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Jobs (5 Matches)
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1. HI-Oahu-Honolulu   (Fulltime)1 day ago
WellCare - Nationwide - United States - Not rated - (view employer jobs)
Title: HI-Oahu-HonoluluLocation: true1401678Evaluates the pre-service authorization request received for scheduled inpatient admissions, ambulatory surgeries, outpatient services and out of network providers. Reviews medical records, uses clinical expertise and compares information to established guidelines and the members benefit plan. Works closely with departmental management staff to impact the treatment ...
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2. HI-Oahu-Honolulu   (Fulltime)6 days ago
WellCare - Nationwide - United States - Not rated - (view employer jobs)
Title: HI-Oahu-HonoluluLocation: true1401677Represents WellCare at assigned facilities to provide concurrent review, discharge planning and coordination and evaluates of members for Case Management needs during face-to-face interaction. Identifies members with high risk medical conditions that will require complicated medical treatments to refer for an individualized post-acute plan of care to reduce ...
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3. HI-Oahu-Honolulu   (Fulltime)6 days ago
WellCare - Nationwide - United States - Not rated - (view employer jobs)
Title: HI-Oahu-HonoluluLocation: true1403490Provides education and consultation to providers’ and provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Serves as the market clinical subject matter, expert in the field, for HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation ...
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4. HI-Oahu-Honolulu   (Fulltime)25 days ago
WellCare - Nationwide - United States - Not rated - (view employer jobs)
Title: HI-Oahu-HonoluluLocation: true1305257Responds to member, provider and regulatory agencies’ inquiries and escalations (phone, written, or walk in) regarding all aspects of WellCare business, including but not limited to enrollment, billing, claims and pharmacy in a professional, timely, accurate and caring manner while consistently meeting all regulatory guidelines. Serves in ...
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5. HI-Oahu-Honolulu   (Fulltime)26 days ago
WellCare - Nationwide - United States - Not rated - (view employer jobs)
Title: HI-Oahu-HonoluluLocation: true1402400DEPARTMENT NAME: Behavioral Health/Health ServicesHIRING MANAGER: Director, State Behavioral HealthCoordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. ...
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