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Knowledgeable of the health care system including managed care contracting, Medi-Cal, Medicare, and local IPAs. The Referral Coordinator will use this information to communicate medically necessary information to other health care providers to facilitate care for the patient.
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Additionally, this role will contribute to a wide variety of complex projects involving the contracting, reserving, pricing, and financial modeling of a full array of value-based care programs for providers and payors.
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Experience counseling and advising medical device, healthcare providers and/or pharmaceutical company clients on federal and state laws related to heath care fraud and abuse issues (e.g., False Claims Act, Anti-Kickback statute.
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Health care regulatory knowledge focusing on Fraud, Waste, and Abuse; knowledge of Value-based care, Medicare Advantage Organizations, ACO REACH and MSSP programs is required. This role will provide regulatory guidance on various healthcare-related issues with a focus on Anti-kickback Statute (and related state statutes), Stark Law, Civil Monetary Penalties Law, and develop compliant solutions to to facilitate and promote One Medical’s business objectives, including value-based care, care coordination, and clinical integration.
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While the primary internal client will be the Semiconductor Foundry Services business unit, the successful candidate will also work in such legal subject matters as commercial contracting and risk assessment, technology transactions, IP protection, litigation, corporate governance, compliance and employment.
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Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years.
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A portion of our profits goes towards education, health care, nutrition services, housing programs, legal services, elder and child care, and community support programs designed specifically for Chickasaw citizens.
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JOB SUMMARY This is an in-house position for an experienced attorney with five to seven years of experience handling general health care, commercial contracting, risk mitigation, business, regulatory, and transactional matters.
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With the unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care. Manages contracts via GPO or Local agreements and/or a bid process that encourages competition from any supplier with the capacity, quality and service to meet the needs of Christiana Care in a timely fashion.
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Managed Care, MCO, Healthcare, Health Plan, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming, Remote, Contract, Litigation, ADR, Transactional, Negotiation, Legal, Contracting, Corporate.
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Call Points: Acute Care, Biomed, Radiology, Cath Lab, VP of Imaging, Supply Chain, Contracting, Service Line Coordinators. Call Points: Acute Care, Biomed, Radiology, Cath Lab, VP of Imaging, Supply Chain, Contracting, Service Line Coordinators.
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Molina's Behavioral Health function provides leadership and guidance for utilization management and case management and quality programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.
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The Bilingual (Spanish & English) Customer Care Specialist I assists members or providers with routine service inquiries. Bilingual Spanish - Customer Care Specialist. Resolve member or provider routine service inquiries; examples include claims processing, member benefit education, contracting and credentialing requests, eligibility inquiries, and transportation arrangements.
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Our experts in Addiction Medicine—including highly educated clinical and medical professionals and expert psychiatrists and nurses—deliver care that never stops. Maintains and fosters cooperative working relationships with funding or contracting agencies, current and potential referral resources and services, community organizations, and criminal justice and social services agencies.
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Working Knowledge: Managed Care Operations, Contracting Strategy, Healthcare Systems Structure and Function. 2+ years of managed care account manager or equivalent experience. We are a $6.5 billion global healthcare company focused on making a world of difference for women, their families and the communities they care for.
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