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They will maintain the primary responsibility for coordinating all financial and managed care aspects of the patient experience across the continuum of the patient care encounter.
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Two to five years of experience, preferably in a managed care environment. Care Management: Reviews all cases meeting criteria to determine if the member qualifies for TPTN s internal Care Management program.
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Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
Starting at $161,914.25 - $315,732.79 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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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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Is knowledgeable regarding managed care implications – precertification and utilization review procedures. St. Luke’s C.A.R.E. delivery model (Continuity, Accountability, Relationship-based, Evidence-based) reflects a commitment to compassionate, competent care delivered by the interdisciplinary team.
$62,000 - $104,000 a yearPart-timeRemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Internal Medicine or Family MedicinePrevious experience as a physician advisorExperience in managed care contracting and familiarity with Medicare and managed care reimbursement policies.
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Preferable board certified or board eligible in primary care specialty (Family Practice, Internal Medicine, Emergency Medicine, Public Health or Occupational Medicine) with administrative experience in corrections and/or managed healthcare delivery.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Join our dynamic team and be part of our commitment to efficient Utilization Management and patient-focused care. Proficiency in federal and state regulations (DOH, Medicaid/Medicare) and familiarity with third-party payers and managed care principles.
Full-timeRemoteExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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A cost containment background, such as utilization review or managed care is helpful. Attends hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy.
Full-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Submitting concurrent review package and follow up with Utilization Management team at the Managed Care Plan for status. Obtain authorization single case agreement for all Managed Care patients.
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Implements care such as negotiation the delivery of durable medical equipment and nursing services. Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others.
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Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Experience with Utilization Management or Case Management preferredCompany ProfileFounded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children.
RemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Nationally recognized criteria such as Medicare Local Coverage Determination, Medicare National Coverage Determination, Milliman Care Guidelines, InterQual, and Apollo Managed Care Guidelines/Medical Review Criteria.
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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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Responsible for overseeing and coordinating all clinical aspects of the health plan, including medical and pharmacy management, utilization review, and initiatives to ensure care and services provided align with evidence-based guidelines and best practices.
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