20 Best project specialist jobs in Remote (Hiring Now!)

Referral Specialist, RN, Health Plan
Sanford Health —South Dakota
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Ensure services comply with professional standards, national and…
$27.50 - $44.00 an hour
Quick Apply
2h
Property Management Specialist
Wilhoit Properties, Inc —Houston, TX
Ensure deposits and rental payments are collected on a timely basis. General knowledge of repair and apartment maintenance. Section 8 experience is a huge plus.
Estimated: $40.6K - $51.5K a year
Quick Apply
REMOTE Senior Risk Adjustment Coding Consultant (Commercial)
The CSI Companies —Jacksonville, FL
Required Certification: Active certified coder certification through AHIMA or AAPC required: CRC, CPC, CCS-P, CCS (Certified Risk Adjustment Coder, Certified…
$26 - $30 an hour
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Configuration Specialist
Hexure —Dallas-Fort Worth, TX
1 – 3 years’ experience in a technical field. We are committed to being a driving force in the innovation of the insurance market and that means that we help…
$76,000 - $86,000 a year
3d
Marketing RFP Specialist
Pathway Capital Management —Providence, RI
5+ years of experience in proposal management, RFP writing, or relevant field; preference for financial services. Experience with RFP tools/software a plus.
$75,000 - $110,000 a year
Quick Apply
Human Resources Specialist
GC Associates USA, LLC —Remote
Education and Experience Requirements: *Must have a bachelor’s degree or four years’ of experience. Provide answers and help to employees with questions.
Estimated: $62.5K - $79.2K a year
Quick Apply
US Based Accounting Client Onboarding Specialist
KeepingCount —Remote
Identifying opportunities for the implementation of apps and automation. Proficient in cloud accounting technologies (1+ years in QBO, Sage Intacct, Gusto,…
Up to $85,000 a year
Quick Apply
6d
Communication Specialist, Ethics & Compliance
NAVEX Global —Remote
As our Communication Specialist, you will capture highly sensitive information via inbound calls pertaining to confidential workplace concerns, unethical issues…
$15.50 an hour
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10d
ServiceNow Technical Architect
Forward Air —Remote
Create comprehensive technical documentation, including design specifications, architecture diagrams, and user guides.
$110,000 - $140,000 a year
Licensed Professional Clinical Therapist
Complete Well Care Source LLC —Salisbury, NC
Follow license criteria when licensure applies. Completion of an accredited program with certification and licensure as a Licensed Professional Clinical…
Estimated: $67.8K - $85.8K a year
Quick Apply
Senior Digital Marketing Specialist (Paid Search), SMB Growth
Indeed —Remote
Prioritize with internal marketing teams to identify opportunities, develop and implement effective marketing strategies, and manage paid budgets to meet KPIs…
$103,000 - $144,000 a year
Quick Apply
Creative Project Management Specialist - Remote
Hilton Grand Vacations —Orlando, FL
Proactively and consistently conceive of, define, and develop process improvements to increase efficiency and productivity across the Branding & Creative…
Estimated: $55K - $69.6K a year
1d
Senior Bookkeeping Specialist
Bookkeeping For Painters —Remote
Certification: Must have QuickBooks ProAdvisor certification; Advanced certification strongly preferred. Lead and Coach: Initiate client onboarding, oversee…
$22 - $32 an hour
Quick Apply
Implementation Specialist - UKG Ready TLM
Andrews Technology —Remote
Be the key point of contact during your implementation projects. Work cross-functionally and amongst a team on new client implementation, upgrade and change…
$70,000 - $90,000 a year
Quick Apply
9d
HR Compliance Specialist - REMOTE
Ryder System —Helena, MT
Bachelor's degree required in Human Resources or a related field or an equivalent combination of education and work-related experience.
$60,000 - $70,000 a year
1d
Sales Support Specialist
Indonesha LLC - chicka-d —Remote
This position will involve supporting the Head of Sales, managing your own set of small accounts, as well as attending tradeshows and markets as needed.
$50,000 a year
Quick Apply
Real-time Monitoring (GIS & Remote Sensing) Specialist
Amazon Conservation Association —Remote
Help develop, improve, and implement protocols for data analysis, processing, visualization, publication, and storage. Bachelor's degree in a related field.
Estimated: $58.2K - $73.7K a year
Quick Apply
Dermatology Coding Specialist
Clarity RCM —Remote
CPC or equivalent certification (CPC-D or current dermatology coding designation is a plus). *Provider Education: *Communicate with providers via video, phone,…
From $25 an hour
Quick Apply
Certification Specialist
American Osteopathic Association —Remote
Deals with the administrative and clerical duties of the position as needed to support the Vice President, Associate Vice President, and Certification Manager’s…
$58,000 - $63,500 a year
Quick Apply
3d
Project Specialist - Church HR
HR Ministry Solutions —Remote
The HR Project Specialist is a detail oriented and driven person with an innate ability to see God’s fingerprints in HR for churches and has a passion to…
$20 - $22 an hour
Quick Apply
1d

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Referral Specialist, RN, Health Plan

Sanford Health - South Dakota

Quick Apply

Job Details

Full-time $27.50 - $44.00 an hour 2 hours ago

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

Nursing
RN License
ICD coding
3 years
Medical administrative support
Bachelor's degree
Case management
Utilization management
CPT coding
Medical terminology
Communication skills

Full Job Description

Careers With Purpose

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote SD (Central Time)

Location: City - Remote SD, SD

Address:
Shift: 8 Hours - Day Shifts

Job Schedule: Full time

Weekly Hours: 40. 00

Salary Range: $27.50 - $44.00

Department Details

Fun, fast paced work, remote work

Job Summary

Communicate with providers and/or members regarding management of out-of-network exception requests. Provide care coordination for designated Health Plan members that includes managing and directing members to appropriate resources, services and programs. Work directly with referring providers and participating provider specialty groups in coordinating care.

Responsible for managing the authorization process for participating plan members ensuring that all services are performed within assigned evidence-based guidelines and performed at the appropriate level of care in a timely, cost-effective and efficient manner. The collection and interpretation of clinical information is necessary to initiate and execute authorizations. Essential functions must occur simultaneously; therefore, the specialist must be able to appropriately handle and prioritize various daily tasks. Must be able to collaborate with other health plan departments as needed for medical coverage, case agreement negotiation and policy application. Obtain and maintain appropriate documentation concerning services in accordance to regulatory and accreditation guidelines and timelines. Provide information to providers and members in regards to authorization and/or denial of services. Ability to review, analyze and summarize reports and have effective oral and written communication skills. Understanding of medical terminology, international classification of diseases and current procedural terminology (CPT) codes. Understanding and administration of medical, administrative and management principles and policy necessary to operate within a managed care organization.

Ability to determine appropriate action for referring cases that do not meet departmental standards and require additional secondary review and/or escalation as needed.

May also be actively involved in collaborating with members of the healthcare team to promote medically necessary resource utilization and achievement of fiscal outcomes when appropriate. Collaborates with physicians and other clinical professionals as needed to assist in documentation improvement practices for effective and appropriate services. Dynamic and tactful interpersonal skills, particularly in relating to physicians and other health care professionals. Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.

Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in accordance with guidelines and criteria. Assist in report preparation, correspondence, and maintenance of appropriate records. Ensure services comply with professional standards, national and local coverage determinations (NCD/LCD), centers for Medicare and Medicaid services (CMS), as well as state and federal regulatory requirements. Maintain working knowledge of payer standards for UM functions for authorization requirements.

May assist with additional special projects related to work, upcoming initiatives, new organizational goals and audits when delegated. Considered a resource to all team members and acts as a point of contact for guidance, training, and assisting with questions. Demonstrate flexibility and adaptability where scheduling may fluctuate due to communication needs within interdepartmental and clinical units are required.

Possesses strong clinical knowledge and skills. Collaborates with team members both internally and externally to ensure care is coordinated and appropriate based on evidence based medicine. Ability to work independently or as a member of a team. Ability to multitask and work with little direction. Works primarily day hours.

Administer and prioritize daily tasks, and apply Sanford Health Plan policies and regulatory requirements consistently and use good judgment as when to seek out guidance. Possess broad understanding of products and benefits and a demonstrated understanding of regulatory requirements and timeframes.

Assist with coordination of activities related to insurance pre-certification/authorization. Provide counseling to members or their representative regarding pre-service requirements and instructions.

Qualifications

Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).

Will consider applicant with significant background in case management and/or utilization management experience. Minimum of three years nursing experience is required.

Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Obtains and subsequently maintains required department specific competencies and certifications.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0189887

Job Function: Health Plan

Featured: No

Quick Apply

project specialist jobs in Remote

Referral Specialist, RN, Health Plan

Property Management Specialist

REMOTE Senior Risk Adjustment Coding Consultant (Commercial)

Configuration Specialist

Marketing RFP Specialist

Human Resources Specialist

US Based Accounting Client Onboarding Specialist

Communication Specialist, Ethics & Compliance

ServiceNow Technical Architect

Licensed Professional Clinical Therapist

Senior Digital Marketing Specialist (Paid Search), SMB Growth

Creative Project Management Specialist - Remote

Senior Bookkeeping Specialist

Implementation Specialist - UKG Ready TLM

HR Compliance Specialist - REMOTE

Sales Support Specialist

Real-time Monitoring (GIS & Remote Sensing) Specialist

Dermatology Coding Specialist

Certification Specialist

Project Specialist - Church HR

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