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Experience with strategic and tactical planning and market/opportunity analysis within the healthcare or managed care industry is highly preferred. Experience and knowledge managing Health & Wellness products, and health insurance plans and portfolios preferred.
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The Provider Relations Manager will be working with contracted providers on managed care operations and to comply with IPA and Health Plan standards. You are: Experienced in healthcare, provider engagement, Medicare, Commercial and Medi-Cal managed care systemsRelentlessly resourceful.
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Experience with Managed Care, Utilization Management, Prior Auth, and Benefits Management decision support in the Vascular Surgical Domain. This high-performing individual contributor will be responsible for serving as a National Medical Director of the Vascular Solution, leading the strategic implementation of improving the health of the people we serve, influencing product strategy and design and medical management approaches that impact healthcare quality, cost, and outcomes, and improving access to and usefulness of health improvement tools offered to our health plan customers and members.
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Acts as an advisor and consultant in the establishment of operational policies of the practice to include: (1) Purchasing and capital allocations; (2) Managed care plan participation; (3) Budget and practice expenses; (4) Medicare/Medicaid participation; (5) Billing and collection of professional fees; (6) Personnel management and related policies; (7) Risk management and quality assurance; and (8) Coding compliance.
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In partnership with and under the direction of the Lead Director, National Medicaid Business Compliance Office (BCO), this position will help develop and maintain systems and processes for the management, execution, and oversight of the implementation of new state Medicaid contract amendments and program requirements across Aetna’s 16 Medicaid managed care markets (and 26 distinct state contracts.
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Experience working within a government-sponsored health plan, preferably a managed care plan, or very familiar with health plan operations. Knowledgeable of HIT enabling health plan operations such as Enrollment and Eligibility systems, Claims Processing systems, and Utilization / Disease / Care Management systems.
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Assist Division of Health Plan Contract Oversight, Bureau of Managed Long Term Care (BMLTC), Surveillance Unit in a broad range of planning, implementation, investigation, and oversight activities.
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Interview, screen and assist potentially eligible recipients with the enrollment process into Medicaid/Medicaid Managed Care, Child Health Plus the Essential Plan and Qualified Health Plans for Molina and other plans who operate in our service area.
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Knowledge of terminally ill patients and their families along with understanding of hospice concept; knowledge of roles of all disciplines providing hospice services; excellent patient assessment skills; good oral and written communication; thorough knowledge of managed care principles, regulatory guidelines (i.e., Medicare, Medicaid, and human resource) management principles.
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Responsibilities are likely to include: Providing care for clients in accordance with their Plan of Care Assisting clients with personal care and hygiene Preparing meals and assisting with feeding Transporting clients to and from appointments and errands Ensuring a safe environment for the client Documenting and keeping records of client care and changes The benefits of being a Caregiver with EHHC Services: Paid time off Flexible shifts, based on YOUR availability.
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Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community resources.
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The Diabetes Business Specialist will conduct their business with key targeted healthcare providers and community hospitals, and may have additional responsibilities in teaching hospitals, federal and military hospitals, managed health care facilities, group purchasing organizations, integrated delivery networks, etc.
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About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Job Highlights: Additional Job DescriptionThe incoming Cardiologist will be an employee of SSM Health Medical Group’s Heart & Vascular Care. This physician will join an experienced and collegial group of cardiologists and mid-level practitioners in the South St. Louis County, MO, market.
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With integrated services including medical, dental, pharmacy, orthodontia, primary care nutritional counseling, autism screening, and primary care behavioral health, YVFWC s patient-centered model of care offers patients the full spectrum of care and shelter assistance, energy assistance, weatherization, HIV and AIDS counseling and testing, home visits, and four mobile medical/dental clinics.
$87,000 - $116,000 a yearExpandApply NowActive JobUpdated 3 days ago
health plan managed care jobs
FEATURED BLOG POSTS
The Effects of Workplace Racism and Sexism
One day it's a covert statement to a mother returning to work after maternity leave. Another day it's a lingering gaze at an employee enjoying a culturally rich meal. These microaggressions (or sometimes macroaggressions) can take an employee from a confident, high-performer to one that feels insecure being themselves at work. Your employees engage with people with different ideas and feel most comfortable and valued when they can work without losing their cultural, racial, and gender identity. While most employers know this, why have workplace racism and sexism often been neglected?
When Rage Applying Strikes: How to Identify Unserious Candidates
As the job market remains highly competitive, we have seen a surge in "rage applying." This is when candidates apply to multiple jobs, often without considering whether they are truly interested in the role. Rage applying goes hand-in-hand with quiet quitting. Often, employees want to entertain the thoughts and feelings of leaving their job, but they aren't necessarily serious about leaving yet. Meanwhile, other employees engaging in this trend are actually trying to find a better role. As a recruiter, it can be hard to identify who are the real applicants in a sea full of quiet quitters, but understanding rage applying and identifying red flags will certainly help.
How to Increase Job Ad Exposure
In today's competitive job market, writing quality job ads is critical for attracting top talent to your organization. While networking and candidate referrals are prime real estate for finding qualified candidates, nothing beats the tried-and-true method of writing an extraordinary job ad. But while writing a great job ad is the first step, what's more important is increasing visibility. You could have the most detailed, well-written ad on the internet, but if no one sees it, then you are wasting time (and potentially money!). Employers often believe that job boards are the root of the problem, but you can learn how to increase job ad exposure by tweaking a few steps of your recruitment process.
How to Navigate Hiring Out of State
The job market has shifted significantly in recent years. The accelerated adoption of technology has not only pushed many companies into remote working arrangements but also increased the availability of supporting tools and technologies (i.e., video conferencing and collaboration software).
Building a Candidate Pipeline Through Internships
Building a candidate pipeline through a great internship program for local college students and recent graduates at local universities is a great and cost-effective way to attract and retain top talent. By offering meaningful and impactful work experiences, regular feedback, coaching, and mentorship, you can create a positive internship experience that will make your organization a sought-after destination for future employees. This not only benefits the organization in the short-term but also in the long-term, as you'll have a pool of well-trained and experienced candidates who may be interested in full-time employment once they graduate. Furthermore, building relationships with local universities and college students can increase brand awareness and build a positive reputation for your organization in the local community.
Hiring Transparency
Transparency in hiring refers to the open and honest communication and information sharing that takes place between employers and job candidates. It encompasses all aspects of the hiring process, from posting job descriptions to providing feedback on performance during and after the interview process. In today's job market, hiring transparency has become increasingly important for both employers and candidates alike.
Recruitment strategies that are weird, but actually work
In the current candidate-driven job market, recruiters are looking for unique ways to attract talent. Some have resorted to even (dare we say it?) recruitment strategies on the border of weird and wacky. What can we learn from the unusual recruitment tactics that are being used and actually getting results? Here’s a rundown of some unique recruitment strategies that actually work.