- Pfizer (Albany, NY)
- …as appropriate. The individual may be involved in presentations to payers, managed care organizations, formulary decision makers and regional medical advisory ... of the following: + Clinical, formulary, and/or other management experience + Managed Care , pharmaceutical industry, and/or Quality Improvement + Data Analytics… more
- Highmark Health (Albany, NY)
- …Consulting or related area + 3 years Value-based reimbursement, through managed care contracting, provider reimbursement, consulting, population health delivery ... both the return on investment (ROI) and other decisions on the payer partnership constructs. These new approaches require new operational capabilities, and this… more
- Guthrie (Binghamton, NY)
- …b) Maintains a positive and professional relationship with payers that supports continued managed care contracts. c) Articulates the primary objectives of ... in an acute care setting with strong care management, utilization review, and payer knowledge....and community providers. a) Works closely with the Medical Director and other members of the healthcare team to… more
- Mount Sinai Health System (New York, NY)
- …pharmacy group. 11.Obtains prior authorizations from intermediaries and payers, including managed care companies, insurance companies or others as appropriate. ... **Job Description** Under direct supervision of the Director of Specialty Pharmacy, the Specialty Pharmacy Manager...years of retail pharmacy technician experience or related health care administrative, and a strong familiarity with the prior… more
- Mount Sinai Health System (New York, NY)
- …timely charge capture. + Organizes routine meetings with health system business leaders and managed care to review charge and revenue capture and performance. + ... Senior Revenue Analytics Associate will report to the Senior Director of Revenue Analysis and Reporting of the MSHS....with key stakeholders across departments (eg, DTP, Human Performance, Managed Care , Finance, and clinical departments) +… more
- NYU Rory Meyers College of Nursing (New York, NY)
- …identifying contractual variances between posted and expected reimbursement for Article 28, Managed Care , Commercial Insurance and other payers. Analyze, audit ... and experience. Required Skills, Knowledge and Abilities: Knowledge of guidelines of managed care and claims guidelines and ability to identify trends/issues… more
- Mount Sinai Health System (New York, NY)
- …and governmental programs, regulations, and billing processes (eg, Medicare, Medicaid, etc.), managed care contracts and coordination of benefits is required. ... and reimbursement. This position will report to the Senior Director CDM of the Mount Sinai Health System This...payers, applicable federal and state regulations, healthcare financing and managed care . ? Expected to stay updated… more
- Ellis Medicine (Schenectady, NY)
- …and/or linkage to community resources, medical insurance coverage - Medicaid, managed care /dual-eligible parameters; etc. + Actively assists and facilitates ... and federal regulations to ensure most appropriate level of care to conserve patient, payer and hospital...+ Tracks inappropriate admissions and escalates cases to the Director to facilitate process improvements and/or education. + Performs… more
- Guthrie (Corning, NY)
- …c) Maintains a positive and professional relationship with payers that supports continued managed care contracts. d) Articulates the primary objectives of ... most appropriate cost. a) Works closely with the Medical Director and other members of the healthcare team to...for communication for healthcare team members, patient, provider, and payer . b) Maintains accountability for coordination of care… more
- Cognizant (Albany, NY)
- …Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in health ... management and managing clinical denials from Providers to the Health Plan/ Payer . The comprehensive process includes analyzing, reviewing, and processing medical… more