Managed Care Consultant Job at Office Angels (Tonbridge)

Provider Management Consultant

This role is responsible for supporting development and growth of positive, long...

Location

United States , Chicago

Salary:

60300.00 - 133400.00 USD / Year

Health Care Service Corporation

Expiration Date

Until further notice

Requirements

Bachelor's Degree with 5-7 years experience in a Healthcare or Managed Care environment
3 or more years of hands-on experience in Provider Contracting, Network Management, or Provider Relations
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
Demonstrated ability to manage multiple projects and meet deadlines
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Detail oriented professional with excellent written and verbal communication skills
CMS regulatory requirements, including Medicare Marketing Guidelines
Experience with Medicare products (including Medicare Advantage, Medicare Prescription Drug Plan (PDP) and Medicare Supplement products)

Job Responsibility

Support development and growth of positive, long-term relationships with physicians, providers, multi specialty clinics, and healthcare systems to support and improve financial and quality performance within the contracted working relationship with the health plan
Identify the business plan and have growth objectives
Navigate the C Suite and execution of strategies in conjunction with the HCSC Contracting teams

Fulltime

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).

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

Oracle BRM (Billing & Revenue Management) Consultant

Cognizant is seeking a highly skilled and experienced Oracle BRM (Billing & Reve...

Location

United States

Salary:

Not provided

Inabia Solutions & Consulting

Expiration Date

Until further notice

Requirements

Proven hands-on implementation and configuration experience with Oracle BRM (Billing & Revenue Management)
Must have direct experience in industries such as Telecom, Media, Utilities, or Subscription Services
Strong understanding of customer lifecycle management, including: Real-Time Rating & Charging (RTC), Prepaid and Postpaid Billing Systems, Invoice Generation, Discounting and Promotions, Payment Processing
Technical proficiency with key BRM components like Pipeline Manager (PLM), Customer Center (BCC), Billing Care, and Real-Time Charging
Experience with BRM data models, opcodes, and PCM C++.
Ability to write and debug stored procedures, and work with BRM APIs.
Excellent communication skills and the ability to work effectively in a remote setting.
Must be legally authorized to work in the United States without the need for employer sponsorship.

Job Responsibility

Analyze client business requirements and design scalable, robust billing architectures using Oracle BRM.
Configure and customize the Oracle BRM platform to implement complex pricing models, including prepaid, postpaid, and hybrid billing scenarios.
Develop, integrate, and optimize rating, discounting, and invoicing pipelines to handle high-volume transaction processing.
Manage and automate the end-to-end revenue management cycle, from customer charging to revenue recognition.
Integrate Oracle BRM with other systems such as CRMs, order management, and ERP financial modules for a seamless data flow.
Perform advanced troubleshooting, debugging, and performance tuning of the BRM environment.
Provide expertise in upgrading, patching, and maintaining the BRM application stack.
Collaborate with cross-functional and client teams to ensure solutions meet business needs and are delivered effectively.

Nurse Care Manager

A unique and exciting opportunity exists for a registered nurse to progress thei...

Location

Australia , Sydney

Salary:

87600.00 AUD / Year

CRT Program

Expiration Date

Until further notice

Requirements

Current Registered Nurse with AHPRA without conditions – essential
Profession Certificate in Immunisation – preferable
Highly organised and efficient with a strong commitment and demonstrated customer service skills
Excellent interpersonal skills, effective written and verbal communications
Ability to work autonomously, possess a mobile telephone and laptop
IT proficient in Microsoft Office, shared folders and online/mobile Apps
Proficiency with medical software eg: Best Practice or another electronic management system
A can-do attitude and ability to own and solve problems
Be flexible and accommodating when required
Current CPR Certificate

Job Responsibility

Lead a dynamic team that embrace digital tools, data analytics
Improve the lives of those living with Chronic Health Conditions
Conduct health assessments, draft care plans, ensure all preventative care is actioned according to clinical guidelines, review patients via face-to-face and/or telehealth consultations, conduct home and aged care facility visits, and liaise with specialists and other service providers
Practice nurse duties such as
triage and assessment of patients
wound management
assisting with minor procedures
maintaining recall and reminder system
cold chain management
infection control management

What we offer

Generous Salary Packaging
Training and professional development opportunities included

Fulltime

Candidate Care Consultant

As a Candidate Care Consultant, you’ll be the heartbeat of our candidate experie...

Location

United Kingdom , Sheffield

Salary:

27000.00 GBP / Year

AFFINITY WORKFORCE

Expiration Date

Until further notice

Requirements

Excellent communication and interpersonal skills
A genuine passion for education and people
Organised, proactive, and detail-oriented
Previous experience in recruitment, HR, or customer service (preferred)
Knowledge of safeguarding and compliance in education (desirable)

Job Responsibility

Build strong relationships with candidates throughout their recruitment journey
Conduct onboarding calls, compliance checks, and regular welfare check-ins
Manage candidate queries with empathy and efficiency
Coordinate interviews, feedback, and placement logistics
Maintain accurate records and ensure compliance with safeguarding standards
Support marketing and engagement campaigns to attract top talent

What we offer

A vibrant, collaborative team culture – a Sunday Times Best places to work organisation for 2024 and 2025!
Your Birthday and Christmas Eve off (in addition to your annual leave entitlement)
Ongoing training and professional development
Clear progression pathways
Regular team socials and wellbeing initiatives
The chance to make a real impact in education

Fulltime

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

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 for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

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

Fulltime

Appeals Nurse Consultant

This is a full-time telework position. Hours for this role are Monday-Friday 8a-...

Location

United States

Salary:

Not provided

CVS Health

Expiration Date

Until further notice

Requirements

Must have active and unrestricted RN licensure in state of residence
3+ years clinical experience

Job Responsibility

Responsible for the review and resolution of clinical appeals
Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues
Independently coordinates the clinical resolution with internal/external clinician support as required

Fulltime

Dementia Consultant - Hospital to Community and Residential Care Transition

A rewarding opportunity to be involved in a Dementia Centre initiative looking t...

Location

Australia , Daw Park

Salary:

Not provided

HammondCare

Expiration Date

July 31, 2028

Requirements

Expertise in supporting people living with dementia
Experience in Australian residential aged care and or community aged care
Be relatable and able to share knowledge in a way that supports change at all levels
High level of negotiation, communication and relationship building skills
Excellent problem solving and decision-making skills
Ability to prioritise multiple tasks and meet deadlines
Excellent written and verbal communication skills
Excellent stakeholder management
A current Australian drivers licence and willingness to travel
Empathy and patience

Job Responsibility

Support families, caregivers and clinical staff to understand how dementia impacts each individual
Equip carers and clinicians to prevent and respond to behaviour changes through modelling, coaching, and development of resources including behaviour support planning
Be able to synthesise information, through observation and written documentation to provide recommendations that are relationship centred and informed by evidence based best practice
Develop reports that are contextualised to individual situations and people, that effect change on the ground and improve quality of life for people living with dementia
Undertake a range of assessments that help to understand the holistic experience of the person and their care network
Work in partnership with the broader Dementia Support Australia to build capability across the home and aged care sectors
Contribute to research, projects and programs and work innovatively to meet the changing needs of the sector
Work on other projects and assignments as required and in line with areas of skill, expertise and knowledge

What we offer

Market leading remuneration
Salary packaging
$15,900 annually for living expenses, plus up to $2,650 each year for entertainment benefits
Flexible hybrid work arrangements in a friendly workplace with an emphasis on work life balance
Additional training & career development opportunities
Leave benefits – purchased additional annual leave
Reward and Recognition Program
Fitness Passports: Full facility access can include gyms, group classes and pools for yourself and your family
Free independent and confidential counselling sessions and free wellbeing resources and webinars available through our Employee Assistance Program in multiple languages
Exclusive discounts at MyCar

Fulltime

Managed Care Consultant

Office Angels

Location:
United Kingdom , Tonbridge

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 28, 2026

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Job Description:

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Nice to have:

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Job Posted:February 28, 2026

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