jazzhr
Claims Analyst III
J29, Inc
Remote, USA
Full-time
Senior Level
Remote
Discovered 1 weeks ago
Free
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- Facilitates and manages assigned projects and contracts relating to pharmacy services. Leads and provides oversight to assigned tasks and contracts, making sure that contract specifications are understood, tasks are assigned appropriately, and information is available and circulated.
- Prioritizes and accomplishes tasks and programs independently and in a team to ensure successful implementation of goals and objectives.
- Works with the appropriate stakeholders to build partnerships, support data sharing, and develop tools and references to support changes in care practices in the pharmacy arena.
- Reviews and interprets contract deliverables to ensure timely and accurate completion.
- Contributes to the conceptual design and implementation of projects, as well as assists with project execution as needed.
- Ensures all project deliverables and timelines are met and reports on variances in a timely manner.
- Testifies at various legal proceedings or administrative hearings, when subpoenaed.
- Provides educational programs, as necessary, to meet project goals. Contributes professional presentations at pharmacy, medical, and quality organization meetings.
- Requires 5-7 years work experience (this could be a combination of clinical and utilization review, case management, etc.) 8-11 years preferred.
- Must hold a current, active RN license issued by the state board of nursing. Compliance with all regulatory standards and ability to maintain licensure throughout employment is required.
- BSN degree is strongly preferred to ensure advanced clinical knowledge and leadership skills. Candidates with an Associate Degree in Nursing (ADN) will be considered if they demonstrate equivalent experience and commitment to continuing education.
- Coding certification preferred
- Demonstrates strong analytical skills and the ability to make sound, timely decisions.
- Proven ability to work effectively within diverse teams and foster a cooperative environment.
- Embraces continuous learning, adaptability, and supports the development of self and others.
- Skilled in planning, organizing, and delivering results while ensuring quality and support throughout processes.
- Proficient in using digital tools and technologies to enhance efficiency and communication.
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