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BPO Clinical Review Specialist at NTT DATA
Manila, Metro Manila, Philippines - Full Time
Skills Needed
Clinical Reviews, Appeals Processing, Utilization Management, Communication, Analytic Skills, Research, Medical Necessity Review, Ncqa Standards, Medicaid Regulations, Case Recommendations, Decision Making, Training, Subject Matter Expertise, Interdepartmental Collaboration, Timeliness Standards, File Maintenance
Specialization
Candidates should have 1-3 years of experience in processing appeals or utilization management and must possess a valid RN license. Knowledge of NCQA and Medicaid regulations is essential, along with strong communication and analytic skills.
Experience Required
Minimum 2 year(s)
General Manager in Training - East Windsor at Hand & Stone - 6455 Dobbin Rd - Columbia, MD
Hightstown, New Jersey, United States - Full Time
Skills Needed
Leadership, Sales, Customer Service, Team Management, Coaching, Recruiting, Training, Communication, Organization, Multitasking, Critical Thinking, Conflict Resolution, Computer Proficiency, Attention To Detail, Positive Attitude, Flexibility
Specialization
Candidates should have a passion for providing excellent service and the ability to work flexible hours. Strong communication skills and a positive attitude are essential for success in this role.
Experience Required
Minimum 2 year(s)
RESTAURANT MANAGER at Stonefire Pasadena
Torrance, California, United States - Full Time
Skills Needed
Leadership, Communication, Team Management, Customer Service, Training, Coaching, Problem Solving, Organizational Skills, Safety Management, Catering Coordination, Financial Management, Relationship Building, Integrity, Service Standards, Health Standards, Cultural Awareness
Specialization
Candidates should have 2+ years of experience in a high-volume role, preferably in fast casual restaurants. Strong leadership, communication skills, and a passion for service are essential.
Experience Required
Minimum 2 year(s)
Inspecteur Qualité H/F at TRIGO
Conflans-Sainte-Honorine, Ile-de-France, France - Full Time
Skills Needed
Quality Inspection, Dimensional Inspection, Geometric Inspection, Visual Inspection, Non Conformity Analysis, Technical Documentation, Plan Reading, Technical Knowledge, Office Suite Proficiency, Sap Knowledge, 3d Software Knowledge, Technical English
Specialization
Candidates should have a diploma related to quality or industrial mechanics, or 1 to 3 years of experience in quality inspection. Ideal skills include plan reading and knowledge of inspection tools.
Product Manager at Third Bridge
Shanghai, Shanghai, China - Full Time
Skills Needed
Product Management, B2b Saas, Data Analysis, Financial Industry Knowledge, Data Modeling, Ai Integration, Client Engagement, Strategic Vision, Proactive Ownership, Execution Focus, Communication Skills, Technical Acumen, Content Delivery, Investment Workflow, Stakeholder Engagement, Analytical Skills
Specialization
Candidates should have 3+ years of experience in Product Management, ideally in a B2B SaaS or content-focused business serving the financial sector. Strong knowledge of the financial industry and proficiency in data analysis tools are essential.
Experience Required
Minimum 2 year(s)
Financial Wellness Coach, CFS-Hybrid at United Way Miami Inc
Miami, Florida, United States - Full Time
Skills Needed
Financial Coaching, Client Engagement, Budgeting, Debt Management, Financial Literacy, Customer Service, Multitasking, Detail Oriented, Teamwork, Communication, Spanish Speaking, Assessment, Outreach, Data Management, Reporting, Professional Development
Specialization
An associate degree is preferred, along with one to three years of work experience in an office environment. Strong customer service skills and proficiency in English and Spanish are required.
Physical Therapist at MOUNTAIN LAND REHABILITATION LLC
Eagle, Idaho, United States - Full Time
Skills Needed
Physical Therapy, Outpatient Orthopedic Therapy, Patient Care, Collaboration, Autonomy, Diagnostic Imaging, Rehabilitation, Documentation, Continuing Education, Teamwork, Caseload Management, Innovative Approaches, Ai Driven Emr, Growth Opportunities, Sports Specialization, Clinical Management
Specialization
Candidates must have a current PT license or the ability to obtain one and a passion for outpatient orthopedic therapy. Adaptability to different work settings is also required.
Occupational Therapist at Providence Medical Grp.
Orange, California, United States - Full Time
Skills Needed
Patient Care, Evaluation, Assessment, Treatment Planning, Program Development, Education, Coordination, Collaboration
Specialization
Candidates must have completed an approved educational program for occupational therapy and possess a California Occupational Therapist License upon hire. A minimum of 4 months of experience in direct patient care is required, with internships acceptable.
Senior AML Specialist at Five Star Bank
Sacramento, California, United States - Full Time
Skills Needed
Leadership, Collaboration, Organizational Skills, Problem Solving, Time Management, Analytical Skills, Verbal Communication, Written Communication, Presentation Skills, Discretion, Attention To Detail, Project Management, Software Proficiency, Aml Regulations Knowledge, Legal Process Management, Team Development
Specialization
A bachelor's degree and experience with a financial institution are required. Candidates should have experience leading a team and in-depth knowledge of AML regulations.
Experience Required
Minimum 5 year(s)
Physical Therapist at Team Rehabilitation Services, LLC
West Lafayette, Indiana, United States - Full Time
Skills Needed
Physical Therapy, Patient Care, Communication Skills, Collaboration, Pain Management, Documentation, Goal Setting, Education, Research Participation, Evidence Based Techniques
Specialization
Candidates must have a Doctorate or Master's degree in Physical Therapy and a valid Physical Therapy license or eligibility to obtain one. A commitment to diversity, equity, and inclusion, along with strong communication skills, is essential.
Theatre Specialist at SCHULER SHOOK
Dallas, Texas, United States - Full Time
Skills Needed
Technical Theatre, Cad, Revit, Autocad, Technical Drawings, Communication, Organizational Skills, Live Entertainment Production, Theatre Production Design, Research, Calculations, Equipment Layouts, Client Meetings, Documentation, Photoshop, Enscape
Specialization
Around 4 years of experience in technical theatre or related fields is desired, with proficiency in AutoCAD or Revit. A bachelor's degree in a related field is preferred, along with strong communication and organizational skills.
Experience Required
Minimum 2 year(s)
Global Mobility Tax - Trainee at Vialto Partners
Campbell, California, United States - Full Time
Skills Needed
Data Analysis, Tax Research, Problem Solving, Communication, Networking, Automation, Digitization, Data Visualization, Tax Compliance, Client Interaction, Model Building, Collaboration, Risk Management, Technical Analysis, Time Management, Prioritization
Specialization
A Bachelor's Degree in relevant fields such as Accounting, Taxation, or International Business is required. Candidates should have 1-2 years of experience and demonstrate problem-solving skills and the ability to prioritize multiple tasks.
Cashier/Sales Associate - Midday/2nd Shift at Rose Mart
Creedmoor, North Carolina, United States - Full Time
Skills Needed
Customer Service, Cash Handling, Sales, Cleaning, Teamwork, Communication, Math Skills, Detail Oriented, Reliability, Flexibility
Specialization
Candidates must be at least 18 or 21 years old depending on the state and should be available to work weekends and holidays. Basic math skills and the ability to lift up to 50 lbs are required, along with a friendly demeanor and attention to detail.
Esthetician at East Bank Club
Chicago, Illinois, United States - Full Time
Skills Needed
Skincare, Customer Service, Facials, Body Treatments, Waxing, Product Recommendations, Communication Skills, Interpersonal Skills, Teamwork, Health Regulations, Skincare Trends, Client Relationships, Time Management, Luxury Spa Experience, Hydrafacial Experience, Physical Tasks
Specialization
Candidates must have a current State of Illinois esthetician license and a minimum of three years of experience. Full body waxing experience is required, and Hydrafacial experience is preferred.
Experience Required
Minimum 5 year(s)
Planner, Amazon at The Children's Place
, , United States - Full Time
Skills Needed
Financial Management, Retail Planning, Analytical Skills, Problem Solving, Decision Making, Communication, Organization, Detail Orientation, Planning Systems, Microsoft Office, Team Player, Relationship Building, Process Improvement
Specialization
Candidates must have a bachelor's degree and at least 3 years of experience in retail planning and analysis. Strong analytical skills and a proven track record in business management are essential.
Experience Required
Minimum 2 year(s)
Professional Services Consultant at Nexthink
Bengaluru, karnataka, India - Full Time
Skills Needed
Technical Consulting, Analytics, Automation, Digital Workplace, End User Computing, Troubleshooting, It Operations, Itil, Microsoft Windows, Macos, Json, Sql, Xml, Windows Powershell, Data Integration, Data Science
Specialization
Candidates should have a preferred BE in computer science or computer engineering and a minimum of 5 years of experience in technical consulting, analytics, and automation. Extensive technical knowledge in Digital Workplace and good troubleshooting skills are essential.
Experience Required
Minimum 5 year(s)
Client Management Specialist at Mercer Ltd
St. Louis, Missouri, United States - Full Time
Skills Needed
Project Management, Organizational Skills, Attention To Detail, Analytical Skills, Communication Skills, Teamwork, Multi Asset Investing, Technical Competence, Microsoft Excel, Microsoft Powerpoint
Specialization
Candidates should have a minimum of 5 years of relevant industry experience and exceptional organizational skills. Strong analytical abilities and proficiency in Microsoft applications are also required.
Experience Required
Minimum 5 year(s)
Environmental Services Specialist at CommonSpirit Health Mountain Region
West Valley City, Utah, United States - Full Time
Skills Needed
Communication Skills, Basic Computer Skills, Disinfection Knowledge, Power Equipment Skills, Equipment Operation, Team Collaboration, Problem Solving, Safety Awareness
Specialization
Candidates must possess strong communication skills and basic computer skills, along with knowledge of disinfection levels and equipment operation. The role requires the ability to work independently and follow safety protocols.
LAB ASSISTANT at American Health MW LLC
Nashville, Tennessee, United States - Full Time
Skills Needed
Laboratory Experience, Phlebotomy, Medical Office Experience, Word Processing, Spreadsheet Skills, Detail Oriented
Specialization
A high school diploma or equivalent is required, along with prior laboratory, phlebotomy, or medical office experience. Word processing and spreadsheet skills are preferred, and candidates should be detail-oriented.
Casino Custodian at Hard Rock Hotel & Casino Tulsa
Roland, Oklahoma, United States - Full Time
Skills Needed
Cleaning, Maintenance, Heavy Duty Floor Scrubbers, Vacuums, Extractors, Lifting, Safety Guidelines, Biohazardous Spill Handling
Specialization
Candidates must be able to lift objects up to 50 lbs and operate cleaning equipment. Exposure to second-hand smoke and crowd noise is expected.
BPO Clinical Review Specialist at NTT DATA
Manila, Metro Manila, Philippines -
Full Time


Start Date

Immediate

Expiry Date

13 Feb, 26

Salary

0.0

Posted On

15 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Clinical Reviews, Appeals Processing, Utilization Management, Communication, Analytic Skills, Research, Medical Necessity Review, NCQA Standards, Medicaid Regulations, Case Recommendations, Decision Making, Training, Subject Matter Expertise, Interdepartmental Collaboration, Timeliness Standards, File Maintenance

Industry

IT Services and IT Consulting

Description
Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals. Provides guidance on preparing case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal. Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards. May also perform clinical reviews. Communicates with providers, facilities and other departments regarding appeal requests. Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal an d NCQA standards. Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeal requests. Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices. Individuals have a well-rounded knowledge of the policies and procedures for appeals processing, specifically for Medicaid and medical necessity review. Uses sound judgement, especially in non-rooutine appeals, to make decisions to keep the appeal process moving forward in accordance with contractual timeliness standards. Maintain files on individual appeals by gathering, analyzing and reporting verbal and written member and provider appeals. Review claim appeal for reconsideration and recommend approvals/denials based on determination level or prepare for medical review presentation. Prepare case recommemdations for medical review as necessary. 1-3 years of experience in processing appeals or utilization management. RN - Registered Nurse - State required Licensure and/or Compact State Licensure Knowledge of utilization management process Knowledge of NCQA, Medicaid requlations Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills Required shift timings - US daytime
Responsibilities
The BPO Clinical Review Specialist performs training and provides expertise on clinical reviews for appeals. They ensure timely processing and communication regarding appeal requests while collaborating with interdepartmental teams to improve processes.
BPO Clinical Review Specialist at NTT DATA
Manila, Metro Manila, Philippines - Full Time
Skills Needed
Clinical Reviews, Appeals Processing, Utilization Management, Communication, Analytic Skills, Research, Medical Necessity Review, Ncqa Standards, Medicaid Regulations, Case Recommendations, Decision Making, Training, Subject Matter Expertise, Interdepartmental Collaboration, Timeliness Standards, File Maintenance
Specialization
Candidates should have 1-3 years of experience in processing appeals or utilization management and must possess a valid RN license. Knowledge of NCQA and Medicaid regulations is essential, along with strong communication and analytic skills.
Experience Required
Minimum 2 year(s)
General Manager in Training - East Windsor at Hand & Stone - 6455 Dobbin Rd - Columbia, MD
Hightstown, New Jersey, United States - Full Time
Skills Needed
Leadership, Sales, Customer Service, Team Management, Coaching, Recruiting, Training, Communication, Organization, Multitasking, Critical Thinking, Conflict Resolution, Computer Proficiency, Attention To Detail, Positive Attitude, Flexibility
Specialization
Candidates should have a passion for providing excellent service and the ability to work flexible hours. Strong communication skills and a positive attitude are essential for success in this role.
Experience Required
Minimum 2 year(s)
RESTAURANT MANAGER at Stonefire Pasadena
Torrance, California, United States - Full Time
Skills Needed
Leadership, Communication, Team Management, Customer Service, Training, Coaching, Problem Solving, Organizational Skills, Safety Management, Catering Coordination, Financial Management, Relationship Building, Integrity, Service Standards, Health Standards, Cultural Awareness
Specialization
Candidates should have 2+ years of experience in a high-volume role, preferably in fast casual restaurants. Strong leadership, communication skills, and a passion for service are essential.
Experience Required
Minimum 2 year(s)
Inspecteur Qualité H/F at TRIGO
Conflans-Sainte-Honorine, Ile-de-France, France - Full Time
Skills Needed
Quality Inspection, Dimensional Inspection, Geometric Inspection, Visual Inspection, Non Conformity Analysis, Technical Documentation, Plan Reading, Technical Knowledge, Office Suite Proficiency, Sap Knowledge, 3d Software Knowledge, Technical English
Specialization
Candidates should have a diploma related to quality or industrial mechanics, or 1 to 3 years of experience in quality inspection. Ideal skills include plan reading and knowledge of inspection tools.
Product Manager at Third Bridge
Shanghai, Shanghai, China - Full Time
Skills Needed
Product Management, B2b Saas, Data Analysis, Financial Industry Knowledge, Data Modeling, Ai Integration, Client Engagement, Strategic Vision, Proactive Ownership, Execution Focus, Communication Skills, Technical Acumen, Content Delivery, Investment Workflow, Stakeholder Engagement, Analytical Skills
Specialization
Candidates should have 3+ years of experience in Product Management, ideally in a B2B SaaS or content-focused business serving the financial sector. Strong knowledge of the financial industry and proficiency in data analysis tools are essential.
Experience Required
Minimum 2 year(s)
Financial Wellness Coach, CFS-Hybrid at United Way Miami Inc
Miami, Florida, United States - Full Time
Skills Needed
Financial Coaching, Client Engagement, Budgeting, Debt Management, Financial Literacy, Customer Service, Multitasking, Detail Oriented, Teamwork, Communication, Spanish Speaking, Assessment, Outreach, Data Management, Reporting, Professional Development
Specialization
An associate degree is preferred, along with one to three years of work experience in an office environment. Strong customer service skills and proficiency in English and Spanish are required.
Physical Therapist at MOUNTAIN LAND REHABILITATION LLC
Eagle, Idaho, United States - Full Time
Skills Needed
Physical Therapy, Outpatient Orthopedic Therapy, Patient Care, Collaboration, Autonomy, Diagnostic Imaging, Rehabilitation, Documentation, Continuing Education, Teamwork, Caseload Management, Innovative Approaches, Ai Driven Emr, Growth Opportunities, Sports Specialization, Clinical Management
Specialization
Candidates must have a current PT license or the ability to obtain one and a passion for outpatient orthopedic therapy. Adaptability to different work settings is also required.
Occupational Therapist at Providence Medical Grp.
Orange, California, United States - Full Time
Skills Needed
Patient Care, Evaluation, Assessment, Treatment Planning, Program Development, Education, Coordination, Collaboration
Specialization
Candidates must have completed an approved educational program for occupational therapy and possess a California Occupational Therapist License upon hire. A minimum of 4 months of experience in direct patient care is required, with internships acceptable.
Senior AML Specialist at Five Star Bank
Sacramento, California, United States - Full Time
Skills Needed
Leadership, Collaboration, Organizational Skills, Problem Solving, Time Management, Analytical Skills, Verbal Communication, Written Communication, Presentation Skills, Discretion, Attention To Detail, Project Management, Software Proficiency, Aml Regulations Knowledge, Legal Process Management, Team Development
Specialization
A bachelor's degree and experience with a financial institution are required. Candidates should have experience leading a team and in-depth knowledge of AML regulations.
Experience Required
Minimum 5 year(s)
Physical Therapist at Team Rehabilitation Services, LLC
West Lafayette, Indiana, United States - Full Time
Skills Needed
Physical Therapy, Patient Care, Communication Skills, Collaboration, Pain Management, Documentation, Goal Setting, Education, Research Participation, Evidence Based Techniques
Specialization
Candidates must have a Doctorate or Master's degree in Physical Therapy and a valid Physical Therapy license or eligibility to obtain one. A commitment to diversity, equity, and inclusion, along with strong communication skills, is essential.
Theatre Specialist at SCHULER SHOOK
Dallas, Texas, United States - Full Time
Skills Needed
Technical Theatre, Cad, Revit, Autocad, Technical Drawings, Communication, Organizational Skills, Live Entertainment Production, Theatre Production Design, Research, Calculations, Equipment Layouts, Client Meetings, Documentation, Photoshop, Enscape
Specialization
Around 4 years of experience in technical theatre or related fields is desired, with proficiency in AutoCAD or Revit. A bachelor's degree in a related field is preferred, along with strong communication and organizational skills.
Experience Required
Minimum 2 year(s)
Global Mobility Tax - Trainee at Vialto Partners
Campbell, California, United States - Full Time
Skills Needed
Data Analysis, Tax Research, Problem Solving, Communication, Networking, Automation, Digitization, Data Visualization, Tax Compliance, Client Interaction, Model Building, Collaboration, Risk Management, Technical Analysis, Time Management, Prioritization
Specialization
A Bachelor's Degree in relevant fields such as Accounting, Taxation, or International Business is required. Candidates should have 1-2 years of experience and demonstrate problem-solving skills and the ability to prioritize multiple tasks.
Cashier/Sales Associate - Midday/2nd Shift at Rose Mart
Creedmoor, North Carolina, United States - Full Time
Skills Needed
Customer Service, Cash Handling, Sales, Cleaning, Teamwork, Communication, Math Skills, Detail Oriented, Reliability, Flexibility
Specialization
Candidates must be at least 18 or 21 years old depending on the state and should be available to work weekends and holidays. Basic math skills and the ability to lift up to 50 lbs are required, along with a friendly demeanor and attention to detail.
Esthetician at East Bank Club
Chicago, Illinois, United States - Full Time
Skills Needed
Skincare, Customer Service, Facials, Body Treatments, Waxing, Product Recommendations, Communication Skills, Interpersonal Skills, Teamwork, Health Regulations, Skincare Trends, Client Relationships, Time Management, Luxury Spa Experience, Hydrafacial Experience, Physical Tasks
Specialization
Candidates must have a current State of Illinois esthetician license and a minimum of three years of experience. Full body waxing experience is required, and Hydrafacial experience is preferred.
Experience Required
Minimum 5 year(s)
Planner, Amazon at The Children's Place
, , United States - Full Time
Skills Needed
Financial Management, Retail Planning, Analytical Skills, Problem Solving, Decision Making, Communication, Organization, Detail Orientation, Planning Systems, Microsoft Office, Team Player, Relationship Building, Process Improvement
Specialization
Candidates must have a bachelor's degree and at least 3 years of experience in retail planning and analysis. Strong analytical skills and a proven track record in business management are essential.
Experience Required
Minimum 2 year(s)
Professional Services Consultant at Nexthink
Bengaluru, karnataka, India - Full Time
Skills Needed
Technical Consulting, Analytics, Automation, Digital Workplace, End User Computing, Troubleshooting, It Operations, Itil, Microsoft Windows, Macos, Json, Sql, Xml, Windows Powershell, Data Integration, Data Science
Specialization
Candidates should have a preferred BE in computer science or computer engineering and a minimum of 5 years of experience in technical consulting, analytics, and automation. Extensive technical knowledge in Digital Workplace and good troubleshooting skills are essential.
Experience Required
Minimum 5 year(s)
Client Management Specialist at Mercer Ltd
St. Louis, Missouri, United States - Full Time
Skills Needed
Project Management, Organizational Skills, Attention To Detail, Analytical Skills, Communication Skills, Teamwork, Multi Asset Investing, Technical Competence, Microsoft Excel, Microsoft Powerpoint
Specialization
Candidates should have a minimum of 5 years of relevant industry experience and exceptional organizational skills. Strong analytical abilities and proficiency in Microsoft applications are also required.
Experience Required
Minimum 5 year(s)
Environmental Services Specialist at CommonSpirit Health Mountain Region
West Valley City, Utah, United States - Full Time
Skills Needed
Communication Skills, Basic Computer Skills, Disinfection Knowledge, Power Equipment Skills, Equipment Operation, Team Collaboration, Problem Solving, Safety Awareness
Specialization
Candidates must possess strong communication skills and basic computer skills, along with knowledge of disinfection levels and equipment operation. The role requires the ability to work independently and follow safety protocols.
LAB ASSISTANT at American Health MW LLC
Nashville, Tennessee, United States - Full Time
Skills Needed
Laboratory Experience, Phlebotomy, Medical Office Experience, Word Processing, Spreadsheet Skills, Detail Oriented
Specialization
A high school diploma or equivalent is required, along with prior laboratory, phlebotomy, or medical office experience. Word processing and spreadsheet skills are preferred, and candidates should be detail-oriented.
Casino Custodian at Hard Rock Hotel & Casino Tulsa
Roland, Oklahoma, United States - Full Time
Skills Needed
Cleaning, Maintenance, Heavy Duty Floor Scrubbers, Vacuums, Extractors, Lifting, Safety Guidelines, Biohazardous Spill Handling
Specialization
Candidates must be able to lift objects up to 50 lbs and operate cleaning equipment. Exposure to second-hand smoke and crowd noise is expected.
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