Empleos de document en San Juan

**Registered Nurse Essential Functions** - Provide and coordinate care by assessing patients’ physical and behavioral health needs. - Develop and implement nursing care plans. - Maintain medical records and educate patients and their families about various physical and behavioral health conditions. - Provide nursing care and services within the standards...

Regular Non-Exempt **GENERAL DESCRIPTION:** Provides software, hardware, and network support for incidents and requests that are escalated by the IT Service Desk Analyst Level I due to complexity. Actively reviews, prioritizes, documents, tracks, and resolves clients’ incidents and service requests in person. Works together with network and...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for the execution, monitoring, and evaluation of clinical pharmacy initiatives to ensure they align with organizational goals, regulatory requirements, and performance standards. Supports the development of cost-effective, patient-centered interventions, analyzes clinical and operational data,...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for managing administrative tasks, coordinating services, and maintaining compliance with established protocols. Serves as a vital link between members, healthcare providers, and the multidisciplinary team within the organization. Facilitates the delivery of services to members in an...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for the monitoring and implementation of regulatory processes such as Explanation of Benefits (EOB), Maximum Out of Pocket (MOOP), and Financial Information Report (FIR) transactions. Monitor monthly invoices, validate, and create Likely to Benefit (LTB) letters for the Medicare Prescription...

Regular Exempt **GENERAL DESCRIPTION:** The Senior Account Executive represents the company in official service procedures and group renewals. Ensures effective attendance, communication, and resolution of various service-related situations as required by the clients. Serves as primary liaison between the employer or group and the management of...

Feeling stuck? Put your career in motion with a great, new opportunity. Join the Kelly® team as a Strategic Services Coordinator to work at a leading organization in San Juan, PR. We’re here every step of the way to help you and your career be the best it can be. Bring your energy and expertise. We’ll help you get where you want to be. Salary/Pay...

Regular Exempt **GENERAL DESCRIPTION:** Serves as a liaison between the company and extended care home administration to coordinate, refer, and manage documents and/or services related to the company’s Home Health Program. Responsible for handling, channeling, and resolving service situations related to complaints, claims, and operational...

Regular Non-Exempt **GENERAL DESCRIPTION:** The Executive Secretary is responsible for supporting and managing administrative processes in the assigned department, in accordance with established company guidelines, policies, and procedures. **ESSENTIAL FUNCTIONS:** - Answers, makes, and forwards telephone calls within the department. -...

Regular Exempt **GENERAL DESCRIPTION:** Performs health risk assessments (HRA’s) to determine if the member is eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI). Reviews the member's individualized care plan and performs specific interventions to monitor the member's health status. **ESSENTIAL FUNCTIONS:** -...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for providing frontline support within the Human Resources Services function by responding to employee inquiries and processing routine HR transactions throughout the employee lifecycle. Ensures transactions are completed accurately, timely, and in compliance with established policies,...

Regular Exempt **GENERAL DESCRIPTION:** Assists in investigating cases for resolution in compliance with the applicable regulations, guidelines, and contractual agreements. Participates in the implementation processes of the special networks, prompt payment, and directory complaints, which entails analyzing the operational impact, validations,...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for driving consistent and impactful brand visibility and merchandising across the company's facilities and partner locations. Ensures and executes trade marketing initiatives, strengthening brand presence, and delivering the tangible expression of the brand within the healthcare insurance...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for providing guidance and orientation to individuals or members of Medicare and MCS Life products. This includes conducting satisfaction surveys and regulated calls while ensuring compliance with quality, experience, and service standards set by the company and the Centers for Medicare and...

Regular Exempt **GENERAL DESCRIPTION:** Supports regulatory compliance through audit readiness, regulatory reviews, corrective action plan management, and monitoring of provider network activities, including contracting, credentialing, and recredentialing. Responsible for monitoring and analyzing metrics, key performance indicators (KPIs), and...

Regular Non-Exempt **GENERAL DESCRIPTION:** Calls medical offices to request, receive by fax, and register documents contained in the medical records of Classicare policyholders, as required and according to the different initiatives worked on in the unit. Refers documents received by the medical offices to the Risk Assessment unit, to complete...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for coordinating, routing, and following up on operational requests related to the department and/or unit. Provides administrative support, manages documentation, and ensures compliance with internal processes and regulatory requirements, contributing to operational efficiency and service...

Regular Non-Exempt **GENERAL DESCRIPTION:** Analyzes claims and/or adjustments submitted in Centers for Medicare and Medicaid Services Form 1500 (CMS‑1500) and Uniform Billing Form 04 (UB‑04) formats, as well as member reimbursements, by applying payment rules to determine appropriate adjudication, denial, or the need for additional...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for conducting pharmacy audit, monitoring, and compliance activities to ensure adherence to the Center of Medicare and Medicaid Services (CMS) regulations, contractual requirements, and organizational standards across all Lines of Business (LOBs). Oversee Pharmacy Benefit Management (PBM)...

Regular Non-Exempt **GENERAL DESCRIPTION:** Provides first-level technical support to internal and external customers by responding to service requests, answering inquiries, resolving or escalating technology-related issues, and ensuring timely follow-up. Troubleshoots hardware, software, and system problems, documents incidents and requests, and...