- LA Care Health Plan (Los Angeles, CA)
- Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department: Managed Long Term Services and Supports Location: Los ... Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical...and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM).… more
- RWJBarnabas Health (Elizabeth, NJ)
- Managed Care Specialist , OP Adult Partial HospitalReq #:0000172548 Category:Clerical / Administrative Support Status:Full-Time Shift:Day Facility:Trinitas ... Required: + High School Diploma required and one-year related experience required + Managed Care and Insurance experience required Preferred: + Passport software… more
- CaroMont Health (Gastonia, NC)
- …to be documented in patient medical record and shared with managed care organizations when requested. Assesses for best utilization regarding level of ... and reports avoidable days. Acts as liaison to managed care organizations. Communicates with attending physicians regarding utilization issues. Collaborates… more
- Hackensack Meridian Health (Hackensack, NJ)
- …& levels of appeal iv. Root cause analysis & trends v. Participation in Managed Care Contracting & distribution of contract terms where appropriate 7. ... **Overview** **The Senior Utilization Review Specialist collaborates with the...Management and Organizational Strategy a. Development & implementation of Utilization Management strategies to assure appropriate health care… more
- Hackensack Meridian Health (Hackensack, NJ)
- …& levels of appeal iv. Root cause analysis & trends v. Participation in Managed Care Contracting & distribution of contract terms where appropriate 7. ... **Overview** The Senior Utilization Review Specialist collaborates with the...Management and Organizational Strategy a. Development & implementation of Utilization Management strategies to assure appropriate health care… more
- Sharp HealthCare (San Diego, CA)
- …management.Assists other healthcare team members in keeping up with managed care policies specifically relating to drug utilization and reimbursement trends. ... members, and payers to ensure appropriate reimbursement and drug utilization . This member is expected to work effectively and...prior authorization process setting. Or 3 Years experience with managed care , PBM, Medicare Part D, Medicaid,… more
- FLACRA (Clifton Springs, NY)
- …NYS Driver's License. Job Requirements: Key Responsibilities: + Collaborate closely with Managed Care insurance providers to understand their policies, including ... Utilization Management Specialist Finger Lakes Addiction...clients. In this role, you will collaborate with the care team, clients, and families to ensure appropriate treatment… more
- MetroHealth (Brooklyn Heights, OH)
- **Value Based Contracting Attribution Specialist - Managed Care ** **Location:** **BROOKLYN HEIGHTS** **Biweekly Hours:** **80.00** **Shift:** **8am-5pm** **The ... payer partners, and transitions from Pre-Medicare coverage. Collaborates with Payer Strategy, Managed Care , and ACO leadership teams and conducting efforts… more
- Sutter Health (Berkeley, CA)
- …for level of care issues and length of stay as received from managed care or third party payors. Appeal adverse review decisions, notify appropriate staff ... case managers, clinical nursing staff and others to ensure appropriate utilization and quality care through utilization review, tracking and evaluation and… more
- UCLA Health (Los Angeles, CA)
- …Two or more years of experience in healthcare operations, managed care , or Medicare Advantage, preferably handling utilization management and PQI (potential ... Description As the Utilization Management & Quality Review Specialist , you will be responsible for: + Managing service requests and potential quality issue… more
- Westborough Behavioral Healthcare Hospital (Westborough, MA)
- …health care service delivery systems, and third party reimbursement; knowledge of managed care environment. + Ability to apply and interpret admission and ... Discount Program + Employee Assistance Program Job Description: The Utilization Review Specialist is responsible for monitoring...experience. + 2-3 years experience working as a UR Specialist , Medical Billing or health care quality… more
- ManpowerGroup (Columbia, SC)
- **Title: Coordinator, Managed Care I** **Location: 4101 Percival Road Columbia SC 29229 US (Hybrid)** **Duration: 04+ Contract** **Pay Range $25.00 to ... - 5:00 PM)** We are looking for a "Coordinator, Managed Care I" to join one of...manage health interventions, and ensure members receive quality, cost-effective care . The Clinical Review Specialist will review… more
- LA Care Health Plan (Los Angeles, CA)
- Care Management Specialist II Job Category:...care professionals in a hospital, medical group or managed care setting, such as a health ... to support the safety net required to achieve that purpose. Job Summary The Care Management Specialist II utilizes clinical skills and training to perform… more
- Novo Nordisk (Brooklyn, NY)
- …in the market to identify and leverage business opportunities + Analyze impact of managed care in the territory and its effect on prescribing decisions, and ... with other field-based employees (eg, DBMs, IDBMs, DCSs, IDCSs, Managed Markets Sales Team, Diabetes Educators, Medical Liaisons) covering...this job family are as follows: * Endocrinology Diabetes Care Specialist I - $87,000 to $103,000… more
- Novo Nordisk (Lebanon, PA)
- …of patients with obesity to maximize sales within an assigned territory. The Obesity Care Specialist (OCS) must achieve sales goals by implementing marketing and ... identify and leverage business opportunities + Analyze impact of managed care in the territory and its...PLEASE INCLUDE ALL POSITIONS IN JOB FAMILY * Obesity Care Specialist 1 - $87,000 to $106,000… more
- McLaren Health Care (Indianapolis, IN)
- …nursing facility or other health care setting. **Preferred:** + One (1) year Managed Care Utilization review experience + Experience and knowledge of the ... We are looking for a Intake Specialist to join us in leading our organization...and knowledge of Medicare, HMO, PPO, TPA, PHO and Managed Care functions (eg administration, medical delivery,… more
- Organon & Co. (Plymouth Meeting, PA)
- … while meeting the needs of customers. + Understanding of the local managed care and reimbursement environment relevant to various customer segments and ... their current practice structure, business model, and key influencers (ex: Managed Care Organization/payers, Management Service Organizations (MSOs), employers,… more
- Staffing Solutions Organization (Albany, NY)
- Senior Research Specialist - Aging & Long Term Care One Commerce Plaza, Albany, 99 Washington Ave, Albany, New York, United States of America Req #431 Thursday, ... LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed...clients and the people they serve. **Senior Healthcare Program Specialist - Aging & Long Term Care … more