Associate Director, Case Management Systems Job at Robert Half (New York)

Associate Director – Contingency Claims

To service the claims needs of customers, providing quality customer care, ensur...

Location

United Kingdom , London

Salary:

50000.00 - 65000.00 GBP / Year

Lawes Consulting Group

Expiration Date

Until further notice

Requirements

English, Maths and or working towards CII qualifications is desirable
Working with bespoke London market IT platforms (training provided) within Windows Virtual Desktop application
Compliant in using MS Office applications, i.e., MS Word, MS Excel, MS Teams
Prior experience in a client facing role of Contingency claims handling and the entertainment market, 10+ years desirable

Job Responsibility

To service the claims needs of customers, providing quality customer care, ensuring that all issues relating to the claims process are dealt with proactively
To support the London Claims Team including fellow Associate Claims Director, management and colleagues throughout the company in their endeavours to achieve and surpass targets and always provide a first-class service whilst adhering to all FCA principles and the specific requirements of:Treating Customers Fairly, Contract Certainty and Conflict of Interest
Undertaking those enquiries necessary to obtain sufficient information to establish policy liability and progress claims efficiently
Registering new claims accurately on relevant computer systems and updating the records during the life of the claim
Ensuring all claims and correspondence, on delegated authority cases, are correctly maintained and to provide a clear and concise history of events, actions, and quantum assessment
Obtaining and submitting completed Client claim documentation to Insurers or nominated service providers promptly
Answering telephone calls promptly and effectively dealing with all enquiries in a professional and efficient manner
Processing incoming post within agreed service standards
Dealing with Client enquiries within designated time frames or as otherwise agreed with Client
Communicating effectively with Insurers, nominated service providers, engineers and Loss Adjusters etc, using methods appropriate to the circumstances, (including telephone/e-mail/fax, dictation), to ensure the highest levels of customer service are maintained

Fulltime

Rare Condition Manager

To support high-quality, cost-effective care by coordinating services for member...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge
Practice interpersonal and active listening skills to achieve customer satisfaction
Interpret and translate policies, procedures, programs, and guidelines

Job Responsibility

Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan
Make and answer a diverse and high volume of condition management-related member calls on a daily basis
Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs
Analyze medical records, claims data, and other information sources
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, BCBSAZ programs, provider networks, etc
Present status reports on cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy

Fulltime

Integrated Care Manager - Adult

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

Fraud Director

Mastercard Transaction Services (MTS) is looking for a Fraud Director to develop...

Location

United Kingdom , London

Salary:

Not provided

Mastercard

Expiration Date

Until further notice

Requirements

Experienced fraud professional from an international payments or transactional banking background
Exposure to a large global business and high risk markets gained over a number of years
Demonstrable experience of developing and deploying fraud frameworks, policies and procedures, together with the associated fraud management systems
Familiarity with advanced, automated, fraud management systems including the use of AI is a distinct advantage
Used to working in a matrix environment with multiple stakeholders, occasionally with competing objectives
Ability to influence senior leaders and present persuasive arguments
Deep subject matter knowledge to identify and isolate emerging fraud patterns quickly and safely
Experience of emerging markets and the particular fraud typologies applicable within is helpful
A globally recognised fraud qualification (ACFE or equivalent) is essential
Educated to degree level in a relevant discipline

Job Responsibility

Development and implementation of the MTS wide fraud framework
Completion of the MTS fraud risk assessment
Collation of an MTS fraud regulatory inventory for each entity and the development and implementation of associated controls
Completion of new product fraud risk assessments, liaison with product teams and the recommendation of suitable controls
Fraud system selection, integration and management as necessary
Fraud data analysis and interpretation into meaningful actions
Management of fraud incidents, identification of patterns and the rapid closure of control weaknesses identified
Ownership and management of the MTS fraud losses budget
Analysis of significant external frauds and regulatory findings for patterns and improvements MTS could apply
Regulatory and Industry outreach on fraud matters

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service required
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations
Generates approval, modification and denial communications
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review
Collaborates with onsite staff, physicians, providers, member/family to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews
Monitors and oversees the collection and transfer of data and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Director, Methods (Industrialization and Manufacturing Technologies)

At Bombardier, we design, build and maintain the world’s peak-performing aircraf...

Location

Canada , St-Laurent

Salary:

Not provided

Bombardier

Expiration Date

Until further notice

Requirements

Bachelor’s degree in engineering, preferably in industrial engineering or other engineering or technical fields
Over 10 years of professional experience, with the bulk of that experience specifically in an industrial engineering field, program management or other complex manufacturing fields
At least 5 years of leadership experience
Experience leading front-line leaders
Demonstrated competence across the five Bombardier leadership competencies (driving for success
providing direction
engendering confidence and trust
leading change
building effective teams)
High levels of emotional intelligence, business acumen and strategic thinking

Job Responsibility

Lead the team responsible for manufacturing industrial strategy, the capitalized project portfolio, the execution of plant projects, and health and safety improvement projects
Responsible for the St-Laurent plant’s square foot allocation and optimization to reach financial targets
Ensure 5-year strategic planning for capitalized projects is maintained and re-assessed as per yearly process to optimize business outcomes
Responsible for defining equipment required to perform the quantity and quality of parts produced in St-Laurent
Govern the capitalized (investment) projects portfolio
Responsible for the execution of capitalized projects
Responsible for executing health and safety improvement projects and reduce inherent risks associated with work in a plant environment
Lead the manufacturing technology initiatives throughout the manufacturing community
Support the overall Industrialization team in developing business cases for Inload and Offload
Develop the teams and maintain the highest level of competencies in project management, mechanical design and electrical design including health and safety acumen and sensibility

What we offer

Insurance plans (Dental, medical, life insurance, disability, and more)
Competitive base salary
Retirement savings plan
Employee Assistance Program
Tele Health Program

Fulltime

Full time cap case manager social worker

Locates, coordinates, directs, monitors, and assists in determining eligibility ...

Location

United States , North Wilkesboro

Salary:

Not provided

Arcadia Home Care and Staffing - an Addus family company

Expiration Date

Until further notice

Requirements

Bachelors degree in social work, psychology or other related human services field
Knowledge of CAP/DA and CAP/C policies and procedures preferred
Experience in the evaluation and provision of long-term care services as well as working with children, aged, and disabled preferred
Excellent oral and written communication skills
Ability to multi-task under tight deadlines
Strong communication skills and interpersonal skills
Valid driver’s license and proof of insurance is required

Job Responsibility

Facilitate the entire service delivery process, beginning with the screening/assessment, including the identification and procurement of services, on-going monitoring of care and services, and the annual re-evaluation of the client’s needs and services
Obtains pertinent medical records to assist with completion of the SRF in a timely manner
Contacts and schedules the initial and Continued Need Review social work portion of the assessment according to CAP procedures
Develops and completes the assessment and Plan of Care based on information gathered at the initial assessment and at the CNR
Revises the Plan of Care and enters in the E-CAP system as client’s needs change, per NC Medicaid guidelines
Completes necessary forms/notices per NC Medicaid guidelines in the CAP patient files in Microsoft when changes occur and in initial assessment, or CNR
Locates and coordinates sources of help from within the family and community so that the burden of care is not exclusively bore by formal health and social agencies
Monitors the client’s situation to assure the quality of care
the continued appropriateness of the services
the correct level of care

What we offer

Medical, Dental and Vision Benefits
Daily Pay option
Monthly Bonus
Continued Education
Company matched 401K
PTO Plan
Retirement Planning
Life Insurance
Employee discounts

Fulltime

Assistant Manager IT

Leads and operates Information Technology (IT) discipline for properties and man...

Location

India , Bengaluru

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

Hotel or Hospitality Management education, awareness of global hospitality technology trends
Experience in assignments at international locations
Back of the house and guest facing operational and technical experience with hospitality management systems
Minimum 3 years in an Associate Supervisory role
OR Bachelor’s degree level or equivalent
Minimum 2 years project management experience
Proven negotiation skills

Job Responsibility

Leads and operates Information Technology (IT) discipline for properties and managed offices in scope
Manages a team of IT resources and is accountable for day-to-day hotel and company office IT operations
Provides support to operations leaders for owner relations and negotiations on IT matters
Once handed over from the direct manager, accountable for new opening/acquisition construction oversight, countdown, and live operation
Executes property internet support
Works with direct manager on vendor management and product development for the assigned market
Maintains status documentation (goals, scorecard, LPA tracking, etc.) to verify accuracy
Strives to achieve balanced scorecard and goals by leveraging resources and concepts to achieve desired results
Monitors assigned company owned and managed offices to verify IT operations are running effectively
Meets with direct manager to provide updates on IT activities and business plans

Fulltime

Associate Director, Case Management Systems

Robert Half

Location:
United States , New York

Category:
IT - Software Development

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 26, 2025

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