35 physician ii jobs found

Job Description: NOTE: Based on business needs and the geographic territory associated with this opening, we're exclusively seeking candidates who currently reside in the greater Rochester area (Monroe, Seneca, Yates and Livingston counties) Summary: This role is responsible for identifying prospective members that do not have health insurance, providing education regarding On- and Off-Marketplace health insurance products, assisting in selection of the appropriate health plan and primary care physician, and assisting with the enrollment process. The Marketplace Facilitated Enroller (MFE) is also responsible for assisting current members with recertification in their plan. Products include but are not limited to Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP), Stand Alone Dental and the Individual Market Qualified Health Plan (QHP). All MFEs must conduct themselves in accordance with regulations and instruction set forth by NYS and the Federal...

Job Description: This position is responsible for coordinating, integrating, and monitoring the utilization of behavioral health (BH) or physical health (PH) services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as required, to meet departmental time frames. Per department needs, may be responsible for additional hours. Essential Accountabilities: Level I Performs pre-service, concurrent and post-service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical review...

Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation, and/or inpatient coding and has a high level of understanding of the current MS-DRG, and APR-DRG payment systems. This position is responsible for reviewing medical records for appropriate provider documentation to support the principal diagnosis, co-morbidities, complications, secondary diagnosis, surgical procedures, POA indicators to validate coding and DRG assignment accuracy, insuring the physician documentation supports the hospital coded data. Essential Accountabilities: Level I • Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise. Clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently....

Job Description: Summary: The Health Outcomes Specialist I-II supports the Health Outcomes & Community Impact (HOCI) strategic plan, goals, enterprise-wide measures, and efforts to achieve improvement across our markets and populations. The role supports the design, implementation, and evaluation of initiatives that improve measurable health outcomes across priority member populations. This role ensures that interventions designed to address disparities lead to demonstrable improvements in clinical outcomes, utilization, community impact and member experience. Working within the HOCI team, the Health Outcomes Specialist partners with internal stakeholders including Quality, Healthcare Management, Medical Governance, Provider Network, Pharmacy, Data Analytics, and Marketing to operationalize strategies that improve outcomes for members experiencing disproportionate health risks or barriers to care. This role translates population health insights and equity-informed...

BHE GT&S JOB DESCRIPTION BHE GT&S has an exciting opportunity for a Controls Technician I or Controls Technician II, with the level determined based on the candidate's background and experience. This position is located at our Northern-NY Headquarters in New Hartford New York. RESPONSIBILITIES Installs, maintains, and troubleshoots instrumentation control circuits and equipment for natural gas processes, such as compression dehydration to facilitate operation of measurement transmission and storage of natural gas. Installation includes mounting, wiring, connecting, testing, configuring, and programming instruments and devices. Maintenance includes routine calibration and functional testing of process instruments and devices, documentation of calibration data collected during inspections, utilizing the instrument inspection monitoring system, and verification of data communication systems that provide real-time process and alarm information to the facility...

Job Description: Summary: Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation's enrollment regulations, Underwriting Guidelines and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member and group administrator inquiries for all product lines. Inquiries are received by the following but not limited to; telephone, email, written inquiries, lobby walk-in customers and through on-site visits with an employer group. The B version of this role will require the individual to be on the phone regularly. Essential Primary Responsibilities/Accountabilities: Level I: Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations. Responsible...

Job Description: Summary: The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas. Essential Primary Responsibilities/Accountabilities: Level I Responsible for reconciliation of regulatory and Health Plan Enrollment data through audit and review, utilizing the internal and external guidelines/regulations/policies and procedures. Strong knowledge of reporting and associated regulatory guidelines used to verify enrollment and billing accuracy to ensure plan is paid correctly in order to maintain accurate financial records. Responsible for ensuring member and/or group documentation and...

Job Description: Summary: Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation's enrollment regulations, Underwriting Guidelines and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member and group administrator inquiries for all product lines. Inquiries are received by the following but not limited to; telephone, email, written inquiries, lobby walk-in customers and through on-site visits with an employer group. The B version of this role will require the individual to be on the phone regularly. Essential Primary Responsibilities/Accountabilities: Level I: Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations. Responsible...

Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment. Essential Accountabilities: Level I Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment. Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies. Perform triage for UM Services. Serves as the primary contact for providers regarding authorization requests. Contacts members and providers concerning regulatory...

Financial Analyst II This role has been designed as 'Hybrid' with an expectation that you will work on average 2 days per week from an HPE office. Who We Are: Hewlett Packard Enterprise is the global edge-to-cloud company advancing the way people live and work. We help companies connect, protect, analyze, and act on their data and applications wherever they live, from edge to cloud, so they can turn insights into outcomes at the speed required to thrive in today's complex world. Our culture thrives on finding new and better ways to accelerate what's next. We know varied backgrounds are valued and succeed here. We have the flexibility to manage our work and personal needs. We make bold moves, together, and are a force for good. If you are looking to stretch and grow your career our culture will embrace you. Open up opportunities with HPE. Job Description: Partners with the businesses to ensure that the capital strategies are operationally supported and strategically focused...

Company Description At Intuitive, we are united behind our mission: we believe that minimally invasive care is life-enhancing care. Through ingenuity and intelligent technology, we expand the potential of physicians to heal without constraints. As a pioneer and market leader in robotic-assisted surgery, we strive to foster an inclusive and diverse team, committed to making a difference. For more than 25 years, we have worked with hospitals and care teams around the world to help solve some of healthcare's hardest challenges and advance what is possible. Intuitive has been built by the efforts of great people from diverse backgrounds. We believe great ideas can come from anywhere. We strive to foster an inclusive culture built around diversity of thought and mutual respect. We lead with inclusion and empower our team members to do their best work as their most authentic selves. Passionate people who want to make a difference drive our culture. Our team members are grounded in...

Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential...

Job Description: Summary: The SCRUM Master improves the team & customer experience by leveraging Agile delivery techniques. This position is responsible for the continuation of Agile Scrum growth throughout the organization, utilizing the processes and tools that have been established during the Agile transformation to date. This position ensures existing and new Agile Scrum processes and workflows maintain a high level of performance while continuously reviewing and refining those processes. This role supports and grows an Agile culture throughout the Enterprise. We are committed to promoting and maintaining existing Agile standards, creating and evolving the Enterprise Agile Software Development Lifecycle (eSDLC), facilitating the removal of organizational impediments, creating proactive transformation initiatives, assisting new start-up teams with training and coaching, executing Enterprise Agile and documenting best practices and improvements. Essential...

Community Manager II Job Function / Purpose The Community Manager II is responsible for overseeing the day-to-day managing and coordinating of Association operations and administrative functions in order to maintain a smooth running & properly functioning Community. Preferred, CMCA AMS. Work schedule: 8-5 Monday through Friday - based on the needs of the business. Nights and weekends as required for meetings and emergencies. Responsibilities Works with the Board Members, Senior Managers and RM to develop strategic direction for the Associations. This position reports to the Senior Manager of Property Management. Ensures alignment of activities which meet the mission, vision and agreed critical success factors and goals of the Board of Directors. Develops, communicates and monitors property budgets. Reviews monthly finances and makes recommendations to the Board as to anticipated shortfalls and/or excess funding by budget line item. Coordinates, negotiates...

X-Ray Reader - Aerospace Parts (NDT Level II) If you would love to be part of a company that is poised for substantial growth with opportunities for advancement then working for CPP and it's subsidiaries may be the right fit for you! We have multiple facilities in Albany, OR and are a world class supplier of titanium castings and components for the aerospace industry. If you are selected to join our team you will enjoy benefits such as quarterly bonus, medical, dental, vision, 401(k), company paid life insurance, and other great benefits! Summary: The X-Ray Reader will utilize expertise in non-destructive testing to assure compliance with quality requirements of the company and customers. They will interpret radiographic images and document results in accordance with established technique cards, develop shooting techniques as required, calibrate equipment, and train X-Ray Shooters/Readers as needed. Essential Functions: Perform non-destructive testing using...

Job Description: Summary: The Service Control/Operations Methodology at Excellus generally consists of the following disciplines: Asset and Configuration Management Incident/Problem/Change Management Service Desk The Asset-Configuration Management Analyst is specific to the Asset and Configuration Management Function at the Excellus Health Plan. This position oversees the daily and long-term strategic management of software and technology-related hardware within the organization. This position is responsible for the development, implementation, monitoring, administration and compliance of all IT Asset Management tools and services such as but not limited to tracking PC and Server lifecycles, software license compliancy and unauthorized software or hardware installations and usage. The incumbent will develop and implement procedures for tracking company assets to oversee quality control throughout. Essential Primary Responsibilities/Accountabilities: All Levels:...

Job Description: Thank you for your interest in our Customer Care team. Due to the volume of applications we receive, we review all applications in the order in which they were received. If you are chosen to move to the next step in the process, you will receive a Video Assessment from recruiting@jobalerts.excellusbcbs.com. Summary The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently. Essential Responsibilities/Accountabilities...

Job Description: Summer: The Summer College Internship Program is a 10-week, paid internship experience that provides undergraduate and graduate students the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. In addition, through the internship program, our interns can attend development workshops that are focused on key business concept. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per...

Job Description: Summary: The Actuarial Analyst performs actuarial services in support of Health Plan operations and monitors and maintains financial solvency through the understanding of current data & environment and modeling of future events. This role is amongst the group that is responsible for providing a range of experience working to establishing rates, rating structures and systems and reserves. The Actuarial Analyst has accountability to providing in depth analysis on the overall risk management and financial solvency for the health plan operation. Essential Accountabilities: Level I Establishes insurance rates, rating structures, and rating systems for groups and categories of business. Maintains reserve programs, pricing files, risk score models, benefit relativity tables and appropriate documentation for work. Develops financial projections, risk score analysis, unpaid claim liability estimates and conducts actuarial analysis for...

Job Description: This position is onsite/in-person at our Court St. office in Rochester, NY. Multiple Overnight Openings Available! Schedule 1: Mon - Thurs: 10PM - 6:30AM, & Fri: 11:55PM - 8:30AM Schedule 2: Sun-Thurs : 10PM - 6:30AM *New hires will temporarily orient on days to start. Summary: Under general supervision of department management, the Production Floor Operations Specialist may support one or more areas of Production Operations. Assignments are determined based on need; shifts may include day, evening and/or overnight hours, with some including weekend coverage. NOTE: Incumbent will be notified 3 days ahead of any shift assignment adjustment. Essential Accountabilities: All Levels • Specific work activities are assigned daily based on work volumes and department need. • Observes safety and housekeeping standards in work area. Maintains appropriate files, records and equipment manuals. • Informs supervisor of equipment issues. •...