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Senior Specialist jobs at Amgen - 4118 jobs

  • Contract Coordinator

    Coxhealth 4.7company rating

    Springfield, MO jobs

    ◦ This position will be a vital member of the Biomedical Equipment Services Department and will perform various roles in coordinating contracted equipment services. In collaboration with various departments and other staff, the Contracted Services Coordinator will help ensure that vendors adhere to the applicable service agreement terms and conditions. This position will also assist the Regulatory Affairs department with annual contract evaluations. The Contracted Services Coordinator will help ensure that all vendor service documentation is received and stored according to industry standards. This position will report to the Biomedical Equipment Services Director. • Job Requirements ◦ Education ▪ Required: Associate or related Degree in business or Bachelor's degree in business, accounting, economics, health care administration, supply chain management, legal studies or similar field. ▪ Preferred: Master degree in business, accounting, economics, health care administration, supply chain management, legal studies or similar field. ◦ Experience ▪ Required: Two or more years of recent work experience related to compliance, contract negotiation, administration and/or procurement ▪ Preferred: Healthcare experience ◦ Skills ▪ Self-directed, strong attention to detail and excellent writing skills. ▪ Strong problem-solving and process-improvement skills. ▪ Strong ability to reason logically and critically, analyze situations accurately and recommend courses of action. ▪ Ability to maintain confidentiality with the highest degree of integrity and discretion. ▪ Strong organizational skills including effective time management and ability to set/reset priorities accordingly and handle multiple projects and priorities simultaneously. ▪ Exceptional communication and customer relation skills including the ability to communicate verbally and in writing to all levels of the organization, outside vendors and other third parties. ▪ Working knowledge of contract language, terms and conditions. ▪ Experience negotiating contracts on behalf of an entity. ▪ Proficiency in Microsoft Word, PowerPoint, Excel and Outlook. ▪ Knowledge of healthcare compliance, federal and state statutes and regulations, and basic contract principles and negotiations in a hospital setting preferred. ◦ Licensure/Certification/Registration ▪ • N/A◦ Education ▪ Required: Associate Degree, or related degree in Paralegal Studies, or Bachelor's Degree in Business, Healthcare Administration, Legal Studies, or a related field. In lieu of degree, 10+ years' experience in contract management, administration, and/or procurement. Preferred: Master's Degree in Business Administration, Healthcare Administration, Legal Studies, or a related field. ◦ Experience ▪ Required: Two or more years of recent work experience related to law, compliance, contract management, database management, administration, and/or procurement. ▪ Preferred: Experience in contract database management, preferably within the healthcare industry. Familiarity with contract management software and DocuSign platforms. ◦ Skills ▪ • Strong attention to detail, exceptional organizational skills, and able to manage multiple tasks simultaneously. • Excellent communication skills, both written and verbal. • Strong problem-solving and process-improvement skills. • Understanding of legal and regulatory requirements pertaining to healthcare contracts and a working knowledge of contract language, terms, and conditions. • Proficiency in contract management software and Microsoft Office Suite (Word, Excel, PowerPoint). • Ability to work independently and collaboratively within a team. • Ability to maintain confidentiality with the highest degree of integrity and discretion. ◦ Licensure/Certification/Registration ▪ N/A
    $38k-46k yearly est. 15d ago
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  • Senior PM, Identity & Access Platform (Hybrid)

    Hinge-Health 4.4company rating

    San Francisco, CA jobs

    A healthcare technology company in San Francisco seeks a Product Manager to lead the strategy and roadmap for their accounts platform. The ideal candidate has over 6 years of product management experience and is proficient in SQL. This role involves improving user experiences and collaborating across multiple teams. The company provides a hybrid work model, allowing employees to work remote part of the week. #J-18808-Ljbffr
    $98k-150k yearly est. 1d ago
  • Associate Spine Specialist (Boston, MA)

    Globus Medical 4.5company rating

    Boston, MA jobs

    Associate Spine Specialist (Boston, MA) page is loaded## Associate Spine Specialist (Boston, MA)locations: Massachusettstime type: Full timeposted on: Posted 25 Days Agojob requisition id: JR104911At Globus Medical, we move with a sense of urgency to deliver innovations that improve the quality of life of patients with musculoskeletal disorders. Our team is inspired by the needs of these patients, and the surgeons and healthcare providers who treat them. We embrace a culture of exceptional response by partnering with researchers and educators to transform clinical insights into tangible solutions. Our solutions improve the techniques and outcomes of surgery so patients can resume their lives as quickly as possible The Associate Spine Specialist will work together with the Spine Territory Manager and will have territory coverage, inventory management, and limited sales responsibilities. The Associate Spine Specialist will represent the company in accordance with the company's quality policy and procedures.**Essential Functions****:*** Gains and consistently increases product knowledge through formal sales training; surgeon speaker programs, attends surgeries/operating room visits, and industry research* Meeting or exceeds all sales goals and objectives assigned* Conducts sales calls to promote, sells, and services Globus Medical products and services to existing and competitive customers based on a strategic plan* Assists the Spine Territory Manager on field calls for assigned geography and address and problems that arise on the account* Performs field ride along with the Area Director and Spine Territory Manager on a regular basis* Develops and increases customer base and continually enhances Globus product market share within assigned territory* Provides feedback regularly on topics such as product development opportunities, new target accounts, sales performance, and market feedback* Maintains conduct that is aligned with company quality policy and procedures, and protects confidentiality with proprietary information* Stays current with all compliance training requirements* Adheres to the letter and spirit of the company Code of Conduct, the AdvaMed Code, MedTech Code, and all other company policies.* Ensures Compliance with applicable governmental laws, rules, and regulations, both in the United States and internationally, by completing introductory and annual training and maintaining knowledge of compliance as it applies to your role* Represents the company in a professional manner and uphold the highest standards of ethical business practices and socially responsible conduct in all interactions with other employees, customers, suppliers, and other third parties*Reasonable accommodations may be made to enable individuals with disabilities to perform these* essential *functions.***Qualifications****:*** 1-2 years' successful spine sales experience preferred, may consider other healthcare related sales and or business to business sales experience* Bachelor's degree in Science or Business* Exemplary ability to listen, communicate and influence* Ability to travel as necessary, which may include nights and/or weekends* Strong understanding of spinal anatomy* Ability to make sales presentations with positive results**Physical Demands****:**The physical demands listed here are representative of those that must be met by and employee to successfully perform the essential functions of this job.* Required to sit; climb or balance; and stoop, kneel, crouch or crawl* Required to regularly lift and/or move up to 10 pounds, and occasionally lift and/or move up to 25 pounds* Required to possess specific visons abilities, including: close vision, distance vision, color vision, peripheral vision, depth perception and capacity to adjust focus.**Our Values:**Our Life Moves Us philosophy is built on four values: Passionate About Innovation, Customer Focused, Teamwork, and Driven.* **Passionate about Innovation**: Improving patient care by delivering advanced technology to our customers is at the core of what we do. We are passionate in our role in improving the lives of patients by continuously developing better solutions.* **Customer Focused**: We listen to our customers' needs and respond with a sense of urgency.* **Teamwork**: Working together, anything is possible. We value every person on our team and treat each other with respect. We are accountable to one another and support each other. Together, we make each other stronger.* **Driven**: We pursue our mission with energy and passion. We are nimble, results-oriented and decisive. We overcome obstacles that arise in our quest to deliver solutions that will improve the lives of our customers and patients. **Equal Employment Opportunity:**Globus Medical is an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, age, disability, marital status, pregnancy, national origin or citizenship. We are committed to a diverse workforce. We value all employees' talents and support an environment that is inclusive and respectful. **Other Duties:**Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. #J-18808-Ljbffr
    $75k-86k yearly est. 4d ago
  • Senior MSL, New England - Rare Disease CGT

    Beam Therapeutics 4.0company rating

    Boston, MA jobs

    A leading biotechnology company is seeking a Medical Science Liaison for the New England region. This role involves developing territory strategies and building relationships with key opinion leaders in sickle cell disease. Candidates should have an advanced scientific degree and 10+ years of experience in Medical Affairs, with a strong focus on rare diseases and hematology. The position requires outstanding communication skills and the ability to translate complex science into clear narratives. The company offers a competitive salary range of $180,000 to $220,000 USD. #J-18808-Ljbffr
    $180k-220k yearly 1d ago
  • Subject Matter Expert (SME): B-1 Mission Planning

    Leidos 4.7company rating

    Bethesda, MD jobs

    Leidos has an immediate opportunity for a Subject Matter Expert in B-1 Mission Planning. You will be part of a highly focused and diverse team of systems engineers, government program managers, software development teams, and security test engineers. In this opportunity you will also serve as a systems engineer providing leadership to peer engineers, testers, and end users with proposed solutions to complex engineering and integration problems. The enterprise utilizes leading edge methodologies for Agile and Scaled Agile Framework (SAFe). Leidos provides a real work-life balance with options for compressed work schedules and flexible hours. Primary job location is Fort Walton Beach, FL (Eglin AFB area). Applicants in other areas will be considered with the areas of Oklahoma City, OK (Tinker AFB area) or Massachusetts and New Hampshire (Hanscom AFB area) preferred. This position does offer the ability to work remote, but the chosen candidate must be comfortable with being on site at one of the above-mentioned locations as needed. Primary Responsibilities: The successful candidate will be energetic, organized, eager to learn and comfortable working & speaking in a team environment, placing a high value on collaboration and team success. Serve as a SME for Mission Planning software development. Support Agile Product Manager/Systems Engineer/Release Train Manager with a collection of products representing the client stakeholders to the development team to include product vision, design, development, testing and sustainment. Create Technical Requirements Backlogs, Statements of Work, Contract Data Requirements Lists and other documentation in support of new Mission Planning Delivery Orders. Coordinate with enterprise stakeholders to prioritize product backlogs for sprints and releases. Generate Mission Threads, use cases and requirements packages as applicable and managing those requirements and their traceability. Identify and manage internal and external dependencies. Analyze software development metrics, report results, and recommend corrective actions. Utilize common Mission Planning processes while facilitating a continuous learning culture to help drive improvement of those processes. Understanding and leveraging an Enterprise Product approach to identify requirements that represent a gap in capabilities and opportunities for reuse. Report on the technical status of product development to the key stakeholders. Evaluate technical proposals and other technical data items, to include architecture, requirements documents, designs, test plans/reports, and process descriptions. Represent the Government customer in Product Management (with content authority for the Program Backlog), responsible for identifying Customer needs, prioritizing Features, guiding the work through the Program level processes, and developing the program Vision and Roadmap consistent with the Solution Intent and Context. Collaborating to ensure appropriate value is being provided via working software and products (including documentation). Attend Product Owner Scrum meetings and participate in Program Increment (PI) planning events. Also, support the Engineering role as an individual or part of a small team that defines a shared technical and architectural vision for the System/Solution under development. Participate in determining the system, subsystems, and interfaces, validate technology assumptions and evaluate alternatives while working closely with other Agile Release Trains (ARTs) and Solution Trains. Basic Qualifications: US Citizen with at least an active DoD Secret clearance and be eligible to obtain and maintain a TS/SCI clearance. Bachelor's degree with 8+ years of prior relevant experience or Master's with 6+ years of prior relevant experience. Additional experience may be considered in lieu of a degree. Expertise in B-1 or bomber mission planning at the unit level, wing level, or AOC level is required. Strong written and verbal communication skills to collaborate with customer representatives, domain experts, and other systems engineers in the development of complex software systems. Proficiency in using Microsoft Office products (Word, Excel, PowerPoint, Project). Preferred Qualifications: US Citizen with an active DoD TS/SCI security clearance. Experience with Scrum at Scale or SAFe Agile processes is highly desired. Experience with Jira, Jira Align, and Confluence is highly desired. Experience with bomber aircraft operations preferred. Knowledge of software testing concepts. Knowledge of software and systems engineering processes for the software development life cycle. General familiarity of the DoD system development and acquisition processes. General familiarity with DoD technical order systems and processes. At Leidos, we don't want someone who "fits the mold"-we want someone who melts it down and builds something better. This is a role for the restless, the over‑caffeinated, the ones who ask, “what's next?” before the dust settles on “what's now.” If you're already scheming step 20 while everyone else is still debating step 2… good. You'll fit right in. Original Posting: January 7, 2026 Pay Range: $107,900.00 - $195,050.00 The Leidos pay range for this job level is a general guideline onlyand not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law. About Leidos Leidos is an industry and technology leader serving government and commercial customers with smarter, more efficient digital and mission innovations. Headquartered in Reston, Virginia, with 47,000 global employees, Leidos reported annual revenues of approximately $16.7 billion for the fiscal year ended January 3, 2025. For more information, visit *************** Pay and Benefits Pay and benefits are fundamental to any career decision. That's why we craft compensation packages that reflect the importance of the work we do for our customers. Employment benefits include competitive compensation, Health and Wellness programs, Income Protection, Paid Leave and Retirement. More details are available at ************************************ Securing Your Data Beware of fake employment opportunities using Leidos' name. Leidos will never ask you to provide payment‑related information during any part of the employment application process (i.e., ask you for money), nor will Leidos ever advance money as part of the hiring process (i.e., send you a check or money order before doing any work). Further, Leidos will only communicate with you through emails that are generated by the Leidos.com automated system - never from free commercial services (e.g., Gmail, Yahoo, Hotmail) or via WhatsApp, Telegram, etc. If you received an email purporting to be from Leidos that asks for payment‑related information or any other personal information (e.g., about you or your previous employer), and you are concerned about its legitimacy, please make us aware immediately by emailing us at *****************************. If you believe you are the victim of a scam, contact your local law enforcement and report the incident to the U.S. Federal Trade Commission. Commitment to Non-Discrimination All qualified applicants will receive consideration for employment without regard to sex, race, ethnicity, age, national origin, citizenship, religion, physical or mental disability, medical condition, genetic information, pregnancy, family structure, marital status, ancestry, domestic partner status, sexual orientation, gender identity or expression, veteran or military status, or any other basis prohibited by law. Leidos will also consider for employment qualified applicants with criminal histories consistent with relevant laws. #Remote #Featuredjob #J-18808-Ljbffr
    $107.9k-195.1k yearly 1d ago
  • Senior AI Digital Operations Specialist

    Generali Global Assistance | Travel Insurance 4.4company rating

    Pembroke Pines, FL jobs

    Embark on a Journey That Makes a Difference. At Generali Global Assistance (GGA), every day is an opportunity to help people explore the world with confidence. We're not just in the business of protection-we're in the business of adventure and peace of mind. Whether it's a backpacker trekking through the Andes, a family cruising the Mediterranean, or a solo traveler chasing the Northern Lights, we're there to ensure their journey is safe and supported. From assisting with emergency medical claims to guiding customers through trip disruptions or ID theft, your work helps turn travel challenges into stories of resilience. Set Sail on a Career Path to Success. Our teams value curiosity and collaboration while priding ourselves on fostering a welcoming and inclusive atmosphere for our employees. Elevate your journey through our internal programs, including: Diversity, Equity, and Inclusion (DEI) Committee Career pathing and Individual Development Plans Internal training and intern opportunities Women in Business Mentorship Program Employee awards and recognition Education and professional development assistance program Passport to Perks Includes: Generous Employer contribution for health, dental, and vision insurance Paid Maternity and Paternity Leave Scholarship Program for Employee Dependents Company match on 401k Employee Assistance Program (EAP) Company paid short-term and long-term disability insurance Company paid life insurance Voluntary Pet Insurance Voluntary Legal Benefit Discounts on travel insurance Time off policies including vacation days, sick days, personal days, holidays and volunteer days (VTO) Your Role on the Expedition: The Sr AI Digital Operations Specialist oversees the efficiency and development of Generali's digital assets. As the Sr AI Digital Operations Specialist, this incumbent will be responsible for implementing digitization initiatives, overseeing their implementation, and evaluating their effectiveness. The Senior AI Digital Operations Specialist will focus on both enhancing existing digital assets and identifying and deploying new assets with a strong focus on AI. The role will also be responsible for analyzing market data and interacting with internal and external stakeholders. This role will report directly to the Senior Manager, Digital Operations. Chart Your Course: Lead digital initiatives, including identifying and prioritizing projects and overseeing project execution. Develop and implement solutions to digitize services with a focus on Operations. Work closely with Operations, IT, and third-party technology partners to leverage data and reporting, optimize efficiencies, and drive improvements using technology. Ongoing research of potential use cases for Generative AI technologies (e.g., customer service support...) and implementation at scale, including KPI monitoring, efficiency optimization and impact measurement. Analyze and evaluate tool performance to identify areas for improvement and implement key digital transformation strategies to improve efficiency, productivity, and employee/customer experience. Manage process optimization and automation tools (preferably able to modify workflows, etc. within existing or future tools). Responsible for delivering digital/automation roadmaps by mapping companies' needs with available technology, with strong focus on AI. Analyze and evaluate existing business processes and digital solutions to identify areas for automation and improvement. Extract, transform, and load data to facilitate automation processes and generate insights for decision-making. Conduct rigorous testing of automated processes and digital assets to ensure accuracy, reliability, and compliance with quality and security standards. Stay up to date with emerging automation technologies and best practices to continuously enhance our automation capabilities. Frequently benchmark competition and Insurance market automation practices. Stay updated with the latest trends, you will communicate clear and actionable recommendations to stakeholders. Your Ticket to Success: Required Qualifications: High School Diploma or Equivalent (GED) required. Bachelor's degree in business management, Information Technology, or related field. 5+ years of digital transformation, project management or operational excellence. Exceptional quantitative and problem-solving skills. Ability to analyze data, overcome data noise, and make data-driven decisions. Experience working with complex projects with high quality deliverables and rollout of new technology solutions. Organized, efficient and a critical thinker who can work on complex projects, break them down logically, and own them from start to finish. A strong communicator that can efficiently convey takeaways and insights to drive improvements. Flexibility to learn, understand, and evaluate new concepts in unfamiliar functional areas and new technologies. Excellent project management skills with proven ability to meet deadlines, comfortable with a fast-paced environment. Preferred Qualifications: Strong experience in Data Analysis, Excel is mandatory, PowerBI/Python. Good understanding and proven experience with Generative AI. Requires IT knowledge, project management and business/operations skills, experience working at the intersection between IT and business departments. Position Coordinates: This is a hybrid role based out of our Pembroke Pines, FL office. As a hybrid role, you will be working onsite 2-3 days a week and working from home 2-3 days a week. Time for Take-off: While there is some flexibility in the hours, this position will be Monday-Friday during regular business hours (approximately 8:00am-5:00pm). Occasional overtime may be required according to business need. One team. Every destination. Generali Global Assistance is proudly part of the Europ Assistance Group and our products utilize a number of corporate and product brands. The brands for our North American team include the following: CSA: US travel insurance brand for retail, tour operator, cruise and lodging partners. Learn more here. Generali Global Assistance (GGA): The primary Corporate brand in the United States for our travel insurance, travel assistance, identity and cyber protection, and beneficiary companion products. Learn more here. GMMI: the industry standard for global medical cost containment and medical risk management solutions. Learn more here. Iris, Powered by Generali: identity and digital protection solution. Learn more here. Explore new horizons - apply today! Don't meet every single requirement? At Generali Global Assistance, we are dedicated to building a diverse, inclusive and enriching workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles. California Residents - Privacy Notice for California Residents Seeking Employment with Generali Global Assistance is available here: *************************************************************************************************** The Company is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal because of blindness, deafness, or physical handicap, or any other legally protected basis under applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absences, compensation, and training. Any employees with questions or concerns about equal employment opportunities in the workplace are encouraged to bring these issues to the attention of Human Resources. The Company will not allow any form of retaliation against individuals who raise issues of equal employment opportunity. All Company employees are responsible for complying with the Company's Equal Opportunity Policy. Every employee is to treat all other employees equally and fairly. Violations of this policy may subject an employee to disciplinary action, up to and including termination of employment.
    $54k-88k yearly est. 2d ago
  • Senior PMM, B2B Software & Services Storytelling

    El Camino Health 4.4company rating

    San Jose, CA jobs

    A leading technology company is seeking a Senior Product Marketing Manager to craft compelling narratives for their software and services. This role involves collaborating with product teams, delivering impactful storytelling through various media, and leading sales education initiatives. Candidates should possess exceptional writing and communication skills, and a strong understanding of product positioning. A hybrid work model is available, allowing flexibility in the workplace. #J-18808-Ljbffr
    $69k-89k yearly est. 23h ago
  • Senior HRBP, Commercial Talent & Org Strategy

    Gilead Sciences, Inc. 4.5company rating

    Santa Monica, CA jobs

    A leading biopharmaceutical company is seeking a Senior Director, HR Business Partner to shape talent strategies for their Commercial Organization in Santa Monica, CA. This role involves organizational development, advising leaders, and enhancing talent acquisition and development processes. The ideal candidate will have extensive experience in Human Resources, strong leadership competencies, and a commitment to inclusion and diversity. The position requires on-site presence three days a week. #J-18808-Ljbffr
    $103k-135k yearly est. 3d ago
  • Operations Specialist

    Grip 4.0company rating

    Miami, FL jobs

    We are seeking a dedicated and enthusiastic Operations Specialist to join our team. You will be the face of the company for our clients, responsible for ensuring customer satisfaction through exceptional customer service and experience. You will play a pivotal role in fostering strong relationships with our clients, understanding their needs, and ensuring that their interactions with Grip are positive and rewarding. This role requires a proactive approach to problem-solving, a deep commitment to customer care, and the ability to work seamlessly with various internal teams to enhance the overall client experience. Specific responsibilities: Serve as the primary point of contact for clients, responding to chats, emails, and calls. Build sustainable, long-term relationships with clients and ensure satisfaction by providing professional client support. Collaborate with the operations team on fulfillment requests and warehouse-related tasks. Schedule regular meetings with clients and document these meetings with well-written notes. Identify opportunities to improve the client experience and propose new ideas or solutions when appropriate. Utilize our task creation and project management system to ensure all client requests are completed on time. Handles proactive communication to clients for events impacting orders and on-time delivery. Oversee projects, which include client reports, client onboardings, and claims. Qualifications: Excellent oral and written communication skills. Experience in retail/customer service. Ability to multi-task, prioritize, and manage time effectively. Proactive approach to enhancing the client experience. Strong attention to detail and problem-solving skills. Excellent problem-solving and critical-thinking skills. Experience in 3PL, Client Experience, or Account Management is preferred. Equal Employment Opportunity Statement: Grip is an equal opportunity employer, dedicated to complying with all applicable non-discrimination laws. We are committed to providing an inclusive workplace environment, where all employees and applicants are treated with respect and without discrimination based on race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), national origin, age, disability, genetic information, or any other characteristic protected by law.
    $38k-68k yearly est. 3d ago
  • Light Housework & Errands For Seniors

    Guardian Angel Senior Services 3.7company rating

    Leominster, MA jobs

    Our mission To provide home care services with love, to enhance the quality of your living through our attentive yet subtle style of care, to maintain your dignity and your independence while serving your needs with honor and integrity. After all, is your home! Guardian Angel Senior Services of Leominster, MA is now hiring in-home Caregivers. Salary: $17.00 - $20.00 After completing all required training Flexible Schedule - Build your own schedule one client at a time Caregiving is a significant responsibility that becomes more challenging as people age. Their needs tend to grow over time, making the caregiving process even more demanding. This job consists heavily of traveling from home to home to serve our senior clients that are in need of help, this job is for Caregiver that are willing to be responsible and reliable from day one, HHA/CNA - Home Health Aide assist clients in their own homes with activities of daily living, boosting their spirit and significantly improving their quality of life, delivering quality and safe home health care services, including personal care and homemaking. Personal Care - Personal Care services could include toileting, bathing, showering, dressing, grooming, assist with personal hygiene, Homemakers - Provide Light Housekeeping, run errands or provide transportation if needed. Prepare meals, purchase food and provide personal assistance with general living needs. shopping, menu planning, laundry, and the performance of general household tasks. **TRAINING AVAILABLE FOR HHA CERTIFICATION** Qualifications: Must have Valid Driver's License Must have own Vehicle Must be able to drive 15 to 20 minutes to client's home (Paid Milage and travel time) Ability to write, read, and speak English fluently. Willingness to adhere to health and safety standards Respectful and compassionate Good time management skills Outstanding communication and interpersonal skills Responsibilities: Med reminders Assist clients with ambulation and mobility around the house or outside. Assist clients with personal care and hygiene. Plan and prepare meals with assistance from the clients (when they are able) Assist with client's shopping. Perform Light Housekeeping duties that clients can't complete on their own. Be a pleasant and supportive companion. Report any unusual incidents. Act quickly and responsibly in cases of emergency Perks: $250 Sign on Bonus Daily Pay Paid Milage and Paid travel time Flexible Schedule (short Shift) Health insurance (Must be able to work at least 30 hours Continuously) Life insurance Paid time off (accumulate vacation time) Professional development assistance Referral program Aflac Insurance 401k Guardian Angel Senior Services is an Equal Opportunity Employer. We do not discriminate against race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or genetic information. Powered by JazzHR
    $17-20 hourly 3d ago
  • Organizational Quality Nurse Specialist

    Hospice of Michigan 4.7company rating

    Ann Arbor, MI jobs

    Responsible for maintaining compliance with all State, Federal regulatory guidelines and third party payers; Accreditation standards and quality activities of the organization. Provides leadership and expertise to facilitate and support staff competency through best practice teaching, consultation, collaboration and the use of current knowledge, research and technology. Essential Functions: Ensures that there are processes in place to monitor and measure all activities related to quality assessment and performance improvement (QAPI). Provides direction and coordination of quality improvement activities utilizing continuous quality improvement principles and methodologies. Provides education and training to organization personnel on the QAPI plan, and team development. Performs clinical record review activities for data collection. Compiles, analyzes, trends and reports quality data in the following areas: hospice & palliative care quality reporting, patient care, safety, risk management, infection control, outcomes and customer satisfaction. Works collaboratively with nursing supervisors/managers/directors to assure documentation is complete and consistent with care and reflects legal requirements. Promotes professional standards of care, compliance with regulatory requirements, third-party payor reimbursement models, and organization policies and procedures through use of performance improvement methodology. Ensures complete responses to Additional Development Requests (ADRs), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC) etc., requests and participates in appeal processes. Participates in the development and annual revision of Quality Assessment and Improvement Plans and Program Evaluation. Participates in analyzing, developing, coordinating and implementing plans of correction for noted deficiencies. Makes recommendations to the education committee for mandatory education related to accreditations and compliance topics. Acts as a mentor and resource for staff with regard to performance improvement methodology, regulatory, educational and patient care issues. Participates in the evaluation, development and revision of policies and procedures for hospice. Participates on various committees related to Organizational Quality and Education. Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal and professional networks. Adheres to organizational Code of Conduct, policies, procedures, protocols and processes and all regulatory and legal requirements Adheres to the C.A.R.E. Model of Service: courtesy, acknowledgement, response and empathy. Qualifications: Registered Nurse with a baccalaureate degree in nursing, preferably a Master's Degree in a health-related discipline. Minimum three (3) years' direct hospice experience may be considered in lieu of BSN degree. Requires two to three years related quality and accreditation experience. Current RN licensure in State of Michigan and maintain such licensure in accordance with applicable laws and regulations and perform within the scope specified. Extensive knowledge of Hospice regulations and standards preferred. Excellent written, verbal and interpersonal skills necessary to interact with a wide variety of staff. Is self-directed and able to work with minimal supervision. Requires knowledge of quality assessment and utilization review functions, principles and practices. Theoretical and practical knowledge of principles of adult learning and ability to develop and present educational programs. Quantitative, analytical and computer skills to collect, analyze, display and present data. The physical and sensory demands of the position include: vision, effective speech and hearing for extensive telephone contact; repetitive motion; traveling; driving or riding in motor vehicle; standing, sitting, walking, bending, reaching, and stretching; lifting up to forty five (45) pounds unassisted and the ability to assist in lifting patients using appropriate lifting techniques and/or devices. Must be able to work variable hours/shifts and/or days, including weekends. Must have ability to occasionally work extended days. Must be eligible to work in the United States.
    $80k-97k yearly est. 2d ago
  • RCM OPEX Specialist

    Femwell Group Health 4.1company rating

    Miami, FL jobs

    The RCM OPEX Specialist plays a critical role in optimizing the financial performance of healthcare organizations by ensuring that revenue cycle management processes are efficient and compliant with industry regulations. This position requires detail-oriented professionals who can navigate complex insurance claims and reimbursement processes. Essential Job Functions Manage internal and external customer communications to maximize collections and reimbursements. Analyze revenue cycle data to identify trends and proactively remediate suboptimal processes. Maintain fee schedule uploads in financial and practice operating systems. Review and resolve escalations on denied and unpaid claims. Collaborate with healthcare providers, payors, and business partners to ensure revenue best practices are promoted. Monitor accounts receivable and expedite the recovery of outstanding payments. Prepare regular reports on refunds, under/over payments. Stay updated on changes in healthcare regulations and coding guidelines. *NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position. Other Essential Tasks/Responsibilities/Abilities Must be consistent with Femwell's core values. Excellent verbal and written communication skills. Professional and tactful interpersonal skills with the ability to interact with a variety of personalities. Excellent organizational skills and attention to detail. Excellent time management skills with proven ability to meet deadlines and work under pressure. Ability to manage and prioritize multiple projects and tasks efficiently. Must demonstrate commitment to high professional ethical standards and a diverse workplace. Must have excellent listening skills. Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures. Must maintain compliance with all personnel policies and procedures. Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members. Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position. Education, Experience, Skills, and Requirements Bachelor's degree preferred. Minimum of 2 years of experience in medical billing, coding, revenue cycle or practice management. Strong knowledge of healthcare regulations and insurance processes. Knowledgeable in change control. Proficiency with healthcare billing software and electronic health records (EHR). Knowledge of HIPAA Security preferred. Hybrid rotation schedule and/or onsite as needed. Medical coding (ICD-10, CPT, HCPCS) Claims management (X12) Revenue cycle management Denials management Insurance verification Data analysis Compliance knowledge Comprehensive understanding of provider reimbursement methodologies Billing software proficiency
    $34k-49k yearly est. 3d ago
  • Managed Care Contract Analyst, Corporate, FT, Day

    Prisma Health 4.6company rating

    Greenville, SC jobs

    Inspire health. Serve with compassion. Be the difference. Coordinate system-wide hospital and physician services contracting, including but not limited to, strategy formulation, contract terms and contract performance. Coordinate the implementation, presentation and servicing of all contracts for the entire system. Provides system wide managed care education and communication. Accountabilities Coordinate the processing of all payer contracts and amendments. Coordinate all the steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers. Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specifiedtime framesor deadlines. Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms and recommend revised terms that meet the needs of Prisma Health. Negotiate single case agreements when necessary.40% Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers.10% Develops and maintain contracting decision making and tracking tools.10% Develops model contracts or contract language for use in proposing contract or amendments to payers. Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues.15% Provide problem solving support to Prisma Health affiliates and departments. Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents. This position distributes this information throughout Prisma Health in a timely fashion. Conduct pro-active communication, contract compliance, and educational sessions. Develop and maintain effective relationships with payers and internal customers25% Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Bachelor's Degree. 5 years-Managed-care experience, preferably in a contracting or provider relations role. Required Certifications/Registrations/Licenses N/A In Lieu Of The Minimum Requirements Listed Above In lieu of manage care experience, fie years experience in healthcare administration, health insurance, or provider contracting. Other Required Sills and Experience Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques- Required Work Shift Day (United States of America) Location Independence Pointe Facility 7001 Corporate Department 70019069 Managed Care Contracting Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
    $37k-51k yearly est. 5d ago
  • Outpatient Specialist - Denver

    Biomerieux Inc. 4.7company rating

    Durham, NC jobs

    The Outpatient Specialist's main mission is to maintain and grow the current customer base while creating new opportunities through selling the BIOFIRE product line. This includes the sales of instruments, reagents and other services to drive increased adoption and market share within a defined geographical region. The Outpatient Specialist is directly responsible for achieving the territory sales goal through outpatient clinics affiliated with IDNs and clinics not affiliated with IDNs within their assigned territory. Additionally, the Outpatient Specialist will manage both direct sales as well as sales through our distribution partners to achieve high performance in the areas of customer satisfaction, revenue, and profitability. Primary Responsibilities Deliver effective sales call management, opportunity management, pipeline management and forecast accuracy. Identify and establish relationships with key customers and opinion leaders within defined territory. Establish and maintain relationships with our distribution partners to support and advance opportunities and closes. Assess, clarify, validate, and quantify the customer's existing and unmet needs on an ongoing basis. As a part of the Regional Sales team, the Outpatient-Market specialist will identify high value targets within assigned territory and develop strategies to close new business those accounts. Maintain existing customer business to minimize lost business. Work cooperatively in a matrix team and other colleagues to advance and close opportunities. Serve as a liaison between the Outpatient market and Marketing. Channel competitive intel from the field to Marketing and participate as needed in marketing projects and new product launch request. Identify key opinion leaders (KOLs) within defined territory. Manage opportunity pipeline to ensure the timing of closes matches the monthly forecast as it is represented in our CRM tool and related dashboards. Ensure the compliance of business activities meet the most stringent requirements of legal and ethical standards and current company policies. Education and Experience Associates degree and a minimum of 4 years of professional sales experience ORBachelors degree and a minimum of 2 years of professional sales experience required Bachelors degree with 4 years of customer facing experience within the IVD market in lieu of professional sales experience will receive consideration. Strong Knowledge of molecular biology technologies, techniques, and disciplines preferred. In vitro diagnostic (IVD) capital equipment preferred. Point-of-care (POC) sales experience preferred. Distribution-sales experience preferred. Knowledge, Skills, and Abilities Business Skills Functional skills including critical thinking, adaptability, time management, communication, problem-solving and digital literacy. Leading without authority through influence and guidance of others towards a common goal by using expertise, persuasion, and personal qualities to inspire action. Business acumen to understand how a business operates and how to make it successful. Intellectual Horsepower Effective and efficient problem analysis that leads to high-quality decisions. Understand complex information and interpret it accurately, often requiring critical thinking and analysis to grasp the full picture. Manage and meet competing deadlines, requiring careful prioritization and time management to ensure all tasks are completed on time. Creating the New and Different Influence change using skills and relationships to persuade others to adopt new ideas, behaviors, or processes. Perspective to see the world from another person's viewpoint thus gaining new insights and finding creative solutions to challenges. Effectively deal with ambiguity requiring adaptability, critical thinking, and proactive communication to navigate situations with limited details Maintaining Focus Make timely decisions by quickly choosing effective solutions in high-pressure situations for optimal outcomes Priority setting that align with business objectives Thriving in a fast-paced environment by managing tasks, multitasking, and adapting quickly to maintain productivity. Getting Organized Organizing work and resources efficiently to ensure smooth operations Planning objectives and strategies to achieve them within a set timeline Practicing time management to allocate tasks, balance priorities, and meet deadlines efficiently Getting Work Done Through Others Informing others by sharing clear, timely information to ensure alignment. Managing and measuring work by tracking progress, performance, and goal achievement using metrics and KPIs. Managing Work Processes Collect and analyze data to drive informed decision-making to improve performance and identify issues Dealing with Complex Situations Communicates instructions clearly and effectively Demonstrates assertiveness and confidence in the face of a challenge Conflict Management Solution oriented in the face of conflict Comfortable giving clear, direct, and actionable feedback Ability to deal with difficult situations in a timely and bold manner Focusing on the Bottom Line Drive for Results: Drive for Results while successfully removing barriers Action Oriented: Takes action even when facing challenges Being Organizationally Savvy Ability to cooperate with others at all levels including leadership Ability to work cross-functionally allowing for better collaboration and communication when working across teams to achieve shared objectives Communicating Effectively Effective verbal communication skills Written Communications - including the ability to communicate technical data in written form Effective Presentation Skills - including the ability to present technical data Relating Skills Build and maintain positive, productive interactions with colleagues Easily accessible and open to communication Effectively navigate social interactions in the workplace Developing and Inspiring Others Reach mutually beneficial agreements through effective communication and compromise Managing Diverse Relationships Participate in a way that enhances team performance and cohesion. Fosters a culture of inclusiveness among all team members Acting with Honor and Being Open Consistently uphold and reflects the core ethical principles and values that bio Merieux promotes Actively and attentively listen to others, ensuring a clear understanding of their messages, needs, and concerns. Emotional intelligence by having the ability to recognize, understand, and manage one's own emotions, as well as the emotions of others. Maintain composure by having the skill of staying calm, focused, and professional in high-pressure or stressful situations. Working Conditions and Physical Requirements Ability to remain in stationary position, often standing, for prolonged periods. Ability to ascend/descend stairs, ladders, ramps, and the like. Ability to adjust or move objects up to 50 pounds in all directions. Domestic travel required 70% of time Location dependent the selected incumbent will be required to be masked while working in client locations for extended periods when on site in hospitals. Ability to conduct client visits which entails the safe operation of motor vehicles, physically accessing customer facilities and frequent air travel in performance of assigned duties. The estimated salary range for this role is between $87,700 - $140,000. This role is eligible to receive a variable annual bonus based on company, team, and individual performance per bio Merieux's bonus program. This range may differ from ranges offered for similar positions elsewhere in the country given differences in cost of living. Actual compensation within this range is determined based on the successful candidate's experience and will be presented in writing at the time of the offer.In addition, bio Merieux offers a competitive Total Rewards package that may include: A choice of medical (including prescription), dental, and vision plans providing nationwide coverage and telemedicine options Company-Provided Life and Accidental Death Insurance Short and Long-Term Disability Insurance Retirement Plan including a generous non-discretionary employer contribution and employer match. Adoption Assistance Wellness Programs Employee Assistance Program Commuter Benefits Various voluntary benefit offerings Discount programs Parental leaves #LI-US#biojobs Please be aware that recruitment related scams are on the rise. Fraudulent job postings are being placed on other websites, and individuals posing as bio Merieux Talent Acquisition team members are reaching out via email or text message in an attempt to collect your personal and confidential information. In some cases, these scammers are also conducting bogus interviews prior to extending fraudulent offers of employment. Beware of individuals reaching out using general phone numbers and non-bio Merieux email domains (i.e. Hotmail.com, Gmail.com, Yahoo.com, etc.). If you are concerned that an interview experience or offer of employment might be a scam, please make sure you are searching for the posting on our careers site or contact us at [emailprotected]. BioMerieux Inc. and its affiliates are Equal Opportunity/Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Please be advised that the receipt of satisfactory responses to reference requests and the provision of satisfactory proof of an applicant's identity and legal authorization to work in the United States are required of all new hires. Any misrepresentation, falsification, or material omission may result in the failure to receive an offer, the retraction of an offer, or if already hired, dismissal. If you are a qualified individual with a disability, you may request a reasonable accommodation in BioMerieux's or its affiliates' application process by contacting us via telephone at , by email at [emailprotected], or by dialing 711 for access to Telecommunications Relay Services (TRS).
    $87.7k-140k yearly 2d ago
  • MRO Specialist

    Quest Global 4.4company rating

    Windsor Locks, CT jobs

    Who We Are: Quest Global delivers world-class end-to-end engineering solutions by leveraging our deep industry knowledge and digital expertise. By bringing together technologies and industries, alongside the contributions of diverse individuals and their areas of expertise, we are able to solve problems better, faster. This multi-dimensional approach enables us to solve the most critical and large-scale challenges across the aerospace & defense, automotive, energy, hi-tech, healthcare, medical devices, rail and semiconductor industries. We are looking for humble geniuses, who believe that engineering has the potential to make the impossible possible; innovators, who are not only inspired by technology and innovation, but also perpetually driven to design, develop, and test as a trusted partner for Fortune 500 customers. As a team of remarkably diverse engineers, we recognize that what we are really engineering is a brighter future for us all. If you want to contribute to meaningful work and be part of an organization that truly believes when you win, we all win, and when you fail, we all learn, then we're eager to hear from you. The achievers and courageous challenge-crushers we seek, have the following characteristics and skills: What You Will Do: Preparation and maintenance of program tracking metrics Utilize SAP to run reports and analyze large volumes of data Understand and appropriately allocate critical detail parts across repair facilities to facilitate on time delivery metrics and engine centers testing requirements Prepare status reports as required, present weekly data packages and complete monthly MRO overdue reports Lead status and operational meetings for internal and external stakeholders What You Will Bring: Bachelor's degree in engineering 10+ years of experience working within an MRO facility Strong emphasis on data management, analysis, forecasting, and SAP knowledge. Strong communication and presentation skills Ability to work within both a shop floor and office environment Ability to work independently Pay Range: $70,000 to $80,000 per year Compensation decisions are made based on factors including experience, skills, education, and other job-related factors, in accordance with our internal pay structure. We also offer a comprehensive benefits package, including health insurance, paid time off, and retirement plan. Work Requirements: This role is considered an on-site position located in Windsor Locks, CT You must be able to commute to and from the location with your own transportation arrangements to meet the required working hours. Shop floor environment, which may include but not limited to extensive walking, and ability to lift up to 40 lbs. Travel requirements: Due to the nature of the work, no travel is required. Citizenship requirement: Due to the nature of the work, U.S. citizenship is required. Benefits: 401(k) matching Dental insurance Health insurance Paid time off Vision insurance Employer paid Life Insurance, Short- & Long-Term Disability
    $70k-80k yearly 2d ago
  • Enterprise Accreditation Specialist III

    Caresource 4.9company rating

    Dayton, OH jobs

    The Enterprise Accreditation Specialist III is responsible for supporting the organization to obtain and maintain appropriate accreditations, distinctions and recognitions through NCQA, URAC or other accrediting bodies. This person will serve as the subject matter expert for various accreditations, including but not limited to NCQA Health Plan Accreditation, LTSS Distinction, Health Equity, UM, and Population Health. This person will work cross-functionally with business owners to identify gaps and deficiencies between current processes and the accreditation requirements and assist in implementing any necessary mitigation activities as needed. They will also ensure all changes made by accrediting bodies are communicated and incorporated into business processes. Essential Functions: Serve as subject matter expert in accreditation standards, including NCQA Health Plan, LTSS Distinction, Health Equity, UM and Population Health. Clearly define deliverables associated with delegation agreements including appropriate responsible parties Maintain a strong understanding of the business processes within the assigned Market Collaborate with the business owners to obtain documents, reports, and materials for accreditation submission Provide oversight and monitoring of all surveys and deliverables within assigned Market Monitor, track, and document deliverables related to accreditation process by applying accreditation standards to CareSource processes and documents in conjunction with the business owners Act as advisor to business areas on appropriate documentation and data analysis needs for required improvement opportunities to meet the intent of the NCQA standards Maintain an in-depth knowledge of the standards within the scope of work and ensure that changes made by NCQA are communicated and incorporated into business processes Review and analyze documents, reports, and materials for submission. Ensures accuracy prior to submission Facilitate ongoing annual qualitative and quantitative analyses, assuring business owners are acting on their opportunities for improvement Responsible for preparing materials including but not limited to updating and reformatting for submission to accrediting entities in accordance with standards, coordinating efforts with internal business owners, and tracking readiness against work plans and timelines Manage survey submission process for assigned Market Maintain accreditation roadmaps/workplans Identify and communicate survey status, gaps, and escalations and ensure mitigation plans are implemented, gaps are closed and escalations are resolved Provide management recommendations for improvement related to accreditation processes and document processes Ensure all workplans and dashboards are updated for reporting Manage and execute on multiple module activities consistency Perform a variety of complex work in planning, coordinating, and managing accreditation activities Provide education to staff and business owners on accreditation standards and provide timely updates to affected departments including accreditation activities, survey dates and timelines for deliverables Act as a mentor to the Accreditation Specialist II Assist with the onboarding of new team members on module and Market specific requirements Participate in Market Quality Committees and other applicable committees as required Perform any other job duties as assigned Education and Experience: Bachelor's degree in science, arts, healthcare or other related field or equivalent years of relevant work experience is required. Minimum of three (3) years of experience in a Managed Care Organization or other healthcare related field is required Project Management Experience is preferred Accreditation experience is required Knowledge of IHI, DMAIC, or other process improvement methodologies preferred Competencies, Knowledge and Skills: Knowledge of accreditation bodies and various forms of accreditations, distinctions and recognitions. Expert knowledge of the NCQA Submission process Strong interpersonal skills and high level of professionalism Strong critical thinking/listening skills Excellent problem-solving skills with strong attention to detail Excellent written and verbal communication skills Ability to work independently and within a team environment Ability to develop, prioritize and accomplish goals Analytical and organizational skills Ability to coordinate complex projects and multiple meetings Proficient in Microsoft Office Suite to include Word, Excel, Adobe Pro and SharePoint Excellent written and verbal communication skills Proficient knowledge of the healthcare field and with Medicaid, Medicare, and Marketplace Training/teaching and technical writing skills Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1
    $62.7k-100.4k yearly 2d ago
  • Grievance & Appeals Specialist II (Must live in Indiana)

    Caresource 4.9company rating

    Indianapolis, IN jobs

    The Grievance & Appeals Specialist II reviews appeals submitted by Medicaid and Medicare providers and all future providers contracted with CareSource. Must live in Indiana. . Essential Functions: Prepare the appeals for clinical review and be responsible for recording and tracking on a regular basis Review submitted appeals daily for validation of the appeal Identify appropriate claim problem within the appeal Prepare all clinical edit appeals for review by computer research, print claim from Facets system, and print off all the code descriptions to assist the reviewer in decision making for committee meetings Attend and participate in Appeals Committee meetings as needed Maintain spreadsheet of all appeals reviewed with the outcomes resulting from the Appeals Committee Meetings Document within Facets the detailed information as to the outcome of the claim appeal Identify System changes, log the ticket and track the resolution Complete claim appeal through claim adjustments or letters of denials Review claim appeals for possible fraud and abuse and report to SIU Research and release claim appeals with other health insurance, notifying the COB unit when there is other insurance Process a variety of appeals, including but not limited to: dental appeals, low difficulty appeals, non-clinical appeals - (i.e. tobacco surcharge, etc.), medically frail appeals, RCP appeals, member and provider appeals Resolve assigned appeals within regulatory timeframes, achieve departmental quality expectations, and meet daily production requirements Identify and log any related issues Perform UAT testing when necessary Perform any other job related instructions, as requested Education and Experience: High school diploma or equivalent is required Associates Degree or equivalent years of relevant work experience preferred Minimum of two (2) years of healthcare customer service, claims, compliance or related experience is required Competencies, Knowledge and Skills: Technical writing skills Intermediate level skills in Microsoft Word & Excel with Access skills a plus Communication skills (written, oral and interpersonal) Multitasking ability Able to work independently and within a team environment Familiarity of the Healthcare field Knowledge of Medicaid Time Management Decision-making and/or problem solving skills Proper grammar skills Phone etiquette skills Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $41,200.00 - $66,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Hourly Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SD1
    $41.2k-66k yearly 3d ago
  • ECMO Specialist, FT, Night

    Prisma Health 4.6company rating

    Greenville, SC jobs

    Inspire health. Serve with compassion. Be the difference. In collaboration with perfusion and physician staff, in an acute, critical care inpatient setting, provides clinical direction for all aspects of patient care related to Extracorporeal Membrane Oxygenation [ECMO] therapy. Demonstrates clinical competency utilizing evidence based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit, and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to: licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control and medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the scope of their South Carolina license. The acute inpatient setting usually requires staff to be scheduled for a significant amount of shift, weekend, holiday, and/or on-call work. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Manages and assists with cardio-pulmonary support devices, ECMO (extracorporeal membrane oxygenation). Maintains accurate records of cardio-pulmonary support devices, ECMO, as a permanent copy of the medical record. Follows laboratory procedure for handling specimens, processing test analyses and reporting results. Assists in patient transport activities and manages cardio-pulmonary support devices, ECMO (extracorporeal membrane oxygenation) during patient transport process. Provides direct patient care for patients within scope of practice. Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - Associate degree in Nursing or Respiratory Therapy Experience - ECMO specialty device course and required CMEs to maintain proficiency In Lieu Of Three (3) years of intensive care experience may be considered. Required Certifications, Registrations, Licenses Licensed to practice as a RN or RT in South Carolina Knowledge, Skills and Abilities Working knowledge of patient equip-suction, defibrillator, vitals I-STAT point of care competency Work Shift Night (United States of America) Location Greenville Memorial Med Campus Facility 1008 Greenville Memorial Hospital Department 10086166 Mechanical Circulatory Support Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
    $20k-29k yearly est. 5d ago
  • Network Subject Matter Expert (SME) II

    Waypoint Human Capital 4.1company rating

    Augusta, GA jobs

    Network Subject Matter Expert (SME) II Position Type: Full-time Onsite Aberdeen Proving Ground, MD Clearance Required: Active Top Secret Waypoint's client is seeking a highly qualified Network Subject Matter Expert II to join their team. The successful candidate will be responsible for designing, planning, installing, integrating, and maintaining core-area tactical and strategic communications networks, including elements of the Defense Information Systems Network (DISN) and the Global Information Grid (GIG). Key Responsibilities: Gather requirements from users, Operational Need Statements, and Capability Production Documents (CPDs) for the Army's tactical communications systems and translate them into technical solutions that are standards-based and cost-efficient. Develop network architecture for adjacent, higher, and lower units, as well as for allied nations, other government agencies, and commercial service interfaces. Provide engineering design, development, integration, installation, operation, and maintenance of the tactical network. Support technical tasks in the integration of Data/Voice/Video/Telephony in the Tactical Network, and assist in developing technical requirements, specifications, plans, reports, and engineering documentation. Prepare independent assessments, provide systems engineering support, and ensure quality engineering throughout the project lifecycle. Develop equipment and network configurations and products; support technology insertion testing relative to emerging PM TN network requirements and capabilities. Provide technical expertise at field locations and PM TN equipment labs. Technical Skills and Experience: Strong knowledge and understanding of current and future Force tactical and strategic military communications networks, including architecture, protocols, security, network management, and the underlying physics. Proficient in Cisco technologies, including Cisco IOS, NXOS, ISE, UCS Networking, and Configuration, and Cisco ASA. Familiarity with routing protocols such as BGP, OSPF, RIP, EIGRP, and proficiency in MULTICAST; experienced in designing and implementing LANs and VLANs. Subject matter expertise in VOIP, Cisco Call Manager, Call Manager Express, and Redcom Sigma Core. Experience with network protocol analysis tools such as Sniffer or Wireshark. Familiarity with Army Software Baselines and Architectures. Experience working with Microsoft technologies, particularly Active Directory. Knowledge of virtualization and storage technologies from VMware, EMC, NetApp, Microsoft, Dell, HP, and others. Qualifications: Bachelor's Degree in Engineering or a related field. Minimum of 12 years of relevant experience as a subject matter expert in Tactical SATCOM. Must possess a valid Secret security clearance. *Waypoint Human Capital is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender, national origin, age, protected veteran status, or disability status.
    $68k-100k yearly est. 3d ago
  • Network Subject Matter Expert (SME) II

    Waypoint Human Capital 4.1company rating

    Aberdeen Proving Ground, MD jobs

    Network Subject Matter Expert (SME) II Position Type: Full-time Onsite Aberdeen Proving Ground, MD Clearance Required: Active Top Secret Waypoint's client is seeking a highly qualified Network Subject Matter Expert II to join their team. The successful candidate will be responsible for designing, planning, installing, integrating, and maintaining core-area tactical and strategic communications networks, including elements of the Defense Information Systems Network (DISN) and the Global Information Grid (GIG). Key Responsibilities: Gather requirements from users, Operational Need Statements, and Capability Production Documents (CPDs) for the Army's tactical communications systems and translate them into technical solutions that are standards-based and cost-efficient. Develop network architecture for adjacent, higher, and lower units, as well as for allied nations, other government agencies, and commercial service interfaces. Provide engineering design, development, integration, installation, operation, and maintenance of the tactical network. Support technical tasks in the integration of Data/Voice/Video/Telephony in the Tactical Network, and assist in developing technical requirements, specifications, plans, reports, and engineering documentation. Prepare independent assessments, provide systems engineering support, and ensure quality engineering throughout the project lifecycle. Develop equipment and network configurations and products; support technology insertion testing relative to emerging PM TN network requirements and capabilities. Provide technical expertise at field locations and PM TN equipment labs. Technical Skills and Experience: Strong knowledge and understanding of current and future Force tactical and strategic military communications networks, including architecture, protocols, security, network management, and the underlying physics. Proficient in Cisco technologies, including Cisco IOS, NXOS, ISE, UCS Networking, and Configuration, and Cisco ASA. Familiarity with routing protocols such as BGP, OSPF, RIP, EIGRP, and proficiency in MULTICAST; experienced in designing and implementing LANs and VLANs. Subject matter expertise in VOIP, Cisco Call Manager, Call Manager Express, and Redcom Sigma Core. Experience with network protocol analysis tools such as Sniffer or Wireshark. Familiarity with Army Software Baselines and Architectures. Experience working with Microsoft technologies, particularly Active Directory. Knowledge of virtualization and storage technologies from VMware, EMC, NetApp, Microsoft, Dell, HP, and others. Qualifications: Bachelor's Degree in Engineering or a related field. Minimum of 12 years of relevant experience as a subject matter expert in Tactical SATCOM. Must possess a valid Secret security clearance. *Waypoint Human Capital is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender, national origin, age, protected veteran status, or disability status.
    $87k-125k yearly est. 60d+ ago

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