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This job supports Medicare Advantage and government programs managed care health plan business and investigates factual situations and presents well-reasoned and creative solutions and alternatives based upon independent legal research and analysis of the facts and the law.
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TravelNurseSource is working with CareerStaff Unlimited to find a qualified Other RN in Pittsburgh, Pennsylvania, 15106 Pay Information $2,050 per week About The Position Registered Nursing- RN - Long Term Care/Skilled Nursing Facility Invest in your future by discovering a facility in Pittsburgh, PA with resources, technology, and opportunities that will positively impact the rest of your healthcare career.
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Provides Medicare, Medicaid (case mix), and managed care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident. A family-owned company, we have grown to become one of the nation's largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH.
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Responsibilities:Responsible for all account management functions in the Western PA market, including managed care products, funding mechanisms and consumer-directed services. The ideal candidate will have prior account management experience in managed care.
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Through this effort we create "Caring Communities" where staff, residents, clients, and family members care for and about one another. The RN/LPN MDS Coordinator reports to the Executive Director and is responsible for accurate and timely completion of MDS assessments and coordination of the RAI process.
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Knowledge of managed care pre-authorization procedures, preferred. EConsults are asynchronous, non-face-to-face consultations between a primary care provider and a specialist that utilize secure messaging to exchange information.
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Registered Nursing- RN - Long Term Care/Skilled Nursing Facility. CareerStaff Unlimited, LLC ("CareerStaff") is a renowned industry leader in healthcare staffing, managed services, and workforce solutions.
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Boston Medical Center HealthNet Plan (BMCHP) is a not-for-profit managed care organization which provides health insurance coverage to residents in Massachusetts and New Hampshire. We were established in 1997 by Boston Medical Center, the largest safety net hospital in New England and have more than 20 years experience delivering accessible care to complex populations.
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This role requires a strong knowledge of PBM/managed care and formulary management including development and implementation. Pharmacy Practice or Managed Care residency preferred.
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Assist program leadership with monitoring by DPW, County authorities, Managed Care Organizations, and COA accreditation. Employees are supported in these efforts through ongoing development and trainings such as trauma-informed care, co-occurring integrated treatment methods, and many other efforts.
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Knowledge of how to interpret a managed care contract, Medicare and Medicaid and Workers Compensation claims is a must. Southwestern Ambulatory Surgery Center has an immediate opening for a full time Billing Collections/Patient Registration.
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100% Remote / W2 Only *Overview: Our client, a US Fortune 500 company and a provider of managed Health care, Pharmacy benefits & specialty areas for managed care organizations / employers / government agencies, seeks an accomplished Principal Data and Integration Engineer.
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Knowledge of insurance regulations, specifically Medicare, BC/BS, managed care plans and workers compensation carriers regarding scheduling and approval of surgical procedures. This Division is comprised of 3 clinic locations and one administrative space, all working as a team to provide the highest level of care to patients and families through clinical expertise, research initiatives, and strong administrative support.
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Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred. Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population.
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Working knowledge of utilization review, quality assurance and managed health care concepts. The remainder of the day is spent visiting patients in our day center medical clinic, attending interdisciplinary meetings, intake & assessment care-planning meetings, and office time for documentation.
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managed care jobs in Brentwood, PA
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