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Assist ECM Providers with the coordination of member care with internal L.A. Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and Support (MLTSS), Social Services, Behavioral Health, Community Health, Health Education, as well as external providers such as Participating Physician Groups (PPGs) and Primary Care Physicians (PCPs.
$88,854 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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POSITION REQUIREMENTS A. Education Completed MD or DO accredited residency program, B. Qualifications/Experience Four (4) years in the health care setting and in a managed care environment with Hospitalist experience preferred.
Part-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Minimum of 5 years of Case Management experience, with Managed Care experience preferred. The role involves monitoring case assignments, ensuring the timely completion of Individualized Care Plans (ICPs), and coordinating Interdisciplinary Care Team (ICT) meetings for the Medicare Medi-Medi population.
$55 an hourFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Two or more years of managed care or health plan experience preferred. As a key leader within our Medicare Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators.
$121,400 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The ECM Clinical Consultant ensures that the care provided is consistent with the Penny Lane philosophy and meets the current standards for quality of care, medical necessity and outcome measurement as defined by the contracted Managed Care Plans and the Joint Commission.
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Enhanced Care Management (ECM) is a benefit available to Medi-Cal managed care Members under specific populations of focus for children/ families and adults to address social drivers of health.
$23 - $26 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Maintains current knowledge of regulatory requirements pertinent to BHI UM which includes the Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), Managed Risk Medical Insurance Board (MRMIB) and Department of Managed Health Care (DMHC.
$145,312 a yearFull-timeExpandApply NowActive JobUpdated 21 days ago - UpvoteDownvoteShare Job
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Job Title: Manager Provider Data Management – Managed Care - (LA8996) Managed care experience. 3 Key Consulting is recruiting a Manager Provider Data Management for a consulting engagement with our direct client, a leading global biopharmaceutical company.
Full-timeExpandApply NowActive JobUpdated 23 days ago - UpvoteDownvoteShare Job
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1+ years Managed Care or Healthcare experience in Network Management, a plus. Under the Provider Network Operations (PNO) Database Management Supervisor's general direction, the PNO Database Management Support I is responsible for ensuring accurate, timely, and efficient provider profile creation in all Client IPA databases.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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A minimum of two years experienced in managed care environment to include but not limited to an IPA or MSO preferred. Current knowledge of Managed Care UM procedures. Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company.
$26 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Minimum of 5 years of clinical practice in direct patient care and at least three years of medical management experience in a managed care setting plus knowledge of managed care operations processes and managed care contracting, including Capitation and Risk Pool Management also required.
$348,920 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Previous utilization review/utilization management experience in a managed care setting is preferred. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community resources.
$55.32 an hourFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Minimum 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments.
$142,166 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Adhere to California Children Services (CCS) care management guidelines when responsible for managing CCS patients. Proactively call/fax daily concurrent chart reviews to managed care companies (MCO)/medical groups according to payor contract/hospital policy.
$73.95 an hourFull-timeExpandApply NowActive JobUpdated Yesterday
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