Role Description The Field Nurse Case Manager is a work from home position located in the New Jersey area visiting people injured in automobile and on-the-job accidents and coordinating their care with health care providers and insurance carriers. Earn a competitive salary and excellent benefit package, including a specialized incentive plan for full-time staff. The ideal candidate is detail-oriented with Case Management experience (CCM and/or CRRN preferred) and strong interpersonal skills. Candidates should understand the medical management of a workers’ compensation, automobile and health insurance claims. They should also have knowledge of the hospital setting, including familiarity with hospital administration. Travel is required in surrounding counties and candidates must be licensed drivers. Qualifications - Medical management related to Worker’s Compensation, Auto and Health claims. - Hospital setting and administration. - Microsoft Office Suite programs. - Principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. - Structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Requirements - Case Management experience a plus. - ER/Rehab/Home Health nursing a plus. - Nursing – 2-3 years. - Unencumbered NJ driver’s license. Benefits - Competitive salary. - Excellent benefit package. - Specialized incentive plan for full-time staff. Company Description Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

Role Description This position is responsible for contacting healthcare providers to discuss negotiations for a specific dollar range of eligible claims/bills prior to payment, in order to achieve maximum discounts and savings on behalf of payor/client. Job Roles and Responsibilities: - Manage a high volume of healthcare claims thoroughly to maximize savings opportunities on each claim within the established department production standards and individual goals by contacting provider on all assigned claims and presenting a proposal while maintaining high quality standards. - Perform provider research to provide support for desired savings. - Address counteroffers received and present proposal for resolution while adhering to client guidelines and policy and procedures. - Seek opportunities to achieve savings with previously challenging/unsuccessful providers. - Seek opportunities to establish ongoing global or concurrent agreements for future claims. - Update provider database for reference and claims processing on subsequent claims. - Initiate provider telephone calls as often required with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims. - Up to 40% of time will be on phone with providers. - Provider education to providers online provider portal services available for proposal review and approval. - Meet and maintain established departmental performance metrics. - Handle post claim closure service inquiries, including payment status and defending original negotiation terms. - May require ACD phone responsibilities and tracking outcomes. - Collaborate, coordinate, and communicate across disciplines and departments. - Ensure compliance with HIPAA protocol. - Demonstrate Company's Core Competencies and values held within. - Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role. - The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary. Qualifications - Minimum high school diploma or GED. - Minimum 6 months experience in the health care industry (provider billing, medical coding, provider collections, insurance, or managed care); 1 year preferred. - State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification. - Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical ("auto") bills a plus. - Knowledge of general office operations and/or experience with standard medical insurance claim forms. - Good Communication (verbal, written and listening) teamwork, negotiation, and organizational skills. - Ability to process verbal and written instructions. - Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone in a business professional environment. - Ability to commit to providing a level of customer service within established standards. - Provide attention to detail to ensure accuracy including mathematical calculations. - Identify issues and determine appropriate course of action for resolution. - Organize workload to meet deadlines and participate in department/team meetings. - Adjust/alter workflow to meet deadlines in a fast-paced environment. - Work independently and handle confidential information. - Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software. - Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone. Requirements - The salary range for this position is 20.23. - Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. - This position is also eligible for health insurance, 401k and bonus opportunity. Benefits - Medical, dental and vision coverage with low deductible & copay. - Life insurance. - Short and long-term disability. - 401(k) + match. - Generous Paid Time Off. - Paid company holidays. - Paid Parental Leave. - Tuition reimbursement. - Flexible Spending Account. - Employee Assistance Program. - Summer Hours. Company Description MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status.

Role Description Would you like to be part of an amazing team that helps Arizonans thrive? At the Department of Economic Security (DES), we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals that are committed to service, community, and teamwork. The Department of Economic Security, Division of Employment and Rehabilitation Services (DERS) strengthens Arizona communities by bridging and minimizing gaps to employment and independence. DES is seeking an experienced and highly motivated individual to join our team as an Adjudicator with the Unemployment Insurance Administration (UIA). This position is responsible for reviewing applications for various public assistance programs and determining the eligibility of applicants and recipients for public assistance programs through interactive interviewing and fact gathering. Job Duties - Perform interactive interviews to elicit eligibility information to determine eligibility for government programs based on income levels, household composition, etc. Review applications for eligibility to ensure they meet all program requirements. - Initiate and process applications through automated systems; determine the level of benefits to which the client is entitled by making complex computations and/or computer entries and then analyzing the results; enter and retrieve numerical and narrative data and issue benefits from an automated computer system. - Interact with clients to provide information about program eligibility requirements, program rules and regulations, and application procedures; assist clients in completing applications for program eligibility; identify needs and make appropriate referrals for health, social, and/or employment services. - Monitor ongoing eligibility by obtaining periodic updated information of eligibility factors and take appropriate actions on changes. - Attend and participate in staff meetings, trainings, presentations, and orientations. - Respond to questions and complaints of clients in person, by telephone, mail and/or email communication. Qualifications - Knowledge of laws, rules, regulations, policies, and procedures governing eligibility for diverse public assistance programs and related case administrative techniques. - Knowledge of principles and practices of effective customer service. - Knowledge of computers and software programs (e.g., Microsoft software applications) to conduct research, assess information, and/or prepare documentation. - Skill in written and verbal communication to explain and interpret federal and state laws, statutes, rules, regulations, and guidelines applicable to the area of the assignment. - Skill in time management, organization, and problem solving. - Ability to apply the policies, procedures, and programs. - Ability to apply the laws, rules, and regulations governing eligibility for multiple public assistance programs and the case administration of these programs. - Ability to use fact finding techniques and perform in-depth and interactive interviewing. - Ability to review a variety of tax documents to obtain needed household filing information. - Ability to explain complex rules and programs so they can be understood by people of diverse socio-economic, cultural, and educational backgrounds. - Ability to detect and evaluate potential fraudulent situations. Requirements - High School diploma or GED and one (1) year of experience performing eligibility reviews or one (1) year of customer service experience. - Successfully pass background and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions. - All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). - Travel will be required for State business. Any employee operating a motor vehicle on State business must possess and retain a current, valid class-appropriate driver’s license, complete all required training, and successfully pass all necessary driver’s license record checks. Benefits - Affordable medical, dental, life, and short-term disability insurance plans. - Participation in the Arizona State Retirement System (ASRS) and long-term disability plans. - 10 paid holidays per year. - Rideshare and Public Transit Subsidy. - Career Advancement & Employee Development Opportunities.

Job Summary: Are you passionate about ensuring accuracy and quality? The IMA Group is seeking a dedicated Quality Assurance Specialist to join our team. This remote role focuses on maintaining the highest standards in reviewing reports and addenda generated by our physician panel. This position is 4 hours a day for 5 days per week. This position is not considering candidates from New York City, Chicago, California, Colorado, or Washington states at this time. The hourly rate for this position ranges from $25 to $28, based on experience. Key Responsibilities: - Review IME reports, addenda, peer reviews, and other documentation to ensure accuracy, completeness, and adherence to formatting guidelines. - Address issues in referral letters and ensure all quality assurance expectations are exceeded. - Process revisions, follow up on pending changes, and re-review corrected reports to maintain high-quality standards. - Communicate effectively with team members and supervisors, providing regular updates on report status and managing addendum requests from start to finish. - Monitor deadlines, including urgent client requests, to ensure timely report completion and release. - Deliver exceptional customer service by addressing client issues promptly and streamlining communication with all stakeholders involved in the IME and file review process. Qualifications: - Associate degree required; Bachelor’s degree preferred. Clinical background highly desired. - 1-3 years of related experience in claims management or quality assurance, with at least 1 year in Disability claims. - Additional experience in Worker’s Compensation is desired. - Must have excellent attention to detail and be able to learn client guidelines thoroughly, while also working on tight turnaround times. - Must be proficient in Microsoft Word. Experience with Microsoft Excel also desired. The IMA Group is an Affirmative Action/Equal Opportunity Employer Our Government Services Division supports local, state, and federal agencies and delivers professional and objective medical and psychological examinations as well as ancillary services. Our Payer Services Division meets the evaluation and screening needs of Carriers, TPAs, Public Entities and Employers and includes behavioral health and physical medicine specialty services, working with a wide range of organizations within the workers' compensation, disability, liability, and auto markets. Our Clinical Research Division performs all types of Phase II-IV clinical trials in multiple therapeutic areas through a flexible nationwide network of site locations and virtual capabilities. #LI-BC1 #LI-REMOTE