- Trinity Health (Columbus, OH)
- …supports performance in alternative payment models. Collaborates with MCHS and Trintiy Health managed care teams on APM contracting. Attends Board meetings and ... and implementation of agreed upon clinical strategies. Partners with Managed Care leadership in the development of...a mission-driven, innovative health organization, we will become a leader in improving the health of our communities and… more
- Molina Healthcare (Dayton, OH)
- …integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape ... **Job Description** **Job Summary** Provides lead level support as a highly capable business...as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan… 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 ... skills necessary to advocate for patients in regard to managed care organizations + Conducts utilization review...are Tennessee's first comprehensive stroke center and a national leader in neuroscience. In addition, we are equipped with… more
- Grifols Shared Services North America, Inc (Albany, NY)
- …contract strategy, and represent needs of the customer. *Remain cognizant of managed care coverage throughout the business territory including major accounts ... like pharmacy DOP and Emergency Room. As the sales lead for a given geography(territory) the SSR will need...to business customers. The SSR will liaise with Marketing, Managed Markets, Operations, CL&D, Medical Affairs and Telesales to… more
- Mount Sinai Health System (New York, NY)
- …and EHR systems. + Organizes routine meetings with health system business leaders and managed care to review payer issues and denials. + Builds effective, ... of the MSHS. **The Senior Director is a key leader within the Patient Financial Services Management team, responsible...with key stakeholders across departments (eg, DTP, Human Resources, Managed Care , Finance, and clinical departments) +… more
- Humana (Springfield, IL)
- …, or related disciplines. + Experience working in a Managed Care Organization + Demonstrated ability to lead large-scale, multi-stakeholder initiatives and ... help us put health first** The Behavioral Health Strategy Lead Behavioral Health Executive Leader (known to...+ Deep knowledge of Illinois' behavioral health landscape, Medicaid managed care , CCBHC models, 1115 Waiver programs,… more
- Mount Sinai Health System (New York, NY)
- …clinical, contracting, finance, IT, analytics, operations, and product development expertise. The Managed Care Contracting Team within MSHP is responsible for ... Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as...Issues: * Proactively escalate issues to Directors that could lead to significant legal ramifications or require intervention by… more
- Humana (Montgomery, AL)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Molina Healthcare (Mount Vernon, WA)
- …care systems, social services, and community resources. (Bonus, but not required in Managed Care , Medicaid, Health Plan or Health Insurance etc..) + Previous ... Manager, Care Manager, Community Engagement, CHW, Public Health, Healthcare, Health Care , Managed Care , MCO, Medicaid, Medicare, HEDIS, CAPHS, equity… more
- Molina Healthcare (Ridgeland, MS)
- …in quality compliance/HEDIS operations, customer service or provider service in a managed care setting with previous leadership experience to include managing ... Molina strategic plans. + Serves as operations and implementation lead for local execution of Molina plan quality improvement...years experience in a Quality leadership role with a Managed Care Payer with experience in all… more