4 project manager ii jobs found in Rancho Cucamonga, CA

The Workers’ Compensation   Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as...

The Network Relations role supports the frontline of Network Development, responsible for providing excellent customer service while impacting and overseeing provider data integrity. This role must combine strong interpersonal skills with an aptitude in the medical provider market. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Assist Developer with implementing medical providers, using written and verbal communication Verify all provider signatures, contracts and documentation before submitting for internal processing Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols Provide orientation on managed care procedures and establish liaison(s) with all participating providers Assist and communicate with provider orientation program in cooperation with Developer Distribute and maintain provider manual and orientation materials per state guidelines...

The Workers’ Compensation   Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as...

The Utilization Review Supervisor RN is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised May be required to travel overnight and attend meetings May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be responsible for limited marketing and sales activities May be required to oversee case management clinical activities (dependent on whether or not unit manager is an RN) For Supervisors who are not RN’s, the clinical oversight and direction will be performed by a designated RN with a nationally...