- Centene Corporation (Trenton, NJ)
- …management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides and/or facilitates education to members and their ... families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits + Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in… more
- ChenMed (Deerfield Beach, FL)
- …+ Prescribes medication and treatment in accordance with patient condition, payer coverage/guidelines and industry standards. + Reviews PCP requests for external ... cardiology referrals and participates in delegated utilization authorizations; determines level of urgency of follow-up, referral/consultation appointments. + May have responsibility for cardiology clinical operations of 2-5 centers in the market, under the… more
- R1 RCM (Florence, AL)
- …of the top 100 US health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare ... organizations unlock greater long-term value. To learn more, visit: https://www.r1rcm.com . more
- Sanford Health (Fargo, ND)
- …practices, including reimbursement of services. Keep abreast of regulatory processes and payer systems such as Medicare, Medicaid, managed care, and private sources, ... as applicable. Demonstrate extensive advanced knowledge of medical principles, practices and techniques. **Qualifications** Completion of a master's, postmaster's, or doctorate from an nurse practitioner program accredited by the Commission on the Collegiate… more
- Henry Ford Health System (Detroit, MI)
- …and other hospital-based interdisciplinary teams. Knowledge of CMS, commercial payer requirements and hospital financial/ reimbursement processes desired. Excellent ... written/verbal communication skills, critical thinking skills, creative problem-solving skills, good organization, and planning skills. Must be self-directed, have the ability tolerate frequent interruption and work in a fast-paced work environment.… more
- Robert Half Technology (Princeton, NJ)
- …Benchmark pricing strategies across therapeutic areas and geographies; track payer /PBM behavior, formulary trends, and contract performance. Oversee advanced ... analytics efforts, including price elasticity analysis, scenario modeling, and value-based pricing strategy development. Use claims data and forecasting tools to inform data-backed reimbursement strategies. Collaborate cross-functionally with Market Access,… more
- Select Medical (Fort Myers, FL)
- …business development team + Collect co-pays from patients, manage payer approvals, and conduct insurance authorizations and verifications **Qualifications** ... **Minimum:** + High School Diploma or GED + 1 year of Front Desk Experience + Insurance Verification Experience **Preferred:** + Health care experience + 1 Year of Scheduling Experience **Additional Data** _Equal Opportunity Employer/including… more
- Carle Health (Champaign, IL)
- …American Health Information Management Association (AHIMA); Certified Professional Coder - Payer (CPC-P) - American Academy of Professional Coders (AAPC); Certified ... Professional Coder - Hospital (CPCH) - American Academy of Professional Coders (AAPC), Education: Highschool diploma or GED Work Experience: Coding Responsibilities Perform accurate and timely quality reviews of internal and vendor coding team members using… more
- Select Medical (Phoenix, AZ)
- …Planning + Care Planning Management + Fiscal Management + Payer /Referral Management **Qualifications** **Minimum Qualifications** + Current Licensure per state ... guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline. **Preferred Qualifications** + Previous experience in Case Management and Discharge Planning preferred. + CCM Certification Preferred.… more
- Select Medical (Hummelstown, PA)
- …Planning + Care Planning Management + Fiscal Management + Payer /Referral Management **Qualifications** **Minimum Qualifications** + Current Licensure per state ... guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline. **Preferred Qualifications** + Previous experience in Case Management and Discharge Planning preferred. + CCM Certification Preferred. **_*Post… more