- WTW (New York, NY)
- …Wealth and Career and Risk and Broking. The Managed Care Growth Leader is the primary client lead managing the totality of the Willis Towers Watson ... (WTW) relationship for clients within the Managed Care Industry. This individual is accountable...business while managing existing revenue and profit streams + Lead the development and execution of client account plans… more
- Humana (Trenton, NJ)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Amneal Pharmaceuticals (Bridgewater, NJ)
- Description: The primary responsibilities of the Manager, Managed Care Rebates, are to provide management, mentoring, and training analysts as needed and ensure ... role will be responsible for leading and supporting the Managed Care claims processing, contract maintenance, formulary...active role in the closing process. The Manager will lead , manage, develop and motivate individuals to collectively build… more
- Hackensack Meridian Health (Edison, NJ)
- …applicable. + Write Care Plans in EPIC Healthy Planet for high-risk patients being care managed . + Other duties and/or projects as assigned. + Adheres to HMH ... our mission to transform healthcare and serve as a leader of positive change. The ** Care Coordinator...Registered Nursing Program. + Minimum 2-3 years experience in managed care or health education/coaching is preferred.… more
- Centene Corporation (New York, NY)
- …guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities ... State RN License.** **Position Purpose:** Assesses, plans, and implements complex care management activities based on member activities to enable quality,… more
- Hackensack Meridian Health (Edison, NJ)
- …(BSN) or 1 year experience for non BSN HackensackUMC employees. + Knowledge of managed care principles. + Knowledge of Quality Improvement Program - New Jersey ... our mission to transform healthcare and serve as a leader of positive change. The **Nurse Navigator, Transitions of... of positive change. The **Nurse Navigator, Transitions of Care ** is a member of the healthcare team and… more
- City of New York (New York, NY)
- …State agencies (eg, SDOH, SOMH, OASAS, OPWDD), community health, mental health, and managed care organizations around child mental health services at DHS. ... of succeeding in permanent housing and independent living, improving access to care and health outcomes for low-income and vulnerable populations. The Office brings… more
- City of New York (New York, NY)
- …impact of the 2022-2027 NYS Medicaid 1115 Waiver on public health outcomes. - Lead managed care collaboration initiatives for COVID-19 management and ... Local, State, and Federal legislation, policies, and programming. Medicaid Managed Care and Medicare Advantage payment and...78], Local Law 52 Local Law 163, etc.). - Lead efforts to maximize impact of NYS AHEAD model.… more
- Dr. Reddy's Laboratories (Princeton, NJ)
- …contracting dynamics in the Buy & Bill Biologics space. Strong expertise in managed care landscape across medical and pharmacy benefit, commercial and government ... unmet medical needs, we are dedicated to helping people lead longer and healthier lives. We are seeking dynamic...+ Monitor key external trends in the areas of managed care , reimbursement and other healthcare policies… more
- Erickson Living (Tinton Falls, NJ)
- …informational and developmental meetings to include Medicare and Medicaid coverage changes, Managed Care information, and other pertinent information for family ... Seabrook Village by Erickson Senior Living Seabrook is seeking a strong sales leader who will be responsible for developing and maintaining maximum census in… more
- Cardinal Health (Trenton, NJ)
- … leader responsible for leading all aspects of Navista's Physician Office's revenue cycle, managed care and value based care programs and services. Key ... developing team members, and innovation + Develops and implements managed care contracting strategy including implementation of...with the payer, provider, and service partners to enhance care delivery and provider support. + Lead … more
- Mount Sinai Health System (New York, NY)
- …clinical, contracting, finance, IT, analytics, operations, and product development expertise. The Managed Care Contracting Team within MSHP is responsible for ... Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as...Issues: * Proactively escalate issues to Directors that could lead to significant legal ramifications or require intervention by… more
- Humana (Trenton, NJ)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Humana (Trenton, NJ)
- …services (such as inpatient rehabilitation). **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Humana (Trenton, NJ)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an… more
- Zurich NA (Trenton, NJ)
- …profitability goals and ensure the delivery of quality, cost effective services to our Managed Care stakeholders. You will act as a subject matter expert and ... the AVP of Utilization Review & Pharmacy, you will lead and direct a team of Utilization Review and...technical resource to Managed Care stakeholders regarding operational and regulatory… more
- Molina Healthcare (New York, NY)
- …and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 8+ years of Medicaid managed care experience or in an equivalent related field * Ability ... with Medicaid Proposals and/or business development and requires demonstrated Medicaid managed care experience comprised of technical operational, sales, growth,… more
- Molina Healthcare (New York, NY)
- …and evidence-based guidelines. + Experience in Utilization/Quality Program management + HMO/ Managed care experience **PR** **E** **FE** **R** **RED L** ... and action plan, which includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate care at the most… more
- Molina Healthcare (New York, NY)
- …guidelines. + Experience in Utilization/Quality Program management + HMO/ Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** ... and action plan, which includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate care at the most… more
- Evolent (Trenton, NJ)
- …and proficiency + Personally initiate and foster executive level relationships at managed care organizations and large provider groups + Collaborate with ... proven success with complex, multi-million-dollar enterprise sales + Knowledge of the managed care and provider markets (both payers and risk-bearing… more