- Mount Sinai Hospital (New York, NY)
- … personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management , Managed Care Contracting and other institutional departments ... of Case Management to maintain, review and update all Case Management specialty policies in accordance with hospital , professional and regulatory standards.… more
- Mount Sinai Hospital (New York, NY)
- …clinical, contracting, finance, IT, analytics, operations, and product development expertise. The Managed Care Contracting Team within MSHP is responsible for ... compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's subject matter experts… more
- Sheppard Pratt (Amesbury, MA)
- …regarding new and/or revised procedures and programs. Works with staff of the Managed Care Contracting office in response to requests for information, ... to the Hospital for Inpatient and Day Hospital levels of care . Trains or ensures...review assignments. Assists Utilization Review Coordinators and Financial Case Management Representatives in resolving problems. Reviews all cases for… more
- Ann & Robert H. Lurie Children's Hospital of Chicago (Chicago, IL)
- …ICD-10 coding, medical terminology, third party billing and collections, and managed care requirements. 4. Excellent communication/listening skills. 5. Ability ... Ann & Robert H. Lurie Children's Hospital of Chicago provides superior pediatric care...patient accounting, third party payer procedures, governmental regulations and managed care contracting to be effectively proactive… more
- Henry Ford Hospital (Detroit, MI)
- …in discharge planning, home health care , rehabilitative medicine, community health, or managed care is preferred. Client Details Address 2799 W. Grand Blvd, ... Details Client Name Henry Ford Hospital Job Type Travel Offering Nursing Profession RN...rotating weekends Experience: Minimum 5 years of inpatient case management experience License: Current valid RN licensure or LMSW… more
- Adventist Health (Bakersfield, CA)
- …professionals and award-winning quality since 1910. We are comprised of a 254-bed acute care hospital and 20 primary and specialty care medical offices. ... experience: Preferred One year leadership experience: Preferred Licenses/Certifications: Project Management Professional (PMP) Certification: Preferred Essential Functions: Collects, measures,… more
- Copious Staffing Solution (Houston, TX)
- About the job Director, Care Management The Director of Care Management is responsible and accountable to work with the Directors of Case Management ... management program Three (3) years of experience in hospital -based nursing or social work preferred Knowledge of leading...in business planning, and targeted outcomes Working knowledge of managed care , inpatient, outpatient, and the home… more
- Cooper University Hospital (Camden, NJ)
- …(ie Excel, Word, PowerPoint); Ability to perform mathematical calculations; Knowledge of managed care insurances, ICD-9 and CPT coding; Ability to communicate ... About Us At Cooper University Health Care , our commitment to providing extraordinary health...customer service. Interfaces with all levels of staff and management . Experience Required 5+ years billing/patient accounting experience. Education… more
- Texas Children's Hospital (Bellaire, TX)
- …and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our ... daily operations of the ADM, reports, audits and database management . Think you've got what it takes? Job Duties...Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary… more
- University of Illinois Hospital and Health Sciences System (Peoria, IL)
- …relationships as needed to meet strategic needs of the MSP. Negotiate with managed care organizations. Ensure that review of monthly financial reports is ... accounting and UIC regulations, guidelines, and policies. Collaborate with the MSP Management and Advisory Committee to Develop and maintain an effective and… more
- Capital Health (Trenton, NJ)
- …all implant or trailer services as outlined by work lists, management and hospital managed care contracts through access to multiple systems. Gathers and ... physicians and other providers who offer primary and specialty care , as well as hospital -based services, to...implant and trailer billing procedures, as required by the hospital 's managed care contracts. Identifies… more
- Novo Nordisk Inc. (Traverse City, MI)
- …in order to influence formulary status, as applicable May analyze impact of managed care in the territory and its effect on prescribing decisions, ... Novo Nordisk, we are the world leader in diabetes care and a major player in defeating other serious...strategies May develop and utilize relationships with specialists, key hospital decision-makers, and other individuals who make or influence… more
- Thomas Jefferson University Hospitals, Inc. (Philadelphia, PA)
- …preferred. Skills/Abilities: Must present polished professional image. Thorough understanding of managed care systems and utilization review criteria Recent ... Nurse is responsible assure cost effective, quality utilization management in the acute level of care ... Knowledge of health insurance including Medicare, Medicaid and managed care Ability to work and communicate… more
- Illinois Bone and Joint Institute LLC (Glenview, IL)
- … managed care basics, and experience working with a managed care and Medicare population Knowledge of practice management and EHR software Able to ... two years of experience in a physician office or hospital preferred. Previous experience working in Urgent Care...Must be a self-starter, highly organized with good time management skills. Able to multi-task and work in a… more
- Baystate Health (Springfield, MA)
- …the management of care for a defined group of patients including complex care management , transitions of care , as well as coordination of care . ... Major responsibilities include accurately identifying patients for care management , developing individualized plans of care , assessing/addressing barriers to… more
- UPMC Senior Communities (Pittsburgh, PA)
- …Plan liaison. Coordinates care and services across the continuum of care with case management , physicians, pharmacy, behavioral health, and other providers ... standard daylight hours, Monday through Friday, onsite at Shadyside Hospital . The Health Plan Specialist will act as a...6 years of experience in medical social work, home care , discharge planning, and case management required.… more
- Sutter Health (Sacramento, CA)
- …Knowledge Deep understanding of pharmaceutical care within managed care , including benefit design, utilization management , formulary management , and ... California, serving over 3.5 million patients through a network of hospitals, clinics, and care services. With a legacy of more than 100 years, our 57,000+ employees… more
- Health Care District (Palm Beach, FL)
- …the EHR including rescheduling patient noshows. Verifies patients' insurance benefits including primary care provider for any managed care plans. Assists ... required of the incumbent that includes assisting community or hospital -based organizations or the Red Cross. Staff will be...of duties does not exclude them from the position. Management of the Health Care District of… more
- NYULMC (New York, NY)
- …Patient Safety initiatives and reporting *Supports key quality initiatives (eg MIPS, Care gap management ) to impact clinical outcome measures. *Demonstrates ... lines and manages complications with appropriate certification Communication and Message Management *Ensures clinical in-baskets are managed and encounters… more
- Vinfen (Hyannis, MA)
- … Manager - Registered Nurse (RN) on the Community Partner team provides clinical care management and intensive care coordination for people with complex ... needs and goals Obtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant...or disability status. Keywords: RN jobs, Registered Nurse, Clinical Care Management , ACO, Medicaid, Care … more
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