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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
$150,000 - $157,236 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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In conjunction with the VP of Managed Care Contracting & Payor Relations/legal department, reviews and negotiates any new 340B contracts and renegotiation of existing transaction fees. Continually monitors 340B regulations to ensure federal compliance, staying up to date on all rule changes, including HRSA/OPA, Medicaid and manufacturer changes.
$65,000 - $85,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Remain in compliance with internal and external policies, procedures, regulations, and standards, including all of River Edge's policies and procedures and Quality Assurance Plan, DBHDD requirements, State Licensing standards, County Monitoring requirements, and managed care regulations.
Part-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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At WPI, we have competitive and comprehensive benefits, including health insurance, long-term care, retirement, tuition assistance, flexible spending accounts, work-life balance and much more. Assist with non-financial award compliance such as IRB and IACUC approvals and monitoring program milestones.
$53,000 - $62,300 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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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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Crossover's Primary Health model integrates primary care, physical medicine, mental health, health coaching, care navigation and more, and delivers care in surround-sound-in-person, virtually and via asynchronous messaging.
$143.82Part-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Knowledgeable of Medi-Cal Managed Care and Medicare compliance, HMO’s and other regulatory agency guidelines. Under the direction of the Operations Director and Executive Director, this position is responsible for the negotiation, optimization and the operational management of the managed care contracts; Medi-Cal, Medicare, Commercial, PPO, FFS and etc.
Full-timeExpandApply NowActive JobUpdated 22 days ago - UpvoteDownvoteShare Job
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In the role of the Compliance Analyst on our Managed Services team, you will be responsible for participating in and ensuring the successful execution of certain compliance reviews and consulting work conducted by ACA Group (“ACA”) for clients.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Minimum 5 years experience practicing law, with emphasis in managed care contracting, credentialing and compliance. Minimum 5 years experience practicing law, with emphasis in managed care contracting, credentialing and compliance.
$185,000 - $200,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Performance Management & Regulatory Compliance: Develop and implement performance metrics, monitor key performance indicators, and provide feedback to clinicians to improve productivity, efficiency, and quality of care in conjunction with the Quality Director and development and implementation of Quality Improvement Plan. Participates in the review of managed care performance data and implementation of corrective action as needed.
Full-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Review referral information as it is presented to help determine eligibility for admission and continued stay for Supported Housing and Crisis Respite where relevant Complete authorizations for stay as needed with each Managed Care Company Supervise meal preparation and compliance of residents with dietary guidelines, providing education as needed.
$16.66 - $20.77 an hourPart-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Is knowledgeable regarding managed care implications – precertification and utilization review procedures. St. Luke’s C.A.R.E. delivery model (Continuity, Accountability, Relationship-based, Evidence-based) reflects a commitment to compassionate, competent care delivered by the interdisciplinary team.
$61,000 - $104,000 a yearFull-timeRemoteExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness.
ExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Control of all operational aspects including; revenue growth, profit, operations & production, quality, plant production development, health & safety, finance and compliance within assigned. Prior experience in leading manufacturing organization in personal care or food manufacturing.
ExpandApply NowActive JobUpdated 22 days ago - UpvoteDownvoteShare Job
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Identifies, organizes and presents issues created by Managed Care contracts, complex billing regulations and other specific payment requirements and works directly with the Patient Account Specialist, the Senior Patient Account Specialist, Manager, Patient Account Analysis and the Third Party Payers as necessary to determine possible solutions.
Full-timeExpandApply NowActive JobUpdated 2 days ago
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