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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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4+ years proven background in healthcare law (contract law, Medicaid, Medicare, CMS standards, federal contracting, procurement, value-based care, QIA, and healthcare transactions.) This position will also serve as a subject matter expert, educational resource, and strategic adviser, to Sharecare business leaders and colleagues on all aspects of governmental healthcare programs including Medicaid, Medicare, and value-based care.
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The AVP will play a key leadership role on the HQRI team, partnering directly with the HQRI leadership team, leaders across the enterprise, including Market leadership, and external companies to create Medicare Risk Adjustment strategies to support Humana's industry leading position.
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The Clinical Pharmacist will have clinical practice experience with evidence-based pharmacotherapy recommendations including but not limited to diabetes mellitus, heart failure, ASCVD, COPD, asthma as well as familiarity with specialty medical conditions managed by specialty medications including inflammatory bowel disease, rheumatoid conditions, neurological disorders, blood disorders, hormonal and enzyme deficiencies.
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Assist residents with daily bath, dressing, grooming, dental care, bowel and bladder functions, preparation for medical tests and exams, ear and eye care and positioning in and out of beds, chairs, bathtubs, etc.
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Responsible for getting the resident ready and to the lobby for scheduled appointments Aware of what constitutes a change of condition and report to Medication Tech/Resident Care Coordinator/HSD immediately.
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Communicates and advises appropriate internal and external stakeholders on Medicare Compliance and Medicare Set-Aside (MSA) matters including, but not limited to, lien negotiation efforts, MSA submissions and/or general information.
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Review healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) Founded in 2020 and backed by leading investors including Oak HC/FT, F-Prime Capital, Health Velocity Capital and Noro-Moseley Partners, Rialtic's best-in-class payment accuracy product brings programs in-house and helps health insurance companies gain total control over processes that have been managed by disparate and misaligned vendors.
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Responsible for obtaining pre-certification and/or managed care referrals for inpatient and out patient encounters. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required.
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Previous case management experience and team experience in managed care is strongly preferred. We achieve this goal by building a value-based care model that uses community engagement to address gaps in care, and allocate social resources to address health inequities, starting with the sickle cell disease (SCD) community.
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Supporting new business development opportunities and providing voice of the TRICARE customer through long term strategic planning, providing decision-making support on behalf of TRICARE for Humana Military's capture planning, and participating in development of proposals and business plans within the framework of the program being managed.
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Orthopedic Surgery, Orthopaedic Surgery, Os, Orthopedic Surgeon, Orthopaedic Surgeon, Orthopedic Physician, Orthopaedic Physician, Orthopedics, Orthopaedics, Physician, Healthcare, Health Care, Patient Care, Hospital, Medical, Doctor, Md, Foot And Ankle Surgery, Foot/Ankle Surgery, Foot, Ankle.
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Current inspections cover a broad range of public health topics such as the COVID-19 pandemic, the opioid epidemic, Medicare drug spending, quality of care in Medicare and Medicaid, and data quality issues.
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JOB DESCRIPTION: The CARE Lab at Emory University is seeking a postdoctoral fellow to engage in the human-centered design of AI systems for care work and community health. The position also provides opportunities to work with collaborators globally, with a special focus on reproductive care and mental health.
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Trella Health provides unmatched, actionable market intelligence to post-acute care and value-based care providers of all sizes. Our industry leading analytics paired with CRM and EHR integration workflows positions us as the most advanced sales enablement platform for the post-acute care market.
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medicare managed care jobs in Atlanta, GA
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