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Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care.
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About NYC Health + Hospitals 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.
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NYC Health + Hospitals is the largest public health care system in the United States. At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception.
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Managed care, value-baed payment model, quality and population health management experience. 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.
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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
$150,000 - $157,236 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Experience working in healthcare provider analytics related to revenue modeling, managed care contracting, population management, case management, clinical or financial decision support required.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Bachelor's degree in Business, Finance or related field, plus 5-7 years of experience in the health care industry (at least 3 years in managed care contracting), or an equivalent combination of education and experience.
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Broad and deep knowledge of managed care operations, the interconnectivity of diverse and complex functions, managed care information systems and related technologies. The Deputy Chief Operating Officer (DCOO) is a member of MetroPlusHealth’s Senior Management team and is vital in providing assistance with the oversight, management, and supervision of Operations, in a matrix organizational structure including: PMO, Process Improvement, Provider Network Operations, Call Center, Credentialing, Facilities, Enrollment & Membership, Vendor Management, Customer Success, and Claims.
$260,000 - $287,000 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Identify eligible Medicaid consumers via Home Care Agencies, Adult Day Care Centers, DME Provider offices, Caregiver Resources Centers, specialty provider offices, HHC Long Term Care Facilities, etc.
$59,012 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Maintains credentialed status with client's Medical Care at Home and associated managed care plans - Maintains NPI, Medicaid, and Medicare provider numbers. Advanced Practice Nurse Practitioner-Clinical Team Lead is needed to act as a key resource in providing clinical and operational guidance and support to patients, families, and clinical care teams.
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2+ years of claims, health care provider payment methods, and billing configuration experience. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health's network includes over 27,000 primary care providers, specialists and participating clinics.
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Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models.
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Requires a demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.
$93,000 - $127,050 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
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At Partnership Solutions, our work is performed in support of, and on behalf of, Care Design NY (a Care Coordination / Health Home), and Partners Health Plan (a Managed Care Organization), dedicated to providing supports and services for persons with intellectual and/or developmental disabilities.
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managed care provider jobs in New York, NY
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