Empleos de to-ecc en San Juan

**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. ...

**Job Description** We are looking for a reliable and experienced Janitorial Cleaner to perform a variety of cleaning duties to ensure a clean, safe, and orderly environment across assigned facilities. This role plays a critical part in maintaining the overall appearance and sanitation of the workplace, contributing to a positive experience for...

🚨 **We’re hiring: CREATOR 🚨** 📍 **VaynerMedia LATAM | Puerto Rico** If you live and breathe content… keep reading. At VaynerMedia we’re not looking for someone who “does social.” We’re looking for someone who **is social** . A creator who understands **Puerto Rican culture** , lives online, moves at internet speed, and can turn...

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...

At Fluor, we are proud to design and build projects and careers. We are committed to fostering a welcoming and collaborative work environment that encourages big-picture thinking, brings out the best in our employees, and helps us develop innovative solutions that contribute to building a better world together. If this sounds like a culture you would like to...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** Manages the orientation, presentation, and medical plan sales process, complying with established policies and procedures in conjunction with the laws and regulations applicable to the industry. Receives calls from prospective clients, identifying their eligibility, and fosters interest to guide...

**(Región - Sur)** Regular Non-Exempt **GENERAL DESCRIPTION:** The Community Outreach Technician provides administrative support within the case management process for addressing the non-clinical needs of policyholders referred to the unit’s program. This role involves assisting in the development of individualized care plans based on...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for handling, validating, and completing requests and reconciliations related to the Beneficiary Value Program. Assess program reconciliation and collaboration with cross-functional teams to enhance overall program performance to ensure that the Beneficiary Value Program goals align with the...

Regular Exempt **GENERAL DESCRIPTION:** Provides education to internal and external clients on operational topics that promote efficiency in the process executed by our providers and business partners, such as the Risk Adjustment payment model “CMS-HCC”, ensuring best practices in coding standards and clinical documentation within the medical...

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 **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:** The Events and Promotions Executive is responsible for handling and coordinating the logistics of Classicare events and activities and the efforts and initiatives related to the Advantage line of business. Identifies and develops work plans for region-level initiatives and provides recommendations to...

Regular Non-Exempt **GENERAL DESCRIPTION:** Receive the Grievances, Pre-Service Appeals, Post-Service Appeals, Payment Disputes, Payment Appeals, and Administrative Organizational Determinations (AOD) filed by Providers and members, as applicable. Responsible for filling and assigning cases to the Specialists in accordance with established time...

Marshalls At TJX Companies, every day brings new opportunities for growth, exploration, and achievement. You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritizes your development. Whether you’re working in our four global Home Offices, Distribution Centers or Retail Stores—TJ Maxx, Marshalls, Homegoods,...

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...

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 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,...

Regular Non-Exempt **GENERAL DESCRIPTION:** Supports daily unit operations by completing document intake, evaluation, classification, and distribution processes. Provides guidance to technicians, resolves escalated issues, and acts as a liaison between internal and external teams to ensure efficient workflow and service delivery. Monitors...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for presenting products to prospects and ensuring thorough follow-up until closing the sales cycle to meet company goals. Prepare accurate sales reports to document the sales process. **ESSENTIAL FUNCTIONS:** - Identify potential clients and market segments for expanding the company's...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for receiving, registering, and forwarding requests for organizational determination and/or any associated clinical documentation or documentation for the clinical management of the insured. Works with the authorizations of services already predetermined through the automatic process using...