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Participates in the strategic planning process and works closely with the VP Managed Care Operations. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.
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Strong working knowledge of current ambulatory healthcare industry, as well as, managed care experience working with Department of Managed Care. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services.
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This role will report into DaVita's Integrated Kidney Care (IKC) Program Management team, which oversees programmatic success across all Value Based Care (VBC) product lines. We are a highly motivated, fast-paced team with extensive experience in operations, managed care, and consulting, and are at the center of DaVita's strategy to evolve from fee for service to value based care.
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Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care.
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Acts as an advisor and consultant in the establishment of operational policies of the practice to include: Purchasing and capital allocations; Managed care plan participation; Budget and practice expenses; Medicare/Medicaid participation; Billing and collection of professional fees; Personnel management and related policies; Risk management and quality assurance; and Coding compliance.
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In conjunction with the VP of Managed Care Contracting & Payor Relations/legal department, reviews and negotiates any new 340B contracts and renegotiation of existing transaction fees. Participates in the policy and procedure development, maintains internal and external relationships (wholesalers, Covered Entities, and third-party administrator [TPA] vendors) as needed, 340B rules/guidance surveillance, assist in 340B off site audits as necessary, contract management/implementation, reporting/analyzing, and program enhancement/ optimization projects including annual budgeting.
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Borgess Ascension Hospital includes more than 130 sites of care in 15 southern Michigan cities, as well as eight owned or affiliated hospitals, a nursing home, ambulatory care facilities, home health care, physician practices, managed care services, a cancer center and an air ambulance service.
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Knowledge of managed care principles and practices with an emphasis in Grievance and Appeals and/or Utilization Management. Apply the use of clinical judgment to identify and coordinate referrals to appropriate departments or programs for member identified needs, such as Case Management, Behavioral Health, Managed Long Term Services and Supports (MLTSS) and Quality.
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Assist Box Office Manager with management of Food & Beverage Vault upon request, assisting the vault clerks as needed. The primary responsibilities are assisting with box office management and handling all aspects of capital for Osceola Heritage Park. ESSENTIAL DUTIES AND RESPONSIBILITIESAssist the Box Office Manager with all box office functions.
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QUALIFICATIONS & EXPERIENCE REQUIREMENTSGraduate of an accredited school of nursing; RNValid RN or LPN license in the state of PennsylvaniaThree years of experience in a long term care environment preferredExperience with the MDS/RAI process and/or case management preferredJOB RESPONSIBILITIESThe MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is responsible for accurate and timely completion of mds assessments and coordination of the RAI process.
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Medical Director, Ventura County Health Care Plan Under generalsupervision of the Deputy Director Health Care Agency for theVentura County Health Care Plan (VCHCP), will perform duties setforth in the California Knox- Keene Health Care Service Plan Actas well as regulations and Health and Safety code for VCHCP, aDepartment of Managed Health Care (DMHC) licensed Commercial HMO.This position is part of a team of 65 (including contractors),with no direct reports, and a $90 million dollar budget.
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Minimum 10 years of previous experience working in HEOR and/or RWE outcomes research in the pharmaceutical, managed care or consulting industries. The candidate in this position will provide HEOR & RWE presentations, clinical presentations as necessary, conduct collaborative research, and enter into evidence-based medicine discussions with healthcare providers, RWE researchers, managed markets medical and pharmacy directors, quality improvement specialists, integrated delivery networks, and managed care formulary decision makers and consultant pharmacists, state Medicaid and Medicare decision makers, guideline developers and others.
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Job Title: Managed Care Coordinator. Managed Care Coordinator. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
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May act as system administrator for systems managed by CDM (Medidata Rave, TrialGrid, Jira, Confluence, etc. Clinical Data Management (CDM) supports drug discovery, development, and marketed products across Gilead by ensuring accurate and timely acquisition, analysis and reporting of clinical data.
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The role will also include oversight of managed services teams (e.g., security monitoring, EDR management, Network Security, DLP Monitoring, etc). This individual will be responsible for executing on the operational security program, overseeing Vulnerability Management, Data Security and Protection, Cloud Security, Infrastructure Security, and the Cyber Threat Intelligence program.
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care management managed jobs Title: management practice in Rogers, Arkansas
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