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1+ years Managed Care (MCO) preferred. Utilization Management nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
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Bachelor’s degree in Finance, Economics, or related field; Five plus (5+) years progressive healthcare finance or analytic experience; Two plus (2+) years managed care experience, preferably working with Medicaid and/or other government-sponsored programs; or equivalent combination of education and experience.
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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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Medi-Cal Managed Care Plan with 24/7 Advice Nurse Operations. Only Medi-Cal Managed Care Plan integrated into a health delivery system in the county. Understands the complexities of health plans and Managed Care.
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Minimum 5 years business-to-business sales experience in the managed care industry (pharmacy or medical insurance benefits). Key contacts may include brokers, consultants, third-party administrator senior-level sales and account executives as well as client VP/Director of Human Resources, CFO, CEO.
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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.
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You will report directly to the Executive Director, Administrator, or Senior Patient Care Manager. Managing the site in the absence of the Executive Director, Administrator, or Senior/Executive Patient Care Manager.
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Member of Business Continuity and Alcon Crisis Management (ACM) team as expert for Product Quality role and backup for ACM Director and Coordinator. We innovate boldly, champion progress, and act with speed as the global leader in eye care.
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QUALIFICATIONS & EXPERIENCE REQUIREMENTSGraduate of an accredited school of nursing; RNValid RN license in the state employedThree years of experience in a long term care environment preferredExperience with the MDS/RAI process and/or case management preferred JOB RESPONSIBILITIESThe MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is responsible for accurate and timely completion of mds assessments and coordination of the RAI process.
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Our offerings include health, life, disability, financial, and retirement benefits, as well as paid leave, professional development, tuition assistance, work-life programs, and dependent care. Experience with modern Cloud Service Provider native and managed services and emerging AI technology applications such as generative/LLMs or CV.
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Knowledge of federal and state laws and URAC/NCQA regulations relating to managed care, disease management, utilization management, transition planning and complex care case management.
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The Assistant Director joins a multi-disciplinary project team whose responsibilities include assessment, reporting, and improvement of health care quality on behalf of IPRO's state Medicaid agency clients.
$100,000 - $120,000 a yearFull-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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2 -3 years of Utilization Review experience at a Managed Care Organization is preferred. The Senior Director of Clinical Review will monitor the Clinical Review Nurse's activities and outcomes, ensuring compliance with established regulatory and contractual requirements.
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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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Provides weekly reports to the executive director regarding any problems associated with the provision of core services, or any problems or concerns associated with the managed residential community or the assisted living services agency, summaries of which shall be provided to the governing authority in accordance with the schedule established by the governing authority.
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