Associate Director, Case Management Systems Job at Robert Half (New York)

Associate Director – Contingency Claims

To service the claims needs of customers, providing quality customer care, ensur...

Location

United Kingdom , London

Salary:

50000.00 - 65000.00 GBP / Year

Lawes Consulting Group

Expiration Date

Until further notice

Requirements

English, Maths and or working towards CII qualifications is desirable
Working with bespoke London market IT platforms (training provided) within Windows Virtual Desktop application
Compliant in using MS Office applications, i.e., MS Word, MS Excel, MS Teams
Prior experience in a client facing role of Contingency claims handling and the entertainment market, 10+ years desirable

Job Responsibility

To service the claims needs of customers, providing quality customer care, ensuring that all issues relating to the claims process are dealt with proactively
To support the London Claims Team including fellow Associate Claims Director, management and colleagues throughout the company in their endeavours to achieve and surpass targets and always provide a first-class service whilst adhering to all FCA principles and the specific requirements of:Treating Customers Fairly, Contract Certainty and Conflict of Interest
Undertaking those enquiries necessary to obtain sufficient information to establish policy liability and progress claims efficiently
Registering new claims accurately on relevant computer systems and updating the records during the life of the claim
Ensuring all claims and correspondence, on delegated authority cases, are correctly maintained and to provide a clear and concise history of events, actions, and quantum assessment
Obtaining and submitting completed Client claim documentation to Insurers or nominated service providers promptly
Answering telephone calls promptly and effectively dealing with all enquiries in a professional and efficient manner
Processing incoming post within agreed service standards
Dealing with Client enquiries within designated time frames or as otherwise agreed with Client
Communicating effectively with Insurers, nominated service providers, engineers and Loss Adjusters etc, using methods appropriate to the circumstances, (including telephone/e-mail/fax, dictation), to ensure the highest levels of customer service are maintained

Fulltime

Rare Condition Manager

To support high-quality, cost-effective care by coordinating services for member...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge
Practice interpersonal and active listening skills to achieve customer satisfaction
Interpret and translate policies, procedures, programs, and guidelines

Job Responsibility

Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan
Make and answer a diverse and high volume of condition management-related member calls on a daily basis
Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs
Analyze medical records, claims data, and other information sources
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, BCBSAZ programs, provider networks, etc
Present status reports on cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy

Fulltime

New

Integrated Care Manager

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN.
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC.)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan.
Answer a diverse and high volume of health insurance related customer calls on a daily basis.
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements.
Maintain complete and accurate records per department policy.
Demonstrate ability to apply plan policies and procedures effectively.

Fulltime

Integrated Care Manager - Adult

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

Complex Inpatient Medical Social Worker

Provides care management/social work services to Complex patients, families, and...

Location

United States

Salary:

33.05 - 49.60 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Master’s Degree in Social Work
LSW license issued by the State in which the team member practices (WI & IL Divisions)
Accredited Case Manger SW (ACM-SW) certification issued by the American Case Management Association (ACM) needs to be obtained within 2 years, or Certified Case Manager (CCM) issued by the Commission for Case Manager Certification (CCMC) needs to be obtained within 2 years, or Certified Social Worker in Health Care (C-SWHC) issued by National Association of Social Workers to be obtained within 2 years
3 years of hospital care management experience
Ability to prioritize and organize work
Effective communication skills
Utilization of critical thinking and timely decision making
Ability to navigate the electronic health record
Basic utilization of MS Office products
Knowledge of Medicare A and B guidelines

Job Responsibility

Provides care management/social work services to Complex patients, families, and individuals including perming thorough patient psychosocial assessments, screening, determination of needs evaluation, appropriate interventions and follow up, and discharge planning
Implements targeted interventions and patient-family centered care plans to achieve optimal health outcomes
Collaborates and negotiates effectively with socially complex patients, family and the clinical team while striving to achieve patient and organizational goals regarding care needs, choices, and satisfaction during discharge planning and care transitions
Provide continuity of care and discharge planning services for socially complex patients compliant with regulatory standards
Provides advanced care management guidance and mentorship to frontline care management team members fostering a culture of excellence and continuous improvement
Initiates internal and external referrals to ensure timely progression of care and transitions for socially complex patients
Documents discharge planning interventions and utilization review activity according to department and organization standards in a timely manner
Advocates for patients and their families to ensure their voices are heard and their needs are met within the healthcare system while optimizing the utilization of hospital resources ensuring cost-effective care delivery and adherence to regulatory guidelines
Communicates effectively with the healthcare team regarding socially complex patients
Serves as a leader of the multidisciplinary rounds and work closely with clinical team members, hospital departments and ancillary services to identify and resolve barriers to discharge, expedite care delivery to avoid delays in timely service provision, and implement and report on care coordination and discharge planning

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Associate Director, Humanoid Systems Safety

The Systems Engineering, Integration, and Test (SEIT) Department of Boston Dynam...

Location

United States , Waltham

Salary:

Not provided

Boston Dynamics

Expiration Date

Until further notice

Requirements

Exceptional interpersonal and leadership skills
10+ years of relevant product development experience
Deep technical expertise in the engineering of safety-critical autonomous systems
BS in Engineering (MS Electrical, Computer, Systems, and/or Mechanical Engrg preferred)

Job Responsibility

Work with employees and peers to develop effective safety and reliability strategies, efficient processes, and needed infrastructure
Oversee safety and reliability engineering requirement development, lifecycle management, compliance forecasting, and verification
Support system risk assessment and management
Lead or support safety case development
Provide training and coaching across the team
Oversee failure analysis, root cause identification, corrective action planning, and execution
Technical project management skills, including resource planning, work planning, risk management, prioritization, conflict management, change management, issue resolution, and progress reporting

Fulltime

Fraud Director

Mastercard Transaction Services (MTS) is looking for a Fraud Director to develop...

Location

United Kingdom , London

Salary:

Not provided

Mastercard

Expiration Date

Until further notice

Requirements

Experienced fraud professional from an international payments or transactional banking background
Exposure to a large global business and high risk markets gained over a number of years
Demonstrable experience of developing and deploying fraud frameworks, policies and procedures, together with the associated fraud management systems
Familiarity with advanced, automated, fraud management systems including the use of AI is a distinct advantage
Used to working in a matrix environment with multiple stakeholders, occasionally with competing objectives
Ability to influence senior leaders and present persuasive arguments
Deep subject matter knowledge to identify and isolate emerging fraud patterns quickly and safely
Experience of emerging markets and the particular fraud typologies applicable within is helpful
A globally recognised fraud qualification (ACFE or equivalent) is essential
Educated to degree level in a relevant discipline

Job Responsibility

Development and implementation of the MTS wide fraud framework
Completion of the MTS fraud risk assessment
Collation of an MTS fraud regulatory inventory for each entity and the development and implementation of associated controls
Completion of new product fraud risk assessments, liaison with product teams and the recommendation of suitable controls
Fraud system selection, integration and management as necessary
Fraud data analysis and interpretation into meaningful actions
Management of fraud incidents, identification of patterns and the rapid closure of control weaknesses identified
Ownership and management of the MTS fraud losses budget
Analysis of significant external frauds and regulatory findings for patterns and improvements MTS could apply
Regulatory and Industry outreach on fraud matters

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

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 varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service required
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

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

Fulltime

Associate Director, Case Management Systems

Robert Half

Location:
United States , New York

Category:
IT - Software Development

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 26, 2025

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Job Description:

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