- Diversicare Healthcare Services & Diversicare Ther (Birmingham, AL)
- …ensure the highest level of customer service to the managed care plan. * The case manager provides center case management/utilization review and ... expectations. **RN Case Manager ** Our case managers are accountable for the care ,...**Responsibilities** **Responsibilities** * This position requires multi-tasking to ensure managed care authorizations are received at the… more
- Humana (Kissimmee, FL)
- …+ A good understanding of AHCA regulations, NCQA and Medicaid guidelines + Managed care experience + Certified Case Manager (CCM) + Bilingual Creole or ... conditions, congenital conditions, developmental disabilities, and learning disabilities to care services. The ECC Case Manager...learning disabilities to care services. The ECC Case Manager (CM) assists families (if applicable)… more
- Corewell Health (Grand Rapids, MI)
- …and or case management/ managed care or related field + CRT- Case Manager , Certified About Corewell Health As a team member at Corewell Health, you ... license upon hire + 2 years of relevant experience, clinical nursing and or case management/ managed care or related field Preferred + 5 years of relevant… more
- Saint Francis Health System (Tulsa, OK)
- …Tulsa, OK Schedule: Monday - Friday | 8:00am - 5:00pm Job Summary: The Manager , Managed Care oversees the modeling, rate development and negotiation ... but not limited to the execution, implementation, and performance of all managed care agreements. Minimum Education: Bachelor's degree in Business Administration… more
- Cedars-Sinai (Los Angeles, CA)
- …people throughout Los Angeles and beyond. **Req ID** : 10223 **Working Title** : Program Manager - Managed Care (Hybrid) **Department** : MNS Managed ... **Job Description** The Program Manager is responsible for supporting all facets of...membership. + Monitors and Tracks all other aspects of Managed Care , quality & efficiency measures, Star… more
- City of New York (New York, NY)
- …(MCP), interfaces with managed care delivery systems comprised of Managed Care Organizations (MCOs) and case management providers through which ... Assistance Program (MAP), is recruiting for one (1) Administrative Manager NM-III, to function as the Executive Director, of...the Executive Director, of the Office of Mail Renewal, Managed Care Program (MCP), and Third-Party Health… more
- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Job Summary: Under the direction of the Sr. Managed Care Coordinator and Practice Manager initiate and process ... APG PCPs, patients and practice support staff to coordinate, and process all specialty care managed care referral authorization requests in compliance with… more
- CommuniCare Health Services Corporate (Akron, OH)
- …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 assigned caseload...cash collections team, CBO cash posting team, Business Office Manager , Regional Director of Finance, MDS, Case … more
- Henry Ford Health System (Troy, MI)
- …EDUCATION/EXPERIENCE REQUIRED: + Bachelor's degree in Finance, Accounting, Business Administration, Managed Care Contracting, Reimbursement, or related field. + ... GENERAL SUMMARY: Under minimal supervision of the Manager , independently leads financial and data analysis to...to seven (5-7) years of experience in healthcare finance, managed care contracting, or reimbursement in a… more
- Stanford Health Care (Palo Alto, CA)
- …social work, care coordination and discharge planning. + Knowledge of managed care and commercial insurance, MediCal, Medicare, and other third-party ... **A Brief Overview** This role independently supervises a multidisciplinary team including case managers, social workers, complex care managers and support… more
- ChenMed (North Miami Beach, FL)
- … Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired. We're ChenMed and we're transforming healthcare for ... facilities, as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves... givers, primary care physicians, specialists, other care providers, social workers, other case managers… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …other projects, work, and activities as assigned by the Pharmacy Director Qualifications: + Managed Care experience preferred, but not required + Part D Coverage ... and coding to be submitted to the Pharmacy Benefit Manager , New Contract Year formulary evaluation, and rebate strategy...of, or currently enrolled in, residency program (PGY1) in managed care pharmacy, or pharmacy practice. +… more
- Guthrie (Binghamton, NY)
- … Manager monitors clinical approaches and make recommendations for alternate levels of care . The Acute Case Manager collaborates cooperatively with the ... patient and members of the interdisciplinary health care team. The Acute Case ...positive and professional relationship with payers that supports continued managed care contracts. c) Articulates the primary… more
- Arnot Health (Elmira, NY)
- …participates in quality improvement and evaluation processes related to the management of patient care . The Case Manager will review all patients for ... Job Description MAIN FUNCTION: The Case Manager coordinates, negotiates, procures services...of care meetings related to the appropriate case managed population. d. Manages the appropriate… more
- Banner Health (Phoenix, AZ)
- …we want to hear from you. As the RN Case Manager in Care Coordination,...members of the health care team on case management and managed care ... positions require a minimum of one year Case Manager experience in an acute care hospital. PREFERRED QUALIFICATIONS Certification for CCM (Certified Case … more
- Providence (Santa Rosa, CA)
- …+ Master's degree for Case Management/ UM Review: Nursing or related field. + Certified Case Manager (CCM) or Accredited Case Manager (ACM) upon hire ... assures federal, state, and local contracts and grants are managed and required reporting is accurate and timely. Assists...in alignment with the Community Benefit strategic plan. The CARE Network provides community based comprehensive case … more
- Banner Health (Phoenix, AZ)
- …satisfaction, wellbeing and fulfilment of their employees. As the Registered Nurse RN Case Manager Care Coordination, you will have the opportunity ... members of the health care team on case management and managed care ...require a minimum of one year Case Manager experience in an acute care hospital.… more
- Banner Health (Tucson, AZ)
- …and resources that promote a healthy work-life balance. As the Registered Nurse RN Case Manager Care Coordination, you will have the opportunity to ... members of the health care team on case management and managed care ...require a minimum of one year Case Manager experience in an acute care hospital.… more
- InGenesis (Columbia, SC)
- …Identify and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). * ... InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will review… more
- Banner Health (Gilbert, AZ)
- …requirements. 6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts ... positions require a minimum of one year Case Manager experience in an acute care hospital. PREFERRED QUALIFICATIONS Certification for CCM (Certified Case … more
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