• TN

Screen incoming calls and/or faxes, investigate and resolve customer inquiries and claims, and interact with membership, hospital, and provider staff. Work independently under general supervision in a fast-paced environment.

• US National (Not hiring in CA, MA, NH, NJ, NY)

Establish and maintain relationships to support company response. Provide technical services for investigations and assist in drafting post-incident reports. Mentor junior engineers and provide guidance during crisis scenarios.

• Chattanooga, TN (Not hiring in NY, NJ, MA, NH, CA)

Lead, direct, and oversee clinical aspects of pharmacy benefit programs. Manage staff, develop clinical services, and ensure appropriate drug utilization through formulary creation and utilization management activities.

• Chattanooga, TN

Support customer service activities for multiple products/clients. Resolve inquiries through various channels, document communication, educate callers, and work flexible schedules. Requires 1 year experience, MS Office proficiency, time management, a..

• Chattanooga, TN

Ensuring timely responses to employee questions and inquiries about employee benefits programs and human resources policies. Providing employees assistance with disability, health and life benefits, paid time off, and retirement plans.

• Chattanooga, TN

Provides first line support and problem resolution for technology products or applications. Monitors calls and emails, maintains documentation, responds to inquiries, and provides remote technical support services.

• Oakland, CA, Long Beach, CA, El Dorado Hills, CA, Rancho Cordova, CA, Redding, CA, San Diego, CA, Woodland Hills, CA

Provide legal counsel on health law issues, develop policies, negotiate contracts with major health systems, engage with key regulators on filings and approvals, and work with executives to develop vision and strategy.

• Chattanooga, TN

Support clinical team and educate members on benefits and services. Conduct health needs assessments, assist with appointment scheduling, and manage member outreach. Assist with research and analysis of inquiries and complaints.

• Chattanooga, TN, Johnson City, TN, Knoxville, TN, Memphis, TN, Nashville, TN, KY, GA, FL, AL, VA, NC, LA, AR, SC, MS, or US National

Perform comprehensive clinical review of requested services utilizing clinical criteria, coordinate care, seek advice from Medical Director, assist non-clinical staff, perform provider and member appeals, and pass Windows navigation test.

• TN, KY, GA, FL, AL, VA, NC, LA, AR, SC, MS, or US National (Not hiring in NY, NJ, MA, NH, CA)

Perform clinical review of requested services using clinical criteria. Initiate referrals, coordinate care, and assist non-clinical staff in administrative reviews. Utilize medical appropriateness criteria, clinical judgment, and contractual eligibil..

• TN, KY, GA, FL, AL, VA, NC, LA, AR, SC, MS, or US National

Perform clinical review of requested services, initiate referrals, assist non-clinical staff, and perform comprehensive provider and member appeals. Must have RN license and 3 years clinical experience. Strong communication and organizational skills ..

• Knoxville, TN

Perform assessments, planning, and monitoring of service provision and member well-being. Identify needed supports and collaborate with colleagues to meet member needs for health, employment, and independent living.

• TN

Collaborate with care/support coordinators and external partners to ensure continuity of care. Utilize clinical knowledge to manage LTSS requests, referrals, screenings, and hospital admissions. Submit completed requests and documents to appropriate ..

• Trenton, TN

Manage member care and progress for cases with multiple levels of risk. Serve as a liaison between members, providers and internal/external customers. Oversee complex cases and perform essential activities of case management.

• Nashville, TN

Manages member care and progress for cases with multiple levels of risk. Supports utilization management functions for complex cases. Serves as a liaison between members, providers, and internal/external customers in coordination of healthcare delive..

• Chattanooga, TN

Manage member care and progress for cases with multiple levels of risk. Serve as a liaison between members, providers, and internal/external customers. Oversee highly complex cases identified through various mechanisms to ensure effective implementat..

• Memphis, TN

Manages member care and progress for cases with multiple levels of risk. Supports utilization management functions, serves as a liaison between members, providers, and internal/external customers, and oversees complex cases to ensure effective implem..

• Chattanooga, TN

Provide financial services to the organization including planning, record keeping, reporting, and identifying trends. Develop financial modeling, reports, and presentations for management. Filing tax forms and other government reports required by the..