- Humana (Trenton, NJ)
- …+ Minimum of 3 years of clinical nursing experience + Minimum of 1 year of managed care and case management experience + An active designation as a ... serve as POC for MTF CMs. + Perform telephonic care management with beneficiaries throughout the East... care + Minimum of 1 year of managed care experience **OR** A current, valid,… more
- MyFlorida (Tallahassee, FL)
- …does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive ... the Bureau's responsibility: Fraud and Abuse Detection, Prevention, Overpayment Recovery, and Managed Care oversight. MPI operates with dynamic and fast-paced… more
- Monroe Plan for Medical Care (Rochester, NY)
- …who are recipients of government sponsored health insurance. Monroe Plan is the largest Care Management Agencies serving 28 counties and over 3000 members with ... throughout our service area! We've earned that reputation by providing quality care management focused on compassion, empowerment, and teamwork. Our… more
- CommonSpirit Health (Englewood, CO)
- …with senior management , physicians, hospital staff, and managed care /payer strategy leaders. + Lead payer contract modeling strategy and consolidation ... analysis. + Monitor contract financial performance. + Analyze and publish managed care performance statements and determine profitability. + Review and… more
- Actalent (Sunrise, FL)
- …mental health providers, to manage care for all lines of business, including managed care contract programs that serve adults and children with severe ... + Care coordination + Chronic disease management + Plan of care management + Managed care experience + Medicaid knowledge + Needs assessment… more
- Baptist Memorial (Memphis, TN)
- …management of contract activity. + Maintains proficient knowledge of managed care contracting concepts, including but not limited to reimbursement ... develop new business and expand provider network. In-depth understanding of health care and managed care contracting concepts, reimbursement, methodologies,… more
- LA Care Health Plan (Los Angeles, CA)
- … management involved topics. Preferred: At least 4 years of experience in Program Management within a Managed Care Organization or Top 10 management ... executive stakeholders with different interests and priorities. Experienced in vendor/ contract management and negotiations. Experienced in collaborating with… more
- Blue KC (Kansas City, MO)
- …3 years of experience in a supervisory or lead capacity + Previous managed care network contracting experience associated with commercial or Government Programs ... applications such as Word, Excel, Access, and PowerPoint + Extensive knowledge of managed care processes and contracting + Extensive knowledge of specialized… more
- State of Massachusetts (Boston, MA)
- …a general summary and not all inclusive):_*//*__*/ * /Support hospital administration in contract negotiations with Managed Care Providers and ensure ... pivotal role is responsible for developing and implementing case management policies, supervising daily operations, and coordinating care...operational alignment with managed care and capitated arrangements./ * /Develop and… more
- Ascensia Diabetes Care (Parsippany, NJ)
- …Rebate Administrator will be assigned to process one or more of the following: Managed Care rebates, Medicaid claims, government and Trade/Mail Order claims, and ... of experience processing one or more of the following: Managed Care rebates, Medicaid claims, government and...analyses and reporting. + Intermediate to advanced knowledge of Contract Management Systems, such as Model N… more
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