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The Deputy Director has two primary responsibilities: 1) ensuring that Managed Care Organizations who contract with MassHealth are appropriately utilizing state funds, and 2) enabling the operational effectiveness of Program Integrity across all its sub-teams.
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Compass Healthcare Consulting & Placement is conducting a search for a Full Time Remote - NYS LMSW Social Work Care Manager for our client a Managed Long Term Care Plan. Qualified candidates will have a NYS LMSW and prior LMSW Care Management experience from a Managed Long Term Care Plan (MLTC.
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Human Resources Direct supervisor for the ambulatory practice leadership and technical leads, including practice managers/administrators (5 FTEs), Genetic Counselor Manager (1 FTE), Chief Sonographer (1 FTE), Embryology Technical Director (1 FTE), and Managed Care Manager (1 FTE.
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With charting managed through Aria and Meditech EMR systems, this position requires a Board Certified Radiation Oncologist with a fellowship, showcasing an experience level of 5+ years in the field.
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Strong knowledge of and/or experience with government programs regulatory, operational, financial, and clinical requirements for the delivery of health insurance and managed care products and services, including Medicare, Medicaid, MMP, LTSS, SNP, Duals, CHIP and behavioral health, as well as the associated and relevant federal, state and local regulatory entities.
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Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities.
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Contributes as a managed care resource for everyone on the unit including all patients, physicians, social workers, nurses, practice assistants, and support staff. Collaborates with referring physicians, patients and support staff to request, obtain, record, and attach primary and/or specialty care managed care referral and authorization requests for multiple managed care insurance payers for a high volume of patients.
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The TPI is managed by civic-minded medical and non-medical professionals who have great concern for public good in general, and the equality of access to healthcare services in the underserved communities (i.e., the African American, Hispanic and Latino communities that have long experienced inequality in educational opportunities and healthcare disparities), in particular.
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The emphasis is placed on supporting the Managed Care Team, Financial Counselors and Media Senior Practice Assistance. Provides back-up coverage to the Billing Managed Care, the Patient Business Representative, and Media Senior Practice Assistance.
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These benefits include comprehensive health care coverage and emotional well-being support, market-leading retirement, generous paid time off and parental leave, charitable giving employee match program, and educational assistance including student loan repayment, tuition reimbursement, and learning resources to develop your career.
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Minimum 10 years field-based pharmaceutical/biotech Sales and/or Marketing experience with at least 3 years of direct managed care experience. The National Account Manager (NAM) will work with the Sanofi Specialty Care National Account Director (NAD) to be responsible for establishing credible relationships within assigned national accounts to include national payers, specialty pharmacies, PBMs, Medicare Health plans and GPO customers to achieve and maintain open access for all Sanofi Specialty Care specialty portfolio.
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Collaborate and communicate with the enrollee's other medical, behavioral health and home-based providers regarding changes in services, hospitalizations, and other care needs and goalsObtain required Prior Authorization from Managed Care Plan (ACOs, MCOs) for relevant and necessary services.
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Structure and execute analytics plans (e.g., inferential statistics, longitudinal studies, and structured decision support)Scope, sell, and deliver commercial data projects, which can include but are not limited to market sizing/ segmentation, provider profiling/targeting, provider affiliation mapping, epidemiology studies, managed care analytics, pull-through modeling / program design, forecasting, field force design, and incentive comp.
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Experience providing direct care to disabled and/or elderly populations or working in or with managed care organizations (e.g. PACE, SCO, or Integrated Care Organizations (ICOs.
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Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS. Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial.
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