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Specifically, DHCS, in collaboration with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), is establishing a statewide, multi-payer, school-linked fee schedule (CYBHI fee schedule) to reimburse school-linked providers for the provision of specified outpatient mental health and substance use disorder (SUD) services furnished to students 25 years of age or younger at a school site.
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We are seeking an experienced and dynamic Interim Chief Financial Officer (CFO) to join a Managed Care Organization (MCO). Proven experience as a CFO or senior finance executive in a healthcare or managed care organization.
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Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry. Experience working in Medicaid and/or Medicare in the Managed Care setting.
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The CFO is responsible for the Hospital System, financial operations, financial reporting, financial planning and analysis, decision support, budgeting/accounting systems and procedures, revenue cycle management including patient admitting and registration department, capital budget planning, managed care contracting, and Hospital System purchasing and procurement processes.
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Reading, interpreting, and responding to Managed Care regulatory bodies and contracts. Molina Healthcare of Nevada is hiring for a Managed Care, Gov Contracts Sr. Specialist.
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Differentiation of the unique characteristics of the following insurance types: Medi-Cal, Medicare, Managed Care, Indemnity and Workers Compensation including eligibility requirements and benefit coordination.
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Coordinating the delivery of analytical support to internal customers including the Central Business Office, Pharmacy Services, Business Planning, Accounting, Managed Care Contracting, Claims, Marketing, and Utilization Management departments and partnering with the Business Intelligence team to automate and improve reporting.
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The Employer Solutions Project Manager is in the Managed Care department at AdventHealth and reports to the Director of Employer Solutions. The Project Manager is responsible for obtaining, maintaining, analyzing, and reporting the data concerning employers and their purchasing of healthcare, and vendors and others in the employer healthcare ecosystem.
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Foster and sustain FHCSD’s community relationships including those with community hospitals, managed care plans, and other social services agencies. Collaborate with clinic administration and ancillary leadership to improve upon the patient care continuum.
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Minimum Experience: 8 years in A/R management and/or managed care contracting and analysis as well as directing a multi-facility business office. Owns reporting and provides support to CFO.
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Requires knowledge of all aspects of hospital billing and profession claims, including Medicare, AHCCCS, commercial, managed care, work comp and self pay billing guidelines. Reporting to the Director of Patient Financial Services, the Billing and Insurance Follow-Up Manager is accountable for ensuring the accurate and timely billing of all patient accounts across the Health System.
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The Assistant Research Scientist/ Research Scientist 1/ Research Scientist 2 will work for the Director of the Managed Long Term Care Evaluation Unit to help the Office meet its expanding responsibilities to promote health care quality and patient safety through a variety of data-driven means including quality measurement and reporting, research, evaluation, and health information analysis.
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3 years’ experience in a managed care environment. Proficient in compiling data, creating reports, and presenting information, using Crystal Reports (or similar reporting tools), SQL query, MS Access, and MS Excel.
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In partnership with and under the direction of the Lead Director, National Medicaid Business Compliance Office (BCO), this position will help develop and maintain systems and processes for the management, execution, and oversight of the implementation of new state Medicaid contract amendments and program requirements across Aetna’s 16 Medicaid managed care markets (and 26 distinct state contracts.
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We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Develop ERM methodologies for the assessment, analysis and management of enterprise risks and provide for monitoring and reporting of risk information.
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