- Guidehouse (Arlington, VA)
- …notified by **Friday, Oct. 24** **What You Will Do** **:** Guidehouse's Managed Care practice sits within the broader Payer Provider Advisory group. The ... to develop a strategy to improve their outcomes in payer negotiations. Our approach is founded in analytical exercises...etc.) and driven by critical thinking to inform the managed care strategy and to unlock the… more
- Banner Health (AZ)
- …Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options ... PREFERRED QUALIFICATIONS Master's degree and/or professional designations preferred. Previous payer , health care or academic compliance experience preferred… more
- Whidbey General Hospital (Coupeville, WA)
- …resource utilization, the discharge planning and appeal/denial management. The RN - Care Manager serves as the organizational consultant to providers and ... throughput and assure that the organization and the patient's care are managed in the most efficient...inpatient medical necessity reviews daily, unless otherwise specified by payer . Completes Observation medical necessity reviews at a minimum… more
- AbbVie (Irvine, CA)
- …including Botox, and treatments for Parkinson's, as well as higher cost and payer managed medications typically processed through retail pharmacy in Migraine, ... key therapeutic areas - immunology, oncology, neuroscience, and eye care - and products and services in our Allergan...navigate trade complexities and challenges as an advisor and consultant to the Integrated Brand Teams that they support.… more
- HCA Healthcare (San Antonio, TX)
- …contracting issues. + Provides medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials ... regarding delegated utilization management and disease management operations under managed care contracts. Meets all regulatory/contractual/accreditation requirements… more
- HCA Healthcare (Nashville, TN)
- …and authorization of level of care . + Offers input on managed care contracting issues, best demonstrated practices, process improvement and utilization ... of over 180 hospitals and about 2,000 sites of care in 21 states and the United Kingdom. We...The Medical Director serves as a clinical resource and consultant to hospitals by providing identification, facilitation, and resolution… more
- Trinity Health (Nampa, ID)
- …Type:** Full time **Shift:** Day Shift **Description:** **AMBULATORY CARE ** **CLINICAL PHARMACIST** Responsible for providing comprehensive medication management ... for by the Saint Alphonsus Medical Group (SAMG) Clinics and/or patients managed by the Saint Alphonsus Health Alliance (SAHA). Works collaboratively with physicians,… more
- Sanofi Group (Cambridge, MA)
- …Launches (NPL) Team, this role will act as a thought partner and consultant by presenting scope analysis, strategic options and recommendations ensuring the strategy ... execute a robust, evidence-based market access strategy that maximizes payer adoption and patient access to critical therapies. +...ensuring that pricing, rebates, and discounts [by channel] are managed efficiently to optimize net sales / BOI. +… more
- HonorHealth (AZ)
- …Reviews concurrent denials and intervenes with attending and/or consulting physicians and managed care medical directors, as needed, for reconsideration and ... discuss the needs of patients and alternative levels of care . The PA acts as consultant to...+ Attends JOC as requested by Utilization Management or Managed Care : Works with Director, Management and… more
- Avera (Sioux Falls, SD)
- …between health plans and the provider community to provide recommendations in coordination with managed care and coding leadership teams. + Serves as an expert ... cycle, billing teams, charge master committee, pro-fee audit team, health information management, managed care services, and others as necessary. + Helps improve… more
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