guidingcare

The role of the MMC is to assist analyst with triaging and entering appeals. They will print and assist with medical records request and create overturn notices. They are required to assist with creating shell cases in GuidingCare and create appeal letters.Intake and case build — MMCs screen all channels daily, return misroutes, confirm member/claim data,...

Senior Technical Product Manager, Health Plan Technology & Delivery Right to Hire. 3 days a week in the office. Only Locals to NY The ideal candidate brings strong healthcare payer experience together with a working understanding of enterprise architecture, APIs, integrations, data flows, Agile delivery, HealthEdge/HealthRules Payer, GuidingCare, and...

Amtex Systems Inc is an information technology and talent solutions company offering talent and BI consulting to the companies in US for over 25 years.Our solutions are designed to fill resource gaps, by providing the right candidates who deliver value to the organization. Our propensity to nurture and build strong relationships with our clients helps us...

Senior Technical Product Manager, Health Plan Technology & Delivery Engagement Type: 6 - 12+ Months Contract to Hire 3 days a week onsite in NYC Ideal Profile TPM first, Health Plan domain expertise throughout. This person should understand enough technology to challenge delivery teams, manage complex dependencies, recognize integration and architecture...

Position Details: * Job Title: Medical Management Coordinator * Location: Baltimore, MD * Work Arrangement: Hybrid - On-site training and in-office attendance at least twice per week Job Responsibilities: * Provide administrative support to Utilization Management and clinical teams. * Review, triage, and process medical appeals and authorization...

Title: Medical Management Coordinator Location: Baltimore, MD 21224 (Hybrid) Duration: 6 Months Contract Job Description: * Terms of Employment * W2 Contract, 6 Months * Hybrid: 1-2 days on-site per week; regular weekly in-office presence required) * Work Hours: Full-time, 40 hours/week (Core hours: 8:00 AM - 5:00 PM) * Overview * Client is seeking...

Job DescriptionJob DescriptionAuthorization Coordinator – HybridLocation: Midtown Manhattan, NYCPay: $19–$20/hourSchedule: Hybrid – In Office & RemoteWe are seeking a detail-oriented and highly organized Authorization Coordinator to join our team. This position is ideal for someone with strong administrative skills and experience within healthcare,...

Activate Care seeks a field-based Registered Nurse to travel throughout Massachusetts performing in-person health assessments for dually eligible members in a managed care program. You will document findings in GuidingCare and hand off to care management, with focus on assessment and reporting rather than ongoing case management. The role requires MA RN...

Position Details: Job Title: Medical Management Coordinator Location: Baltimore, MD Work Arrangement: Hybrid – On-site training and in-office attendance at least twice per week Job Responsibilities: Provide administrative support to Utilization Management and clinical teams. Review, triage, and process medical appeals and authorization...

A leading healthcare technology firm is seeking an IT Analyst - Healthcare to support teams by gathering requirements and analyzing issues in healthcare applications. This role involves documenting business needs, developing test scripts, and acting as a liaison between business and IT. Ideal candidates should have experience with GuidingCare and a solid...

Laphcc in Baltimore, MD is seeking a detail-oriented Medical Management Coordinator for a 6-month hybrid contract. You will support the Clinical Appeals and Analysis Unit by handling case entries, generating overturn notices, processing medical records requests, and packaging materials for mailing. Applicants should have 2+ years of healthcare administrative...

Job DescriptionJob DescriptionAuthorization Coordinator – HybridLocation: Midtown Manhattan, NYCPay: $19–$20/hourSchedule: Hybrid – In Office & RemoteWe are seeking a detail-oriented and highly organized Authorization Coordinator to join our team. This position is ideal for someone with strong administrative skills and experience within healthcare,...

GeBBS Consulting is a healthcare technology professional services and consulting firm based in Towson, Maryland servicing clients throughout the US. We are celebrating our 28th year in business. We have two divisions: 1) Hospital / Provider Practice 2) Managed Care / Payer Practice – we work directly with health plans (very strong in the Blue Cross Blue...

Heathcare/ Medical Management CoordinatornTech WorkforceBaltimore, MD, United States**Description**Title: Medical Management Coordinator Location: Baltimore, MD 21224 (Hybrid) Duration: 6 Months Contract Job Description: Terms of Employment W2 Contract, 6 Months Hybrid: 1–2 days on-site per week; regular weekly in-office presence required) Work Hours:...

Position Details: Job Title: Medical Management Coordinator Location: Baltimore, MD Work Arrangement: Hybrid – On-site training and in-office attendance at least twice per week Job Responsibilities: Provide administrative support to Utilization Management and clinical teams. Review, triage, and process medical appeals and authorization requests. ...

We are seeking an experienced Senior Project Manager with a strong background in healthcare, clinical operations, and health plan administration. The ideal candidate will have expertise in provider information and provider data management, care management, utilization management, and clinical policy. Candidates should have hands-on experience working with...

Overview Projé, Inc. is a woman-owned consulting firm providing advisory consulting services, project management, and analytical business resources in the health care industry. As a trusted advisor, Projé provides the knowledge, skills, and leadership to help clients achieve their goals. Projé offers a strong team-centered culture, focused on meeting...

Analyst, Business LdDuration: 04 Months Location: 100% Remote The Lead BA will be responsible for building clinical letters using SmartComm for HealthEdge's care tool, GuidingCare. Applicants must have expert understanding of the end to end, integration processes. Core deliverables will be clinical letters that meet regulatory requirements for clinical...

The work Triage, diagnose and resolve production incidents across clinical and provider-facing applications, against defined response and resolution targets.Work a high-volume inbound support queue — classifying, resolving or routing each request.Investigate prior authorization exceptions, tracing them from the inbound transaction through to the...

Activate Care Registered Nurse (RN) Opportunity At Activate Care, we're on a mission to improve health equity and drive improved health outcomes across the country. Our Community Care Record platform, Care Link, enables healthcare and community organizations to coordinate care for populations challenged with health-related social needs (HRSN). Path Assist...