118 jobs found

Summary As a Senior Application Processor, you will work as part of a team responsible for consulting, communicating and corresponding on issues related to the input of life insurance application data, including auditing applications and data input, for the purpose of establishing computer records for underwriting and other required purposes. You will troubleshoot and resolve complex application issues, whether technical/system or application-related, identifying errors and determining appropriate corrective action. As appropriate, you will handle analytical and technical review of sensitive/confidential cases referred by Application Processors and others, as appropriate. You have a commitment to staying up-to-date on company guidelines to better enable yourself to effectively analyze and respond to exceptions and unusual situations. Above all, you demand excellence of yourself; you handle tasks with the highest possible degree of accuracy and discretion. Primary Duties and Responsibilities The Sr. Processor is responsible for all the duties outlined in the lower level position with additional responsibilities for the job tasks involving more in-depth analytical and technical review of sensitive cases referred by Processors as well as LUCs, and other workgroups in TC/TUP. The Sr. Processor is accountable for accurate and timely completion of all Home Office and Field Office input work types. The incumbent is also responsible for inputting the confidential applications for HO employees and VIP cases. The employee must be familiar with company guidelines and unusual situations to analyze the in-force term contract. The Sr. Processor initiates appropriate resolution or referral to the underwriter/coordinator upon same day completion of H.O. input. Accurate Home Office input is an integral part of establishing permanent client data records which impacts premium billing, premium refunds, corporate planning and New Business analysis. The employee completes Field Office input of applications that are submitted as part of the Centralized Application Input program and those that cannot be done by the field staff or need to be reprocessed as required for cases with system limitations, new products, and/or department and training test cases. The Sr. Processor must inspect, analyze, and check for completeness and discrepancies and makes appropriate E-Referrals (notes) to the underwriter within department guidelines and standards. The Sr. Processor also serves as a resource for Field Office Input Coordinator for questions and provides recommendations for case completion. The incumbent also serves as the contact resource for cases that need special handling such as, JCL, Manual Splits and Premium Waiver Splits. The Sr. Processor is responsible to troubleshoot and resolve complex App Input issues whether system or application related. The Sr. Processor demonstrates analytical and technical skills by: Identifying errors, determining the appropriate corrective action to take Reviewing and correcting insurance rejects on the data base" Adding/Removing applications from exiting and new ISA Inputting the detailed changes and communicate them to the underwriter or TC Coordinator. Identifying and referring specific fields which require underwriter attention Activating new Insurance Service Accounts (ISA) Documenting necessary case notes for proper handling of app Maintaining performance levels within the standards set for quality and other metrics. The Sr. Processor is responsible to provide customer-focused service to internal and external customers by: Fostering a positive work team environment Participating in divisional or department committees Providing service through interpersonal, verbal and written communication Providing training support to the Network Offices upon request Serving as an App Input resource to the Field as the primary contact for the New Business Call Center Supporting and participating in divisional PACE objectives Distributing exception cases and FOI to all App Processors Independently resolves problems with applications submitted Not in Good Order (NIGO) Training and supporting new team members as needed Qualifications Successful completion of any required testing. Demonstrated ability to handle fast-paced, high volume work with high degree of accuracy. Ability to interact tactfully and positively with the Field Force and Home Office personnel. Keyboarding skills required. Demonstrated ability to complete assignments with minimal direction and to handle details accurately. This position has been classified as an Associated Person under NMIS guidelines and requires fingerprinting and completion of required form.Non-Registered Fingerprinted - FINRA Compensation Range: Pay Range - Start: $18.37 Pay Range - End: $27.55 Geographic Specific Pay Structure: Structure 110: Structure 115: We believe in fairness and transparency. It's why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you're living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable, click here to learn more. Grow your career with a best-in-class company that puts our clients' interests at the center of all we do. Get started now! Northwestern Mutual is an equal opportunity employer who welcomes and encourages diversity in the workforce. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives. Skills Information Gathering (NM) - Intermediate, Underwriting Practices (NM) - Intermediate, Problem Management (NM) - Intermediate, Regulatory Compliance & Suitability Analysis (NM) - Intermediate, Insurance Contract Management (NM) - Intermediate, Insurance Acumen (NM) - Intermediate, Dispute Resolution (NM) - Intermediate, Application Processing (NM) - Intermediate, Customer Centricity (NM) - Intermediate, Analytical Thinking (NM) - Intermediate, Field Relations (NM) - Intermediate, Adaptive Communication (NM) - Intermediate, Learning Agility & Critical Thinking (NM) - Intermediate, Decision Making (NM) - Intermediate, Attention to Detail (NM) - Intermediate, Insurance Products (NM) - Intermediate, Change Adaptability (NM) - Intermediate, Customer Support (NM) - Intermediate, Data Application (NM) - Beginner FIND YOUR FUTURE We're excited about the potential people bring to Northwestern Mutual. You can grow your career here while enjoying first-class perks, benefits, and our commitment to a culture of belonging. Flexible work schedules Concierge service Comprehensive benefits Employee resource groups PandoLogic. Category:Insurance,

locationsColumbia County Medical Center Hospital time typeFull time posted onPosted 4 Days Ago job requisition idJR-58393 How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Work Shift Job Summary: The Director of Care Coordination will be based at Wellstar Columbia County Medical Center in Grovetown, Georgia and will report to the Chief Medical Officer. This leader will also work closely with other members of the senior leadership team to build strategies that are aligned with current performance and hospital goals and vision for the care management program, timely patient throughput, appropriate care and utilization, safe disposition planning as well as utilizing data and analytics to drive departmental performance. The director will be responsible for adherence to the system Utilization Management Plan and care coordination policies and procedures, Care Coordination standards of care, CMS and other Payer regulations, Joint Commission regulations, and will ensure that the system strategic vision is fully integrated into the culture of the care coordination program. Will align closely with physician and share performance data with individual physicians and service lines. The Director of Case Management is responsible for the day-to-day operations for all case management activities across the hospital, including utilization management, safe transitions planning, financial performance related to payer authorization processes, avoidable day tracking and reporting, medical necessity, ongoing quality, productivity and overall efficiency for case management processes. This director will ensure that the system standardize care coordination processes are implemented and followed always. As part of the role, the director will collaborate with physicians and other departmental leaders and staff to ensure that barriers to CM outcomes such as length of stay (LOS), avoidable days, readmissions, payer denials and other CM related outcomes are address timely with attention given to identifying root causes and driving performance improvement initiatives that ensures performance is aligned to targeted goals. Must be able to manage, interpret and share data. Other duties of the director include creating and enhancing current tools, methodologies, recruiting practices, and personnel development processes. Plays a key role in the retention, professional development and performance review of staff, including mentoring, coaching, performance appraisals and recruiting as well as departmental budgets. The director participates in committees with the hospital medical staff and other leaders to address and solve issues that drive variation from goals. Is also responsible for collaborating with other key departments that drive throughput delays and work to jointly eliminate those barriers. Core Responsibilities and Essential Functions: Care Coordination Leadership Along with senior leadership, collaborate on departmental and system wide objectives and goals. Co-chairs the Utilization Management Committee with the VPMO and serves as representative on internal and external committees impacting care coordination and other key hospital/system committees Participates in and attends WellStar Care Coordination Leadership meetings on a minimum of monthly basis. Recommends final approval for policies and procedures as well as operational structure for the department. Develop, revise and maintain education materials. Responsible for patient throughput and medically necessity for all patient admissions and outpatient observation and outpatient cases that occupy a hospital bed Accountability for sate transitions planning, timely discharges and appropriate placements for post-acute care services. Responsible for all hospital social services functions. Partners with the system to develop education modules to facilitate advanced competencies of care coordinators Mentors and coach staff Ensures focus on care coordination activities such as authorizations from payer, pre-certifications and denials management functions to assure seamless integration of care and payer reimbursement. Identify PI opportunities to achieve compliance with best practice by all caregivers. Track, trend and analyze data. Define opportunities for improvement from data analysis. Results Oriented Leadership Sets challenging and productive goals for team. Holds team accountable for actions while providing leadership and motivation. Provides resources and support, Uses checkpoints and data to track progress, setting up system and processes to measure results Liaison for Regulatory Compliance Interfaces with governing bodies for necessary accreditation and utilization reimbursement for the facility and system. Accountable for departmental compliance and regulatory standards as well as contractual guidelines. Develops/implements professional standards for the program based upon recognized standards of care, The Joint Commission (TJC) and CMS standards, state/federal regulations and overall system policies and procedures. Monitors staff compliance of payer requirement and regulatory standards, including CMS Conditions of Participation, Represents team at local, State, and national meetings through educational offerings and through involvement in professional organizations Fiscal Accountability Creates departmental budget and performance standards. Assists with the development and implementation of operational and capital budgets that are consistent with system-wide, facility/divisional goals and objectives. Establishes productivity measures and facilitates program and team achievement of established goals. Maintains FTE, salary and expense budgets at or below budgeted levels, demonstrating the ability to review/analyze current/historical data relevant to budget variances. Develops and maintains collaborative approaches that promote quality, cost-effective utilization services across the continuum. Customer/Employee Satisfaction Promotes a positive environment to patients, families, staff and the community. Responds to inquiries and complaints timely and effectively and promotes a positive, professional image serving as a liaison between staff, physicians, and administration. Demonstrates commitment to teamwork through positive interactions and feedback to/from subordinates, physicians, peers and other customers. Responsible for employee morale and team performance toward goal achievement. Develops measurable, team goals, monitors progress and keeps staff abreast of progress toward achievement. Utilizes department metrics and develops plans to direct clinical practice performance initiatives, patient and staff satisfaction initiatives and improvements in physician relations and overall customer service. Represents WellStar by exhibiting values and credo Performs other duties as assigned. Complies with all Wellstar Health System policies, standards of work, and code of conduct. Required Minimum Education: Bachelors in Nursing or Masters in Social Work is required Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated. BLS-I - Basic Life Support - Instructor or BLS - Basic Life Support or ARC-BLS - Amer Red Cross Basic Life Support RN-COMPACT - RN - Multi-state Compact or RN - Reg Nurse (Single State) Required Minimum Experience: Minimum 3 years management experience of a multidisciplinary team in the field of case management or quality and patient safety is required. Minimum 6 years of experience in a hospital environment is required. Strong supervisory experience showing proven track record is required. Clinical Practice/Experience is required in licensed field. Experience in case management and/or social work is required. Strong employee engagement skills demonstrated by results is required. Required Minimum Skills: Excellent organizational, verbal, and written communication skills Independent and self-directed Strong ability to manage data - interpret and analyze Ability to handle and manage change, perform critical analysis, and mentor and develop direct reports Knowledge of management practices and procedures, budgetary process and development and administrative and operational process Join us and discover the support to do more meaningful work-and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. About Wellstar At Wellstar, people are at the center of everything we do and every decision we make. As a not-for-profit organization, we have made a generational commitment to transform healthcare for all. We work to ensure every person has access to personalized care that helps them spend more time being a person, rather than a patient. That s what we mean when we say we re more than healthcare we re PeopleCare. Wellstar is nationally recognized for our inclusive culture, exceptional doctors and team members, and personal, high-quality care . click apply for full job details

Description Calling All Healthcare Visionaries! Are you a dynamic leader with a passion for transformative healthcare delivery? Do you excel at navigating intricate challenges and driving change? If so, we have the perfect opportunity for you! The Role: Under the supervision of the North Division Executive Director of Care Management, the Director of Care Management is a pivotal role responsible for orchestrating and optimizing care management. You will lead and inspire a dedicated team, ensuring a seamless continuum of care, patient advocacy, and efficient resource management from admission through to discharge. This role is integral in maintaining financial viability by overseeing care management teams to coordinate the best next site of care for our patients. This position oversees St. Peter Hospital (390 beds) and Centralia Hospital (128 beds). What You'll Do: Master Coordinator: Direct, coordinate, and facilitate care management processes to ensure the highest standard of patient care and operational efficiency. Champion of Continuity and Care Coordination: Oversee the delivery of consistent and expected clinical outcomes, advocate for patients, and manage resources effectively to minimize fragmentation within the healthcare delivery system. Communication Facilitator: Ensure robust communication amongst all members of the healthcare team, fostering an environment of collaboration to enhance patient care. Cultural Advocate: Promote cultural and religious sensitivity, ensuring patient care respects diverse beliefs and backgrounds. Essential Functions: Mission-Driven Leadership: Ensure team alignment with the organization's Mission, Vision, and Core Values. Customer Satisfaction: Develop and maintain a comprehensive departmental customer satisfaction program. Human Resource Management: Attract and retain top talent, coach, and manage staff to achieve peak performance. Compliance and Confidentiality: Adhere to infection control, risk management, confidentiality policies, and regulatory guidelines. Cultural Competency: Foster a respectful environment that is sensitive to cultural and religious diversity. Safety and Security: Ensure compliance with all safety and security policies and procedures. Patient-Centric Care: Provide competent care tailored to diverse patient populations, including neonates, pediatrics, adolescents, adults, and older adults. Policy Development: Contribute to the creation and maintenance of departmental policies in line with organizational, legal, and community standards. Goal Setting: Assist in setting departmental goals that align with organizational strategies. Budget Management: Participate in annual budget planning to deliver cost-effective and high-quality services. Admission and Discharge Management: Oversee admission and discharge services, ensuring alternatives are considered for non-qualifying inpatient admissions. Physician Relations: Build strong cooperative relationships with physicians. Utilization Management Oversight: Lead the Utilization Management Committee, ensuring effective use of resources and monitoring data trends. Contract Management: Supervise services provided by external partners, maintaining high service standards. Referral Agency Coordination: Establish and maintain relationships with external agencies to facilitate timely patient discharges. What You'll Bring: Educational Background: Bachelor's Degree in Nursing; Master's Degree preferred. Clinical Experience: At least 2 years as an RN in an acute care setting. Leadership Experience: Minimum 3 years managing care coordination. Utilization review knowledge preferred. Independent Leadership: Proven ability to work independently and lead teams to achieve objectives. Systemic Thinking: Expertise in applying system thinking to identify and solve problems efficiently. Why Join Us? Impactful Work: Contribute to meaningful change in healthcare delivery, improving countless lives. Professional Growth: Leverage your autonomy and our support to innovate and excel. Collaborative Excellence: Work with a team of dedicated, talented professionals passionate about healthcare. Dynamic Environment: Thrive in a fast-paced, evolving industry. Vibrant Community: Enjoy the unique cultural and natural beauty of our location. Ready to Shape the Future of Healthcare? If you are a visionary leader with a passion for healthcare, we encourage you to apply! Join our team and help us create a healthier future for all. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Requsition ID: 351392 Company: Providence Jobs Job Category: Care Management Job Function: Clinical Care Job Schedule: Full time Job Shift: Day Career Track: Leadership Department: 3030 CASE MGMT WA SPH Address: WA Olympia 413 Lilly Rd NE Work Location: Providence St Peter Hospital-Olympia Workplace Type: On-site Pay Range: $71.15 - $112.34 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. PandoLogic. Category:Healthcare,