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Community Health Network of Connecticut, Inc.
Community Health Network of Connecticut, Inc.
501 – 1 000 Xodimlar
KonsaltingSog‘liqni saqlashSug‘urta
Community Health Network of Connecticut, Inc. — aholi salomatligini boshqarish va tibbiy yordamni muvofiqlashtirish orqali Konnektikutga xizmat ko‘rsatuvchi notijorat sog‘liqni saqlash rejasidir. Tashkilot faoliyati surunkali kasalliklarni boshqarayotgan, tibbiy yordam bosqichlari o‘rtasidagi o‘tishlarni boshdan kechirayotgan yoki salomatlikning ijtimoiy omillari bilan bog‘liq muammolarga duch kelayotgan insonlarni qo‘llab-quvvatlash uchun ma’lumotlar tahlili, a’zolar va tibbiy xizmat ko‘rsatuvchilarni jalb etish hamda dalillarga asoslangan tibbiy yordam choralarini birlashtiradi. Tashkilot, shuningdek, salomatlik natijalarini yaxshilash, xizmatlarni muvofiqlashtirish va tibbiy xizmatlardan foydalanish hamda xarajatlarni boshqarishga ko‘maklashish uchun jamoat hamkorlari bilan ishlaydi. 501–1 000 kishidan iborat jamoasi sog‘liqni saqlash, sug‘urta va konsalting sohalari kesishmasida faoliyat yuritadi; ishga qabul qilish ham shu yo‘nalishlardagi tajriba bilan bog‘liq.
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Kompaniyadagi ish o‘rinlari

Remote Prior Authorization Coordinator - Connecticut

Review Medicaid authorizations and medical necessity for Community Health Network of Connecticut members. Apply InterQual criteria and coordinate provider communications about coverage decisions and denials.

USAmerika Qo‘shma ShtatlariCTKonnektikut
51 075 $ – 68 100 $ / yil
MasofaviyTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaUmumiy

Tavsif

  • Collaborate with Health Services staff on medical necessity reviews for Community Health Network members
  • Approve or deny services using benefit packages and medical necessity guidelines
  • Handle telephone and written authorization and benefit coverage requests from CHNCT providers
  • Review authorization requests for durable medical equipment, outpatient therapies, and inpatient and outpatient procedures
  • Assess coordination-of-benefits requirements and third-party liability
  • Apply InterQual and Medicaid criteria when making authorization decisions
  • Prepare, format, proofread, and print denial letters for members and providers
  • Refer cases to the CHNCT Medical Reviewer when clinical documentation does not support medical necessity
  • Help providers understand CHNCT policies and procedures
  • Keep current with covered Medicaid benefits and communicate updates to clinical staff
  • Identify cases that may require Intensive Care Management evaluation and make referrals
  • Escalate authorization concerns to the Manager for resolution
  • Evaluate non-participating provider and non-covered service requests under applicable guidelines and policies
  • Complete additional assigned duties

Talablar

  • Completion of two years of post-secondary education
  • Associate degree
  • Major in practical nursing
  • Three to five years of related experience
  • Current Licensed Practical Nurse license
  • Working knowledge of covered benefits under Medicaid programs
  • Ability to apply InterQual and Medicaid criteria when making decisions
  • Ability to perform medical necessity reviews and determine benefit coverage
  • Ability to evaluate authorization requests for durable medical equipment, outpatient therapy, and inpatient and outpatient procedures

Imtiyozlar

  • Medical, dental, and vision coverage options
  • Flexible spending and health savings accounts
  • Group term life insurance
  • 401(k) plan with company matching and immediate vesting
  • Voluntary accidental injury coverage
  • Tuition reimbursement and continuing education opportunities
  • Paid-leave bank and company holidays
  • Wellness program
  • Inclusive, accessible interview process with reasonable accommodations available

O‘xshash ish o‘rinlari

Export Development Canada | Exportation et développement Canada

AI Administrator – Microsoft 365 Copilot Platform

Export Development Canada | Exportation et développement Canada
1 001 – 5 000 Xodimlar
HukumatMoliyaSug‘urta
CAKanada
96 557 $ – 128 743 $ / yil
GibridTo‘liq stavkaSeniorYetakchiTalab Qilinadigan Til: inglizchaTalab Qilinadigan Til: fransuzchaSun’iy intellekt

Administer AI governance, security, and operations for Microsoft 365 Copilot at EDC. Support enterprise AI capabilities that help Canadian businesses succeed internationally.

Ochish
Excelerate360

German-Speaking Business Development Executive – Berlin Hybrid

Excelerate360
51 – 200 Xodimlar
KonsaltingLogistikaMarketing
DEGermaniya
38 000 € – 40 000 € / yil
GibridTo‘liq stavkaJuniorO‘rta darajaDiplom talab qilinmaydiTalab Qilinadigan Til: nemischaTalab Qilinadigan Til: inglizchaBiznesni rivojlantirish vakili

Generate qualified sales opportunities for a technology organisation across Germany. Use calls, email, LinkedIn, and Salesforce to prospect and manage sales activity.

Ochish
Paul Davis Canada

Commercial Business Development Specialist – Hybrid, United States

Paul Davis Canada
501 – 1 000 Xodimlar
KonsaltingLogistikaSug‘urta
USAmerika Qo‘shma Shtatlari
55 000 $ – 75 000 $ / yil
GibridTo‘liq stavkaJuniorO‘rta darajaDiplom talab qilinmaydiTalab Qilinadigan Til: inglizchaBiznesni rivojlantirish vakili

Drive commercial sales growth for Paul Davis by developing referral partnerships, generating leads, and managing client relationships across assigned territories.

Ochish