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Acts as an advisor and consultant in the establishment of operational policies of the practice to include: (1) Purchasing and capital allocations; (2) Managed care plan participation; (3) Budget and practice expenses; (4) Medicare/Medicaid participation; (5) Billing and collection of professional fees; (6) Personnel management and related policies; (7) Risk management and quality assurance; and (8) Coding compliance.
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The health system includes 24 hospitals, more than 300 physician offices and other outpatient care sites, 10 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, an insurance company, a technology company and an Accountable Care Organization.
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Physician environment experience in practice transformation/quality improvement, ambulatory care setting quality and efficiency metrics, population health and care management structures, data analytics and electronic health records preferred.
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You will collect data from various internal systems (examples: Claims processing or membership systems) and external systems (EMR/EHR) and convert those data into actionable insights to guide business decision making for BSC population health management and quality of care.
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The University of Georgia Small Business Development Center, Rome office, seeks an experienced management professional with strong skills in financial analysis, business budgeting, small business lending practices, and problem solving to serve the Rome area as a business consultant.
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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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Position Overview:This position assists the Sutter Health Plan Ethics & Compliance Officer and ethics & compliance leadership in the oversight and administration of the ethics & compliance program at the entity level to ensure compliance with the organization’s policies and procedures and applicable state and federal laws, regulations, and standards (e.g., General Compliance Program Guidance, antifraud laws, physician self-referral laws, and anti-kickback statutes.
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Supports practice implementation of action plans around population health management, patient satisfaction and quality and cost performance. The Care Consultant Sr. for Provider Success is responsible for consulting with providers (Commercial, Medicare Advantage and Medicaid Lines of Business) to assess and deploy appropriate interventions to drive success in value-based care.
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Deep understanding of the pharmacy benefit management and US healthcare ecosystems, either at a PBM, health plan, health tech company or as a benefits consultant. As a Pharmacy Consultant you will be at the forefront of managing pharmacy benefits projects for clients and leverage your experience as a pharmacy benefits expert to make recommendations on plan design and management.
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It's more than a career, it's a calling OK-SSM Health St. Anthony Hospital - Oklahoma City Worker Type: Regular Job Highlights: Physician - Endovascular Neurosurgery - SSM Health - Oklahoma City, OK Presence is exceptional care that delivers exceptional outcomes.
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Certification as a Case Manager (CCM), Insurance Rehabilitation Specialist (CIRS), Disability Management Specialist (CDMS), Rehabilitation Nurse (CRRN), or Occupational Health Nurse (COHN) a plus.
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The model is a fully integrated population health and customer service solution for large plan sponsors high-touch, high-tech member advocacy service which combines data-driven processes with the expertise of highly trained clinical and concierge member services.
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Qualifications Job Requirements: Graduate of an accredited school of nursing Current Oklahoma RN License Must possess and maintain current BLS for the Healthcare Provider NRP must be obtained within 6 months of hire Currently certified as a Lactation Consultant Previous experience in maternal-child health nursing.
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As an Employee Benefits Consultant focused on Health & Welfare Consulting, you will manage projects and client relationships spanning a variety of topics including, but not limited to plan design, compliance and reporting services, health plan underwriting and employee contribution setting, health and well-being management, and retiree health care solutions.
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Acts as technical expert, in specialty areas for internal and external business partners, (e.g., health & welfare, retirement, plan design, ERISA, etc. Development of CNA's benefit plan communication and engagement strategy and oversight of CNA's online benefit communication channels and external communications consultant.
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management consultant health plan jobs in Bentonville, Kansas
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