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Juris Doctor and minimum 5 years' experience, with emphasis in managed care contracting, credentialing and compliance. Dependent Care Flexible Spending Account. Health Care Flexible Spending Account.
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Experience in managed care contracting preferred. Experience in managed care contracting preferred. Identify and oversee the development of the community relations programs necessary to meet the key mental health and substance abuse treatment needs of the community.
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Or equivalent education/experience 5 years claims processing experience with 2 years as a Claims Manager, Or 3 years managed care experience, Or Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
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Your experience with market access and B2B, as well as your success in driving sophisticated contract negotiations and completion of contracts, PBM and managed care expertise, with a focus on the management of pharmacy budgets related to manufacturers, will be key.
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Provide legal guidance and advice regarding managed care contracting and dispute resolution, as well as compliance with related laws and regulations. The position also is a strategic partner to the Vice President-Litigation, assisting with complex managed care disputes and a broad range of litigation, investigative and administrative matters.
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Provide guidance for corporate structure, formalities and service reconfigurations for all subsidiaries, managed care contracting, licensure and accreditations; regulatory compliance, surveys, supply chain contracting; group purchasing organization management; physician contracting and relationships (employment, independent contractor, investment/ownership.
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Support of a professional management team: HR, IT, Billing, Collections, Marketing, Managed Care and Enrollment, Compliance, and Payor Contracting. Enjoy autonomy to practice medicine within accepted standards of care.
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With a team that includes recognized national leaders in areas such as clinical research, psoriasis, and Mohs Surgery, our vision is to build the premier dermatology care community in America. As one of the largest physician-owned dermatology practices in the country, U.S. Dermatology Partners patients not only have access to general medical, surgical, and cosmetic skin treatment through its coordinated care network, but also benefit from the practice’s strong dermatology subspecialty thought leaders and medical advisory board.
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A minimum of 8 years experience in managed care which may include PBM, Pharma, market access, account management, specialty pharmacy, or health plan. In this non-supervisory Director level position, you will assume a highly visible role and responsibility to lead discussions and engage in strategic negotiations on high-value medical rebate contracts for Medicare Part B, Managed Medicaid, and Commercial segments.
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The health care team advises on a vast array of health care legal matters, including Medicaid and Medicare reimbursement issues, health care regulatory matters, health care operations, managed care, contracting, payer-provider disputes, health information privacy and security, mergers and acquisitions, finance and litigation.
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3 years Familiarity with managed care contracting, provider operations and/or payer operations. Routinely communicates trends and other data findings to PFS Manager for consistent and effective feedback to the Ministries and the PSJH Contracting team to assist in developing and implementing processes to maximize collections on denied accounts, as well as improve processes within the ministry to prevent denials from happening.
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Partner with Contracting Entities and EDI Clearinghouse to research and resolve claim submission and payment issues. Manage claim issues generated by credentialing challenges, partner with Network Management Associates and Third Party Billing to produce resolutions.
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Supervises all administrative management including Managed Care Contracting, Finance/Network Relations, Client Services, Credentialing and Referral Management and non-clinical staff.
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5+ years of Managed Care Provider Contracting, Provider Relations or Physician Network development experience. Working knowledge of managed care health plan and provider operations.
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5+ years experience in managed care operations, provider reimbursement and analytics, and value-based care. Expertise in Medicaid and Medicare managed care. Collaborate with matrixed corporate and market teams, including provider services, finance, analytics, and contracting, to operationalize VBP models and ensure alignment of VBP models with enterprise strategies.
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contracting managed care jobs
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