health

**PURPOSE AND SCOPE:** Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. Responsible for maintaining the overall cleanliness and hygiene of the facility and overall physical plant. **PRINCIPAL DUTIES AND...

**About Scene Health** Scene’s 360° model of care enhances the gold standard of medication adherence, Directly Observed Therapy. Combining personalized video coaching, education, and motivational content, we bring healthcare professionals, patients, and their families together to solve the $500B medication non-adherence problem. Our mobile app allows...

**About Lyra** Lyra Clinical Associates partners with Lyra Health, a leading provider of evidence-based mental health care, serving more than 20 million people globally in partnership with employers and more than 100 million through health plan and partner relationships. The company has delivered more than 15 million sessions of mental health care, published...

**About Scene Health** Scene’s 360° model of care enhances the gold standard of medication adherence, Directly Observed Therapy. Combining personalized video coaching, education, and motivational content, we bring healthcare professionals, patients, and their families together to solve the $500B medication non-adherence problem. Our mobile app allows...

**About Scene Health** Scene’s 360° model of care enhances the gold standard of medication adherence, Directly Observed Therapy. Combining personalized video coaching, education, and motivational content, we bring healthcare professionals, patients, and their families together to solve the $500B medication non-adherence problem. Our mobile app allows...

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 Exempt **GENERAL DESCRIPTION:** Carries out nursing functions in performing care management process, organizational determinations, and transitional care, including, but not limited to, health assessments, biopsychosocial needs assessment, and barriers for policyholders with medical conditions to develop a comprehensive and customized...

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers. When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our...

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...

**GENERAL DESCRIPTION:** Responsible for answering and making telephone calls to participating and non-participating providers offering services in the service area and outside the plan service area, as well as to policyholders. Guarantees that situations or service needs are solved at the time of the call and, if necessary, refer to their supervisor any...

Regular Exempt **GENERAL DESCRIPTION:** Administers, manages, and monitors the operation of the Contracting area to guarantee compliance with organizational goals, following the applicable regulations for each line of business and the contracting and credentialing policy. Oversee the operation and experience of contracting end-to-end Providers...

We're seeking a Browser Automation Engineer to join our team in Puerto Rico. We’re building an intelligent automation framework powered by large language models to solve complex, real-world workflows. We’re looking for a Browser Automation Engineer II with a strong foundation in JavaScript and experience designing complex browser automations for a...

## Responsibilities **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...

**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 Exempt **GENERAL DESCRIPTION:** Responsible for the operation of the units that manage the Comprehensive Health Risk Assessment (CHRA), retrospective projects, and clinical coding processes. Guarantees compliance with established procedures following operational guidelines and rules established by the different accrediting agencies, such...

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:** Represents the company in official service negotiations with assigned group. Attend, channel, and solve the different situations from customers, underwriters, and producers as required. Responsible for coordinating and negotiating with the underwriting department the renewal proposal of groups assigned to...

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...

**About Lyra** Lyra Clinical Associates partners with Lyra Health, a leading provider of evidence-based mental health care, serving more than 20 million people globally in partnership with employers and more than 100 million through health plan and partner relationships. The company has delivered more than 15 million sessions of mental health care, published...

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers. When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our...