- Molina Healthcare (Queens, NY)
- …eligible recipients for enrollment into Government Programs such as Medicaid/Medicaid Managed Care , Child Health Plus and Essential Plan. Additionally, ... in selection of the appropriate health plan. The Enroller provides information on managed care programs and how to access care . The MFE is responsible… more
- New York State Civil Service (Albany, NY)
- …eMedNY. The selected candidate will aid in the development and issuance of Medicaid managed care audits; analyze data and make determinations on audit disputes, ... overseeing mail-out recovery projects. These audits recover improper payments made to managed care organizations when one Medicaid member is issued more than one… more
- Staffing Solutions Organization (Albany, NY)
- …and Oversight (DHPCO) in development, analysis and oversight associated with the Medicaid Managed Care Operating Cost Reports for Medicaid and Managed ... quarterly financial reports to collect financial information from the Medicaid Managed Care Organizations (MCOs) in NY inclusive of Medical Loss Ratio reporting… 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 ... related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's subject matter experts on:… more
- Humana (Albany, NY)
- …services such as inpatient rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed ... The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments… more
- Mount Sinai Health System (New York, NY)
- …+ Opportunity to work at the forefront of innovation in healthcare The Managed Care Contracting Team within MSHP is responsible for the negotiation, ... related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's subject matter experts on:… more
- Mount Sinai Health System (New York, NY)
- …and EHR systems. + Organizes routine meetings with health system business leaders and managed care to review payer issues and denials. + Builds effective, ... relationships with key stakeholders across departments (eg, DTP, Human Resources, Managed Care , Finance, and clinical departments) + Collaborates with… more
- Mount Sinai Health System (Astoria, NY)
- …and re-credentialing functions, including meeting requirements for government, commercial, managed care , and other health plan credentialing following ... **Responsibilities** + Ensure enrollments for new providers in Medicaid, Medicare, Managed Care plans, Commercial Health plans and Exchange plans. + Identify… more
- Grifols Shared Services North America, Inc (Albany, NY)
- …contract strategy, and represent needs of the customer. *Remain cognizant of managed care coverage throughout the business territory including major accounts ... approach to respond to business customers. The SSR will liaise with Marketing, Managed Markets, Operations, CL&D, Medical Affairs and Telesales to achieve the goals… more
- Molina Healthcare (NY)
- …* 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare ... discuss and resolve issues related to utilization management, pharmacy, quality of care , and correct coding. * Independently delivers training and presentations to… more