Managed Care Coordinator jobs at BlueCross BlueShield of South Carolina - 25 jobs

RN Managed Care Coordinator I - Utilization Management
Bluecross Blueshield of South Carolina 4.6
Managed care coordinator job at BlueCross BlueShield of South Carolina
We are currently hiring for a Managed Care Coordinator I to join BlueCross BlueShield of South Carolina. In this role as a Managed Care Coordinator I, you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Description Location This position is full time (40 hours/week) Monday-Friday from 8:30am - 5:00pm EST and will be fully remote. The candidate may be asked to report on-site occasionally for trainings, meetings, or other business needs. What You'll Do: Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Provides patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. To Qualify for This Position, You'll Need the Following: Required Education: Associates in a job-related field. Degree Equivalency: Graduate of Accredited School of Nursing or 2 years of job-related work experience. Required Work Experience: 2 years' clinical experience. Required Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in typing, spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire. We Prefer That You Have the Following: Previous experience working with National Alliance. Preferred Education: Bachelor's degree- Nursing. Preferred Work Experience: Work experience in healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. 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$43k-70k yearly est. Auto-Apply 11d ago

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Bilingual Behavioral Health Care Manager
Heritage Health Network 3.9
Riverside, CA jobs
This role works closely with Care Team Operations, Clinical Operations, Behavioral Health clinicians (LMFT/LCSW/LPCC), Community Health Workers (CHWs), Compliance, Finance (for authorizations), Care Operations Associates, and external partners including hospitals, primary care providers, behavioral health agencies, housing providers, and community-based organizations. Responsibilities Serve as the primary point of contact for assigned members with behavioral health and psychosocial complexity, building trust through consistent, trauma-informed engagement. Conduct comprehensive, holistic assessments addressing behavioral health, substance use, functional status, social determinants of health, safety risks, and care gaps. Develop, implement, and maintain person-centered care plans that integrate behavioral, medical, and social goals; update plans following transitions of care or changes in condition. Coordinate services across the continuum of care, including behavioral health providers, primary care, hospitals, housing supports, transportation, social services, and community-based organizations. Conduct required in-person home or community visits based on acuity, risk stratification, and payer requirements. Support Transitions of Care (TOCs) by completing timely follow-up, coordinating post-discharge services, and reinforcing discharge instructions and medication understanding. Utilize motivational interviewing, behavioral coaching, and health education to promote engagement, adherence, self-management, and long-term member stability. Identify, escalate, and address behavioral health risks, safety concerns, service delays, benefit lapses, and environmental barriers using HHN escalation protocols. Coordinate and track referrals, appointments, transportation, and follow-ups to ensure continuity and timeliness of care. Maintain accurate, timely, and audit-ready documentation of all assessments, encounters, and interventions in eClinicalWorks (ECW) and other HHN systems. Meet or exceed HHN and health plan productivity standards, including outreach cadence, encounter requirements, documentation timeliness, TOC completion, and quality measures. Actively participate in multidisciplinary case reviews, care conferences, team huddles, and escalations with nurses, behavioral health clinicians, CHWs, care operations, and compliance. Assist members with plan navigation, eligibility redeterminations, social service applications, housing resources, and crisis intervention support. Communicate professionally with members and care partners using HHN-approved channels, including phone, RingCentral, secure messaging, and SMS workflows. Contribute to continuous quality improvement efforts by identifying workflow gaps, documenting barriers, and sharing insights to improve care delivery. Uphold confidentiality and comply with all HIPAA, Medi-Cal, ECM, and payer regulatory requirements. Remain flexible and responsive to member needs, including field-based work and engagement in community settings. Skills Required Bilingual (English/Spanish) proficiency required to support member engagement and care coordination. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field. Licensure: Licensed LMFT, LCSW, LPCC.; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.
$61k-76k yearly est. 1d ago
Lead Care Manager (LCM)
Heritage Health Network 3.9
Los Angeles, CA jobs
The Bilingual Lead Care Manager partners with Care Team Operations, Clinical Operations, Compliance, Community Health Workers, Behavioral Health staff, and external providers (medical, housing, and social services) to ensure seamless, culturally responsive, member-centered care coordination. The bilingual LCM additionally supports members with limited English proficiency by facilitating communication, translation, and cultural interpretation as needed. Responsibilities Serve as the primary point of contact for assigned members, building trust and maintaining active engagement through consistent outreach, relationship-based strategies, and a trauma-informed approach. Provide all communication in the member's preferred language. Conduct comprehensive assessments (physical, behavioral, functional, social) and develop person-centered care plans that reflect the member's goals, risks, preferences, cultural needs, and social determinants of health. Implement, monitor, and update care plans following transitions of care, significant changes in condition, or required reassessments; ensure timely and compliant submission of all care plans. Coordinate services across the continuum-including medical, behavioral health, housing, transportation, social services, and community programs-to reduce fragmentation and remove barriers to care. Conduct required in-person home or community visits based on member need and risk stratification and maintain a compliant monthly visit structure. Utilize motivational interviewing, coaching, and health education to promote behavioral change, self-management, and long-term member stability. Identify gaps in care, service delays, lapses in benefits, unmet needs, and environmental risks; collaborate with internal and external partners to resolve issues quickly and effectively. Maintain accurate, timely, audit-ready documentation of all interactions, assessments, and interventions using required HHN platforms, including eClinicalWorks (ECW), Google Suite, RingCentral, PowerBI dashboards, and payer portals. Meet or exceed HHN and payer productivity standards, including encounter metrics, outreach requirements, documentation timelines, and quality measures. Actively participate in multidisciplinary case reviews, team huddles, care conferences, and escalations with nurses, behavioral health staff, CHWs, care operations, and compliance. Coordinate and schedule appointments with primary care, specialists, behavioral health providers, and community partners; manage referrals, transportation, and follow-ups to ensure continuity of care. Support hospital discharge (TOC) planning through follow-up scheduling, care transitions, medication reconciliation support, and education on discharge instructions. Assist members in navigating plan eligibility, redeterminations, documentation, social service applications, housing resources, and crisis interventions. Maintain active and professional communication with members and care partners through HHN-approved channels, including RingCentral, secure messaging, SMS workflows, and phone. Participate in HHN's continuous quality improvement efforts, identifying workflow gaps, documenting barriers, sharing insights, and contributing to best-practice development. Uphold confidentiality and adhere to all HIPAA and payer regulatory requirements across all areas of care delivery. Open to seeing patients in their home or their location of preference. Provide real-time interpretation and translation support (verbal and written) for members and families with limited English proficiency. Help bridge cultural gaps that may impact communication, trust, adherence, or engagement. Skills Required Fluency in English and another language (Spanish preferred); ability to read, write, and speak at a professional level. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Bilingual Communication (interpretation + translation) Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field preferred; equivalent experience considered. Licensure: Not required; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.
$36k-47k yearly est. 4d ago
Global insurance Clinical Care Manager - Bilingual Japanese RN - Remote
Unitedhealth Group 4.6
Tampa, FL jobs
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. Primary Responsibilities: A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Registered Nurse with an active unrestricted United States license Must be bilingual in Japanese and English, with strong verbal and written communication skills 3+ years of experience in medical-surgical inpatient acute care Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals Proven communication skills at all levels Proven ability to be flexible and display a positive attitude Proven solid problem-solving, organizational and crisis management skills Proven ability to function confidently and efficiently in fast paced work environment Proven ability to foster team cohesion in an international virtual environment Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members Proven advanced software skills with ability to work in multiple platforms with clinical case reviews Proven advanced skills with Microsoft Office - Excel, Word Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs Preferred Qualifications: Bachelor's degree 2+ years of experience in utilization management or case management in a managed care or hospital environment Experience in international healthcare and/or air medical transport Experience in discharge planning and/or chart review International travel experience Demonstrated familiarity with InterQual criteria guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$72.8k-130k yearly 3d ago
Care Management Coordinator, Medical Review - Remote (PA/NJ/DE)
Blue Cross and Blue Shield Association 4.3
Philadelphia, PA jobs
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health. The Care Management Coordinator, Medical Review conducts post service reviews on medical claims and cases to ensure medical criteria has been met in accordance with current Company medical policies and medical management guidelines for inpatient, outpatient, surgical and diagnostic procedures including out of network services. This position is within the Claims Medical Review team. Responsibilities/Duties * Reviews provider submission of medical records for specific services that have been processed through system automation and require documentation to determine if additional payment is warranted. * Reviews specific medical services during the claims adjudication process against medical policies and medical management guidelines to ensure criteria has been met and provides direction to claims processing area. * Conducts analysis review of post payment claims against current medical policy and medical management guidelines * Identifies claims/services that require medical records review retrospectively * Works with Hospitals and Professional providers to obtain medical records to conduct retrospective reviews * Reviews medical records for identified claims/services to ensure medical criteria based on policies and guidelines have been met * Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Directors for further evaluation determination * Collaborates with appropriate areas of the Company including Care Management, Medical Policy, CFID, Appeals, Clinical Vendor Management and Claims Operations. * Summarizes and tracks all analyses performed and reports to Management * Identifies and suggests process improvements or potential process efficiencies based on reviews conducted * Participates in key business area projects * Assists with review and maintenance of the Claim Medical Review team's policies, procedures, checklists and documentation as required. * Performs other related duties as assigned Knowledge/Skills/Qualifications * RN license, BSN Preferred * Minimum 3-5 years' experience with medical criteria reviews * Strong knowledge of ICD-10, HCPCS and CPT coding/billing * Claims auditing experience a plus * Proficiency with Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances. * Self motivated, highly organized and detailed oriented as well as problem solving, analytical, verbal and written communication skills are required * Demonstrate the ability to work in a multi-tasking environment Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
$35k-52k yearly est. Auto-Apply 36d ago
Care Coordinator
Brown & Brown 4.6
Remote
Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. The Care Coordinator will coordinate the with the Care Team Lead and Care Team Member Services Manager to ensure the team has the resources required to satisfy member enrollment and maintenance in the IPC Copay Assistance Program. The Care Coordinator will respond accordingly to incoming and make external calls to client members to ensure appropriate processing of copay assistance. Essential Duties and Functions: Provide client support where needed Coordinate member implementation calls with Care Team Lead Provide adhoc claims review as required Identify utilizing patients, review history, determine next coverage date Assist patient with enrollment in the manufacturer's program Maintain patient database for follow-up, tracking and reporting Receive notification of new patient's prior authorization/or review daily rejected and paid claims This position will include job duties that require risk designations for access to Electronic Protected Health Information (PHI) in the course of their job responsibilities Other duties may be assigned Competencies: Planning/organizing-the individual prioritizes and plans work activities and uses time efficiently. Makes good and timely decisions that propels our company forward Interpersonal skills-the individual maintains confidentiality, remains open to others' ideas and exhibits willingness to try new things. Creates an environment where teammates feel connected and energized. Written and Oral communication-Communicate a concise message that resonates every time. The individual speaks clearly and persuasively in positive or negative situations and demonstrates group presentation skills. Problem solving-Create innovative ways for our customers and our company to be successful. The individual identifies and resolves problems in a timely manner, gathers and analyzes information skillfully and maintains confidentiality. Quality control-the individual demonstrates accuracy and thoroughness and monitors own work to ensure quality. Adaptability-the individual adapts to changes in the work environment, manages competing demands and is able to deal with frequent change, delays or unexpected vents. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Required Certified Pharmacy Technician (CPhT.) License or 2-5 years of experience in a retail pharmacy or pharmacy benefit management environment Excellent communication skills Proficient with MS Office Suite Professional telephone demeanor Ability to maintain a high level of confidentiality Pay Range 18.00 - 20.00 Hourly The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.
$33k-48k yearly est. Auto-Apply 5d ago
CHOICES Care Coordinator- Hickman, Lewis, and Perry Counties
Bluecross Blueshield of Tennessee 4.7
Remote
Are you a compassionate individual who enjoys helping others achieve their personal health and wellness goals? If so, a career as a CHOICES Care Coordinator might be perfect for you. As a Care Coordinator, you will make a lasting impact on members' lives by ensuring their safety at home or within a community setting. In this role, you'll travel to member's homes for visits, while managing various demands and requests from both internal and external stakeholders. We're seeking individuals who excel in problem-solving through critical thinking, and who are adept at time management and prioritizing daily tasks. You should be self-motivated, flexible, and thrive in a fast-paced environment. Most importantly, you should have a passion for improving the quality of life for diverse members in their communities. You will be a great match for this role if you have: • 3 years of experience in a clinical setting • Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). • Exceptional customer service skills • Must live within the following counties: Hickman, Lewis, and Perry Counties • Available for an 8:00am - 5:00pm EST(no on call) schedule, with the option (upon management approval) to work a compressed work week after 1 year. Job Responsibilities Partnering with members and families to identify needed supports and direct services to meet personal goals for good health, employment and independent or community living. Collaborates with a team of clinical and social support colleagues to meet the physical, behavioral health and long term service needs of each member. Conduct thorough and objective face-to-face visits with and assess each members situation to determine current status and needs, including physical, behavioral, functional, psycho-social, financial, and employment and independent living expectations. Utilizing criteria for authorizing appropriate home and community based services and confirm those services are being provided and that members needs are being met. Valid Driver's License. TB Skin Test (applies to coordinators that work in the field). Position requires 24 months in role before eligible to post for other internal positions. Various immunizations and/or associated medical tests may be required for this position. Job Qualifications Experience 2 years - Clinical experience required Skills\Certifications PC Skills required (Basic Microsoft Office and E-Mail) Effective time management skills Excellent oral and written communication skills Strong interpersonal and organizational skills License Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters in Social Work with an active unrestricted license (LCSW, LMSW, or LAPSW). Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
$40k-58k yearly est. Auto-Apply 7d ago
RN, Clinical Care Manager I
Gold Coast Health Plan 4.1
Camarillo, CA jobs
is intended to start January 2026. The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in. Work Culture: GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work - Together. GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer). GCHP's focuses on 5 Core Values in the workplace: • Integrity • Accountability • Collaboration • Trust • Respect Disclaimers: • Flexible work schedule is based on job duties, department, organization, or business need. • Gold Coast Health Plan will not sponsor applicants for work visas. POSITION SUMMARY The Gold Coast Health Plan (GCHP) RN, Clinical Care Manager I supports the GCHP mission to improve the health of the members through provision of the best possible quality care and services. As defined by the Case Management Society of America (CMSA): Care management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. The RN, Clinical Care Manager I works closely with other team members and is a role model and resource to colleagues. This position acts as a bridge by facilitating communication between the member, member's family and the providers. The RN, Clinical Care Manager I also provides member advocacy and education to maintain or improve clinical outcomes. Amount of Travel Required: 5-10% Work Schedule: Predominately remote work. Flexibility to work beyond normal business hours as needed. Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions. ESSENTIAL FUNCTIONS Job Function & Responsibilities • Assess and identify members who may benefit from additional education, clinical support, and connecting them with appropriate medical providers. • Promote the most cost-effective healthcare delivery by coordinating with the medical management team. • Engage members into care coordination activities to reduce care gaps. • Evaluate for and work toward elimination of barriers to care. • Formulation of a member-centric care plan in partnership with the member. • Collaborate with internal partners including but not limited to; social workers, health education, pharmacy staff and ECM/ Community Supports team, member services • Ensure confidentiality of utilization review, quality assurance information, and individual beneficiary identification • Assist with data collection for special member determination as required • Prepare written reports such as summaries of case management functions and updates of case status, use of covered services, supporting and reporting required metrics and other pertinent performance data, as directed • Provide accurate documentation to meet departmental policies, regulatory requirements and audits • Attend community meetings concerning health issues or provision of health-related services Establish and maintain effective working relationships with community resources and service agencies • Strong organizational, delegation and task prioritization skills • Member advocacy focus • Knowledge of required regulatory timelines to ensure department compliance with State contracts • Ability to convey empathy and is nonjudgmental of the member • Demonstrates team support by consistently seeking opportunities to recognize and promote colleagues • Ability to stay calm and professional when working with internal and external partners • Exhibits accountability by maintaining good attendance • Adhere to all GCHP Policies and Procedures and meet required performance standards • Review referral requests for Enhanced Care Management and Community Supports referral requests. • Authorize referral requests for various ECM and CS providers. • Serve as liaison for Justice Involved population. • Attend National Health Foundation meetings with Enhanced Care Management. • Attend CalAim meetings with Ventura County. • Educate members, staff and providers about policies for ECM and CS. MINIMUM QUALIFICATIONS Education: • Bachelor's Degree (four-year college or technical school) is preferred, Field of Study: in a health-related field and managed care experience is desired • Registered Nurse (RN) valid and current license. Experience: • 2 plus years of experience in the health care field. Required. • Care management, discharge planning, or equivalent combination of education and experience. • Managed care experience in a health plan, preferred. • Ability to evaluate clinical and other health data and to communicate effectively both orally and in writing. • Ability to synthesize thoughts and plans succinctly in writing. • Ability to balance multiple tasks. • Strong organizational skills. • Critical thinking skills. • Flexibility in role delineation and workload assignments. • Team player KNOWLEDGE, SKILLS & ABILITIES Preferred Qualifications: Technology & Software Skills: Strong background and knowledge of computer skills in MS Office products. Certifications & Licenses: • Active, valid and unrestricted license, California Registered Nurse CCM or other CM certification preferred. • A valid and current Driver's License, Auto Insurance, and professional licensure(s) Other: • Bilingual in English and Spanish preferred • An attitude to excel, a special empathy for working with multiple populations, an investigative personality and a willingness to mentor colleagues. • A working knowledge of Medi-Cal and related policy and regulations. Competency Statements • Management Skills - Ability to organize and direct oneself and effectively supervise others. • Business Acumen - Ability to grasp and understand business concepts and issues. • Customer Oriented - Ability to take care of the customers' needs while following company procedures. • Coaching and Development - Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas. • Communication, Oral - Ability to communicate effectively with others using the spoken word. • Team Builder - Ability to convince a group of people to work toward a goal. • Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
$64k-91k yearly est. Auto-Apply 60d+ ago
Care Coordinator
Viva Health 3.9
Dothan, AL jobs
Nurses and Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a Care Coordinator in Dothan, AL! VIVA HEALTH knows that nursing and social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION REQUIRED: Licensed BSN/ADN Licensed BSW PREFERRED: Licensed MSW and/or Certified Case Manager (CCM) designation Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.
$30k-38k yearly est. 11d ago
Care Coordinator
Viva Health 3.9
Dothan, AL jobs
Nurses and Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a Care Coordinator in Dothan, AL! VIVA HEALTH knows that nursing and social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION REQUIRED: * Licensed BSN/ADN * Licensed BSW PREFERRED: * Licensed MSW and/or Certified Case Manager (CCM) designation * Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.
$30k-38k yearly est. 11d ago
Physician Review Coordinator - LHB
HCSC 4.5
Remote
At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job SummaryThe Physician Review Coordinator is primarily responsible for initiation and oversight of the Healthcare Management Division's physician-level review process with Independent Review Organizations. Additionally, when business needs warrant, the individual conducts medical necessity reviews utilizing evidence-based medical criteria.Required Job Qualifications: Active RN License required Minimum three years of experience in a clinical setting Active MCG UM/CM Certification or obtain MCG UM/CM Certification within 6 months of hire Possess strong time management and organizational skills Ability to work independently and complete tasks in a timely manner, reprioritizing workload to meet customer and business needs Willingness to adjust and adapt to meet the business needs in an atmosphere that sometimes requires rapid change Comfort with telephonic and written communications with all levels of leadership within the organization, providers, IROs and business contacts in an efficient, professional manner Excellent customer service and interpersonal skills Comfort with using electronic applications including electronic documentation system and the ability to accurately document electronically while engaging callers or reviewing medical documents Excellent verbal and written communication skills Ability to use commonsense understanding to carry out instructions furnished in written, oral or diagram form Demonstration of excellent critical thinking skills to deal with problems in varying situations and reach reasonable solutions Proficient in MS Word, Excel and Outlook with the willingness to expand knowledge of the MS Suite of tools Preferred Job Qualifications: Utilization Management, Case Management, or Claims experience with a TPA or insurer highly preferred Bachelor of Science in Nursing Must reside in one of the following States: Illinois Montana New Mexico Oklahoma Texas Indiana Missouri Wisconsin Iowa Kansas North Carolina Pennsylvania Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! EEO Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Pay Transparency Statement: At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Min to Max Range: $56,700.00 - $106,400.00 Exact compensation may vary based on skills, experience, and location.
$56.7k-106.4k yearly Auto-Apply 5d ago
Care Coordinator- Pike or Bullock County
Viva Health 3.9
Dothan, AL jobs
Nurses and Social Workers! VIVA HEALTH, ranked one of the nation's Best Places to Work by Modern Healthcare, is currently seeking a Care Coordinator in Dothan, AL! The ideal candidate will be located in Pike or Bullock county. VIVA HEALTH knows that nursing and social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! Care Coordinators use psychosocial and/or clinical knowledge to provide non-clinical services for Medicaid recipients to improve the medical compliance and health outcomes of the populations served. This position identifies barriers to medical compliance such as lack of transportation, illiteracy, or other social determinants that impact a member's health, and ensures services are delivered and continuity of care is maintained. The position analyzes the home and community environment and makes autonomous decisions regarding appropriate care plans and goals using a thorough knowledge of available community resources. These services are provided primarily in community and home settings via phone and/or in person. Local daytime travel is required via a reliable means of transportation insured following Company policy. This position will have work-from-home opportunities. GENERAL CARE COORDINATION REQUIRED: Licensed BSN/ADN Licensed BSW PREFERRED: Licensed MSW and/or Certified Case Manager (CCM) designation Experience in case management, human services, public health, or experience with the underinsured population Also requires a valid driver's license in good standing, willingness to submit to vaccine testing and screening, and may require significant face-to-face member contact with duties performed away from the principal place of business. All positions require excellent interview and telephone skills as well as the ability to deal with recipients in a caring and helpful manner. The Care Coordinators should have a working knowledge of health-related service delivery systems and excellent communication and relationship skills. This position requires the ability to analyze varied environmental factors to members' well-being and work independently in an autonomous setting and the ability to locate, augment, and develop resources, including information on services offered by other agencies.
$30k-39k yearly est. 11d ago
Strategic Partnership Coordinator
The Strickland Group 3.7
Austin, TX jobs
Now Hiring: Strategic Partnership Coordinator 🚀 Are you passionate about making a difference through sales? Do you thrive in a dynamic environment where your efforts directly impact success? If so, we're looking for a Strategic Partnership Coordinator to join our team! What We're Looking For: ✅ Licensed Life & Health Agents OR ✅ Motivated Individuals (We'll help you get licensed!) We need goal-oriented professionals who are ready to create impact-whether that means stepping into leadership or building a flexible, high-earning income stream. Are You a Good Fit? ✔ Excited about making a real impact through sales and client relationships? ✔ Ready to invest in yourself and take your career to new heights? ✔ Self-motivated and driven to succeed without constant supervision? ✔ Coachable and eager to learn from top sales professionals? ✔ Looking for a business that is recession- and pandemic-proof? If you answered YES, keep reading! What We Offer: 💼 Flexible Work Environment - Work remotely, full-time or part-time, on your own schedule. 💰 Unlimited Earning Potential - Part-time: $40,000-$60,000/month | Full-time: $70,000-$150,000+++/month. 📈 Warm Leads Provided - No cold calling, no chasing friends & family. ❌ No Sales Quotas, No High-Pressure Tactics, No Micromanagement. 🧑 🏫 Comprehensive Training & Mentorship - Learn from top-performing professionals. 🎯 Daily Pay - Earn directly from insurance carriers. 🎁 Bonuses & Performance Incentives - 80%+ commissions + salary 🏆 Leadership & Growth Opportunities - Build your own agency (optional). 🏥 Health Insurance Available for qualified agents. 🚀 Create real impact, grow your career, and unlock your potential. 👉 Apply today and start making a difference! ( Your success depends on effort, skill, and commitment to training and sales systems. )
$35k-56k yearly est. Auto-Apply 60d+ ago
Telephonic Care Coordinator
Viva Health 3.9
Birmingham, AL jobs
VIVA HEALTH ranked one of the Best Places to Work by Modern Healthcare has an opportunity for a Telephonic Care Coordinator (Social Worker) in Birmingham, AL! VIVA HEALTH knows that social work is not just a job, it is a calling. If you would like to fulfill your calling in healthcare, check us out! We offer regular hours with no mandatory nights or weekends. This way you can do what you love at work and can take care of the people you love at home! We also offer a great benefits package including tuition reimbursement for employees and dependents, paid parental leave, and paid day for community service, just to name a few! VIVA HEALTH employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. Come join our team! The Telephonic Care Coordinator will work alongside the Alabama Coordinated Health Networks (ACHN) team to complete telephonic follow up calls to ensure that recipients have access to all covered services appropriate to the patient's condition or circumstance. This role will assist other ACHN team members in carrying out care management services by providing assistance with promoting disease self-management, utilizing approved education tools, providing information to the patient on medical and community services as directed, and assisting with carrying out established plan of care as directed. This individual may also assist with additional referral outreach or outreach related to Quality Improvement Projects. This individual must reside in Jefferson or Shelby County. REQUIRED: LBSW Two years of clinical experience Willing to submit to vaccine testing and screening Excellent interview and telephone skills, as well the ability to work with patients in a caring and helpful (confident and tactful) manner Working knowledge of health-related service delivery systems Excellent communication and relationship skills Ability to analyze varied environmental factors in relation to patient wellbeing and work independently in an autonomous setting Ability to locate, augment and develop resources, including information on services offered by other agencies Strong organizational and time management skills Ability to be flexible and adaptable Basic computer skills including use of Microsoft Word and Excel PREFERRED: LMSW CCM One year of assessing resources and coordinating care with low-income populations
$30k-39k yearly est. 11d ago
Commercial Coordinator
Crump Group, Inc. 3.7
Remote
The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Commercial Underwriting Assistant that is responsible for handling large volumes of files for NY & National Commercial transactions. Responsibilities: Extensive experience with National or NY commercial transactions Serve as the point of contact for all parties to the transaction including, underwriters, clients and their respective counsel, lenders, brokers and third-party vendors. Review title insurance products such as commitments, pro-formas, policies and endorsements with support of in-house legal team or agency counsel if necessary. Work with Buyer/Seller and Lenders to clear and close transactions. Assist Underwriter and Coordinators in preparing invoices on deals. Firm understanding of Title bills and Title policies. Analyze and review Purchase/Sale Agreements to ensure compliance with all terms and conditions of the same. Experience with national commercial transactions, firm understanding of compliance and settlement including disbursements and funding. Review Purchase/Sale Agreements to prepare closing statements Confirm financial figures with all parties involved in the closing transactions. Respond to and resolve all client and third-party inquiries in a timely manner. Requirements Candidates with experience and strong knowledge of Title Insurance are encouraged to apply. 5+ plus years of experience Knowledge of SoftPro Select a plus Great time management skills Outstanding work ethic with the ability to work in both team oriented and self-directed environments. Detail-oriented and professional; able to handle confidential information. High level of accountability Customer service oriented Creative problem-solving skills Ability to communicate effectively (written and verbal). Ability to work in a fast-paced environment and handle multiple tasks simultaneously About Kensington Vanguard National Land Kensington Vanguard National Land Services is one of the largest independent full-service national title insurance agencies in the country providing: • Commercial & Residential Title Insurance• Real Property & Cooperative Lien Searches• Settlement Services• Escrow Services• Recording Services• 1031 Exchange Services Kensington Vanguard National Land is an Equal Opportunity Employer. Job Type: Full-time Benefits: Health insurance Dental insurance Vision insurance Employer Paid Life insurance Employer Paid LTD Paid Time Off 401(k) 401(k) Employer Match Flexible Spending Account Health Savings Account Employee Assistance Program The annual base salary for this position is $85,000.00 - $105,000.00. General Description of Available Benefits for Eligible Employees of CRC Group: At CRC Group, we're committed to supporting every aspect of teammates' well-being - physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan. CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace. EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify
$32k-52k yearly est. Auto-Apply 7d ago
CGA Triage Coordinator
Oscar 4.6
Remote
We're hiring a CGA Triage Coordinator to join our CG&A team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: (You will play a critical role in the initial management and routing of all member complaints, grievances and appeals. You will be responsible for the timely and accurate intake, categorization, and prioritization of incoming cases. By ensuring that each case is promptly triaged and assigned to the appropriate liaison, the Coordinator directly supports the team's ability to meet strict regulatory deadlines and maintain the highest standards of member and provider service. You will report into the CGA Team Lead. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $22.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year. Responsibilities: Receive, log, and process all incoming complaints, grievances, and appeals through various channels, including mail, fax, email, and internal systems. Monitor and manage case queues, proactively flagging urgent cases and assigning them to the appropriate liaison or team. Identify, investigate, and triage incoming documents within determined SLAs Collaborate with colleagues, specialists, and Leads to identify trends and roadblocks Utilize internal tools and resources seamlessly Escalate updates or incorrect information in the internal knowledge management system for Member and Provider Services Compliance with all applicable laws and regulations Other duties as assigned Requirements: 1+ years of customer support/service experience Excellent organizational and time management skills Foundational knowledge of escalations or complaints, grievances and appeals processes Bonus points: Experience in a Complaints, Grievances or Appeals department Experience using CRM and knowledge management tools to resolve issues Experience using ticket management and reporting tools Experience managing an assignment caseload Healthcare and/or SAAS experience This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.
$22 hourly Auto-Apply 7d ago
Aggregate Audit Coordinator
Risk Strategies 4.3
Remote
Coordinates and tracks audit activities for the claims audit team. Ensures audit schedules, documentation, and reporting are completed accurately and on time. Your Impact Manage audit calendars and coordinate audit logistics. Collect, compile, and distribute audit results. Maintain audit records and track corrective actions. Support communication between auditors and claims departments. Successful Candidate Will Have High school diploma or Associate's degree; Bachelor's preferred. 2+ years of administrative or audit coordination experience. Strong organizational, communication, and time management skills. Proficiency in Microsoft Office, especially Excel and SharePoint. At Risk Strategies Company, base pay is one part of our total compensation package, which also includes a comprehensive suite of benefits, including medical, dental, vision, disability, and life insurance, retirement savings, and paid time off and paid holidays for eligible employees. The total compensation for a position may also include other elements dependent on the position offered. The expected base pay range for this position is between $32,200 - $50,000 annually. The actual base pay offered may vary depending on multiple individualized factors, including geographical location, education, job-related knowledge, skills, and experience. Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, Risk Strategies serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and over 5,000 employees across the US and Canada. Our industry recognition includes being named a Best Places to Work in Insurance for five years (2018-2022) and on the Inc. 5000 list as one of America's Fastest Growing Private Companies. We are committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues. Pay Range: 32200 - 50000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role. Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: ******************************** Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.
$32.2k-50k yearly Auto-Apply 17d ago
Commercial Lines Coordinator
Dimond Bros. Insurance 4.0
Bloomington, IL jobs
Join our Commercial Lines Team! This position supports the day-to-day servicing of clients by ensuring accurate processing, documentation, and communication across all aspects of policy management. Responsibilities: Organize and label mail in ImageRight Review new/renewal policies Process endorsements, cancellations, and audits Generate proof of insurance Respond promptly to service requests Maintain detailed records in agency systems Follow SOPs and best practices consistently
$35k-54k yearly est. 36d ago
Commercial Lines Coordinator
Dimond Bros. Insurance 4.0
Springfield, IL jobs
Join our Commercial Lines Team! This position supports the day-to-day servicing of clients by ensuring accurate processing, documentation, and communication across all aspects of policy management. Responsibilities: Organize and label mail in ImageRight Review new/renewal policies Process endorsements, cancellations, and audits Generate proof of insurance Respond promptly to service requests Maintain detailed records in agency systems Follow SOPs and best practices consistently
$35k-53k yearly est. 60d+ ago
7 - Accts Pay Coordinator
Wikoff Color 4.4
Fort Mill, SC jobs
We are seeking a detail-oriented and results-driven Billing and Payables Coordinator to join our team. This role is responsible for ensuring the timely and accurate execution of all billing functions for the various Wikoff locations. Ideally a person with good problem solving and great communication skills that can work well with different personalities to achieve a common goal. Duties & Responsibilities Billing Management: Receive and review all billing that is submitted to Corporate ensuring the billing is accurate and complete. Invoice Distribution: Process and distribute Invoices via an online billing app, email, or mail. Timeliness and Organization of Billing: Maintain accurate accountability of open billing batches by location ensuring all billing batches are processed timely, issues are resolved quickly and accounted for. Branch Assistance: Assist branches with credits and other billing issues. Monthly Allocations: Monthly allocations and debit memos to assist in keeping our sales presentations accurate. Rebate Calculation: Assist with calculating and processing month end rebates, asset recoveries and allocations for select customers. Invoice Provision: Provide invoice copies as needed by branches and customers. Processing Payments: Process incoming credit card payments using a third-party processing solution. Reporting: Maintaining and distributing the Daily Invoicing Report. Accounts Payable: Assist in processing accounts payable and payment distribution as needed. Other responsibilities and duties as necessary assigned by your supervisor. Education/Experience Minimum of 3 years of experience of Billing, Accounts Receivable, or Accounts Payables. Associate's degree or higher in Accounting, Business, or Finance is a plus Proficiency in financial software, ERP systems, and Microsoft Office Suite (Excel, Outlook). Strong verbal and written communication skills. Excellent negotiation and problem-solving abilities. Highly organized with exceptional attention to detail. Competencies Excellent verbal and written communication skills. Experience with B2B collections. Organizational and prioritization skills. Ability to maintain professionalism in stressful situations. Familiarity with collection techniques and relevant laws, such as the Fair Debt Collection Practices Act (FDCPA). Working Conditions: Sitting for extended periods Extensive use of computer Ability to lift up to 25 lbs. Health and Safety Responsibilities: Must work in accordance with Health and Safety regulations, Company Rules, Plant Rules, policies and procedures. Must use or wear equipment, protective devices, or certain clothing as required by the company. Benefits: Competitive pay Profit sharing retirement benefits Health, dental, and vision insurance Paid time off and holidays 401(k) Employee Stock Ownership Career development and training opportunities Clean, safe, and team-oriented work environment This position contributes to the overall health and success of our company. Additionally, this position promotes a safe work environment by complying with the defined safety rules and regulations at all times.
$27k-43k yearly est. 8d ago