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Strong analytical skills needed to compile and analyze data including: managed care denials/underpayment/ overpayment identification and resolution, contract modeling and evaluation, filing appeals as well as aiding in decision support reporting.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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7+ years of medical economics, actuarial informatics, analytics or highly impactful reporting development experience for a health provider, plan, or managed care organization required.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Providing comprehensive and high-quality legal support in the areas of sales, marketing, promotional/medical/patient materials, patient access/support/reimbursement, government contracts and pricing, managed care, fraud & abuse, and regulatory and legal compliance with federal and state statutes, FCPA, rules and regulations, privacy, safety/product liability law, and other laws, regulations and Company policies and procedures.
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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 Sr Financial Analyst maintains current knowledge of the Medicare Cost Report regulations related to SOT and uses that knowledge to ensure all data vital is present to assure accurate MCR reporting.
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At least 1+ years of RN experience as RN Care Manager in Medicare Advantage Plan, Managed Care is required. Reporting to the Supervisor of care management, this position will provide telephonic case management to our members including medical, social, psychological, physical and spiritual needs by developing, implementing and monitoring the member's care plan in conjunction with the PCP, caregivers and other team members in order to help meet the member's needs.
$100,000 - $106,000 a yearFull-timeRemoteExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Keywords: Remote, Actuary, Bachelor's, ASA, Actuarial Healthcare, Health Plan, Managed Care, MCO, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming.
RemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Data and Informatics Responsibilities: Associate Director, Managed Care Informatics and Data oversees and coordinates the extraction, aggregation, and quality assurance of data from multiple sources in support of performing managed care plan and Ryan White reporting, operational reporting and quantitative analyses of utilization, eligibility, quality, and claims data.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Completes all requested forms, documentation and other reporting requirements in a timely manner and in accordance with Department of Children and Family (DCF), managed care, probate court, JCAHO and other standards with which program must comply, as evidenced by chart reviews and supervisor observation.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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The Care Coordinator will be Trilogy's clinical liaison to managed care organizations (MCOs), Integrated Health Homes (IHH), The Illinois Health Practice Alliance (IHPA), and will ensure compliance with The Healthcare Effectiveness Data and Information Set (HEDIS) measures.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Meet deliverables based on MCO care coordination contracts and complete required reporting. The Care Coordinator will assess the needs of Williams and Colbert Class Members as they prepare to transition into the community ; and act as an advocate / liaison between the provider team, facility , and the payor.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement. Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care.
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Reporting to the Director of Talent Acquisition, the Talent Acquisition Manager – Home Care is a trusted business partner of RiverSpring Living’s companies who builds and fosters the connection between recruitment and retention for business development and growth for RiverSpring Living Programs.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The Research Scientist I (RS I) will plan, organize, and carry out epidemiology/biostatistics scientific research studies of limited scientific scope and complexity for the Program Data Reporting Division, Managed Care Plan Data Support Branch, Managed Care Network Adequacy and Methods.
$6,512 - $8,093 a monthFull-timeExpandUpdated 23 days ago - UpvoteDownvoteShare Job
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Providing legal guidance for sales, marketing, promotional/medical/patient materials, patient access/support/reimbursement, government contracts and pricing, managed care, etc. Broad knowledge of and significant legal experience in anti-kickback, Sunshine Act reporting, FDCA, OIG, privacy, FCPA and other statutes, regulations, guidances, enforcement, and trends applicable to the development, marketing and sale of pharmaceutical products, especially the US environment.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Managed care organization leadership experience as a Medical Director or CMO role preferred.
ExpandApply NowActive JobUpdated 4 days ago
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