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Strong analytical skills needed to compile and analyze data including: managed care denials/underpayment/ overpayment identification and resolution, contract modeling and evaluation, filing appeals as well as aiding in decision support reporting.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Minimum of six (6) years in a managed care operations, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals.
$38.37 - $48.93 an hourFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Knowledge of CMS policies, commercial insurers, managed care, government and federal payer sectors, IDNs, and IHS required. Must have general payer policy knowledge including public & private payers, foundational knowledge of benefit verifications & prior authorization/pre-determination requirements (including appeals/exceptions), & knowledge of access & reimbursement processes within various sites of care.
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Support patient access assistance from prescriber decision through to fulfillment, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
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The Field Reimbursement Manager will be responsible for the management of defined accounts in Urology and Oncology area, specifically supporting our client's product. The Field Reimbursement Manager will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, including acting as an extension of patient support program and in other collaboration with other partners.
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The Reimbursement Manager will also work on patient level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI), navigating access issues, and working with payer and NCCN guidelines for product utilization.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria.
Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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7-10 years' experience in Healthcare Administration, Health Plan Operations, Managed Care, and/or Provider Services. Experience with Medicaid and Medicare managed care plans.
$122,430.44 - $238,739.34 a yearExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible.
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May also engage in grievance and appeals reviews. Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age.
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3-5 years clinical nursing experience, with 1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as needed or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy, etc.
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Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities.
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Including but, not limited to Managed Care, Reimbursement, Clinical, Admissions, Facility Business Office Manager, Coding, Case Management, HIM and Charge Master Departments. Interpretation of Managed Care ContractsWork collaboratively with team members and staff outside of the CBO to resolve issues on accounts.
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