- Evolent (Albany, NY)
- …and proficiency + Personally initiate and foster executive level relationships at managed care organizations or health systems and large provider groups ... cycles requiring diverse stakeholder management + Knowledge of the managed care and provider markets (both payers...for healthcare and subscribed to the vision of value-based care + Strong familiarity with risk-based contracting … more
- Molina Healthcare (Rochester, 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, for example. + Independently delivers training and… 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 Long ... quarterly financial reports to collect financial information from the Medicaid Managed Care Organizations (MCOs) in NY inclusive of Medical Loss Ratio reporting… more
- Evolent (Albany, NY)
- …discussions . Experience building and developing team members . Knowledge of the managed care and oncology market trends (both payers and risk-bearing ... organizations) . Passion for healthcare and subscribed to the vision of value-based care . Strong familiarity with risk-based contracting . Thrives in an… more
- Molina Healthcare (Albany, 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
- Molina Healthcare (Yonkers, NY)
- …10+ years relevant experience, including 5+ years of clinical practice and 3+ years HMO/ Managed Care experience **OR** 5 years experience as a Molina Medical ... inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that authorization decisions are rendered… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …exams. + An understanding of health insurance & health insurance products, managed care , accounting principles, the competitive market, the legislative ... of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting , Analytics & Data Technology, Population Health Engagement, Marketing &… more
- Kaleida Health (Buffalo, NY)
- …outlook required. 8 years of experience in multi- hospital system and / or managed care required. 10 years of experience in Federal, state and accreditation ... reimbursement methodologies, coverage issues, documentation, coding conventions and insurance / managed care practices including but not limited to: utilization… more
- SUNY Upstate Medical University (Syracuse, NY)
- …established criteria. Obtain prior authorization from intermediaries and payers, including managed care companies, insurance companies, and review organizations. ... Experience with healthcare insurance prior authorization/coding and performing insurance carrier/ managed care review preferred. National Pharmacy Technician… more
- Molina Healthcare (Albany, NY)
- …equivalent combination of education and experience **Required Experience** * 5-7 years managed care experience, including min. 2 years of supervisory experience ... Association** N/A **Preferred Education** Bachelor's Degree **Preferred Experience** * 7+ years managed care experience * QNXT; SQL experience * Crystal Reports… more