- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and ensure evidence-based treatment is being applied. An experienced case manager with managed care experience will be successful in this role. This position ... the US Preferred Skills and Experience * 2+ years of managed care experience; eg case management/health coach, utilization management and/or auditing experience… more
- Pacific Medical Centers (Seattle, WA)
- **Description** Responsible for maintaining and updating the GE/Centricity/IDX Managed Care Application (MCA) module for US Family Health Plan's managed ... as required by URAC. + Minimum of four years' experience in managed care operations or large group practice setting. + Microsoft SQL Server experience… more
- CVS Health (Tallahassee, FL)
- …training in a medical specialty). * Three 3+ years of experience in the managed care industry. * Experience in leading interdisciplinary teams. * Solid ... understanding of and concurrence with evidence-based medicine (EBM) and managed care principles. * Ability to travel on as needed basis; planned and scheduled in… more
- Penn Medicine (Philadelphia, PA)
- …practice revenue cycle management/oversight. Ensure practice alignment with all standards. + Managed Care /Payer Management - Support implementation of managed ... our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future...+ 10+ = # of staff directly and indirectly managed . + 15,000+ = # of budgeted annual visits.… more
- University of Southern California (Alhambra, CA)
- …MCG reviews are completed within 24 hours of admission; Observation patients are effectively care managed on a daily basis; and Facilitate throughput and timely ... ER Visits, Hospital admissions, or Re-admissions. 4. Maintains awareness of current managed care contract requirements. 5. Coordinate the management of all… more
- HCA Healthcare (Nashville, TN)
- …status. + Works to ensure that patient treatment is reimbursed by contacting managed care organizations and completing initial utilization review. Documents in ... Demonstrates interpersonal skills necessary to advocate for patients in regard to managed care organizations + Conducts utilization review for managed … more
- Houston Methodist (The Woodlands, TX)
- …services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and state and ... tasks and role components + Knowledge of Medicare, Medicaid and Managed Care requirements + Comprehensive knowledge of community resources, health care… more
- Mount Sinai Health System (New York, NY)
- …effectively. . Organize routine meetings with health system business leaders and managed care teams to review authorization performance, payer issues, and ... relationships with key stakeholders across departments (eg, DTP, Human Performance, Managed Care , Finance, and clinical departments). . Collaborate with… more
- Penn Medicine (Philadelphia, PA)
- …practice revenue cycle management/oversight. Ensure practice alignment with all standards. Managed Care /Payer Management - Support implementation of managed ... our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future...* 10+ = # of staff directly and indirectly managed * 15,000+ = # of budgeted annual visits… more
- Houston Methodist (Houston, TX)
- …by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, state, and federal ... national coverage determinations + Comprehensive knowledge of Medicare, Medicaid, and Managed Care requirements + Comprehensive knowledge of community resources,… more