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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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Assignments in Managed Care require strong contract writing skills as well as a general understanding of health care claims. Possess the interpersonal skills to interact effectively and cultivate supportive relationships with internal customers, managed care payors, consultants, outside agencies, and internal/external corporate executives.
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Effectively communicate and appropriately collaborate with the Market Access team to ensure strategic alignment and effective implementation of the clinical strategy for National and Regional Managed Care accounts, covering all books of business (e.g., Commercial, Managed Medicaid, Fee-for-Service, Medicare, PBMs, and Exchange Plans.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Knowledge of accreditation standards for managed care organizations, e.g., NCQA, and Federal, State, and local requirements for FQHC and managed care organizations preferred.
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Experience working in healthcare provider analytics related to revenue modeling, managed care contracting, population management, case management, clinical or financial decision support required.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Collaborates with Finance staff and Managed Care Contracting staff to ensure accurate billing of accounts under global contracts/Center of Excellence agreements. The Senior Financial Analyst will serve as the Solid Organ Transplant primary internal consultant responsible for providing critical analytical support for regulatory and financial implications of the Transplant components of the Medicare Cost Report (MCR.
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Provides Medicare, Medicaid (case mix), and managed care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident.
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QUALIFICATIONS & EXPERIENCE REQUIREMENTS Graduate of an accredited school of nursing; RN Valid RN license in the state employed Three years of experience in a long term care environment preferred Experience with the MDS/RAI process and/or case management preferred JOB RESPONSIBILITIES The 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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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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Healthcare especially Managed Care experience preferred but not required. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics.
$45,277 - $50,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Review the Medicare, Managed Care, Medicare Advantage and Medicaid UB, CHAMPS, WebDenis. Ciena Healthcare is Michigans largest provider of skilled nursing and rehabilitation care services.
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As the Vice President of Payer Contracting Strategy within the Business Development team, you will lead and execute the Company's payer contracting strategy, including, but not limited to, Commercial, Medicare Advantage, and Medicaid plans, and oversee the development of new initiatives to enhance payer value and alignment for value-based care programs.
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The Regional Registered Nurse ("RRN") is a critical player in coordination of health care services for the Care Design NY (CDNY) Care Coordination Organization/Health Home (CCO/HH) members and Partners Health Plan (PHP) Managed Care Organization (MCO) members.
Starting at $74 an hourFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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About NYC Health + Hospitals MetroPlusHealth 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.
$50,000Full-timeExpandApply NowActive JobUpdated 4 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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