Top 24 Utilization management Jobs in Carolina, Pr

Case Review Representative
OncoHealth —Guaynabo, PR
- $13 - $15 an hour
- Monday to Friday
- Hybrid work
- Spanish
- English
- Mid-level
- Health insurance
Quick Apply
Especialista En Revisión De Utilización Hospitalaria
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
10d
Case Review Specialist - PR
OncoHealth —Guaynabo, PR
- Weekends as needed
- Hybrid work
- Spanish
- English
- Mid-level
- Health insurance
Quick Apply
Provider Navigator
Triple-S —San Juan, PR
- $40,000 a year
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
14d
Especialista en Revision Medica
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
Field Reimbursement Specialist
Cencora —Carolina, PR
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Paid parental leave
- Health insurance
Medical Network Representative
IT Staffing PR —San Juan, PR
- $16 an hour
- Full-time
- Hybrid work
- Spanish
- Microsoft Outlook
- English
Quick Apply
Medical Case Manager
Family Medicine Group —Carolina, PR
- $11 - $14 an hour
- Full-time
- Bilingual
- HIPAA
- Mid-level
Quick Apply
Remote Administrator on Call PR
LifeLink Foundation, Inc. —Guaynabo, PR
- On call
- Anatomy knowledge
- Customer service
- Writing skills
- Paid holidays
- Disability insurance
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Workforce Management Director
TPIS —San Juan, PR
- $70,000 - $80,000 a year
- Full-time
- Spanish
- HIPAA
- English
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Especialista Operacional de la Red
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- English
- Mid-level
1d
Medical VP
TPIS —San Juan, PR
- $225,000 - $245,000 a year
- Full-time
- Spanish
- Medicine
- 6 years
Quick Apply
RN Care Manager - Hybrid (Bengali/Arabic/Chinese Languages Preferred)
Centers Care Solutions —San Juan, PR
- Full-time
- Spanish
- Nursing
- RN License
Quick Apply
PHARMACY TECHNICIAN
TPIS —Guaynabo Municipio, PR
- $15 an hour
- Full-time
- Spanish
- Computer literacy
- Writing skills
Quick Apply
Primary Care Physician - Relocation to Tucson, Arizona
Vivo HealthStaff —San Juan, PR
- $240,000 - $260,000 a year
- Full-time
- Medicine
- Internal Medicine
- Primary Care
Quick Apply
CLINICAL PROGRAMS VICEPRESIDENT - PHARMACY
TPIS —San Juan, PR
- $150,000 - $160,000 a year
- Spanish
- English
- Supervising experience
Quick Apply
Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
14d

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Technician-QC Laboratory
Eli Lilly —Carolina, PR
Realizar y verificar ensayos microbiológicos a muestras de materia prima, producto final, agua, monitoreos ambientales, identificación de microorganismos,…
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Tecnico de Control de Calidad
Pan American Grain —Guaynabo, PR
Cernido e inspección de los productos terminados a fin de asegurarse de que cumplan con las reglamentaciones vigentes y normas de calidad preestablecidas.
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Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Quick Apply
UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
High school diploma required; associate or bachelor’s degree in nursing, healthcare administration, or related field preferred. Must be 21 or older.
$24 - $32 an hour
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Case Review Representative

OncoHealth -
Guaynabo, PR

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Job Details

$13 - $15 an hour

Benefits

Health insurance

Qualifications

Productivity software

Full Job Description

About OncoHealth

OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all cancer types.

About the Role

The Case Review Representative serves as a one-stop shop and intake of all calls (members and providers). Resolves tier one issues (user resets, provider data management, fax and letter receipt, general questions).

Primary Responsibilities

Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 5:00 pm EST (Office hours may change/extend upon operational needs)
Fax intake and labeling
Prior authorization creation
Quality Performance Program Outreach when assigned
Triage and manage inbound calls, routing case specific calls to an appropriate team member, and resolving tier 1 level issues
Triage and manage inbound emails from health plan clients, routing case specific emails to an appropriate team member, and resolving tier 1 level issues
Triage request/claims processing issues to health plans as needed Prior authorization creation
Quality Performance Program Outreach when assigned

About You

College degree or relevant experience preferred
Fully Bilingual (English and Spanish)
Remote/hybrid work experience preferred
A minimum of 2 years of healthcare related administrative experience and/or customer service or relevant educational attainment required
Skills for implementation of systems for program effectiveness and productivity required
Systems/Tools: MS Office Suite proficient

About the Location

OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided/mandatory requirement) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted.

Our Culture

Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!

We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!

OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.

The Opportunity

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners & McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!

Our Current Solutions

Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.

OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.

OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff.

OncoHealth's latest offering is Iris, a digital telehealth platform that delivers personalized, oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology, staffed 24X7, and delivered with empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.

Quick Apply

Refine Your Search

utilization management jobs in carolina, pr

Case Review Representative

Especialista En Revisión De Utilización Hospitalaria

Case Review Specialist - PR

Provider Navigator

Especialista en Revision Medica

Field Reimbursement Specialist

Medical Network Representative

Medical Case Manager

Remote Administrator on Call PR

Workforce Management Director

Especialista Operacional de la Red

Medical VP

RN Care Manager - Hybrid (Bengali/Arabic/Chinese Languages Preferred)

PHARMACY TECHNICIAN

Primary Care Physician - Relocation to Tucson, Arizona

CLINICAL PROGRAMS VICEPRESIDENT - PHARMACY

Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)

Appeals Professional III (Licensed Clinician)

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