20 Best jobs in Bayamón, PR (Hiring Now!)

Medical Policy Analyst
Elevance Health —San Juan, PR
Typically requires active state RN license. Clinical licensure (PR registered nursing license) preferred. The Medical Policy Analyst is responsible for medical…
Estimated: $71.3K - $90.3K a year
3d
Chiropractic Associate Doctor
QuiroHealth Centers —San Juan, PR
Nuestro compromiso con la excelencia se refleja en el profundo beneficio de salud y alcance clínico que alcanzamos con nuestros pacientes y la atención continua…
$50,000 - $100,000 a year
Quick Apply
Bookkeeper/Accounting Auxiliary
Allpro Homecare —Río Grande Municipio, PR
QuickBooks experience is a plus. Associate Grade or BA in Business Administration with a concentration in Accounting.
Up to $12.50 an hour
Quick Apply
1h
Nurse Reviewer I (NCLEX)
Elevance Health —San Juan, PR
Current unrestricted RN license in applicable state(s) required. NCLEX Certification or current unrestricted RN license from one of the 50 states of the United…
Estimated: $66K - $83.5K a year
3h
4th-6th Grade Math Teacher
Puerto Rico Christian School —Toa Baja, PR
We are looking for a certified elementary teacher with a bachelor's degree in Education. As we are a Christian and an all-English school, we are looking for a…
$1,485 - $1,655 a month
Quick Apply
6d
French Language Acquisition Teacher
Independent School —San Juan, PR
San Juan’s premier English-language, college preparatory independent school, is actively seeking highly qualified teaching candidates for the 2024-2025 school…
From $36,000 a year
Quick Apply
Perito Electricista
Planet Solar —Caguas, PR
Liderar y laborar en instalaciones de sistemas de energía fotovoltaica, utilizando materiales, equipos y herramientas, propios del oficio. *.
Estimated: $24K - $30.3K a year
Quick Apply
Legal Assistants
NSPR Law Services LLC —San Juan, PR
Preparing and filing documents with courts. Work Experience: * Client service, some legal background, or degree from an accredited university.
From $12 an hour
Quick Apply
Data Entry Specialist - Remote
ABC Legal Services —San Juan, PR
No experience necessary; data entry experience a plus. ABC Legal Service is proud to be the national leader in filing service of legal documents.
$12 - $14 an hour
Quick Apply
12d
Liberty Mobile PR - Retail Sales Associate Part-Time - Santa Rosa Mall, PR
My Wireless —Bayamón, PR
My Wireless, an authorized retailer for Liberty is an equal opportunity employer and does not discriminate against current and prospective employees based on…
From $20 an hour
Quick Apply
Service/Rental Hybrid Agent - Caparra (Ave. Roosevelt)
TARGET RENT A CAR —San Juan, PR
\* Validates customer identification and rental eligibility by examining customer's driver's license and entering credit card. *Drivers License (Up to date)*.
$10.65 an hour
Quick Apply
Oficinista
HR Business Solution —Bayamón, PR
Plaza part time, para trabajar martes y Jueves de 8:00am a 5:00pm. Grado Técnico o Asociado en Sistemas de Oficina.
$10.50 an hour
Quick Apply
5h
Administrative Assistant
ROBERTO PEREZ OBREGON LAW OFFICE —Bayamón, PR
Will be in charge of gathering, organizing, and entering information to assist in the electronic filing of the case; The Candidate chosen for this position:
From $460 a week
Quick Apply
4d
Apartment Cleaning Staff
Private Villas Puerto Rico —San Juan, PR
We are professional, customer-centric and our goal is to provide guests a with a comfortable and memorable experience.. Wash and dry towels and linens.
$20 - $25 an hour
Quick Apply
Sales Coordinator
Rimco LLC - Patrono con Igualdad de Oportunidades en el Empleo —San Juan, PR
Associate Degree and/or, two to three years of experience preferably in customer services, billing or related area.
From $11 an hour
Quick Apply
Customer Service Representative
Coca-Cola Puerto Rico Bottlers —Bayamón, PR
Take calls from customers and sellers who need order status or resolve situations related to the sale of products and services. Availability to work ON-SITE.
Estimated: $24.8K - $31.4K a year
Quick Apply
6d
Part Time Sales Representative - Liberty Mobile
My Wireless for Liberty Mobile —Bayamón, PR
Experience in prospecting through outbound calls. Train and develop your skills to become the best Liberty Mobile sales representative, which will allow you…
$20 - $27 an hour
Quick Apply
McDonalds Crew Member- Guaynabo, PR
McDonald's (Arcos Dorados) —Guaynabo, PR
Ofrecemos jornadas Part Time y Full Time y se acomodan a su disponibilidad. Para trabajar en Plaza Guaynabo, San Francisco, Santa Rosa y Jardines de Caparra.
$9.50 - $12.00 an hour
Quick Apply
Medical Receptionist
Caribbean Radiation Oncology Center —Bayamón, PR
The ideal candidate will provide quality receptionist services, including medical eligibility, scanning, provide appointments, answer phones, complete…
$10.50 - $11.50 an hour
Quick Apply
5h
Junior Accountant
LuvBuds, LLC —San Juan, PR
*Education:* Associate’s degree in Accounting, Finance, or a related field; Bachelor’s degree preferred. The Junior Accountant will support various accounting…
$15 - $17 an hour
Quick Apply
2h

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Medical Policy Analyst

Elevance Health - San Juan, PR

Apply Now

Job Details

Full-time Estimated: $71.3K - $90.3K a year 3 days ago

Benefits

Employee stock purchase plan
Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Bilingual
Public Relations
Spanish
Nursing
RN License
Bachelor of Science
English
Bachelor's degree
2 years

Full Job Description

MMM Holdings, LLC is a company that provides Medicare Advantage and Medicaid plans in Puerto Rico. Currently, MMM Holdings, LLC operates in Puerto Rico under Elevance Health, Inc. a leading health company dedicated to improving the quality of life of communities in the United States. Through its affiliated companies, they serve more than 118 million people.

Medical Policy Analyst

Location: This position will work on-site on Torre Chardon Building, Chardon Ave. 350 Suite 500 San Juan, Puerto Rico.

Schedule: This position will work a 1st Shift from 8:00 am- 5:00 pm Monday thru Friday. Additional hours or days may be required based on operational needs.

The Medical Policy Analyst is responsible for medical research and developing criteria for medical policies to be used by review, utilization, and case management nurses.

How you will make an impact

Primary duties may include, but are not limited to:

Review existing policies on a quarterly basis to ensure policy is update accordingly with latest version of the regulatory agency or other source as mentioned above.
Actively collaborates in the evaluation of new incoming CMS medical policies (NCD, LCD, Medicare manual and or Articles changes).
Support the clinical operations in the regulatory process; make all guidelines public. These include but is not limited to removal, replacement and or a new publication of policies.
Researches and evaluates medical claim issues against local and national Medicare policy guidelines.
Reviews new and updated codes for accuracy and consistency.
Researches relevant studies and reviews articles for development of local medical review policies and for responses to inquiries from providers.
Works with Medical Directors on development of local medical review policies.
Assists operations by reviewing complex and non-standard type of claims as related to a policy.
Codes changes into clinical systems using national coding structure for processing accuracy and clinical appropriateness once medical policy has been established by physician plan committee.
Serves as a liaison to business units for correct coding of clinical codes.
Researches questions and issues from internal physicians and nurses as they relate to developed medical policies.
Responds to internal and external requests that seek written clarification of a general or specific policy question.
The response may be reiteration of an established policy, a redefinition of the current policy, or research to determine a new or revised policy.

Minimum Requirements:

Requires a BA/BS degree and a minimum of 2 years related experience including clinical experience and may include operations experience; or any combination of education and experience which would provide an equivalent background.
Typically requires active state RN license.

Preferred Skills, Capabilities, and Experiences:

Bachelor's degree in a clinical healthcare discipline or nursing degree preferred.
Clinical licensure (PR registered nursing license) preferred.
Travels to worksite and other locations as necessary.
Fully Bilingual (English & Spanish). Must be able to write, read and speak both languages in a proficiency level.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

Apply Now

jobs in Bayamón, PR

Medical Policy Analyst

Chiropractic Associate Doctor

Bookkeeper/Accounting Auxiliary

Nurse Reviewer I (NCLEX)

4th-6th Grade Math Teacher

French Language Acquisition Teacher

Perito Electricista

Legal Assistants

Data Entry Specialist - Remote

Liberty Mobile PR - Retail Sales Associate Part-Time - Santa Rosa Mall, PR

Service/Rental Hybrid Agent - Caparra (Ave. Roosevelt)

Oficinista

Administrative Assistant

Apartment Cleaning Staff

Sales Coordinator

Customer Service Representative

Part Time Sales Representative - Liberty Mobile

McDonalds Crew Member- Guaynabo, PR

Medical Receptionist

Junior Accountant

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