HSS Coordinator-Central Harris County-Downtown, TX
Houston, TX
Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals f...

HSS Coordinator - Sherman, TX
Sherman, TX
Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals f...

HSS Coordinator - Crockett, TX
Crockett, TX
Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals f...

RN Nurse Reviewer
Eden Prairie, MN
Utilize the Preferred One medical criteria and those of other regulatory bodies, (i.e. NCQA, DOH), the exempt and focused review programs, and the patient's benefit plan summary to perfo...

HSS Coordinator-Fort Bend and Matagorda County, TX
Bay City, TX
Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals f...

Adult Member Liaison - Hybrid - Phoenix, AZ
Phoenix, AZ
Provide advocacy and system navigation of behavioral health services and social services and supports Build partnerships with individuals, families, youth, and key stakeholders to promot...

Senior Pharmacy Care Technician
Downers Grove, IL
Perform telephonic customer outreach to improve health quality outcomes in collaboration with clinical pharmacists Provide additional telephonic engagement with providers and pharmacies...

Sr. Business Process Analyst - Anaplan Model Builder - WF Planning Mgmt - Remote
Minnetonka, MN
of Job To effectively and promptly Perform the Administration, build, and troubleshooting for Anaplan models within UHC Workforce Planning & Management, including bugs and enhancements, b...

Senior Investigator - Remote Nationwide
Memphis, TN
Investigate medium to highly complex cases of fraud, waste and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy...

Medical Director - Clinical Advocacy and Support - Remote
Minneapolis, MN
Work to improve quality and promote evidence based medicine Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement...

Social Worker Health Coordinator - $5,000 Sign On - Field Based on Maui, HI
Kahului, HI
Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals fo...

HSS Coordinator - Houston, TX
Houston, TX
Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals f...

Senior Data Investigator - Remote Nationwide
Minnetonka, MN
Perform data analysis and generation activities for the fraud investigations team including data extracts, summaries, random sampling, and special projects Prepare Healthcare claims data...

Telephonic Case Manager RN Pediatrics
Wausau, WI
Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self managemen...

Senior Data Engineer - US Remote
Minnetonka, MN
Architect all phases of software engineering including requirements analysis, application design, code development and testing with a focus on business intelligence dataset development i...