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The CRS manages the overall resident assessment process and tracking of all Medicare/Managed Care/Medicaid case mix documents in order to ensure appropriate and optimal reimbursement for services provided within the Care Center.
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Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Previously managed and developed product, UX/design, or technical staffHas a Master’s Degree in Business Administration or EngineeringThe above information has been designed to indicate the general nature and level of work performed in the role.
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Assistant Director, Managed Care Programs for Operations Brochure. Under direction, to direct the design, development and implementation of managed care systems of the Santa Clara Valley Health and Hospital System's Local Initiative Plan; to maintain internal relations with medical staff and administration, managers and other clinicians, and to develop and maintain relations with external potential health care providers, work groups and customer departments and agencies.
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Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. A valid California Residential Care Facility for the Elderly Certification or Licensed Nursing Home Executive Director.
ExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Keep informed on issues and trends relating to Healthcare, Workers Compensation, Bill Review, Cost Containment, Managed Care, and related areas. As our Director of Specialty Bill Review Services, you will maximize savings and client satisfaction by providing strategic direction for Rising's Specialty Services unit involving complex/large medical claims; analyzing and optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse, negotiators and related staff in an environment of continual performance improvement.
RemoteExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Managed Care Organization (MCO) experience preferred. Case Manager-RN - Coordination of Care Services Director. The Director of Case Management leads and manages the day-to-day operations of utilization, clinical resource and case management departments and focuses on the continuum of care for the patient population.
ExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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We are seeking a Sales Director, Marketing Outreach & Enrollment to support a national managed care organization in San Jose, CA. This is an onsite role and relocation assistance is approved on a case-by-case basis by the company.
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All clinical & state regulatory supervision of support teammates (PTA) are to be directly managed with direct support from their Clinic Manager (CM), Regional Clinic Manager (RCM) & Director of Clinical Operations (DCO.
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May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues. The Director - Utilization Management direct and manage the day-to-day operations of the Utilization Review Department.
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Familiarity with the Affordable Care Act, Mental Health Parity and Addictions Equity Act, 2016 Medicaid Managed Care Final Rule, Knox-Keene Health Care Service Act of 1975, electronic health care systems, CalAIM, Medi-Cal delivered specialty mental health services, and DMC-ODS delivery systems to address substance use disorders is highly desirable.
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Managed care principles, medical group management, hospital and health plan operations, California Health and Safety Codes (Title 22 and 28, HEDIS, NCQA standards, Medi-Cal, Medicare, and Utilization Management guidelines such as Milliman and InterQual.
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Identify the managed care operations you have managed in a Knox Keene licensed health plan and the associated regulatory requirements, as applicable (i.e., Contracting, (Ancillary, Facility, Fee-for-service, Professional, Risk Based), Contract and Benefits Configuration, Compliance, Disputes and Grievances, Credentialing, Claims, Provider Data Management, Provider Relations, Service Operations, or Provider Services.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Knowledge of managed care, utilization management, case management, and disease management. Coordinating managed care services and referrals to outside agencies. The Director will ensure that the program operates within the mission and philosophy of the organization to serve and facilitate the comprehensive medical, dental, and behavioral health needs of the families in the community.
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The Maintenance Director is responsible for planning, organizing, developing, and directing the general operating maintenance, repair, and housekeeping of the physical plant the interior and exterior of the Community to maintain proper operations of the property.
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