MCS Puerto Rico Vacatures in België

The Provider Service Representative is responsible for answering telephone calls to participating providers offering services in the service area. · Responsibilities · Evaluate situations presented in the calls by policyholders) · ...

The Compliance Specialist is responsible for coordinating, developing, and delivering training programs; reviewing organization-wide policies and procedures to ensure compliance with regulatory requirements; and analyzing, interpreting, and communicating updates from local and fe ...

Responsible for ensuring that the personnel under their supervision perform clinical interventions to enhance the impact of quality measures such as Adherence and Medication Therapy Management. · ...

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. · ...

This Call Center Representative will be responsible for receiving and initiating phone calls regularly in alignment with the strategies and special projects of the Medicare Stars Program. · ...

Job summary · Act as the primary liaison between the team and external vendors to attend, channel, and resolve grievances and Complaint Tracking Module (CTM's). Serves as an advocate for the vendor management process. · ResponsibilitiesReceives, investigates, processes, and resol ...

Guarantees quality in implementing pharmacy benefits and forms and the medical component for all company business lines. · ...

Responsible for executing processes related to contracting professional service providers. Coordinates visits, negotiates agreements and manages contracts for providers and the company's business lines. · ...

Analyzes and supports Grievances filed by members within the time stipulated contractually for both Lines of Business (LOB) following established contracts. · ...

Responsible for visiting assigned Independent Practice Associations (IPAs), Primary Care Providers (PCPs), and specialists to discuss their performance related to risk adjustment processes for the Classicare line of business. · Collaborates with providers on discussing the work p ...

The Pharmacy Technician is responsible for receiving and responding to calls from clients (insured parties, suppliers, pharmacies) related to the medication management process. · ...

Responsible for performing information system and technology audits. · Plan, perform and oversee complex IT audits. · Conduct comprehensive audits of IT systems to assess risk control effectiveness compliance with HIPAA and delegated entity requirements. · ...

Responsible for executing and reviewing quality controls for monitoring the operational processes established in the Unit to process claims and benefit configuration, seeking continuous improvement and quality. · ...

Evaluate potential fraud waste abuse and or violations of applicable laws or regulations including cases of financial exploitation. · Develop and prepare cases involving high monetary amounts sensitive matters or those meeting criteria for referral to law enforcement agencies suc ...

+The Employee Engagement Coordinator provides administrative and logistical support to the Employee Engagement team. · ...

Analyzing information generated from admissions and discharges in the hospitals belonging to the Inpatient Management Program and presenting the results that support the program's logistics. · ...

The Field Marketing Specialist is responsible for driving consistent brand visibility across company facilities and partner locations. · Bachelor's Degree in Marketing, Business Administration, Communications or related field. · At least three years of experience in trade marketi ...

Responsible for providing strategic leadership in the development, implementation, and governance of compliance and monitoring frameworks across all pharmacy programs and vendor relationships. · ...

Responsible for assisting in coordinating and implementing project milestones objectives schedules and performance standards as assigned. · Coordinate project schedules resources equipment and information. · Remove barriers to project execution in collaboration with the project m ...

The Pharmacy Department's Financial Activities such as Budget and Savings Initiatives are responsible for the lead pharmacist. · ...