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Regular Exempt **GENERAL DESCRIPTION:** The Health Educator is responsible for designing and implementing educational interventions aimed at preventive care, healthy lifestyles promotion and condition management aligned with the goals and objectives of the company’s Wellness Program. **ESSENTIAL FUNCTIONS:** - Design and develop...

Regular Exempt **GENERAL DESCRIPTION:** Manages and ensures the effective execution of the Care Management Program work plan for the Company's lines of business. Ensures that the appropriate resources are in place to ensure compliance with the appropriate care management of the participating members of the program(s). Participates in designing,...

**Company Mission** Duo Health is a new type of medical group designed around the needs of patients living with chronic kidney disease. Our proprietary Health Mobilization™ platform partners multidisciplinary care teams with community nephrologists and activates the clinicians, facilities, and community organizations needed to care for the whole patient. ...

QUALITY CONSULTING GROUP, a leader in the pharmaceutical, biotech, medical devices, and manufacturing industry, is looking for a talented, highly motivated and enthusiastic to join our team. In this role, you’ll work with a highly enthusiastic team, contributing in a world-class manufacturing industry in Puerto Rico & USA. Responsibilities: - Approve...

## Company Description **Publicis Groupe** es líder mundial en comunicación. El Groupe se posiciona en cada paso de la cadena de valor, desde la consultoría hasta la ejecución, combinando la transformación del marketing y la transformación del negocio digital. Publicis Groupe es un socio privilegiado en la transformación de sus clientes para mejorar...

## Company Description **Publicis Groupe** es líder mundial en comunicación. El Groupe se posiciona en cada paso de la cadena de valor, desde la consultoría hasta la ejecución, combinando la transformación del marketing y la transformación del negocio digital. Publicis Groupe es un socio privilegiado en la transformación de sus clientes para mejorar...

Regular Exempt **GENERAL DESCRIPTION:** Analyzes, investigates, supports, and answers Grievances, Dental Pre-Service, and Payment Appeals filed by members, insureds, Providers, and/or Non-Part Providers within the time stipulated contractually for both Lines of Business (LOB)and following the terms stated in the contracts established and the...

Regular Exempt **GENERAL DESCRIPTION:** Evaluates utilization in clinical records and hospital facilities concurrently and retrospectively. Identifies and refers to other clinical departments (Case management, condition management, among others) cases for the management of treatment alternatives. Makes efforts to receive advice in difficult...

**Title:** Senior Specialist QA **Location:** Juncos, PR — Open only to Puerto Rico Residents **Work Schedule:** Onsite | Administrative Shift **Contract Duration:** 1 Year **Positions Available:** 1 **Summary** Our client is seeking a **Senior Specialist QA** to serve as a technical Quality Assurance specialist supporting...

Detalle de la Convocatoria ❮ Regresar al listado❮ Regresar al listado Título del Puesto Director(a) Asociado(a) Entidad o Municipio Administración de Compensaciones por Accidentes de Automoviles (ACAA) **Región** Humacao Región / Municipio No items found.  Convocatoria parte del Plan...

Regular Exempt **GENERAL DESCRIPTION:** Conducts prospective reviews (preauthorization’s) of items or services provided to beneficiaries using the Clinical Guidelines criteria for assessing medical necessity. Determines the appropriate level of care according to the severity of the subscriber’s condition. Ensures the appropriate use of...

Regular Exempt **GENERAL DESCRIPTION:** Supports the planning, development, and execution of specialty pharmacy programs for both MCS lines of business. Responsible for monitoring and reporting to ensure established programs deliver the expected clinical and financial results. Ensures that specialty medication strategies achieve company goals and...

Esta Convocatoria es parte del Nuevo Proceso de Adquisición de Talento en el Servicio de Carrera de las Entidades Participantes del Gobierno de Puerto Rico ADMINISTRACIÓN DE REHABILITACIÓN VOCACIONAL Edificio Oriental Tower, 290 Ave. Jesús T. Piñeiro San Juan PR 00919 Patrono con igualdad de oportunidades de empleo CONVOCATORIA A EXAMEN **INTERNA...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for the ongoing monitoring of all elements of the Special Needs Plan Care Coordination (SNP-CC) as needed to comply with regulatory requirements and quality indicators. Evaluates care coordination frameworks, identifies risks and improvement opportunities, supports audit readiness, and works...

Regular Non-Exempt **GENERAL DESCRIPTION** : The Beneficiary Value Program Efficiency Analyst is responsible for preserving the quality of the product by analyzing and developing operational data and report requests related to Te Paga. Provides administrative and analytical support in the implementation and monitoring of Te Paga-related...

Regular Exempt **GENERAL DESCRIPTION:** Leads orientations and presentations to sell and/or renew MCS Advantage’s line of business products to potential clients or beneficiaries (as applicable) that are eligible for the Medicare Program, according to the regulations established by CMS (Center for Medicare and Medicaid Services), and the...

Regular Exempt **GENERAL DESCRIPTION:** The Beneficiary Value Program Efficiency Manager leads the strategic planning, customer management, “Te Paga” initiatives, and investment efforts aligned with the company’s corporate strategy. Ensures seamless integration of technical and operational requirements to support internal and external...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for receiving, registering, and forwarding applications received within the unit to certify the chronic conditions of beneficiaries for a chronic product. Responsible for the confirmation of chronic conditions for the C-SNP plan members. Enters data from health status and risk factor...

Regular Exempt **Regions of Arecibo, Manati, Mayaguez, Aguadilla, Ponce, Bayamon, Caguas and Carolina.** **General Description** Leads orientations and presentations to sell and/or renew MCS Advantage’s line of business products to potential clients or beneficiaries (as applicable) that are eligible for the Medicare Program, according to the...

Esta Convocatoria es parte del Nuevo Proceso de Adquisición de Talento en el Servicio de Carrera de las Entidades Participantes del Gobierno de Puerto Rico ADMINISTRACIÓN DE REHABILITACIÓN VOCACIONAL Edificio Oriental Tower, 290 Ave. Jesús T. Piñeiro San Juan PR 00919 Patrono con igualdad de oportunidades de empleo CONVOCATORIA A EXAMEN **INTERNA...