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As part of one of the largest Catholic health care systems in the U.S., this physician-led and professionally managed multi-specialty group is the foundation of care and well-being of our patients in seven states, delivered cohesively through 43 hospitals, 900 physician practices and outpatient facilities, and our robust virtual care platform.
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Experience within a hospital setting, with strong emphasis on managed care contract and appeals/underpayment collection activities. Knowledge of medical terminology and CTP/HCPS codesKnowledge of networks, IPA's, HMO's, PPO's and PCP's and contract affiliations.
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Experienced Nurse Practitioner- Managed care model. - All adult patients - Very personal service - Must be experienced with documenting progress notes with HCC risk conditions- State of the art outpatient clinic setting- Outpatient-only with no hospital work- eClinical Solutions EMR- Monday through Friday 8:00 am - 5:00 pm- Excellent negotiable compensation depending on experience and qualifications- Absolutely beautiful location on Florida's Gulf Coast.
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Keeps informed of managed care and contractual arrangements in order to resolve and process accounts by HMO/PPO payers. Posts daily cash and adjustments for Hospital and Professional billing.
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Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities.
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Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired. Provides telephonic or outpatient visits to patients at high-risk for readmissions (as identified by CM Plan) to the ER or hospital, to patients with active care planning requirements, to disease management patients per the Disease Management Plan and to others as referred via transitional care team, acute case managers and Transitional Care team.
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SSR-Pulmonary must possess in-depth knowledge of the medical industry (Specialty Pharmacy, Home Health, Managed Care, Biologics/Biotech, Pharmaceutical and/or Hospital) This individual will be responsible for detailing the following customers: Pulmonologists, Primary Care Physicians, Allergists, Respiratory Therapists, Pharmacist and Nurses.
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Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement. Must have recent acute care case manager hospital experience.
$92,955 - $109,000Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Responsible for managing the efficiency of inpatient care delivered in the organization and collaborates with all levels of managed care team, utilization review management, hospital executive team including the Chief Medical Officers, and leadership of medical and nursing staff.
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Demonstrated strong knowledge of Medicare, Medicaid, managed care, and commercial insurance regulations, options for un and underinsured and their relationship to verification, authorization, and payment.
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Malace|HR is seeking a Healthcare Facilities Manager to oversee hospital maintenance at an acute care facility in Webster, TX. The position will be working for a multi billion dollar Facilities Management/Services company.
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This also includes coordinating with local hospital and market leadership as well as corporate functional departments (Legal, Managed Care, IT, HR, etc.) Must have advanced understanding of physician practice start-up requirements, provider recruitment, RVU principles and concepts, billing/collections, accounts receivable management, employee supervision, managed care, patient relations, physician credentialing, medical office policies/procedures, marketing, coding EHR/Practice Management IT systems, and MGMA benchmarks.
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Identifies situations in which contractual adjustments are warranted by determining the original billed amounts as compared to the amounts allowed and prescribed by Medicare / Medicaid and/or managed care contracts, as applicable.
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The care center is in Lake City MN and connected to a Mayo clinic and hospital, so residents don't have to leave the building for a clinic appointment or emergency care if needed.
$37.95 - $40.25 an hourPart-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Working knowledge of lnterQual IS-SI, Milliman and Robertson Managed Care Guidelines, Erickson Life Skills (Age Competencies}, Medicare Part A and Part B, Medi-Cal, NCQA,HEDIS and other criteria as identified by the Quality/Case Management Department.
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