Our Licensed Health Insurance Agents are at the top of their game. They seek to achieve excellence and can do anything they set out to do. They get the opportunity to sell any number of different plans, from ACA, commercial, group, supplemental, Medicare and more.
We'd like to invite you to come work with one of the fastest growing companies in healthcare. If you are looking to take on work that significantly improves the quality of life for others and you have a passion for helping patients, we want to hear from you. This position has multiple openings throughout the state of Florida.
Claims Processors will be responsible for the accurate and timely entry, review, and resolution of simple to moderate complexity Medicaid claims in accordance with guidelines, procedures, and policies as outlined by our client. Responsibilities.
Our Pharmacy Customer Care Representatives have a high-energy culture and are passionate about providing excellent customer service with empathy while resolving the member’s questions on the first call. It feels good to do this job; you support people when they need it the most. You will take inbound calls and have conversations with our members to answer questions or provide information so that they better understand their coverage and options. Typical topics include: prescription refills, order status, and insurance coverage.
The Social Worker will be responsible for providing guidance to members and program staff regarding psychosocial barriers to managing health conditions. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. This is a REMOTE position.
The Medical Director Manager is responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff.
Clinical Pharmacist Summary: Responsible for the clinical review and medical necessity determination for medical injectable prior authorizations requested for the outpatient setting. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
The BH Provider Quality Manager responsible for leading Behavioral Health (BH) provider engagement, with a focus on leveraging the data available to providers and helping to improve the value delivered to Beacon members. Drives BH provider performance improvement year over year through education and data. This role is responsible for a local market. **Must reside in Florida (Tampa, Miami, etc.) **Position requires a Florida BH Clinical License
The Nurse Medical Management l, ll, and Sr. positions are responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.
"Telephonic" Nurse Case Manager will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.
Our team is looking for a compassionate and trained Home Health Aide who is certified as required by state. The position requires a minimum of six months experience as a Home Health Aide or Nurse Aide within the last year, and completion of the Certified Home Health Aide training program and competency evaluation conducted by our internal team. In this role you'll have the opportunity to perform a variety of duties to care for and comfort the sick, injured, or others who require medical services in the home. If you are a compassionate and caring individual who has experience in home health and/or nursing, we'd love to hear from you!
Our organization as an immediate need for a contract RN to perform home health visits for our adult and geriatric clients. If you are passionate about helping people, providing a safe and comfortable environment for others, and you deliver care with excellence, compassion, and reliability, you should be a Registered Nurse with our team.
The Behavioral Health Associate will be a mental health care professional with a clear understanding of care management and mental health services. You will have the opportunity to play a primary role in direct patient interaction through telehealth solutions and provide direct patient services using innovative technology.