health specialist manager

USAA

Why USAA?At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the choice for the military community and their families.Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful.The Opportunity USAA is seeking a talented Director, Retirement Income to lead multiple teams of Health, Life or Retirement Income Specialists, Sales/Solutions Consultants, and/or Business Process Owners who are responsible for providing appropriate solutions to our members to facilitate their financial security. Responsible for driving and delivering on product, member, and financial goals for Life Co. Leads and develops managers to improve performance and reduce variability amongst sales staff. Analyzes existing workflow and processes by organizing and integrating resources and systems. Implements changes to promote efficient and effective operations. Assists in the developing of programs to maximize effectiveness of member acquisition and relationship efforts We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position will be based in Plano, TX.; San Antonio, TX, Phoenix, AZ.; Colorado Springs, CO.; or Tampa, FL. (Crosstown) campus. Relocation assistance is not available for this position. What you'll do:<ul><li>Leads and develops teams of Health, Life or Retirement managers, Sales/Solutions Consultants and/or Business Process Owners to build leadership skills, improve coaching effectiveness, and/or plan, direct and coordinate activities for complex processes. Responsible for development and implementation of operational plans in Health, Life or Retirement Income areas.</li><li>Contributes to the achievement of Life Co. member, product, and financial goals through teams' performance. Effectively coaches managers to improve sales productivity and exceed departmental goals.</li><li>Conducts data analysis to influence strategy to achieve business outcomes. </li><li>Identifies, develops, and executes detailed continuous improvement plans to achieve measurable process, productivity, and acquisition improvements with Health, Life or Retirement Income.</li><li>Fulfills the responsibilities of a securities principal as appropriate: In conjunction and coordination with Securities Counsel and Securities Compliance, provides research and documentation support for use in responding to regulatory authority inquiries and audits.</li><li>Responsible for the implementation and sustainment of seasonal surge strategies through internal and third-party relationships to serve more members.</li><li>Responsible for achieving call center KPIs that align to best serving USAA members, running an efficient operating model, and high employee and member satisfaction. </li><li>Coordinates efforts with the Situation Management Team and Incident Management Team to reduce downtime with potential risks that could harm employees and members. </li><li>Partners with Legal, Risk and Compliance on interpretation of CMS (Center for Medicare and Medicaid Services) rules to provide guidance and clarification to executive and frontline leadership. </li><li>Supports senior management to ensure plans, operational environment, regulatory obligations, schedules, communication, and training are in place for successful implementation of projects affecting the operations of Life Co. and potential impacts to front line employees.</li><li>Builds and oversees a team of employees for assigned functional area through ongoing execution of recruiting, development, retention, coaching and support, performance management, and managerial activities.</li><li>Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.</li></ul> What you have: <ul><li> Bachelor's degree OR 4 years of related experience (in addition to the minimum years of experience required) may be substituted in lieu of degree. (Total of 12 years without bachelor's degree) </li><li> May be required to have the ability to obtain Life/Health license and any required Carrier appointments within 90 days of job entry. </li><li> RETIREMENT INCOME ONLY: Required maintenance of FINRA Series 7, 66 (or 63 and 65), 24, and 51 (or 53), and/or attainment within 90 days of job entry. </li><li> 8 or more years of related experience in financial services operations to include process improvement and business analysis. </li><li> 4 or more years direct team lead or management experience providing coaching, development and/or leadership in a team-oriented environment. </li><li> Demonstrated knowledge of financial products and services relevant to life or health insurance or retirement income </li></ul>What sets you apart: <ul><li> US military experience through military service or a military spouse/domestic partner </li><li> Current/Active FINRA Series 7, 66 (or 63 and 65), 24, and 51 (or 53) </li><li> Current Life and Health (Group 1) license </li><li> MBA or master's degree in a financial or business-related field </li><li> CERTIFIED FINANCIAL PLANNER (CFP ) designation </li><li> 10 or more years of Retirement Planning and/or Annuity experience. </li><li> 5 or more years of working experience directly leading a team of investment advisors in a Direct Distribution Channel. </li><li> 3 or more years of direct leadership experience over other managers (leader of leaders) </li><li> RICP (Retirement Income Certified Professional) Designation </li><li> Experience managing a team of investment advisors in a call center environment. </li></ul>Compensation range: The salary range for this position is: $114,080 - $218,030 USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Director, Retirement Income - Life Company

Why USAA?At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the choice for the military community and their families.Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful.The Opportunity USAA is seeking a talented Director, Retirement Income to lead multiple teams of Health, Life or Retirement Income Specialists, Sales/Solutions Consultants, and/or Business Process Owners who are responsible for providing appropriate solutions to our members to facilitate their financial security. Responsible for driving and delivering on product, member, and financial goals for Life Co. Leads and develops managers to improve performance and reduce variability amongst sales staff. Analyzes existing workflow and processes by organizing and integrating resources and systems. Implements changes to promote efficient and effective operations. Assists in the developing of programs to maximize effectiveness of member acquisition and relationship efforts We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position will be based in Plano, TX.; San Antonio, TX, Phoenix, AZ.; Colorado Springs, CO.; or Tampa, FL. (Crosstown) campus. Relocation assistance is not available for this position. What you'll do:<ul><li>Leads and develops teams of Health, Life or Retirement managers, Sales/Solutions Consultants and/or Business Process Owners to build leadership skills, improve coaching effectiveness, and/or plan, direct and coordinate activities for complex processes. Responsible for development and implementation of operational plans in Health, Life or Retirement Income areas.</li><li>Contributes to the achievement of Life Co. member, product, and financial goals through teams' performance. Effectively coaches managers to improve sales productivity and exceed departmental goals.</li><li>Conducts data analysis to influence strategy to achieve business outcomes. </li><li>Identifies, develops, and executes detailed continuous improvement plans to achieve measurable process, productivity, and acquisition improvements with Health, Life or Retirement Income.</li><li>Fulfills the responsibilities of a securities principal as appropriate: In conjunction and coordination with Securities Counsel and Securities Compliance, provides research and documentation support for use in responding to regulatory authority inquiries and audits.</li><li>Responsible for the implementation and sustainment of seasonal surge strategies through internal and third-party relationships to serve more members.</li><li>Responsible for achieving call center KPIs that align to best serving USAA members, running an efficient operating model, and high employee and member satisfaction. </li><li>Coordinates efforts with the Situation Management Team and Incident Management Team to reduce downtime with potential risks that could harm employees and members. </li><li>Partners with Legal, Risk and Compliance on interpretation of CMS (Center for Medicare and Medicaid Services) rules to provide guidance and clarification to executive and frontline leadership. </li><li>Supports senior management to ensure plans, operational environment, regulatory obligations, schedules, communication, and training are in place for successful implementation of projects affecting the operations of Life Co. and potential impacts to front line employees.</li><li>Builds and oversees a team of employees for assigned functional area through ongoing execution of recruiting, development, retention, coaching and support, performance management, and managerial activities.</li><li>Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.</li></ul> What you have: <ul><li> Bachelor's degree OR 4 years of related experience (in addition to the minimum years of experience required) may be substituted in lieu of degree. (Total of 12 years without bachelor's degree) </li><li> May be required to have the ability to obtain Life/Health license and any required Carrier appointments within 90 days of job entry. </li><li> RETIREMENT INCOME ONLY: Required maintenance of FINRA Series 7, 66 (or 63 and 65), 24, and 51 (or 53), and/or attainment within 90 days of job entry. </li><li> 8 or more years of related experience in financial services operations to include process improvement and business analysis. </li><li> 4 or more years direct team lead or management experience providing coaching, development and/or leadership in a team-oriented environment. </li><li> Demonstrated knowledge of financial products and services relevant to life or health insurance or retirement income </li></ul>What sets you apart: <ul><li> US military experience through military service or a military spouse/domestic partner </li><li> Current/Active FINRA Series 7, 66 (or 63 and 65), 24, and 51 (or 53) </li><li> Current Life and Health (Group 1) license </li><li> MBA or master's degree in a financial or business-related field </li><li> CERTIFIED FINANCIAL PLANNER (CFP ) designation </li><li> 10 or more years of Retirement Planning and/or Annuity experience. </li><li> 5 or more years of working experience directly leading a team of investment advisors in a Direct Distribution Channel. </li><li> 3 or more years of direct leadership experience over other managers (leader of leaders) </li><li> RICP (Retirement Income Certified Professional) Designation </li><li> Experience managing a team of investment advisors in a call center environment. </li></ul>Compensation range: The salary range for this position is: $114,080 - $218,030 USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. <img src="https://www.jobg8.com/Tracking.aspx?idZ%2bdN1PYqV5omt0%2brwGKZEbVkM29Guon" width="0" height="0" />

One Medical

About Us One Medical is a primary care solution challenging the industry status quo by making quality care more affordable, accessible and enjoyable. But this isn't your average doctor's office. We're on a mission to transform healthcare, which means improving the experience for everyone involved - from patients and providers to employers and health networks. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years. In February 2023 we marked a milestone when One Medical joined Amazon. Together, we look to deliver exceptional health care to more consumers, employers, care team members, and health networks to achieve better health outcomes. As we continue to grow and seek to impact more lives, we're building a diverse, driven and empathetic team, while working hard to cultivate an environment where everyone can thrive. The Opportunity As a Medical Receptionist, internally known as a Member Support Specialist, you will be an ambassador for patients in office, with a mastery of human connection and a strong drive for service. You will remove barriers to care, resulting in a truly exceptional in-office patient experience. You are the steward of the space and ensure the look and feel of the office lobby are on brand with the One Medical experience. You will be the first point of contact for patient feedback, as well as provide any other support as requested by the Practice Coordinator, Operations Managers or in office providers. You are a strong team player and use your innovative problem solving skills to tackle various tasks and challenges. You have a strong grasp of verbal and written communication. You are able to identify opportunities and deliver on customer-centric solutions while using empathy, focus, and compassion in all interactions with patients and teammates. You bring self-awareness to your daily work to utilize your strengths and develop your areas of opportunity. You thrive in cultures that focus on feedback and growth and are nimble in their approach to respond to the needs of the patients and team. You have an unwavering drive to help and serve others and create amazing moments for our members and teammates. If this sounds like you, we would love to connect. What you'll likely work on: <ul> <li> Use impeccable C-I-CARE (a framework containing the key elements of a great interaction and effective communication that we use with patients and each other) in all patient interactions and ensure a fluid and positive in-office experience through patient intake, same day schedule management, appropriate follow up scheduling, strong knowledge of billing and insurance, monitoring patient feedback and assisting with outreach as necessary </li> <li> All front of house duties including check in/check out, insurance verification, printing/paperwork tasks, prepping tests, tasking to service level expectations etc </li> <li> Contribute to team development through rounding, attending team huddles, participating in team problem solving, supporting in office providers with ad hoc asks, etc. </li> <li> Master our technology suite including but not limited to Slack, G-suite, Zoom, and our Electronic Medical Record System 1Life, in order to interact with team members and patients and complete daily work </li> <li> Perform opening and closing duties/daily office upkeep as required, including maintaining the look and feel of both patient and employee facing spaces, restocking supplies, and organization </li> </ul> These responsibilities are intended to describe the general nature and level of work being performed by personnel assigned to this job classification. They are not to be construed as an exhaustive list of job duties performed by personnel in this classification. Other job related duties may be assigned by management. What you'll need: <ul> <li> At least 1 year of experience in high touch customer or patient facing roles </li> <li> Strong written and verbal communication skills </li> <li> Experience working on collaborative, diverse and feedback-driven multi-disciplinary teams </li> <li> A proven track record of persisting through change, demonstrating a forward thinking perspective when under pressure, and consistently stepping up to take action on challenges </li> <li> Proficiency in computer technology such as typing, navigating the internet and using multiple software systems simultaneously </li> </ul> Competitive salary: the base pay for this position is $18.00 per hour based on a full time schedule. Physical Demands: Mostly sedentary work duties require exerting up to ten pounds of force occasionally and/or small amounts of force frequently. Sedentary work typically involves sitting most of the time, but may involve walking or standing for brief periods. This is a part-time role, working 20 hours per week, based in-person with our team and patients in Gilbert, AZ. Flex Member Support Specialist lend support to multiple One Medical locations in a MSA and location and schedule are subject to change. Please note that, except where required by law, part-time employees working under 24 hours per week are not eligible for paid holidays, sabbatical, health and disability benefits, or 401k. One Medical offers a robust benefits package designed to aid your health and wellness. All regular team members working 24+ hours per week and their dependents are eligible for benefits starting on the team member's date of hire: Taking care of you today <ul> <li>Paid sabbatical for every five years of service</li> <li>Free One Medical memberships for yourself, your friends and family</li> <li>Employee Assistance Program - Free confidential services for team members who need help with stress, anxiety, financial planning, and legal issues</li> <li>Competitive Medical, Dental and Vision plans</li> <li>Pre-Tax commuter benefits</li> <li>PTO cash outs - Option to cash out up to 40 accrued hours per year</li> </ul> Protecting your future for you and your family <ul> <li>401K match</li> <li>Credit towards emergency childcare</li> <li>Company paid maternity and paternity leave</li> <li>Paid Life Insurance - One Medical pays 100% of the cost of Basic Life Insurance</li> <li>Disability insurance - One Medical pays 100% of the cost of Short Term and Long Term Disability Insurance</li> </ul> In addition to the comprehensive benefits package outlined above, practicing clinicians also receive <ul> <li>Malpractice Insurance - Malpractice fees to insure your practice at One Medical is covered 100%.</li> <li>UpToDate Subscription - An evidence-based clinical research tool</li> <li>Continuing Medical Education (CME) - Receive an annual stipend for continuing medical education</li> <li>Rounds - Providers end patient care one hour early each week to participate in this shared learning experience</li> <li>Discounted rate to attend One Medical's Annual REAL primary care conference</li> </ul> One Medical is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities. One Medical participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Please refer to the E-Verification Poster and Right to Work Poster for additional information.

Part Time Medical Receptionist - Float

Molina Healthcare

<div>
 
 Job Description
 
 
 
 
 Job Summary
 
 
 
 The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims payment processes, providing counsel to members regarding coverage and benefit interpretation, and appropriate level of care for provision of member services in alignment with state, federal, accrediting, and billing/coding guidelines and regulations. Contributes to overarching strategy to provide quality and cost-effective member care.
 
 
 For this position we are seeking an RN with previous Inpatient Hospital, Skilled Nursing Facility experience, and outpatient coding experience including diagnosis. Candidates with knowledge of CPT/HCPCS codes, record review, chart audit, provider disputes, appeals, and 1500 &amp; UB04 claim experience are highly preferred. Ability to apply state and federal regulations based on specific state and line of business. Must be able to work in a fast paced environment with frequent updates to reviews and processes. Further details to be discussed during the interview process.
 
 
 Remote position
 
 
 Work hours: Monday - Friday 8:00am - 5:00pm.
 
 
 
 Essential Job Duties
 
 
 
 <ul>
 <li>
 Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing.
 </li>
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 Validates member medical records and claims submitted/correct coding to ensure appropriate reimbursement to providers.
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 Identifies and reports quality of care issues.
 </li>
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 Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunity identified by the payment Integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
 </li>
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 Facilitates document management, clinical reviews, bill audit findings and audit details in the database.
 </li>
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 Provides supporting documentation management for denial and modification of payment decisions.
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 <li>
 Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care.
 </li>
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 Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions.
 </li>
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 Supplies criteria supporting all recommendations for denial or modification of payment decisions.
 </li>
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 Serves as a clinical resource for utilization management, chief medical officers, physicians and member/provider inquiries/appeals.
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 Provides training and support to clinical peers.
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 Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
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 Collaborates and/or leads special projects.
 
 
 </li>
 </ul>
 
 Required Qualifications
 
 
 
 <ul>
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 At least 2 years clinical nursing experience, preferably in a hospital setting, including at least 1 year of utilization review, medical claims review, claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience.
 </li>
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 Registered Nurse (RN). License must be active and unrestricted in state of practice.
 </li>
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 Experience working within applicable state, federal, and third-party regulations.
 </li>
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 Strong analytic and problem-solving abilities.
 </li>
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 Strong organizational and time-management skills.
 </li>
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 Ability to multi-task and meet deadlines.
 </li>
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 Attention to detail.
 </li>
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 Critical-thinking and active listening skills.
 </li>
 <li>
 Common look proficiency.
 </li>
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 Decision-making and problem-solving skills.
 </li>
 <li>
 Strong verbal and written communication skills.
 </li>
 <li>
 Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care certification.
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 Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics.
 </li>
 <li>
 Billing and coding experience.
 
 
 </li>
 </ul>
 To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
 
 Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 
 
 Pay Range: $26.41 - $61.79 / HOURLY
 
 
 <ul>
 <li>
 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
 </li>
 </ul>
</div>

RN Medical Claim Review Nurse Remote

Explore 58+ Health specialist manager in Arizona this November. Find roles across top companies and apply now to boost your career.

58 health specialist manager jobs IN Arizona

Director, Retirement Income - Life Company

Director, Retirement Income - Life Company

Director, Retirement Income - Life Company

Director, Retirement Income - Life Company

Director, Retirement Income - Life Company

Part Time Medical Receptionist - Float

RN Medical Claim Review Nurse Remote