- Northern Light Health (Bangor, ME)
- …when issues prevent attendance + Reviews material submitted by Health Plans and Managed Care Organizations to gain full understanding of benefit coverage and ... numbers are identified + Proper name format is consistently followed + Managed care organizations are correctly identified and selected as part of the… more
- Northern Light Health (Bangor, ME)
- …reading/initializing the minutes. + Reviews material submitted by Health Plans and Managed Care Organizations to gain full understanding of benefit coverage ... numbers are identified. + Proper name format is consistently followed. + Managed care organizations are correctly identified and selected as part of the… more
- LA Care Health Plan (Los Angeles, CA)
- …conducting financial audits. At least 5 years of related experience in the managed health care industry. Skills Required: Excellent analytical and critical ... $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created...members, we make sure our members get the right care at the right place at the right time.… more
- Molina Healthcare (Rochester, 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
- CommonSpirit Health (Phoenix, AZ)
- …and negotiation skills, a comprehensive understanding of healthcare reimbursement methodologies, managed care models, and regulatory requirements, and proven ... reimbursement rates associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives. + Review and accurately… more
- Illumination Foundation (Santa Ana, CA)
- …+ Recuperative care and health-related programs + CalAIM and other managed care -related programs, including Enhanced Care Management and Community ... oversight and coordination for CalAIM-related programs and other health plan or managed care contracts. + Ensure compliance with state, county, and managed … more
- UTMB Health (Stafford, TX)
- …United States** Physician UTMB Health Requisition # 2503005 The mission of Correctional Managed Care is to address the healthcare needs of underserved patient ... JOB FUNCTIONS_** **:** + Contribute to the success of the UTMB Correctional Managed Care operation. + Provides direct psychiatric care to assigned patients.… more
- Trinity Health (Troy, NY)
- …via computer. Pre-authorization and case management is done with reviewers at the Managed Care Organization that is responsible for approving a client's ... those determinations are made, presenting the clinical cases to insurers and managed care companies to secure authorizations for admission to treatment at the… more
- AbbVie (Denver, CO)
- …Commercial pharmaceutical industry experiences such as physician/account-based selling, training, managed health care or marketing preferred. English language ... key therapeutic areas - immunology, oncology, neuroscience, and eye care - and products and services in our Allergan...of your position is to satisfy all applicable health care industry representative (HCIR) credentialing requirements to gain and… more
- Healthfirst (FL)
- …and compliant with regulatory standards and timelines (eg, NYS DOH, CMS, Medicaid Managed Care Model Contract). + Ensure timely and accurate case documentation ... or a related field preferred. + 2+ years of experience in managed care , member services, or healthcare grievances or complaints resolution. + Working knowledge… more
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