• MCG Customer Service

    ManpowerGroup (Fort Lauderdale, FL)
    Our client, a leading organization in the customer service industry, is seeking a Customer Service professional to join their team. As a Customer ... abilities, which will align successfully within the organization. **Job Title:** Customer Service **Location:** Fort Lauderdale, FL **Pay Range: $16.50**… more
    ManpowerGroup (11/11/25)
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  • Onsite Clinical Navigator (Hybrid)

    CareFirst (Baltimore, MD)
    …benefits). + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set ... service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer , including… more
    CareFirst (10/09/25)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service . - Reviews and denials notification letters along with ... to be taken. - Maintains a working knowledge of MCG guidelines /InterQual Acute Level of Care Criteria in...monitors for patterns and trends in denial activity by service and/or provider for the purpose of reporting and… more
    BronxCare Health System (09/19/25)
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  • RN Case Manager

    Stony Brook University (Stony Brook, NY)
    …activities including program development, data collection and analysis. + Maintain high level customer service . + All unit coverage as needed and other duties ... with cases. **Preferred:** CM, UM, Quality, Coding, Risk or MCG Certification Working knowledge of MCG or...Risk or MCG Certification Working knowledge of MCG or Interqual PRI Certified Knowledge of regulatory requirements… more
    Stony Brook University (10/23/25)
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  • Utilization Management Specialist (Remote)

    CareFirst (Baltimore, MD)
    …basis. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations ... + Utilization management experience on the payer side using MCG criteria. Working knowledge of managed care and health...Must be able to effectively communicate and provide positive customer service to every internal and external… more
    CareFirst (10/29/25)
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  • Pre-Sales Engineer

    Motion Recruitment Partners (Boston, MA)
    …Group, you will collaborate closely with sales and delivery teams to uncover customer needs, define solutions, help close deals, and kick off new engagements. As ... technologies and practices. **Key Responsibilities:** + **Solution Design:** Analyze customer requirements, pain points, and business goals to design tailored… more
    Motion Recruitment Partners (09/24/25)
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  • Holistic Health Specialist

    Health Care Service Corporation (Richardson, TX)
    …* 2 years of clinical practice experience of direct clinical care to the customer * 1 year of experience in care management/condition management in a health ... to high risk maternity management) * Working toward or completion of CCM/CCP/CDE/ MCG certification or Advanced degree * Knowledge of Milliman Guidelines or similar… more
    Health Care Service Corporation (11/12/25)
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  • Utilization Management Admissions Liaison RN II

    LA Care Health Plan (Los Angeles, CA)
    …literate, with expertise in Outlook, Word, Excel, PowerPoint. Provision of excellent customer service required due to frequent communication with providers and ... acute care facilities. Acts as a department resource for medical service requests/referral management and processes. Actively participates in the discharge planning… more
    LA Care Health Plan (10/03/25)
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  • Manager- Inpatient Care Management

    MetroHealth (Cleveland, OH)
    …and treatment planning functions. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.** Qualifications: ... patient care, for performing a clinical review of selected patients to determine service needs, and for coordinating the care of selected patients within the… more
    MetroHealth (11/07/25)
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  • Supervisor, Care Review (RN) Utilization…

    Molina Healthcare (San Francisco, CA)
    …Health and Long-Term Care for Molina members. + Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring ... cost-effective based on the severity of illness and the site of service . **KNOWLEDGE/SKILLS/ABILITIES** + Oversees an integrated Care Access and Monitoring team… more
    Molina Healthcare (10/18/25)
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