• Rady Children's Hospital San Diego (San Diego, CA)
    …department, this position requires proficiency in English and Spanish.** JOB SUMMARY: The Lead Care Manager (LCM) operates a as a member of the patient's Enhanced ... Care Management (ECM) team and is responsible for coordinating...agencies or community service providers that are engaged in care coordination activities. The LCM will enroll patients in… more
    DirectEmployers Association (12/12/25)
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  • Rady Children's Hospital San Diego (Temecula, CA)
    …health condition(s), reinforce teaching, and/or provide coaching to sustain teaching and Care Plan from Care Management Team, and help patients/families develop ... patient families to adopt healthy behaviors. The CHW supports providers and the Care Management Team through an integrated, holistic approach to care management… more
    DirectEmployers Association (12/12/25)
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  • Rady Children's Hospital San Diego (San Diego, CA)
    …diagnosis, family violence, child-protection, and bio-ethical issues - Experience working in an acute- care hospital setting - Registered as an ASW with the Board of ... family violence, child protection, and bio-ethical issues Experience working in an acute- care hospital setting Certification in Clinical Supervision in the State of… more
    DirectEmployers Association (12/12/25)
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  • Stony Brook University (Stony Brook, NY)
    …clinical and all potential medical interventions. + Demonstrates an understanding of managed care trends, payer regulations and Medicare/ Medicaid criteria for ... Training + Experience in Care Management + Experience in Managed Care /Insurance Industry/MD Office. + Certified in Case Management, UR, Quality or Risk +… more
    DirectEmployers Association (11/20/25)
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  • National Health Care Associates (Bloomfield, CT)
    …responsibilities + Thorough knowledge of Medicare, Medicaid, Pending, Applied Income, and Managed Care reimbursement regulations + Ability to manage multiple ... Work** Bloomfield is a proud affiliate of National Health Care Associates. As a Certified Great Place to Work,...our team! **-** Business Office Manager for Long Tem Care Center **What You'll Do:** As a Business Office… more
    DirectEmployers Association (01/06/26)
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  • Stanford Health Care (Palo Alto, CA)
    …area. + Knowledge of Medical Terminology such as Medicare, Medi-Cal, Workers Comp, Managed Care (HMO, PPO, POS, etc.), Children's Health Programs (CCS, GHPP, ... (United States of America) **This is a Stanford Health Care job.** **A Brief Overview** The Patient Access Services...coverage or existing financial resources to pay for medical care and services. Handles routine customer service inquiries and… more
    DirectEmployers Association (12/30/25)
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  • Stanford Health Care (Palo Alto, CA)
    …terminology, eligibility and enrollment requirements for Medicare, Medi-Cal, Workers' Comp, Managed Care (HMO, PPO, POS, etc.), Children's Health Programs ... (United States of America) **This is a Stanford Health Care job.** **A Brief Overview** The Patient Access Services...coverage or existing financial resources to pay for medical care and services. Handles routine and complex customer service… more
    DirectEmployers Association (12/16/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …experience in provider relations, network management, or healthcare operations within a managed care organization, health plan, or integrated delivery system. - ... vision and operational execution of provider relations for Commonwealth Care Alliance's SCO and One Care lines...for Commonwealth Care Alliance's SCO and One Care lines of business. This role is responsible for… more
    DirectEmployers Association (10/18/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …management Desired Experience (nice to have): - Experience working with managed care organizations, value-based programs, or community-based behavioral health ... for BH providers, promoting alignment with CCA's mission and supporting high-quality, coordinated care for members. In this role, the Program Manager acts as an… more
    DirectEmployers Association (10/18/25)
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  • Stony Brook University (Stony Brook, NY)
    …hospital computer systems such as Life Image. * Knowledge of insurance & managed care requirements. **Special Notes** **:** **Resume/CV should be included with ... Radiology Patient Care Coordinator - Temp At Stony Brook Medicine the Patient Care Coordinator receives patients in the Radiology Department for exams and… more
    DirectEmployers Association (12/13/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …Strong claims experience + Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare/Medicaid) + Experience in health plan ... for building, maintaining and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital,… more
    DirectEmployers Association (10/17/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …(must have):** + 5+ years of experience working within community-based health and/or managed care **Desired Experience (nice to have):** + Experience working ... can be shared with lower performing entities and with CCA's internal BH and Care Partnership teams + Determine regular cadence to check-in with lower performing HHs… more
    DirectEmployers Association (10/18/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …Bachelor's Degree or equivalent experience **Experience (Required)** + 3-5 years + Managed Care experience + Experience in health plan provider relations. ... responsible for cultivating, maintaining and strengthening relationships with the Commonwealth Care Alliance's (CCA) provider community. In this highly visible field… more
    DirectEmployers Association (10/18/25)
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  • Children's Hospital Los Angeles (Los Angeles, CA)
    …Statement/Position Summary:** This position is responsible for directing and coordinating the managed care policies, goals, and objectives related to contract ... Group leadership in working with Physician Organizations in the market regarding managed care contracts, strategies for improving market share and opportunities… more
    DirectEmployers Association (10/17/25)
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  • Katmai (Fort Carson, CO)
    …DUTIES & RESPONSIBILITIES** + Act as coordinator/liaison with providers, staff and Managed Care Support Contractor (MCSC) to ensure that actual health ... care received is appropriate to meet TRICARE beneficiaries' healthcare...alternatives in healthcare, such as Medicare, Medicaid, and TRICARE Managed Support Contractors for which beneficiaries may be eligible.… more
    DirectEmployers Association (11/26/25)
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  • Children's Hospital Los Angeles (Glendale, CA)
    …the billing and follow-up related to HMO's, PPO's, Medi-Cal, CCS, GHPP, PCCM's Managed Care and outside organizations. Responds to inquiries and resolves ... claims for inpatient and or outpatient billing for commercial and managed care payers. Familiarity with medical billing processes, insurance claims, and… more
    DirectEmployers Association (11/08/25)
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  • BeOne Medicines (Albany, NY)
    …Experience in specialty sales, with an understanding of reimbursement, distribution, and managed care processes as well as an understanding of national/corporate ... accounts, managed markets, hospital markets, sites of care , IV medications, injectables, orals, Medicare Part D, etc. + Ability to measure and analyze key… more
    DirectEmployers Association (01/06/26)
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  • BeOne Medicines (Indianapolis, IN)
    …Experience in specialty sales, with an understanding of reimbursement, distribution, and managed care processes as well as previous national/corporate accounts, ... managed markets, hospital markets, various sites of care , IV medications, injectables, orals and Medicare Part D, etc. + Ability to measure and analyze key… more
    DirectEmployers Association (01/05/26)
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  • COOLSOFT (Richmond, VA)
    …its data and works closely with the business teams, MES Technical teams and managed care plans to determine requirements for CRMS system enhancements. Must have ... interfaces between different MES modules and external trading partners such as Managed Care Plans. Looking for someone with prior technical experience as a… more
    DirectEmployers Association (12/31/25)
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  • Organon & Co. (Annapolis, MD)
    …**Required Education, Experience and Skills** + BA/BS. + Two plus years of managed care account manager or equivalent experience. + Customer knowledge and/or ... analytical capabilities. + Highly developed Leadership Skills. + Working Knowledge: Managed Care Operations, Contracting Strategy, Healthcare Systems Structure… more
    DirectEmployers Association (11/26/25)
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