- CommuniCare Health Services Corporate (Linthicum Heights, MD)
- …Biller to support our Central Billing Office team. PURPOSE/BELIEF STATEMENT The position of Managed Care Claims Validator / Biller is responsible for ... accurate and timely filing of all managed care claims on their...protocols, timely filing rules, etc. + Attend, Participate, and/or Lead facility Educational In-services when appropriate. + Attend all… more
- Cardinal Health (Annapolis, MD)
- …team is passionate about helping oncology practices navigate the future. The Director, Managed Care is responsible for strategy and management of managed ... responsible to implement strategic initiatives related to payer contracts. The Director, Managed Care contributes to practice growth and profitability by… more
- Takeda Pharmaceuticals (Annapolis, MD)
- …therapies to patients worldwide. Join Takeda as Associate Director, Global Labeling Lead where you will be responsible for the development and implementation of ... Cross-Functional Team (GLOC) + In alignment with TAU/MPD Labeling Lead , coordinates the process to obtain labeling approval by...labeling requirements to be provided to patients and Health Care Providers while minimizing the risk of write-offs. +… more
- Elevance Health (Hanover, MD)
- …or related field; minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical ... Provides analytic support during complex provider negotiations. + Analyzes claims experience to identify cost of care ...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- CareFirst (Baltimore, MD)
- …plan operations experience and 5 years administrative executive leadership experience in a managed care setting. Previous experience as clinic for a health ... Proficient in utilization management processes, quality assurance standards, and managed care . + Strong people management and...gets a message across. + General understanding of health care claims data, trend analysis, and insurance… more
- Elevance Health (Hanover, MD)
- …the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, ... resources.** **Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also... clinical experience or case management, utilization management or managed care experience; or any combination of… more
- Elevance Health (Woodlawn, MD)
- …the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, ... + Works with medical directors in interpreting appropriateness of care and accurate claims payment. + May... clinical experience or case management, utilization management or managed care experience; or any combination of… more
- Elevance Health (Hanover, MD)
- …the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, ... + Works with medical directors in interpreting appropriateness of care and accurate claims payment. + May...acute care clinical experience, utilization management or managed care experience; or any combination of… more
- Humana (Annapolis, MD)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex… more
- CVS Health (Annapolis, MD)
- …and health care industry + Three (3) or more years of experience in Managed Care + Board Certification in ABMS recognized specialty of Adult Psychiatry + ... for provider education regarding best clinical practices, utilization management, care management, claims adjudication, pharmacy utilization, quality… more
- Elevance Health (Woodlawn, MD)
- …the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, ... + Works with medical directors in interpreting appropriateness of care and accurate claims payment. + May... clinical experience. **Preferred skills, Capabilities, and Experience:** + Managed care experience is preferred. + Working… more
- CareFirst (Baltimore, MD)
- …to CareFirst indemnity business, ensuring that all appropriate materials, related claims , contracts, payment vouchers are included. Develop a summary/assessment of ... with contracts and or statutory requirements especially in the claims processing, preauthorization, appeals, credentialing, enrollment and service arenas all… more
- CVS Health (Annapolis, MD)
- …Minimum 3-5 years of clinical practice experience. Two (2) + years of experience in managed care (Medicare and/or Medicaid) Experience with managed care ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- HealthEdge Software Inc (Annapolis, MD)
- …Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care , and commercial payment methodologies, payment integrity, and ... root-cause issues areidentifiedand addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence. The complete… more
- Prime Therapeutics (Annapolis, MD)
- …and vendor partners to ensure the Strategic Solutions roadmap is created, managed , and executed timely within business and contractual requirements and in support ... software to solve analytic problems + Demonstrated influencing skills with the ability to lead and drive change + Proven ability in building a trusting and safe… more
- Prime Therapeutics (Annapolis, MD)
- …role will serve as a single point of contact for the state and all Managed Care Organizations (MCOs) to build strong relationships and drive partnership on ... of the account including financials, operations, and overall performance. This role will lead a team to develop and execute account plans including retention and… more
- Elevance Health (Hanover, MD)
- …Previous experience as a case manager is strongly preferred. + Previous Medicaid and/or Managed Care experience is very helpful. Please be advised that Elevance ... The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members...as applicable. + Assists in problem solving with providers, claims or service issues. **Required Qualifications** + Requires BA/BS… more
- The Cigna Group (Baltimore, MD)
- …pass government-issued background check (tier 2 suitability). + Intimate knowledge of managed care operations (contracting and provider relations) and outpatient ... Management Senior Manager will have oversight of the Military OneSource network and lead a multi-specialty team in support of MOS. Responsibilities include but are… more
- Humana (Annapolis, MD)
- …skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must ... The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director reviews cases of diverse… more
- Johns Hopkins University (Middle River, MD)
- …report work queue status. + Serve as a department representative on CPA-led Office of Managed Care call and provide a summary to management. + Identifies and ... processing of revenue cycle functions within the production unit. Responsible as a team lead in assisting in reviewing and analyzing the accuracy of staff work. Will… more