- MaineGeneral Health (Waterville, ME)
- …and Managed Care who will oversee all aspects of reimbursement, managed care contracts, and payer enrollment . The successful candidate will have ... the Charge Description Master (CDM) rate setting + Lead contract negotiations and manage payer relationships + Utilize Sorian...of 7 years of experience in healthcare reimbursement and managed care - some leadership experience is… more
- Penn Medicine (Philadelphia, PA)
- …extent possible each provider's effective date is on/before the provider start date; + Managed care payer enrollment is exported timely each month (or ... each day. Are you living your life's work? **Payer Enrollment Manager** Job Summary: + The Payer Enrollment...and billable Penn Medicine providers with 75 government and managed care payers, required in order to… 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 ... touch bases as required. + Monitors and tracks HMO enrollment by payor, line of business and physician for...+ Well versed within the various components that comprise Managed Care and its key concepts including… more
- ManpowerGroup (Columbia, SC)
- …partnered with a leading **Health Insurance company** in the **Columbia, SC (Onsite)** for a ** Managed Care Coordinator 1** role to assist their team. This is an ... on-site role. **Industry: Health Insurance Company** **Title:** ** Managed Care Coordinator 1** **Location: Onsite - (** **Columbia, SC** **)** **Duration:** **6… more
- ManpowerGroup (Columbia, SC)
- …assist their team. This is an Onsite role. **Industry: Healthcare Industry** **Title: Managed Care Coordinator UM II** **Location: ONSITE - Columbia SC** ... critical thinking skills. + Experience in case management or care coordination and telephonic care experience is...healthcare needs of our members **Notes:** + NON SCA CONTRACT TO HIRE MONDAY-FRIDAY, 8AM-4:30PM OR 8:30AM-5PM + PANEL… more
- US Tech Solutions (Columbia, SC)
- …reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease ... clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high… more
- Mount Sinai Health System (New York, NY)
- …leadership as well as the general IPA membership in all aspects of professional managed care contract support including issue tracking and resolution. 18. ... Office (CBO) and Change Departments with key aspects of Managed Care contracting support including communication, fee...the MSHP IPA in both communities. This position provides contract support for regional payers as well as preferred… more
- Sharp HealthCare (San Diego, CA)
- …Administration** **Benefit Engine for Tapestry** 3+ years' experience with Delegated Managed Care Industry Standards and Compliance requirements and ... intervenes as requested by management on vendor issues.Awareness of vendor contract clauses and intervenes as requested by management on contractual issues.Develops… more
- Prime Care Coordination (Webster, NY)
- …with Care Management by assisting Care Managers with their caseload of managed care members + Under the supervision of a licensed Care Manager ... Summary: The Care Manager Assistant assists the Care ...living and injury prevention for members + Participate in enrollment activities such as monitoring potential members and obtaining… more
- Hunterdon Health Care System (Flemington, NJ)
- …on site per week Job Description: Under the direction of the Director of Managed Care Contracting and Provider Relations, this individual is responsible for ... in responsible positions in healthcare or health plan environment, with financial and managed care contracting experience. ? The individual must have experience… more
- LA Care Health Plan (Los Angeles, CA)
- …Range: $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of ... health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: LA Care 's mission is… more
- TAD PGS, Inc. (New York, NY)
- …concern and/or problems to the attention of the Central Operations Supervisor. + Performs managed care education and enrollment services when call volume ... We have an outstanding Contract to Hire position for aCustomer Service Representativeto...event of problems or concerns. + Educates clients on managed care . + Assesses client's health … more
- Penn Medicine (Philadelphia, PA)
- …in support of payer delegated credentialing agreements + Budgets are developed and managed + Contract and vendor relationship is maintained for Penn Medicine's ... is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field… more
- Staffing Solutions Organization (Albany, NY)
- …Preferred: Experience or knowledge of NYS public health insurance programs (eg, Medicaid, Managed Long Term Care , CHPlus or Health Benefit Exchange. **Additional ... Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse… more
- Providence (Torrance, CA)
- …contracts. **Job Specific Knowledge, Skills and Abilities:** + Advanced knowledge of managed care principles and methodologies. + Experience with Cozeva ... these years at a Senior level Provider Relations role. + 5 years Managed care Provider Relations experience. **Preferred Qualifications:** + Bachelor's Degree in… more
- Molina Healthcare (Richmond, VA)
- …related field. **Required Experience** * 7-10 years experience in Healthcare Administration, Managed Care , and/or Provider Services. * 3-5 years experience with ... or related field. **Preferred Experience** Experience with Medicaid and Medicare managed care plans. **Preferred License, Certification, Association** N/A To… more
- State of Colorado (CO)
- …operations staff, as well as to external entities. + Review criteria for escalated managed care enrollment and claims payment requests based on program ... agents' performance under the terms and conditions of the contract . Additionally, the work unit directs and supports the...during the review. + Handle all claim types including managed care capitation payments related to Disabled… more
- Molina Healthcare (Columbus, OH)
- …of CPT, ICD-9, HCPCS and DRG requirements. + Two years of managed care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted ... requirements outlined below and in Appendix D of the contract for new members transitioning to the MCO from...to ensure a seamless transition and ensure continuity of care . + Provision of Member Information + Pre- Enrollment… more
- Spokane County (Spokane, WA)
- …the timelines established for service delivery and to meet the Washington State Health Care Authority (HCA), DOH, Managed Care Organization (MCO), and SCRBH ... and leave). The actual total will vary depending upon each employee's enrollment choices. Examples of Duties + Coordinates services with the Spokane Regional… more
- Humana (Oklahoma City, OK)
- …systems, adjudication, submission processes, coding, and/or dispute resolution + Understanding of managed care contracts, including contract language and ... interactions with Humana's Oklahoma Medicaid plan + Ensure compliance with Oklahoma's managed care contractual requirements for provider relations, such as… more