd on the Fortune 100 list of largest corporations in the U.S. based on 2010 revenue. As of D...
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Liberty Mutual Insurance “Helping people live safer, more secure lives” since 1912, Boston-based Liberty Mutual Insurance is a diversified global insurer and third largest property and casualty insurer in the U.S. based on A.M. Best Company’s report of 2010 net written premium. Liberty Mutual also ranks 82nd on the Fortune 100 list of largest corporations in the U.S. based on 2010 revenue. As of D...
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We have an exceptional opportunity with our New England based client to work as a key member of their Health Informatics, Reimbursement and Management team. This position has a broad scope of responsibility in support of corporate strategic goals and the evolving demands of the health care environment including effective and efficient internal or outsourced operations within disease management, ca...
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Prudential Disability Insurance is in the process of growing its Medical Resource Team by 30%! These RN Clinical Consultants will collaborate with Vocational and Claims Management Specialists with a goal to facilitate individual’s return to a productive lifestyle. Our goal is to hire professionals with leadership and critical thinking skills who are interested in tapping into the sum total of thei...
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The Clinical Lead position provides direct oversight by supervising the day-to-day operations of all aspects of the assigned area within Medical Management Department and provides support to other clinical programs and activities (UM/CM, Population Health and special programs). Additionally, this position provides training and coaching both on the group and individual levels, noting achievements a...
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Assists in the coordination of workflows for the Population Health and Wellness/Clinical Community program management. Works with all members of the Clinical Operations team (which includes but is not limited to Asthma, Diabetes, and MCH outreach services, MCH UM and CM program management, Disabled UM and CM) enhancing and supporting these programs. Enters all referral/data information into the co...
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Assists Network Health Pharmacy Program to manage the pharmacy drug benefit and provide pharmacy operational support to Network Health employees, providers and members. Promotes the values of Clinical Affairs Department, Network Health and Tufts Health Plan. Responsibilities: Assists Network Health employees, providers and members with questions related to the pharmacy benefit. Triages questions r...
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To ensure that the Network Health member population receive coordinated care across the health care continuum by completing timely concurrent review, proactive discharge planning and interventions such as UM Aftercare and assessment of case or disease management needs as established by the Medical Management department of Network Health. Assures efficient operation for the membership with ongoing ...
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