- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …administration, finance, or a related field required. + 7-10 years of experience in managed care contracting, network management , or payer relations within ... + GENERAL SUMMARY + The Leader, Managed Care Contracting, is responsible for...responsible for all aspects of payer contract negotiations, network management , and strategic partnerships for an integrated pediatric healthcare… more
- Beth Israel Lahey Health (Boston, MA)
- …, number of visits being authorized. + Communicates with managed care payers to resolve patient referral management issues. As appropriate, coordinates ... Access. **Preferred Qualifications:** + Two years of experience in referral management or insurance managed care environment. + Basic and complex medical… more
- Fairview Health Services (St. Paul, MN)
- …ultimate accountability for effective and timely execution of all managed care contract negotiations and contract execution for hospital , physician and ... accountable for achieving budgeted net revenue expectations for all managed care contracts; assesses, evaluates, and directs... Management , elevates strategic and tactical decisions of managed care relationships to achieve alignment and… more
- Prime Healthcare (Ontario, CA)
- …This position is full-time in office only. Qualifications + Minimum of three years hospital managed care /commercial collector experience. + 2 years of recent ... hospital managed care billing experience in an automated environment. + Associates degree or equivalent work experience required. + Knowledge of contract… more
- AdventHealth (Maitland, FL)
- …. Minimum 5 years of healthcare experience with 1 year directly related to hospital medical staff or managed care credentialing and/or provider enrollment. ... of record. . Achieves productivity standards as determined by management . . Identifies issues that require additional investigation and...Degree in healthcare . 4 years directly related to hospital medical staff or managed care… more
- Cedars-Sinai (CA)
- …service the network's membership. + Monitors and Tracks all other aspects of Managed Care , quality & efficiency measures, Star ratings, access, physician network ... user or client acceptance. + Well versed within the various components that comprise Managed Care and its key concepts including but not limited to eligibility,… more
- UPMC (Altoona, PA)
- UPMC Altoona Regional Health Services is hiring a full-time Managed Care Specialist. This role will work Monday through Friday 7:30 am to 4:00 pm. This position ... to provider or facility performing test/procedure. + Understands roster management and is able to assist with it as...messages appropriately. + Insures timely flow of information regarding managed care contacts and/or patients to specialist,… more
- Trinity Health (Fresno, CA)
- …care continuum for CVHP members. This includes discharge planning, utilization management , care coordination, and support for resource utilization. This ... professional agencies, familiarity with federal and state regulations governing hospital and home care , as well as understanding of the financial structure of… more
- Sutter Health (Sacramento, CA)
- …of opportunities for improvement. Interacts with local and corporate leadership, other management support staff, third party payer staff, inside and external legal ... and modeling. + Must have thorough knowledge of the hospital accounting systems and audit processes in order to...Must be able to work with all levels of management and translate complex rules and regulation issues, requirements… more
- Mount Sinai Health System (New York, NY)
- … personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management , Managed Care Contracting and other institutional departments ... Life Saver (BLS) Issuing Agency: AHA Non-Bargaining Unit, 329 - Case Management - MSH, Mount Sinai Hospital **Responsibilities** 1. Attends interdisciplinary… more
- Whidbey General Hospital (Coupeville, WA)
- …anti-biotic regime, etc. The RN - Care Manager follows the hospital 's Case Management /Utilization Plan that integrates the functions of utilization review, ... patient's care delivery process while in the hospital , as well as performs denial management ...throughput and assure that the organization and the patient's care are managed in the most efficient… more
- ChenMed (St. Petersburg, FL)
- …perform the follow up patient visits, once patient has completed their episode of care management the register nurse (RN) will review patient chart for discharge ... management theory and practice. + Knowledge of patient care charts and patient histories. + Knowledge of clinical...Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired. We're ChenMed… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …utilization management and/or discharge planning experience. Thorough knowledge of managed care , utilization management , discharges planning, and ... the top 10 pediatric hospitals in the nation, Children's Hospital Los Angeles (CHLA) provides the best care...the multidisciplinary team to develop and implement a case management plan to ensure quality patient outcomes, and customer… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …pathways; or Quality/Utilization Management and/or Review. Ability to utilize managed care , utilization management , and discharge planning concepts. ... the top 10 pediatric hospitals in the nation, Children's Hospital Los Angeles (CHLA) provides the best care... Hospital Los Angeles (CHLA) provides the best care for kids in California. Here world-class experts in… more
- Bon Secours Mercy Health (Fairfield, OH)
- …** **Essential Job Functions** + Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial, ... indicated or when patient condition changes. Completes all necessary care management documentation. Handovers are expected to...to disciplines as indicated. Documentation will reflect plan of care to address post- hospital care … more
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- …Safety and Health Administration, public relations, effect on the other hospital activities, and economic impact. Establishing personnel management policies ... Available Virtual: This is not a virtual position. Position Description/PD#: Hospital Housekeeping Officer (Chief of Environmental Management Services)… more
- Omaha Children's Hospital (Omaha, NE)
- …requirements and standard practices. + Ability to review, interpret and implement managed care contracts with third-party including governmental payers. + Foster ... across all pediatric services. Operating units of responsibility includes Social Work, Case Management , Utilization Management , Spiritual Care , Child Life &… more
- Children's Hospital Boston (Boston, MA)
- …and safety planning. + Developing and maintaining a thorough knowledge of the various managed care health insurances and their provider networks. To qualify, you ... Hours per Week:40 Job Posting Category:Social ServicesJob Posting Description:The Pediatric Intermediate Care Unit (PIMCU) at Boston Children's Hospital is an… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …HMO, Medi-Cal/Medicare and health services. Knowledge of principles and practices of health care service delivery and managed care , Medi-Cal eligibility and ... The PCC will identify and reduce barriers to members' care , assist the member in locating and accessing resources,...system. The PCC may work closely with member's case management team to resolve member concerns, access, medical and… more
- Penn Medicine (Philadelphia, PA)
- …employees in the specific areas. Monitors quality of work and compliance with managed care protocols. Provides assistance to staff to ensure compliance with ... Departments and the Crises Response Center (CRC) within Pennsylvania Hospital (PAH). The Emergency, Admissions and CRC Departments are...that the staff are up to date with all managed care guidelines, contracts of acceptable and… more
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