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🔥 RN Medical Reviewer III (Reporting and Research) - Palmetto GBA

Posted about 1 hour ago

📍 United States

🔍 Health Care

🔧 Requirements

Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, current active, unrestricted licensure/certification from the United States and in the state of hire in specialty area as required by hiring division/area.
Associate degree Nursing, OR, bachelor's degree in health-related field, OR, master's degree in occupational therapy or physical therapy, OR Graduate of accredited School of Nursing.
Two years clinical experience plus two years utilization/medical review, quality assurance, or home health experience.
Working knowledge of managed care and various forms of health care delivery systems; strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.
Knowledge of specific criteria/protocol sets and the use of the same.
Working knowledge of word processing software.
Ability to work independently, prioritize effectively, and make sound decisions.
Good judgment skills.
Demonstrated customer service and organizational skills.
Demonstrated oral and written communication skills.
Ability to persuade, negotiate, or influence others.
Analytical or critical thinking skills.
Ability to handle confidential or sensitive information with discretion.

💡 Responsibilities

Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations.
Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines.
Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement.
Documents medical rationale to justify payment or denial of services and/or supplies.
Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines.
Participates in quality control activities in support of the corporate and team-based objectives.
Provides guidance, direction, and input as needed to LPN team members.
Provides education to non-medical staff through discussions, team meetings, classroom participation and feedback.
Assists with special projects and specialty duties/responsibilities as assigned by Management.

Data Analysis Analytical Skills Microsoft Excel Microsoft Office Research Reporting

Posted about 1 hour ago

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🔥 EDI & Process Improvement Specialist

Posted about 2 hours ago

📍 United States

💸 77013.0 - 117001.0 USD per year

🔍 Claims

🏢 Company: EMC_Careers

🔧 Requirements

Five years of experience in claims adjusting, claims special programs, or related experience, including at least three years of experience with state EDI requirements
Knowledge of state specific reporting requirements preferred
Knowledge in understanding of the EDI Tables and implementation guides at state level
Strong knowledge of workers compensation claims processes, claims handling, and workflows
Good knowledge of computers
Strong investigative and problem-solving abilities
Ability to distill and communicate complex issues for technical and non-technical audience
Ability to multi-task and prioritize deadlines
Strong organizational, written and verbal communication skills
Strong attention to detail
Strong customer service skills
Ability to adhere to high standards of professional conduct and code of ethics

💡 Responsibilities

Maintains high data quality standards across all projects and initiatives as related to EDI
Leads the process of ensuring all state specific requirements are appropriately tracked and implemented with vendor partner and within claims platform
Performs thorough verification and validation of data entries to ensure accuracy and completeness
Identifies, tracks, and rectifies discrepancies, inconsistencies, and errors in datasets through careful analysis and investigation
Utilizes data management tools to conduct data verification processes efficiently
Documents and reports findings, issues, and resolutions
Maintains daily rejection and error reports to stay informed on the efficiency, timeliness, and accuracy of the claims EDI program
Solves reporting errors or state criticisms and respond to inquiries regarding reporting matters
Stays updated on industry trends, emerging technologies, and best practices related to data verification and quality assurance
Proactively monitors proposed changes from states to their EDI process or order of items to be submitted. Ensures implementation of necessary updates for EMC to remain in compliance
Collaborates with internal leadership and IT to monitor timely implementation of required system changes/upgrades, and vendor partners to facilitate data collection, resolve data-related queries and ensure effective use of vendors, communicating updates throughout the process
Monitors reporting activity and assists in ensuring the timely completion of action items
Monitors states where vendor support is not possible based on state requirements
Serves as the primary contact between EMC and vendor as audits occur. Recommends best practices to ensure alignment with state requirements as identified
Researches and tracks untimely filings resulting in penalties in multiple jurisdictions
Identifies opportunities for process improvement to enhance the efficiency and effectiveness of the EDI workflow
Ensures compliance with data reporting requirements set by regulatory agencies, ensures adherence to specific data instructions and standards, and timely submissions
Collects, organizes, and analyzes data to report to claims team leadership
Researches EDI compliance standards and maintains compliance workflows for all jurisdictions, where applicable
Provides training and support to internal users on processes, protocols, proper utilization/efficiency implementation, and systems
Participates in continuous improvement and efficiency initiatives aimed at optimizing data verification processes and workflows
Maintains relationships with the claims team members and jurisdictional parties to ensure compliance and prompt responses to penalties imposed, where applicable
Partners with Quality Assurance and WC Claims leadership to determine if issues persist and if targeted or large scale training is appropriate
Supports claim goals by leading, assisting and/or owning a process, special projects and assignments as directed by Claims Leadership

Project Management SQL Data Analysis Jira API testing Communication Skills Analytical Skills Microsoft Excel Customer service Microsoft Office RESTful APIs Attention to detail Organizational skills Documentation Compliance Problem-solving skills Research Reporting Training Writing Data entry Data visualization Process improvement Data modeling Data management

Posted about 2 hours ago

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🔥 Program Officer x 3 (open to the UK, Europe and South Africa)

Posted about 6 hours ago

📍 UK, Europe, South Africa

💸 30000.0 - 50000.0 GBP per year

🔍 Philanthropic Organization

🏢 Company: Climate Arc

🔧 Requirements

Experience in the project delivery cycle – e.g. planning, resourcing, costing, monitoring & evaluation
Demonstrated experience in contributing to interdisciplinary projects
Meticulous attention to detail and excellent organizational skills with the ability to multitask and intuitively prioritize
Strong communication and presentation skills. The ability to liaise with stakeholders - to collect data, communicate findings, and seek feedback iteratively
Ability to distil complex information into clear, actionable insights
Experience in project management and CRM software as well as MS Office (particularly Excel & PowerPoint) skills
Impeccable verbal and written English skills

💡 Responsibilities

Support the management and coordination of multiple key projects within wider, cross functional programs
Actively engage with stakeholders, gathering feedback and insights that drive the effective implementation of strategies
Coordinate internal and external meetings and workshop scheduling including material preparation, stakeholder consultations, and coordinating actions and follow-ups
Ensure projects are updated within Arc’s project management system (Asana) and work with team members on integration with other systems such as GitLab
Manage data input to Arc’s CRM (Nimble) ensuring contact details are up to date, interactions are logged
Collaborate with the Communications & Engagement team on publications and events – both in person and online
Support procurement and contract management for vendors and independent contractors
Manage and maintain files and documents

Project Management Data Analysis Project Coordination Financial Management Communication Skills Analytical Skills Collaboration Microsoft Excel Problem Solving Agile methodologies Attention to detail Organizational skills Time Management Written communication Multitasking MS Office Research Reporting Cross-functional collaboration Stakeholder management Strategic thinking CRM Financial analysis Data management Change Management Budget management PowerPoint

Posted about 6 hours ago

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🔥 Recruiting Researcher - OP01655

Posted about 6 hours ago

📍 Brazil, Argentina, Colombia

🔍 IT

🏢 Company: Dev.Pro👥 501-1000🫂 Last layoff over 2 years agoDevOps UX Design Outsourcing IT Management Software Engineering Smart Contracts Information Technology Software

🔧 Requirements

1+years of experience in recruitment and candidate research
Familiarity with the IT field, including key technologies and roles
Basic understanding of the full-cycle recruitment process and/or experience in recruiting activities
Familiarity with various search/sourcing tools
Proficiency in Google Docs
Experience with any ATS
Upper-Intermediate English level (written and spoken)

💡 Responsibilities

Proactively sourcing qualified candidates from various sources
Researching to identify potential candidates.
Screening candidates based on specified criteria.
Working with the existing candidate database, performing various reporting and documentation tasks
Assisting recruiters in hiring both technical and non-technical specialists

Communication Skills Analytical Skills Attention to detail Research Recruitment JSON English communication

Posted about 6 hours ago

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🔥 UX Researcher

Posted about 6 hours ago

📍 USA

🧭 Full-Time

🔧 Requirements

Bixal does not provide visa sponsorship.

💡 Responsibilities

Plan, conduct, and analyze user research to inform the design of digital products and services design and strategy for government clients.

Data Analysis UI Design User Experience Design Communication Skills Analytical Skills Written communication Research Market Research Data visualization Stakeholder management Prototyping A/B testing

Posted about 6 hours ago

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🔥 Talent Community - Med Comms General Application

Posted about 7 hours ago

📍 United States

🧭 Full-Time

💸 41600.0 - 192720.0 USD per year

🔍 Scientific Communications

🏢 Company: Precision AQ

🔧 Requirements

Seeking talented individuals for various roles within scientific communications
The company looks for exceptional team members across different disciplines in remote and hybrid positions.

💡 Responsibilities

This is a general application for roles in scientific communications, including Account Services, Creative, Program Management, Writing and Editorial.

Project Management Agile Communication Skills Research Writing Editing

Posted about 7 hours ago

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🔥 Public Policy Coordinator III

Posted about 7 hours ago

📍 United States

🧭 Contract

🔍 Telecommunications, Internet

🏢 Company: Linda Werner & Associates

🔧 Requirements

3-5 years of industry experience in telecommunications, internet service providers, or content OTT.
Specific LATAM experience related to network fees, network investments, telecom policy, and/or telecom regulatory environments.
Experience in researching and developing policies and communication related to freedom of expression, products, online safety, cybersecurity, and privacy.
Ability to draft policy-related materials including enforcement protocols.

💡 Responsibilities

Drafting comments for public consultations
Preparing briefings, memos, and presentations
Conducting research
Keeping all business stakeholder teams informed

Cybersecurity Data Analysis Content creation Communication Skills Analytical Skills Compliance Research Writing Stakeholder management Research skills

Posted about 7 hours ago

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🔥 Double: Remote Personal Assistant-US

Posted about 16 hours ago

📍 United States

🧭 Contract

💸 20.0 - 25.0 USD per hour

🏢 Company: Zirtual👥 101-250💰 $650,000 Debt Financing over 9 years agoOutsourcing Professional Services Collaborative Consumption

🔧 Requirements

3 years of experience as a Personal Assistant or C-suite Executive Assistant
6 months working as a virtual Assistant
Proficiency in Google Suite and Microsoft Office
Strong organizational skills
Tech-savvy

💡 Responsibilities

Organize and coordinate appointments, meetings, events, and travel schedules.
Manage households, coordinate maintenance, and liaise with domestic staff.
Handle emails, phone calls, and correspondence.
Book flights, accommodations, and ground transportation.
Assist in planning and executing events.
Handle sensitive information and ensure privacy.

Google Analytics Communication Skills Microsoft Excel Problem Solving Customer service Microsoft Office Attention to detail Organizational skills Time Management Written communication Multitasking Research Active listening Client relationship management Budgeting Data entry Computer skills CRM Financial analysis WordPress

Posted about 16 hours ago

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🔥 Beef Nutritionist Technical Consultant (Pacific Northwest)

Posted about 16 hours ago

📍 United States

💸 116300.0 - 193800.0 USD per year

🔍 Animal Health

🏢 Company: External_Career

🔧 Requirements

DVM or PhD in animal science or related scientific discipline or MS with 10 of years industry, academic, or government experience.
Candidate must have an expertise in technical consultancy, with special emphasis on addressing customer concerns or needs.
Candidate must have a thorough understanding of the US beef food chain and commercial beef production.

💡 Responsibilities

Work closely with strategic accounts and serve as an active member of account teams
Identify and position opportunities for customers to use Elanco products
Actively participate in account planning and incorporate Elanco’s value strategy
Implement Elanco’s value strategy at the customer level
Technical leader for Elanco Beef Business Unit strategic technical platforms
Train and coach Elanco personnel on disease, products, and industry practices
Build relationships with and influence external customers, consultants, and academics
Identify avenues to deliver value beyond product to customers and Elanco
Maintain good standing with and influence of key industry organizations
Develop long term research strategy focused on serving strategic accounts
Prioritize and execute research aligned with business needs of strategic accounts and Elanco
Conduct research utilizing Elanco products and programs
Ensure publication of research studies in scientific meetings and peer reviewed journals
Identify and facilitate research efforts in conjunction with Elanco R&D
Advise Elanco and key stakeholders of innovation opportunities
Effectively communicate within technical team and account teams
Identify business opportunities and threats for customers and Elanco
Influence long range strategy and product positioning
Identify external talent for technical and other roles within Elanco

Leadership Analytical Skills Problem Solving Written communication Excellent communication skills Account Management Teamwork Research Verbal communication Sales experience Research skills

Posted about 16 hours ago

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🔥 Beef Nutritionist Technical Consultant (Nebraska)

Posted about 16 hours ago

📍 United States

💸 116300.0 - 193800.0 USD per year

🔍 Animal Health

🏢 Company: External_Career

🔧 Requirements

DVM or PhD in animal science or related scientific discipline or MS with 10 of years industry, academic, or government experience
Candidate must have an expertise in technical consultancy, with special emphasis on addressing customer concerns or needs.
Candidate must have a thorough understanding of the US beef food chain and commercial beef production.

💡 Responsibilities

Work closely with strategic accounts and serve as an active member of account teams
Identify and position opportunities for customers to use Elanco products
Actively participate in account planning and incorporate Elanco’s value strategy
Implement Elanco’s value strategy at the customer level
Technical leader for Elanco Beef Business Unit strategic technical platforms
Train and coach Elanco personnel on disease, products, and industry practices
Build relationships with and influence external customers, consultants, and academics
Identify avenues to deliver value beyond product to customers and Elanco
Maintain good standing with and influence of key industry organizations
Develop long term research strategy focused on serving strategic accounts
Prioritize and execute research aligned with business needs of strategic accounts and Elanco
Conduct research utilizing Elanco products and programs
Ensure publication of research studies in scientific meetings and peer reviewed journals
Identify and facilitate research efforts in conjunction with Elanco R&D
Advise Elanco and key stakeholders of innovation opportunities
Effectively communicate within technical team and account teams
Identify business opportunities and threats for customers and Elanco
Influence long range strategy and product positioning
Identify external talent for technical and other roles within Elanco

Leadership Data Analysis Communication Skills Analytical Skills Customer service Research Sales experience Market Research

Posted about 16 hours ago

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