- Molina Healthcare (Tucson, AZ)
- …experience in quality management and clinical quality investigations, preferably in a managed care setting, or equivalent experience * Registered Nurse. License ... critical incident cases; review of medical record documentation for credentialing and model of care oversight; and...Health Quality (CPHQ). * Medical record abstraction experience. * Managed care experience. * Ability to work… more
- CareFirst (Baltimore, MD)
- …years experience in risk adjustment coding, ambulatory coding and/or CRC coding experience in managed care ; state or federal health care programs; or health ... in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing , and contracting rules knowledge to build the effective guides and… more
- Medtronic (Baltimore, MD)
- …connected, compassionate world. **A Day in the Life** The **Clinical Product Specialist (CS)** will be responsible for the implementation and training of Medtronic's ... + Demonstrated success in working in a team setting and matrix managed environment + Excellent interpersonal, written and verbal communication skills with… more
- BronxCare Health System (Bronx, NY)
- …system and operational changes regarding insurance, eligibility and reporting, ie Managed Care Payers, Medicare. Keeps front-end administrators up-to-date with ... and performance reviews for various clinic locations. - Identifies that provider credentialing information is consistent in each system along the billing continuum… more
- Atlantic Health System (Morristown, NJ)
- …+ Support and evaluate delegated credentialing contracts and relationships with managed care organizations and insurers, if requested. + Lead change ... in Medical Services Management) required. + CPCS (Certified Provider Credentialing Specialist ) preferred. Key Competencies: + Executive...one of our facilities, will receive the highest quality care delivered at the right time, at the right… more
- Commonwealth Care Alliance (Boston, MA)
- …Strong claims experience + Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare/Medicaid) + Experience in health plan ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims, Credentialing , Clinical Care Management, Member Services, Provider Services,… more
- Eastern Connecticut Health Network (Manchester, CT)
- …Connecticut State licensure inspection surveys. + Responds to inquiries from other health care institutions, managed care organizations and ECHN departments ... activities of the Medical Staff Office, and the activities of the ECHN Credentialing Program, in compliance with state and federal regulations and Joint Commission… more
- Prime Healthcare (Gadsden, AL)
- …five years of management experience in one of the following venues: hospitals, managed care , credentialing verification organizations, or ambulatory care ... + 5 years of management experience in one of the following venues: hospitals, managed care , credentialing verification organizations, or ambulatory care .… more
- Prime Healthcare (Garden City, MI)
- …five years of management experience in one of the following venues: hospitals, managed care , credentialing verification organizations, or ambulatory care ... Professional in Medical Services Management (CPMSM), required. 3. Certified Provider Credentialing Specialist (CPCS), or equivalent, preferred. 4. Minimum of… more
- Molina Healthcare (Seattle, WA)
- …in health care field including, but not limited to, provider's office, managed care , or other health care field. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS ... requirements of customers as it pertains to contracting, network management and credentialing . **Job Duties** This role negotiates assigned contracts and letters of… more