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The VP Managed Care Contracting and Payor Strategy will play a critical role in driving revenue growth and financial performance for the multi-hospital system in California. The VP Managed Care Contracting and Payor Strategy will be responsible for leading the development and execution of managed care contracting strategies and payor relationships for a multi-hospital system in California.
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Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Develops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements.
$93,000 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Experience with medical record review working on HEDIS/QARR in a managed care, health plan or provider office setting. Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
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The Medical Billing and Collection Specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers.
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MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
$65,000 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Clinical background preferred (Medical Assistant, Nursing Assistant, Health Educator, LPN, RN, LMSW or LCSW. Experience with medical record review working on HEDIS/QARR in a managed care, health plan or provider office setting.
$2,024 a weekFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Expertise in managed care contracting, cost accounting, and service line profitability analysis. The hospital's comprehensive range of services includes a 24-hour emergency department, intensive care units, cardiac and vascular surgery, neurosurgery, comprehensive stroke care, orthopedics, oncology, maternity services, diagnostic imaging, outpatient surgery, and acute physical rehabilitation.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: ASAP Duration: Ongoing Employment Type: Staff Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
$93,000 a yearExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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In-depth knowledge of all Fidelis Care products, including “metal” products offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA and HARP. Ability to answer product feature and benefit questions; compare and contrast Fidelis Care products and provider network of competing plans in assigned territory.
$38.07 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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At least five (5) years of analytics development experience for a health provider, health plan or accountable care organization including:Experience working in a health plan and/or Health Delivery System focused on medical economicsExperience working in healthcare provider analytics related to managed care contracting, population management, clinical or financial decision supportStrong data mining skills using tools like SQL, R, Python, SAS, etc.
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Minimum 1 year of experience in provider network development and/or provider network management capacity, account management, or provider relations experience in a managed care organization.
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2 to 5 years prior experience in managed care, sales, customer service or related experience preferred. They also are fluent and can articulate the QCMI program, are knowledgeable of the provider networks in their territory and have a working knowledge of Fidelis Care’s care management approach.
$38.07 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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If you're a proficient Registered Nurse with a minimum of two (2) years of recent experience in a home environment within the past fifteen (15) years , this could involve working with a Certified Home Health Agency (CHHA), Licensed Home Care Service Agency (LHCSA), Managed Long Term Care (MLTC), or experience in home care as a paraprofessional (e.g., Home Health Aide or Licensed Practical Nurse (LPN), including Private Duty Nursing , we invite you to submit your application.
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The Medical Administrative Support Specialist will be an integral part of this dedicated team responsible for ensuring that HSVS’s foster care children are receiving all needed healthcare services through HSVS’s 29-I primary care clinic and Medicaid Managed Care Plan (MMCP) in-network providers, and that these services are being documented appropriately in the Electronic Health Record (EHR.
$50,600 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Overview:The Adult Protective Services Litigation and Program Counseling Unit represents the agency with respect to support for the Home Care Services Program, the HIV and AIDS Services Administration (HASA), Adult Protective Services (APS), the Medical Assistance Program (MAP), and the Medicaid Managed Care Program.
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care managed jobs in Brooklyn, NY
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