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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 orientation. Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers compensation claims.
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Requires BS/BA degree in Mathematics, Statistics, or related field; minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would provide an equivalent background.
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Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues. -Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals.
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Post-graduate experience in direct patient care. This telecommute role provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours.
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Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. Every Concentra colleague has the responsibility to adhere to data protection principles.
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Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care.
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Minimum of 2 years relevant work experience in Network Management in a managed care setting, health plan or large medical group administration. Network Specialist, Provider Network.
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Provides strategic direction and leadership through effective negotiation and implementation of reimbursement structures and payment models, management of payer and physician relationships, managed care partnerships, and network development.
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In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
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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.
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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.
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Participate in all necessary activities to insure payment for treatment services by insurance/managed care companies including, but not limited to, Medicaid/Medicare. Serving the Westchester community from Yonkers to the river town communities of Hastings-on-Hudson, Ardsley, Dobbs Ferry and Irvington, St. John's Riverside has been and continues to be a unique and comprehensive network of medical professionals dedicated to a tradition of service that spans generations.
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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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Headquartered in King of Prussia, PA, UHS has 89,000 employees and through its subsidiaries operates 26 acute care hospitals, 334 behavioral health facilities, 39 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 38 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.
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