- Emory Healthcare/Emory University (Atlanta, GA)
- …Maintains a thorough working knowledge of Medicare, Medicaid and private payer regulations and processes. Maintains broad knowledge of resources and options ... for patients available within all levels of care: facilitates efficient access and movement of patient across levels of care, and coordinates inter-facility transfer of patients to appropriate level of care. Ensures that a safe and timely discharge is… more
- Centene Corporation (Hilo, HI)
- …management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides education to members and their families on ... procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs + Provides feedback to leadership on opportunities to improve and enhance care and quality… more
- CVS Health (Hartford, CT)
- …role partners with leadership and teams across all facets of the healthcare payer ecosystem to identify strategic opportunities, develop execution plans and dig into ... the details to define the opportunity and outline the path forward to ensure successful delivery of digital health and IT modernization projects primarily in the Medicare domain. **Key Responsibilities** + Lead the design and planning of strategic healthcare… more
- Fresenius Medical Center (East Hartford, CT)
- …knowledge of CMS Conditions of Coverage for ESRD facilities, Value Based Payer Programs, knowledge of quality improvement concepts, principles and practices to ... perform tasks and duties. + Utilizes quality improvement techniques to promote collaboration between facilities and areas to share processes and strategies for success. Mentors and assists facilities in identifying effective practices applicable to their… more
- Avera (Milbank, SD)
- …+ Ensures the department's practices and documentation meet local, state, Medicare, insurance, payer requirements as well as agency policy. + Plans and leads various ... agency activities and meetings including staff meetings, facility function groups and customer service programs. + Responsibilities include interviewing, hiring, developing, training, and retaining employees; planning, assigning, and leading work; appraising… more
- Ochsner Health (Slidell, LA)
- …stay reviews as directed per content management system (CMS) or commercial payer guidelines and/or hospital policy. + Collaborates with hospital staff, as required, ... for authorization/certification processes. + Explores strategies to reduce length of stay and resource consumption for case managed patient populations. + Identifies appropriate patients for the various third-party payor pre-certification or pre-authorization… more
- HCA Healthcare (Savannah, GA)
- …thorough working knowledge of the rules of Medicare, Medicaid, and private payer regulations and processes. You will possess a thorough understanding of managed-care ... concepts and length-of-stay management relating to patient and organizational fiscal responsibility.** + **You will perform thorough assessments and develop appropriate discharge plans for high-risk patients with discharge planning or psychosocial needs.** +… more
- Centene Corporation (West Palm Beach, FL)
- …care management activities to ensure compliance with current state, federal, and third-party payer regulators + May perform home and/or other site visits to assess ... member's needs and collaborate with healthcare providers and partners + Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare… more
- UCLA Health (Los Angeles, CA)
- …the pharmacy analytics field and recognized expertise in financial analysis/transactions, payer contracting, data analytics, and strategic planning. You will provide ... analytical and strategy support for highly complex budget, financial and resource projects supporting the growth of the ambulatory pharmacy department. You will exercise judgement in selecting methods, techniques and evaluating criteria for obtaining results.… more
- Sun Pharmaceuticals, Inc (Princeton, NJ)
- …areas + Relevant experience in pharmaceutical industry within commercial, medical, payer or academic institution + Good understanding of payers and reimbursement ... landscape + Working knowledge of pharmaco-economic principles + Ability to manage cross functional projects + Ability to analyze complex models and scientific data and draw out key messages + Understanding of FDA, ACCME, PhRMA regulations + Proficiency in… more