Agency Service Representative II Job at Elevance Health (Columbus)

Appeals and Grievances Nurse Specialist RN II

The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provi...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of experience in Clinical RN
At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment
Excellent interpersonal and communication skills
Computer literacy and adaptability to computer learning
Time management and priority setting skills
Must be organized and a team player
Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies
Good working knowledge of regulatory requirements/standards
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department
Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements
Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA)
Identification of Expedited Cases and resolution within 72 hours
Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation
Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE)
Process the case thru to effectuation and final case documentation in the A&G system of record
Investigation and preparation of State Fair Hearing cases as assigned
Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE)
Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Pharmacy Technician II

JOB TITLE: Pharmacy Technician II EMPLOYER: Twelfth One, LLC dba Aspen Infusion...

Location

United States , Chandler

Salary:

22.00 - 24.00 USD / Hour

Aspen Infusion

Expiration Date

Until further notice

Requirements

Preferred at least one (1) year of sterile compounding experience in a USP 797 compliant cleanroom OR one (1) year of aseptic preparation of infusion-related pharmaceuticals in a hospital or home infusion setting
USP 797 Sterile Compounding Training certificate or on-the-job training in sterile compounding is highly preferred
Organizational skills sufficient to maintain consistently accurate records
Ability to evaluate options and to make efficient decisions
Current license/certification as a Certified Pharmacy Technician
Current knowledge of all applicable state and federal pharmacy laws, rules and regulations
Computer skills that include proficiency with spreadsheets and use of the internet, as well as word processing, and efficient use of the internet and e-mail

Job Responsibility

Assisting the pharmacist by contacting patients over the phone to schedule routine medication refill deliveries, track lab results (for pharmacist review), fax all lab results (after review) to prescriber office, RX claim adjudication and other day to day activities under the direct supervision of the pharmacist
Support the clinical pharmacist by providing superior customer service to ensure timely delivery of patients' medication to their homes
Report any misconduct, suspicious or unethical activities to the Compliance Officer
Represent the company in a professional and courteous manner in all interactions with patients
Manage the daily schedule for patient deliveries, manage inventory, create delivery tickets with individualized patient supplies based on appropriate therapy
Assist with ongoing patients and also new admissions to review new referrals to ensure all necessary documentation is included prior to pharmacist review
Compound, dispense and package medications under the direction of the on-duty pharmacist
Ensure compliance with all licensure and federal, state, and local laws and regulations
observe the company's policies on ''best practices''
Assist in resolving patient concerns and complaints

Risk Management Framework (RMF) Coordinator 2

Amentum is seeking a Risk Management Framework (RMF) Coordinator Level 2 for a p...

Location

United States , Linthicum

Salary:

160000.00 - 190000.00 USD / Year

Amentum

Expiration Date

Until further notice

Requirements

TS/SCI Poly clearance
Bachelor's degree in Business Management, Computer Science, Electrical Engineering, Information Management, or Program Management etc. (or in lieu of a Bachelor's degree an additional four (4) years may be substituted for a total of 12 years experience)
Eight (8) years of experience in one or more of the following fields: Risk Management
Process Improvement
or Project Management
One (1) year experience with COTS risk management tools (e.g Active Risk Manager (ARM))
statistics
data collection
analysis
data presentation

Job Responsibility

Provide a process that integrates risk management activities into the system life cycle process
Perform and complete organizational and management tasks that support the government cyber mission efforts
Manage information security, systems, enclave risk across the organization
Manage risks, risk mitigation plans and strategies, deadlines and progress across Technical Task Orders and leadership to ensure mission priorities are delivered within budget cost, efficient performance, and delivered on time
Coordinate TTO tasks with customer organizations (directorate/group/office level) as necessary, to implement RMF services
Communicate with clients about expectation and goals
Collaborate with Government Program Manager, leadership, Business Financial Managers, Contracting Officers, Contracting Officer Representatives, mission teams and agency leadership on risks
Work with mission and Government PM to identify risks to organization, programs, systems, etc.
Collaborate with mission and Government PM risk mitigation plans and strategies
Coordinate risks, risk mitigation plans, and progress across the teams to ensure delivery of task is delivered on time, and on budget

What we offer

Health, dental, and vision insurance
Paid time off and holidays
Retirement benefits (including 401(k) matching)
Educational reimbursement
Parental leave
Employee stock purchase plan
Tax-saving options
Disability and life insurance
Pet insurance

Fulltime

Appeals and Grievances Nurse Specialist RN II

The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provi...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of experience in Clinical RN
At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment
Excellent interpersonal and communication skills
Computer literacy and adaptability to computer learning
Time management and priority setting skills
Must be organized and a team player
Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies
Good working knowledge of regulatory requirements/standards
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Provides direct assistance to members with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved
Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests
Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements
Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation
Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE)
Investigation and preparation of State Fair Hearing cases as assigned
Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews
When necessary, outreaches to providers, vendors, hospitals, and members to request necessary information or to provide case status and/or next steps
Participates inter-rater reliability training and assessments

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Admin officer

Administrative Officers are assigned to teams to carry out a variety of general ...

Location

United Kingdom , Bradford

Salary:

Not provided

Brook-St Hiredonline

Expiration Date

Until further notice

Requirements

5 GCSE passes (or equivalent) grades A*-C
NVQ Business Administration level II
Administrative experience
Relevant computer skills to undertake the level of work required

Job Responsibility

Preparing papers and files for court, tribunals, hearings and meetings
Producing court/tribunal documents
General photocopying and filing
Creating and updating records on in-house computer system and data input
Post opening and dispatch
Booking, preparing and organising meeting rooms, supporting training courses and other group activities
Preparing meeting agenda, joining instructions, handouts etc
Drafting standard letters and correspondence, minutes, notes, reports, submissions etc, according to guidelines and instructions
Clerking civil and family courts, tribunals and hearings, ensuring papers and materials are available and up to date
Assisting court users, supporting listing and rota management, checking files

What we offer

Paid Holidays and Pension

Fulltime

Staff Scientist II

Souder, Miller & Associates is recruiting for a Part-Time/On-call Staff Scientis...

Location

United States , Albuquerque

Salary:

27.00 - 30.00 USD / Hour

Souder Miller & Associates

Expiration Date

Until further notice

Requirements

Bachelor's degree in appropriate engineering or science
Minimum 1 year of experience preferred post-graduation
In-training certificate or similar, as appropriate preferred
Should actively pursue professional registration and/or certification
Must have a valid driver's license and able to pass drug tests.

Job Responsibility

Acquire and develop basic technical skills
Apply prescribed techniques and procedures in accordance with established criteria to perform assigned tasks
Perform routine technical work which does not require previous experience
Collect data and gather information or documents
Perform standard computations or analysis
Prepare drawings and visual aids
Perform occasional drafting and/or figure development using technical software as required
Assist in client contact and communication pertaining to specific projects
Assist in the development of scopes of work and cost estimates for projects
Attend client meetings and complete field investigations, day or night

What we offer

Health
Dental
Vision
401K
ESOP
Life/ADD/Short Term/Long Term Insurance
Voluntary Insurance
FSA
Dependent Care
Wellness program for employees

Parttime

Admin officer

Good administrative staff with excellent customer service skills are vital to th...

Location

United Kingdom , Kingston, Outer London

Salary:

15.00 - 15.59 GBP / Hour

Brook-St Hiredonline

Expiration Date

Until further notice

Requirements

5 GCSE passes (or equivalent) grades A*-C
NVQ Business Administration level II
Administrative experience
Relevant computer skills to undertake the level of work required

Job Responsibility

Preparing papers and files for court, tribunals, hearings and meetings
Producing court/tribunal documents
General photocopying and filing
Creating and updating records on in-house computer system and data input
Post opening and dispatch
Booking, preparing and organising meeting rooms, supporting training courses and other group activities
Preparing meeting agenda, joining instructions, handouts etc
Drafting standard letters and correspondence, minutes, notes, reports, submissions etc, according to guidelines and instructions
Clerking civil and family courts, tribunals and hearings, ensuring papers and materials are available and up to date
Assisting court users, supporting listing and rota management, checking files

What we offer

Holiday and Pension

Fulltime

Senior Office Support Specialist

The Wyoming Department of Corrections Women’s Center in Lusk is seeking a Senior...

Location

United States , Lusk

Salary:

24.78 USD / Hour

Wyoming Game and Fish Department

Expiration Date

Until further notice

Requirements

Bachelor's Degree (typically in Business)
0-1 year of progressive work experience (typically in Business Office Communications) with acquired knowledge at the level of an Office Support Specialist II
OR 3-4 years of progressive work experience (typically in Business Office Communications) with acquired knowledge at the level of an Office Support Specialist II
Knowledge of applicable computer applications Excel and Google
Knowledge in the preparation of complicated documents
Knowledge and understanding of the agency and each respective division/program
Must pass a background/reference check
Must pass a drug screen upon appointment
Must meet the standards of the WDOC dress code policy

Job Responsibility

Acts as liaison between director, division administrators, and program managers to coordinate calendars for meetings and conference calls
Provide instruction on office policies, procedures, and rules, and may proctor examinations
Attends, takes minutes, and prepares necessary records for meetings
Reports time for executives weekly and vehicle mileage as necessary
Makes all necessary travel arrangements for executive staff
Receives, analyzes, and responds to requests for information
Compiles and analyzes a variety of data and information and prepares related reports
Explains program requirements and interprets policies
Administers the database for information
Prepares routine response/notification letters

What we offer

Health, Dental, and Vision Insurance
State Retirement plan and additional savings opportunities
Paid vacation, sick leave, and holidays
Tuition reimbursement program
457 deferred compensation program
Longevity pay opportunities for advancement
Eligibility for Public Service Student Loan Forgiveness
Culture of public service and a commitment to work/life balance

Fulltime

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Agency Service Representative II

Job Description

Job Responsibility

Requirements

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