- Sutter Health (Modesto, CA)
- …base of health care delivery and case management within a managed care environment. Comprehensive knowledge of laws, regulations and professional standards ... benchmarking and outcomes measurements preferred. PC skills, word processing, spreadsheets and managed care software programs. Adheres to Sutter Health policies… 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 (Lincoln, NE)
- …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
- The Hartford (Hartford, CT)
- …clinic/facility + Case management and discharge planning experience preferred + Managed care /utilization review experience preferred + Crisis intervention skills ... the medical treatment to ensure quality, effective, and cost-efficient care . Conducts comprehensive evaluations of disability claimants' functionality via functional… 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
- Sharp HealthCare (San Diego, CA)
- …years' experience as a practicing primary care physician with knowledge of managed care and the process for prior authorization review. + California ... and Abilities** + Knowledge of physician social and political behavior and managed care philosophy. + Demonstrate effective communication skills, ability to… more
- Union Hospital Health Group (Terre Haute, IN)
- …Specialist Details Essential Job Duties: + Credentialing/re-credentialing applications for managed care organizations and hospitals + Maintaining provider ... + Assisting with revenue cycle duties and analysis + Performing other managed care tasks as assigned Education, Training & Experience + High School diploma… more
- Highmark Health (Tallahassee, FL)
- …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
- AmeriHealth Caritas (Newtown Square, PA)
- …skills + Proficiency in Microsoft PowerPoint and Excel + Familiarity with Managed Care Organization operations preferred + Bachelor's Degree or equivalent ... to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health… more
- University of Southern California (Los Angeles, CA)
- …Responsible for patient flow, scheduling, patient assessment and action, service to managed care organizations, and coordination of clinical research across the ... management of fiscal operations, (budget, Medicare Cost Reporting, and managed care contract terms) and leads the strategic business development and… more
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