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Medical Management - Supervisor Medical Review 145-4005 at CommunityCare
Tulsa, Oklahoma, United States - Full Time
Skills Needed
Analytical Skills, Problem Solving, Decision Making, Attention To Detail, Organizational Skills, Microsoft Applications, Communication Skills, Teamwork, Supervision, Training, Auditing, Compliance, Healthcare Regulations, Fraud Detection, Claims Processing, Clinical Guidance
Specialization
Candidates must have an active RN license in Oklahoma and a minimum of five years of experience in healthcare settings. Supervisory experience and familiarity with healthcare regulations are preferred.
Experience Required
Minimum 5 year(s)
Intern, Country Music at Endeavor
, , United States - Full Time
Skills Needed
Detail Oriented, Multi Tasker, Problem Solving, Confidentiality, Adaptability, Dependability, Proactivity, Time Management, Interest In Country Music, Learning About Bookings, Live Music Passion
Specialization
Candidates must have a passion for country music and an interest in the bookings side of the music business. They should be detail-oriented, able to multi-task, and possess strong problem-solving abilities.
DEPARTMENT MANAGER - SALES at Von Maur/Dry Goods
Fargo, North Dakota, United States - Full Time
Skills Needed
Customer Service, Sales, Coaching, Training, Relationship Building, Performance Assessment, Problem Solving, Team Leadership
Specialization
The job requires strong leadership skills to train and coach associates, as well as the ability to develop relationships for business growth. Availability for a rotation of day, evening, and weekend shifts is also necessary.
SALES ASSOCIATE - WEEKENDS ONLY at Von Maur/Dry Goods
Bethel Park, Pennsylvania, United States - Full Time
Skills Needed
Customer Experience, Relationship Building, Product Knowledge, Pos Transactions, Sales Goals, Visual Merchandising
Specialization
The position requires availability for day, evening, and weekend shifts. No specific educational or experience requirements are mentioned.
SALES ASSOCIATE - COSMETICS at Von Maur/Dry Goods
Lake St. Louis, Missouri, United States - Full Time
Skills Needed
Customer Experience, Sales, Cosmetic Techniques, Product Knowledge, Pos Transactions, Relationship Building, Visual Merchandising
Specialization
The position requires a friendly demeanor and the ability to achieve sales goals. Availability for various shifts is also necessary.
Brand Ambassador at Alphabe Insight Inc
San Antonio, Texas, United States - Full Time
Skills Needed
Communication, Interpersonal Skills, Professional Appearance, Confidence, Adaptability, Goal Oriented, Reliability, Punctuality, Team Focused
Specialization
Candidates should possess strong communication and interpersonal skills, along with a professional appearance and confident presence. No prior experience is required as full training will be provided.
Director, Head of Integrated Facilities Management (IFM) for Asia at Manulife
, Hong Kong, China - Full Time
Skills Needed
Facilities Management, Engineering, Real Estate, Leadership, Operational Excellence, Cost Optimization, Vendor Management, Stakeholder Management, Communication Skills, Sustainability, Risk Management, Data Analytics, Governance, Health & Safety, Service Excellence, Continuous Improvement
Specialization
Candidates should have a bachelor's degree in a relevant field and a minimum of 10 years of experience in facilities management, with at least 5 years in a leadership role. A strong understanding of workplace operations and excellent stakeholder management skills are essential.
Experience Required
Minimum 10 year(s)
German Speaking Technical Support Agent - Work In Greece - Fully Paid Reloc at Mercier Consultancy MD
, , Poland - Full Time
Skills Needed
Technical Support, Problem Solving, Communication Skills, Customer Service, Technical Issues, Crm Systems, Team Collaboration, Product Knowledge
Specialization
Fluency in German is essential, with proficiency in English being advantageous. Experience in a technical support role is preferred, along with strong problem-solving and communication skills.
German Speaking Technical Support Agent - Work In Greece - Fully Paid Reloc at Mercier Consultancy MD
, , Bulgaria - Full Time
Skills Needed
Technical Support, Problem Solving, Communication Skills, Customer Service, German Language, English Proficiency, Technical Issue Diagnosis, Crm Systems, Team Collaboration, Product Knowledge
Specialization
Fluency in German is essential, with proficiency in English being advantageous. Experience in a technical support role is preferred but not mandatory, along with strong problem-solving and communication skills.
German Speaking Customer Service Agent For Automotive Industry - Work In Gr at Mercier Consultancy MD
, , Poland - Full Time
Skills Needed
Fluency In German, Proficiency In English, Customer Service, Communication Skills, Interpersonal Skills, Troubleshooting, Crm Systems, Office Software, Self Motivated, Automotive Industry Knowledge
Specialization
Fluency in German and proficiency in English are preferred. Experience in customer service, ideally within the automotive industry, is required.
Manufacturing Engineer at ITT Corporation
Irvine, California, United States - Full Time
Skills Needed
Manufacturing Engineering, Continuous Improvement, Cost Reduction, Statistical Methods, Root Cause Analysis, Project Management, Lean Manufacturing, Gd&T, Pro E Cad Software, Electrical Testing, Tooling Design, Mrp Manufacturing, Cmm Machines, Communication Skills, Team Collaboration, Ehs Improvements
Specialization
Candidates must have a bachelor's degree in a STEM discipline and at least 6 years of hands-on manufacturing engineering experience, with 5 years in an aerospace manufacturing environment. Familiarity with Lean Six Sigma and problem-solving methodologies is also required.
Experience Required
Minimum 5 year(s)
Direct Support Professional at Beacon Specialized Living
, , United States - Full Time
Skills Needed
Compassion, Dependability, Teamwork, Communication, Empathy, Reliability, Calmness, Professionalism, Patience, Support, Advocacy, Documentation, Goal Setting, Personal Care, Meal Preparation, Transportation
Specialization
Candidates must be at least 18 years old and possess a valid driver's license. Strong communication skills and a compassionate attitude towards individuals with disabilities or mental health challenges are essential.
Head of Admin and HR Administration at Azeus Systems Limited
, , - Full Time
Skills Needed
Leadership, Decision Making, Interpersonal Skills, Analytical Skills, Problem Solving Skills, Organizational Skills, Negotiation Skills, Self Motivation, Service Orientation, Integrity, Attention To Detail, Communication Skills, Employee Relations, Training Development, Policy Development, Budget Management
Specialization
Candidates must have a bachelor's degree in Human Resource, Business Administration, or a related field, along with at least 7 years of experience in a senior managerial position in HR and Admin, preferably in the IT industry. Strong leadership, analytical, and communication skills are essential.
Experience Required
Minimum 5 year(s)
Occupational H&S Manager at Masdar
Baku, , Azerbaijan - Full Time
Skills Needed
Health Sciences, Environmental Sciences, Biology, Social Sciences, Communication Skills, Interpersonal Skills, Project Delivery, H&S Trends, International Financial Institutions, Research Skills, Analytical Skills, Consultant Management, Innovation Strategy, Business Strategy
Specialization
A Master's degree in Health/Environmental Sciences or equivalent is required, along with 8-10 years of experience in the H&S field, including 3 years in internationally funded projects. Experience working as a consultant or at the client or lender level is also necessary.
Experience Required
Minimum 5 year(s)
Référent Agent d'entretien (H/F) at MS Vacances Campings & Clubs
Vendays-Montalivet, Nouvelle-Aquitaine, France - Full Time
Skills Needed
Communication, Organization, Autonomy, Dynamism, Smile, Responsibility
Specialization
The ideal candidate should be smiling, dynamic, organized, and capable of working autonomously. They should also be proactive and able to seek assistance from their supervisor when necessary.
Genesee/Orleans Self Determination Assistant - GLOW at DAYFORCE EMEA LIMITED
Batavia, New York, United States - Full Time
Skills Needed
Disability Support, Family Support, Learning, Communication, Teamwork
Specialization
Candidates should be eager to learn and willing to support individuals with disabilities. No specific qualifications are mentioned.
House Person - The Sanctuary at Kiawah Island Golf Resort
Kiawah Island, South Carolina, United States - Full Time
Skills Needed
Teamwork, Communication Skills, Attention To Detail, Independence, Organization, Time Management, Problem Solving, Physical Stamina, Customer Service, Task Execution, Supply Management, Cleaning Skills, Radio Communication, Computer Skills, Safety Awareness, Adaptability
Specialization
Candidates should have a high school diploma or equivalent and preferably one year of experience. Good communication skills in English and the ability to work both independently and as part of a team are essential.
Outside Account Manager at State Industrial Products
Austin, Texas, United States - Full Time
Skills Needed
Sales, Customer Service, B2b Prospecting, Cold Calling, Networking, Relationship Building, Inventory Management, Order Placement, Communication, Flexibility, Resilience, Tablet Proficiency, Ios Platforms, Problem Solving, Team Collaboration, Customer Needs Support
Specialization
A bachelor's degree is preferred, and candidates must have a valid driver's license and the ability to travel within the local market. Strong customer service orientation and proficiency with tablets and iOS platforms are also required.
Residential Counselor PRN (58716) at Aurora Mental Health & Recovery
Aurora District, Colorado, United States - Full Time
Skills Needed
Communication, Documentation, Crisis Counseling, Medication Management, Client Support, Team Collaboration, Behavior Observation, Emergency Procedures, Milieu Management, Case Management, Psychoeducational Groups, Client Care, Food Supply Management, Transporting Clients, Basic Life Support, Qmap Certification
Specialization
Candidates must have a high school diploma or GED and at least 6 months of experience in mental healthcare. Additional certifications such as QMAP and Basic Life Support are required within 30 days of hire.
Fundraising Coordinator at ACLU FOUNDATION OF TEXAS INC
, Texas, United States - Full Time
Skills Needed
Fundraising, Event Planning, Crm Systems, Microsoft Office Suite, Organizational Skills, Project Management, Communication Skills, Donor Engagement, Data Management, Attention To Detail, Confidentiality, Research Skills, Teamwork, Stewardship, Financial Reconciliation, Audit Processes
Specialization
Candidates should have a minimum of four years' experience in event planning, fundraising, or related fields. Proficiency in CRM systems and strong organizational skills are also required.
Experience Required
Minimum 2 year(s)
Medical Management - Supervisor Medical Review 145-4005 at CommunityCare
Tulsa, Oklahoma, United States -
Full Time

Start Date

Immediate

Expiry Date

25 Mar, 26

Salary

0.0

Posted On

25 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Analytical Skills, Problem Solving, Decision Making, Attention to Detail, Organizational Skills, Microsoft Applications, Communication Skills, Teamwork, Supervision, Training, Auditing, Compliance, Healthcare Regulations, Fraud Detection, Claims Processing, Clinical Guidance

Industry

Insurance

Description
The Medical Review Supervisor is responsible for overseeing activities and personnel involved in the day to day operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste and abuse, as it relates to provider billing practices. KEY RESPONSIBILITIES: Provides technical expertise to Medical Review (MRE) staff including analysis, problem solving, and decision making of complex claim reviews. Identifies medical necessity and /or quality issues for further evaluation. Oversees triage of pended and high dollar claims. Collaborates with external vendors on cases meeting reinsurance thresholds and specific requirements for ASO lines of business. Works collaboratively with other departments in providing or seeking claims review and/or clinical guidance. Participates in company committees or work groups as assigned. Proactively conducts routine monitoring and identifies areas of potential fraud, waste and/or abuse (FWA). Formulates recommendations based on findings. Suggests opportunities for focused reviews. Works collaboratively with the Compliance Officer and/or Special Investigations (SIU) as needed. Coordinates and/or oversees daily activities of the MRE staff. This includes planning, implementing and evaluating MRE goals. It also includes monitoring workload, staff supervision, training, coaching, auditing, teambuilding, performance evaluation and hiring/retaining staff. Provides training for new MRE staff including one-to-one sessions as required for successful staff mastery of job tasks related to claim reviews and special projects. Develops and implements operational guidelines for applicable payment policies and/or for other processes pertaining to the medical claim review function. Seeks organizational approval as indicated. Monitors the medical claim review tracking database for quality control. Compiles and analyzes data and prepares routine compliance reports. Performs other duties as required. QUALIFICATIONS: Excellent analytical and problem-solving skills Able to work independently as well as supervise others to meet stringent deadlines Strong attention to detail. Highly organized and capable of managing multiple projects. Proficient in Microsoft applications. Possess strong oral and written communication. Ability to work as a team in a high paced environment. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE Current active, unrestrictive license to practice as a Registered Nurse (RN) in the State of Oklahoma. BSN preferred Minimum of five years combined employment in facility/provider health care settings or managed care organization. Two years supervisory experience preferred. Prefer strong clinical related background and case review experience focused in healthcare fraud, waste and abuse. Require experience or familiarity with state and federal regulations governing healthcare coding, billing and claims processing. Recognized healthcare coding certification (CPC, AHIMA, etc.) preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
Responsibilities
The Medical Review Supervisor oversees the daily operations of the medical claim review program and guides staff in auditing and monitoring functions. They also collaborate with other departments and external vendors to ensure compliance and identify potential fraud, waste, and abuse.
Medical Management - Supervisor Medical Review 145-4005 at CommunityCare
Tulsa, Oklahoma, United States - Full Time
Skills Needed
Analytical Skills, Problem Solving, Decision Making, Attention To Detail, Organizational Skills, Microsoft Applications, Communication Skills, Teamwork, Supervision, Training, Auditing, Compliance, Healthcare Regulations, Fraud Detection, Claims Processing, Clinical Guidance
Specialization
Candidates must have an active RN license in Oklahoma and a minimum of five years of experience in healthcare settings. Supervisory experience and familiarity with healthcare regulations are preferred.
Experience Required
Minimum 5 year(s)
Intern, Country Music at Endeavor
, , United States - Full Time
Skills Needed
Detail Oriented, Multi Tasker, Problem Solving, Confidentiality, Adaptability, Dependability, Proactivity, Time Management, Interest In Country Music, Learning About Bookings, Live Music Passion
Specialization
Candidates must have a passion for country music and an interest in the bookings side of the music business. They should be detail-oriented, able to multi-task, and possess strong problem-solving abilities.
DEPARTMENT MANAGER - SALES at Von Maur/Dry Goods
Fargo, North Dakota, United States - Full Time
Skills Needed
Customer Service, Sales, Coaching, Training, Relationship Building, Performance Assessment, Problem Solving, Team Leadership
Specialization
The job requires strong leadership skills to train and coach associates, as well as the ability to develop relationships for business growth. Availability for a rotation of day, evening, and weekend shifts is also necessary.
SALES ASSOCIATE - WEEKENDS ONLY at Von Maur/Dry Goods
Bethel Park, Pennsylvania, United States - Full Time
Skills Needed
Customer Experience, Relationship Building, Product Knowledge, Pos Transactions, Sales Goals, Visual Merchandising
Specialization
The position requires availability for day, evening, and weekend shifts. No specific educational or experience requirements are mentioned.
SALES ASSOCIATE - COSMETICS at Von Maur/Dry Goods
Lake St. Louis, Missouri, United States - Full Time
Skills Needed
Customer Experience, Sales, Cosmetic Techniques, Product Knowledge, Pos Transactions, Relationship Building, Visual Merchandising
Specialization
The position requires a friendly demeanor and the ability to achieve sales goals. Availability for various shifts is also necessary.
Brand Ambassador at Alphabe Insight Inc
San Antonio, Texas, United States - Full Time
Skills Needed
Communication, Interpersonal Skills, Professional Appearance, Confidence, Adaptability, Goal Oriented, Reliability, Punctuality, Team Focused
Specialization
Candidates should possess strong communication and interpersonal skills, along with a professional appearance and confident presence. No prior experience is required as full training will be provided.
Director, Head of Integrated Facilities Management (IFM) for Asia at Manulife
, Hong Kong, China - Full Time
Skills Needed
Facilities Management, Engineering, Real Estate, Leadership, Operational Excellence, Cost Optimization, Vendor Management, Stakeholder Management, Communication Skills, Sustainability, Risk Management, Data Analytics, Governance, Health & Safety, Service Excellence, Continuous Improvement
Specialization
Candidates should have a bachelor's degree in a relevant field and a minimum of 10 years of experience in facilities management, with at least 5 years in a leadership role. A strong understanding of workplace operations and excellent stakeholder management skills are essential.
Experience Required
Minimum 10 year(s)
German Speaking Technical Support Agent - Work In Greece - Fully Paid Reloc at Mercier Consultancy MD
, , Poland - Full Time
Skills Needed
Technical Support, Problem Solving, Communication Skills, Customer Service, Technical Issues, Crm Systems, Team Collaboration, Product Knowledge
Specialization
Fluency in German is essential, with proficiency in English being advantageous. Experience in a technical support role is preferred, along with strong problem-solving and communication skills.
German Speaking Technical Support Agent - Work In Greece - Fully Paid Reloc at Mercier Consultancy MD
, , Bulgaria - Full Time
Skills Needed
Technical Support, Problem Solving, Communication Skills, Customer Service, German Language, English Proficiency, Technical Issue Diagnosis, Crm Systems, Team Collaboration, Product Knowledge
Specialization
Fluency in German is essential, with proficiency in English being advantageous. Experience in a technical support role is preferred but not mandatory, along with strong problem-solving and communication skills.
German Speaking Customer Service Agent For Automotive Industry - Work In Gr at Mercier Consultancy MD
, , Poland - Full Time
Skills Needed
Fluency In German, Proficiency In English, Customer Service, Communication Skills, Interpersonal Skills, Troubleshooting, Crm Systems, Office Software, Self Motivated, Automotive Industry Knowledge
Specialization
Fluency in German and proficiency in English are preferred. Experience in customer service, ideally within the automotive industry, is required.
Manufacturing Engineer at ITT Corporation
Irvine, California, United States - Full Time
Skills Needed
Manufacturing Engineering, Continuous Improvement, Cost Reduction, Statistical Methods, Root Cause Analysis, Project Management, Lean Manufacturing, Gd&T, Pro E Cad Software, Electrical Testing, Tooling Design, Mrp Manufacturing, Cmm Machines, Communication Skills, Team Collaboration, Ehs Improvements
Specialization
Candidates must have a bachelor's degree in a STEM discipline and at least 6 years of hands-on manufacturing engineering experience, with 5 years in an aerospace manufacturing environment. Familiarity with Lean Six Sigma and problem-solving methodologies is also required.
Experience Required
Minimum 5 year(s)
Direct Support Professional at Beacon Specialized Living
, , United States - Full Time
Skills Needed
Compassion, Dependability, Teamwork, Communication, Empathy, Reliability, Calmness, Professionalism, Patience, Support, Advocacy, Documentation, Goal Setting, Personal Care, Meal Preparation, Transportation
Specialization
Candidates must be at least 18 years old and possess a valid driver's license. Strong communication skills and a compassionate attitude towards individuals with disabilities or mental health challenges are essential.
Head of Admin and HR Administration at Azeus Systems Limited
, , - Full Time
Skills Needed
Leadership, Decision Making, Interpersonal Skills, Analytical Skills, Problem Solving Skills, Organizational Skills, Negotiation Skills, Self Motivation, Service Orientation, Integrity, Attention To Detail, Communication Skills, Employee Relations, Training Development, Policy Development, Budget Management
Specialization
Candidates must have a bachelor's degree in Human Resource, Business Administration, or a related field, along with at least 7 years of experience in a senior managerial position in HR and Admin, preferably in the IT industry. Strong leadership, analytical, and communication skills are essential.
Experience Required
Minimum 5 year(s)
Occupational H&S Manager at Masdar
Baku, , Azerbaijan - Full Time
Skills Needed
Health Sciences, Environmental Sciences, Biology, Social Sciences, Communication Skills, Interpersonal Skills, Project Delivery, H&S Trends, International Financial Institutions, Research Skills, Analytical Skills, Consultant Management, Innovation Strategy, Business Strategy
Specialization
A Master's degree in Health/Environmental Sciences or equivalent is required, along with 8-10 years of experience in the H&S field, including 3 years in internationally funded projects. Experience working as a consultant or at the client or lender level is also necessary.
Experience Required
Minimum 5 year(s)
Référent Agent d'entretien (H/F) at MS Vacances Campings & Clubs
Vendays-Montalivet, Nouvelle-Aquitaine, France - Full Time
Skills Needed
Communication, Organization, Autonomy, Dynamism, Smile, Responsibility
Specialization
The ideal candidate should be smiling, dynamic, organized, and capable of working autonomously. They should also be proactive and able to seek assistance from their supervisor when necessary.
Genesee/Orleans Self Determination Assistant - GLOW at DAYFORCE EMEA LIMITED
Batavia, New York, United States - Full Time
Skills Needed
Disability Support, Family Support, Learning, Communication, Teamwork
Specialization
Candidates should be eager to learn and willing to support individuals with disabilities. No specific qualifications are mentioned.
House Person - The Sanctuary at Kiawah Island Golf Resort
Kiawah Island, South Carolina, United States - Full Time
Skills Needed
Teamwork, Communication Skills, Attention To Detail, Independence, Organization, Time Management, Problem Solving, Physical Stamina, Customer Service, Task Execution, Supply Management, Cleaning Skills, Radio Communication, Computer Skills, Safety Awareness, Adaptability
Specialization
Candidates should have a high school diploma or equivalent and preferably one year of experience. Good communication skills in English and the ability to work both independently and as part of a team are essential.
Outside Account Manager at State Industrial Products
Austin, Texas, United States - Full Time
Skills Needed
Sales, Customer Service, B2b Prospecting, Cold Calling, Networking, Relationship Building, Inventory Management, Order Placement, Communication, Flexibility, Resilience, Tablet Proficiency, Ios Platforms, Problem Solving, Team Collaboration, Customer Needs Support
Specialization
A bachelor's degree is preferred, and candidates must have a valid driver's license and the ability to travel within the local market. Strong customer service orientation and proficiency with tablets and iOS platforms are also required.
Residential Counselor PRN (58716) at Aurora Mental Health & Recovery
Aurora District, Colorado, United States - Full Time
Skills Needed
Communication, Documentation, Crisis Counseling, Medication Management, Client Support, Team Collaboration, Behavior Observation, Emergency Procedures, Milieu Management, Case Management, Psychoeducational Groups, Client Care, Food Supply Management, Transporting Clients, Basic Life Support, Qmap Certification
Specialization
Candidates must have a high school diploma or GED and at least 6 months of experience in mental healthcare. Additional certifications such as QMAP and Basic Life Support are required within 30 days of hire.
Fundraising Coordinator at ACLU FOUNDATION OF TEXAS INC
, Texas, United States - Full Time
Skills Needed
Fundraising, Event Planning, Crm Systems, Microsoft Office Suite, Organizational Skills, Project Management, Communication Skills, Donor Engagement, Data Management, Attention To Detail, Confidentiality, Research Skills, Teamwork, Stewardship, Financial Reconciliation, Audit Processes
Specialization
Candidates should have a minimum of four years' experience in event planning, fundraising, or related fields. Proficiency in CRM systems and strong organizational skills are also required.
Experience Required
Minimum 2 year(s)