- Healthfirst (NY)
- …**Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations** + **Work experience interpreting and ... + **Deliver on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner** + **Ensure UM operations meet regulatory requirements… more
- Elderwood (Buffalo, NY)
- …(3) years nursing experience in home care , case management, discharge planning or managed care + Minimum of one (1) year experience working with a frail ... assessments in the Member's home to assess potential enrollees' appropriateness for Managed Long-Term Care (MLTC), or to reassess a member's status and needs. +… more
- Deloitte (Rochester, NY)
- …engagements focused on Medicaid reimbursement, including actuarial rate development across managed care and fee-for-service, Medicaid policy, budget forecasting ... health plan/insurance company experience + 2+ years of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development… more
- Sodus Rehab & Nursing Center (Tarrytown, NY)
- …& paperwork requirements + Maintain knowledge of regulations governing Medicare/Medicaid/ Managed Care reimbursement processes + Coordinate and implement ... + Maintain knowledge of Federal and State regulations and reimbursement processes ( Managed Care , Medicare, and Medicaid). + Effectively manage budgeted occupancy… more
- Humana (Albany, NY)
- …management, or similar activities **Preferred Qualifications:** + Knowledge of the managed care industry, Integrated Delivery Systems, health insurance, or ... staff to provide Humana members with optimal value based care in accordance with Medicare and Humana policy. All...a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial health insurance + Current and… more
- Healthfirst (NY)
- …RN Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations Leadership experience in managing, coaching and ... environment Understanding of health plans such as Medicare, Medicaid and//or Managed Long-Term Care Plan (MLTCP) Experience working as a case manager for a… more
- Highmark Health (Albany, NY)
- …year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or ... + Telephone Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None **Travel Required** 0% - 25% **PHYSICAL,… more
- Molina Healthcare (Rochester, NY)
- …in health care field including, but not limited to, provider's office, managed care , or other health care field. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS ... contracting with large specialty or multispecialty provider groups. * 1-3 Years Managed Care experience **PREFERRED EXPERIENCE** : Provider facing experience and… more
- ZOLL Medical Corporation (New York, NY)
- …+ Experience working with VA hospitals and the VA System and or large managed care organizations (ie, Kaiser, WellStar) preferred. + Two years minimum of ... multi-task and prioritize work. + Familiarity with clinical reimbursement, and managed care policies and procedures is highly desirable. + Above average… more
- Elmcrest Children's Center (Syracuse, NY)
- …to schedule and communicate with team when there are changes. + Completion of Managed care contact notes (progress notes) + Attending supervision and staff ... meetings as needed and requested. + Work cooperatively with the Supervisor, Medicaid Managed Care Liaisons, and potential Care Manager, on each case to… more