The Clinical Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states. Essential Functions Responsible for the completion of clinical appeals and state hearings from all states Review and complete all provider clinical appeals within required timeframes. Review and complete member clinical appeals within required timeframes. Re

Works with members, providers, and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on

PME is looking for a Healthcare Case Manager I (RN, LCSW, LMSW) experienced in Case Management working with complex medical and mental illness cases. The position will require approximately field visits 2 3 days a week and the rest will be from home. Schedule M F 8 30am 5 00pm CST. MUST live in within 30 minutes of Southside of Chicago (60617 & 60619) and surrounding part

PME is looking for a Healthcare Case Manager I ( LPC, RN, MSW in social work ) experienced in Case Management working with complex medical and mental illness cases. Schedule M F 8 30am 5 00pm CST. Fully remote but MUST be local to Chicago and surrounding counties; COOK COUNTY and surrounding areas. Responsible for health care management and coordination of healthcare memb

A customer service representative, or CSR, will act as a liaison, provide services information, and resolve any emerging problems that our customer accounts might face with accuracy and efficiency. The best CSRs are genuinely excited to help customers. They're patient, empathetic, and passionately communicative. They love to talk. Customer service representatives can put

Responsible for health care management and coordination of healthcare members Works with members to create and implement an integrated collaborative plan of care. Conducts assessment of member needs by collecting in depth information from healthcare information system, the member, member's family/caregiver, hospital staff, physicians, and other providers. Develops and imp

Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

Seeking a Member Advocate to act as an advocate for the Member and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote Member education, identify and resolve any systemic barriers that limit Members access to appropriate care. This is a hybrid position requiring 1 week per month in office. Sc

Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims. Analyzes problems and provides information/solutions. Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database. Thoroughly documents inquiry outcomes for accura

Seeking an RN Care Manager II to p rovide Care Management duties to include telephonic outreach to members, assess members for complex medical needs, develop and update care plans, assess members current health , resource utilization , assess progress to goals , assist member with coordinating services and appointments , provide member education, assist with access to com

Data Capture Specialist is responsible for the accurate capture of the alphabetic, numeric, or symbolic data from electronic images and/or source documents according to the custom developed software application including repair of incorrect data resulting from OCR process (optical character recognition results). Pay Rate $14.85hr (Weekly Pay) Work Schedule Monday (9 00 am

Administers medications and treatments in accordance with all accepted standards for administration; Provides safe, efficient personal care of residents; Uses recommended safety devices and follows infection control standards; Answers call lights and residents' requests for assistance; Adheres to resident's rights at all times; Documents medications and treatments adminis

PME is looking for a Healthcare Case Manager I (RN, LCSW, LMSW) experienced in Case Management working with complex medical and mental illness cases. The position will require field visits 3 days a week and the rest will be from home. Schedule M F 8 30am 5 00pm CST. MUST live in within 30 minutes of ARLINGTON HEIGHTS, BARTLETT, HANOVER PARK, BARRINGTON, ELGIN, MOUNT PROSP

Professional Management Enterprises, inc. is looking for an entry level Technical Writer. Their role is to employ their technical knowledge to research, document, and present detailed information in easy to interpret guides, help manuals, white papers, templates, web pages, videos, journal articles, etc. The Technical Writer will transform complex information into concise

The Community Well Care Coordination Manager must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordination Manager must, at a minimum, be a registered nurse or simil