- 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
- 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)
- …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
- Spokane County (Spokane, WA)
- …agency policy. + Provides individual, family, and group counseling. + Practices standards for managed care as it applies to clinical practice. + Provides person ... The actual total will vary depending upon each employee's enrollment choices. Examples of Duties Behavioral Health Agency Clinical...substance use disorder symptoms and diagnoses. + Knowledge of managed care and utilization review required. +… more
- MyFlorida (Tallahassee, FL)
- …Statewide Medicaid Managed Care (SMMC) Plan Communications (ie, Dear Managed Care Plan letters, contract interpretations, policy transmittals, and ... managed care report guide, Medicaid contracts and amendments; Dear Managed Care Plan letters, contract interpretations, policy transmittals, and… 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
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- Summary The primary functions of the incumbent are to assist the Primary Care / Managed Care Product Line (PC/MC PL), in providing advisory and technical ... is assigned as a Program Assistant in the Primary Care Managed Care Product Line...the accountability of over 23 million dollars for CBOC contract services. The incumbent obtains information from the various… more
- Northwell Health (New York, NY)
- …to various inquiries from participating physicians, network staff, hospital staff, and managed care companies. + Resolves issues related to credentialing, ... managed care participation, claims payment, demographic changes, referrals, and accessibility. + Responds to physician requests, provides updates and resolves… 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
- Elevance Health (Miami, FL)
- …+ Service delivery coordination, discharge planning, or behavioral health experience in a managed care setting preferred. + RN, LSW, or LPN/LVN license ... supporting the development, implementation, and coordination of a comprehensive health care program in which members' needs are identified, including physical… more
- Molina Healthcare (Meridian, ID)
- …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
- Mount Sinai Health System (New York, NY)
- …? Experience working in healthcare provider analytics related to revenue modeling, managed care contracting, population management, case management, clinical or ... Hospital **Responsibilities** 1. Analyzes data requests using information technology, enrollment , claims, pharmacy, clinical, contract , medical management,… more
- Matrix Providers (Aurora, CO)
- …Basic Life Support Certified/certification eligible in relevant specialty such as: + Certified Managed Care Nurse through the American Board of Managed ... - Utilization Management to join our team of talented professionals who provide health care services to our Military Service Members and their families in at Buckley… more