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To treat the whole person — body, mind and spirit — the institute offers supportive and palliative care, cancer genetic counseling and high-risk care, and complementary services through various wellness programs, integrative medicine and a Cancer Support Community.
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Three to Five (3-5) years experience in insurance benefit verification and/or collections and/or managed care contracting. understanding of Medicare rules and regulations; understanding of managed care as it relates to benefits and authorizations; advanced MS Office experience; strong verbal and written communication skills.
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Our practices offer: Women's Health, Wellness, X-Ray/Ultrasound, Dental, Chiropractic, Urgent Care, Managed Care, and Workers Comp services. As we continue to grow, we want employees, like you, who value improving the lives of those they care for each day.
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Eight (8) or more years of related commercial experience required; may include (but not limited to) sales, product/brand management, sales training management, national account management (trade and/or managed care), and/or similar experience.
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The CareBridge Long Term Services and Supports (LTSS) Specialist, working under the guidance of an Occupational Therapist, collaborates with Managed Care Organizations to support persons aging in place receiving home and community based services.
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The POM possesses a thorough knowledge of the managed care, primary care clinic, urgent care, senior care, and retail/community pharmacy environment as it relates to pharmacy information systems, reimbursement, regulatory, compliance, and contract management.
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Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs and other payment mechanisms. + Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics required.
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Demonstrated knowledge of state Medicaid program, Medicare/PPS program, Managed Care programs, RUGs III and RUGs IV classification and reimbursement systems, Part A coverage guidelines and documentation requirements.
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2+ years working in social service or health care related field. Educate program participants and MCO representatives on options for home modifications, DME, assistive technology, or other adaptive equipment.
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1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost.
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Since 1983 as a community-based, not-for-profit organization, Chapters Health has provided choices, education and guidance through its managed affiliates: Capital Caring Health, Chapters Health Foundation, Chapters Health Hospice, Chapters Health Pharmacy, Chapters Health Staffing, Cornerstone Hospice & Palliative Care, Good Shepherd Hospice, Hope Healthcare, Hospice of Okeechobee, HPH Hospice and LifePath Hospice.
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Strong understanding of managed care principles, value-based care models, and regulatory requirements related to health equity and healthcare disparities. Deep knowledge of healthcare data standards (e.g., LOINC, SNOMED), product development and interoperability frameworks (e.g., HL7, FHIR.
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Minimum of 7 years of experience in healthcare data strategy, product management, or related roles, with a focus on health equity and diversity, equity, and inclusion (DEI) initiatives. Mentor team members and support their professional development to enhance their skills and capabilities in health equity data strategy.
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Keep informed on issues and trends relating to Healthcare, Workers Compensation, Bill Review, Cost Containment, Managed Care, and related areas. Prepare legal/settlement assessments, manage litigation/bill disputes, respond to defense attorney requests, and provide testimony as an expert witness as required.
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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managed care jobs in Orlando, FL
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