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The Care Coordinator is responsible for promoting coordination in the delivery and receipt of LTSS to enrollees assigned by Accountable Care Organizations (ACO) and Managed Care Organizations (MCO.
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The Provider and Community Relations (PCR) Liaison in conjunction with the MSO Provider Relations team, is responsible for activities and actions related to promoting the services and expertise of NEMS’ network and MSO services to the medical community, as well as providing the community with ongoing education regarding the NEMS managed care services.
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Responsibilities:Responsible for all account management functions in the Western PA market, including managed care products, funding mechanisms and consumer-directed services. The ideal candidate will have prior account management experience in managed care.
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Minimum 3-5 years clinical experience in any of these areas: acute care, home health, physician office management, managed care organization, provider relations, pharmaceutical sales.
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The Care Manager supports the implementation of the CareFirst Value Based Care Management program by working with CareFirst members. Abide by Value Based Care Management Program Description and Guidelines.
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6 years’ leadership / management experience; 4 years’ experience in medical record review, case management, utilization management, managed care, Home Health, QA Review, HEDIS review; 4 years’ experience with healthcare payment and coding methodologies (i.e. ICD-9, CPT, DRG and HCC coding.
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Bachelor's degree in Business, Finance or related field, plus 5-7 years of experience in the health care industry (at least 3 years in managed care contracting), or an equivalent combination of education and experience.
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10 years of experience in health care, managed care, health insurance or strategic consulting. Experience with managed care data systems and reports. Accountable for the overall integration, management and implementation of the Medicare Risk Adjustment Program across HCSC (i.e. network management, customer service, clinical services, information technology, and finance departments.
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Oregon Outpatient Surgery Center is a state of the art ambulatory surgery center (ASC) jointly owned managed by SCA Health. We are a fast-paced, high quality and safety centered outpatient surgery center that provides exceptional care to all patients, offering a tremendous work-life balance and boasting a culture that is employee and patient-focused.
$110,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Eight (8) years of experience in a Managed care setting, with particular focus in value-based care models and population health (e.g., quality, efficiency, cost management). Six (6) years of experience in a Managed Care setting.
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Assist in development and be responsible for implementation of Post Acute/Managed Care programs/partnerships/services. The AVP Business Development & Managed Care will drive company development, expansion and diversification of profitable national and regional contracted business solutions within the acute and post acute care continuum for home health services.
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Knowledge and experience with Medicaid, managed care, MMIS, health claims payment and processing, population health management, or other similar areasHighly desired. This procurement and implementation represent one of the largest and most significant projects at DCH and will impact millions of Georgians with the goal of improving health outcomes and wellness and improving system performance and efficiency.
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Case Manager must have minimum of two (2) years of case management experience assigned to Long-Term Managed Care Medicaid Waiver program and successfully complete all required trainings.
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Experience with Managed Care, Utilization Management, Prior Auth, and Benefits Management decision support in the Non-MSK, Non-Vascular Surgical Domains. (Non-MSK / Non-Vascular), 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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Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. Provides clinical leadership for Utilization Management, Case Management, Disease Management, and Quality Management of Clients in cooperation with solution medical directors and the Chief Medical Officer.
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