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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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Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. Managed Care and/or Credentialing experience preferred.
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2+ years experience with in Home Health/acute/managed care/hospital setting as an RN is Mandatory (Case Manager Expereince Preferred) With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
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Ensures medically appropriate, high quality, cost-effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out-of-network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community resources.
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Minimum Requirements:Requires a LPN, LVN, or RN and minimum of 2 years of clinical or utilization review experience and minimum of 2 years of managed care experience; or any combination of education and experience, which would provide an equivalent background.
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Must possess strong reasoning and critical thinking skills Proficient in use of software applications such as e-mail, Work, Excel, HER Exceptional customer service skills are required Over three years of related medical office work experience is required Associates degree preferred Experience in obtaining and processing insurance referrals and authorizations Knowledge of Healthcare and Managed Care preferred.
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As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
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All positions will be placed in inpatient or long term care units. The clinical nurse is responsible and accountable for the overall nursing care management of a designated group of patients.
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The FP duties and roles include and are not limited to the following: Supporting families (with emphasis on Eastern NC/Trillium connected families) directly in their I/DD and Mental Health (MH) system navigation needs, work with relevant referring UNC pediatric medical providers, liaison and develop key partners in the relevant Managed Care Organizations and other key agencies such as NC START, area provider agencies (Easter Seals, ARC, ASNC, etc.
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Preferred Skills, Capabilities, and Experiences: Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
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Kindbody is a leading fertility clinic network and family-building benefits provider for employers offering comprehensive virtual and in-person care. Kindbody's clinically managed program includes fertility assessments and education, fertility preservation, genetic testing, in vitro fertilization (IVF), donor and surrogacy services, and adoption, as well as physical, mental, and emotional support from preconception through postpartum.
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Responsible for coordinating the health care plan (including discharge plans from the acute setting and transitions of care to the post-acute care network) for assigned patient populations through the use of care plans, critical pathways, managed care and collaboration with all members of the health care team.
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The qualified candidate will have extensive knowledge and relevant work experience in the Managed Care/insurance sectors including network planning/development, contract negotiations, etc.
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5 years of relevant work experience in Network Management, Contracting or Provider Relations in a managed care setting, health plan or large medical group administration. Job Summary: The Manager of Network Operations is responsible for the general management of the Provider network as assigned by the Director of Network Operations.
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Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
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managed care network jobs
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