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Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. HEDIS, Medicare, patient care.
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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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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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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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Know insurance pre-certification/pre-authorization, Managed Care, Medicare/Medicaid and Commercial insurance plans. Support and contribute to UPMC core values and guiding principles of Your Care.
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May complete managed care responsibilities in regard to obtaining pre-certification and authorizations. State criminal background check, and federal, if applicable, as required for state department of health (e.g. PA DOH, OH DOH, MD DOH, WV DHHR) regulated areas based on physical work location.
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Provide appropriate guidance to patients regarding Managed Vision Care. Assist the store with being effectively merchandised according to the Planogram and other Company standards. Fill ophthalmic eyeglass prescriptions, and fit and adapt lenses and frames, to include but not limited to the following:Utilize optical prescription in conjunction to the patient's visual requirements.
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Provide appropriate guidance to patients regarding Managed Vision Care. The basic function of the Optician is to attract and retain patients by delivering an exceptional patient experience, foster patient retention, and promote outstanding doctor satisfaction.
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Broad knowledge of Medicare, managed care, third party payers, and Medicaid required; knowledge of Medicare rulemaking process, Durable Medical Equipment benefit category preferred. Broad knowledge of Medicare, managed care, third party payers, and Medicaid required; knowledge of Medicare rulemaking process, Durable Medical Equipment benefit category preferred.
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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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Full-time associates are eligible to participate in a comprehensive benefit package, which includes medical/dental/vision plans, life insurance, ST/LT disability options, 401K options, tuition assistance, discounted room rates at Concord managed hotels, plus training & development and career advancement opportunities.
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Patient Account Representative (Managed Care Medicaid Claims) Investigate and follow-up on all open Managed Care Medicaid Claims account balances overdue for 45 days or more to determine reason for non-payment.
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The ideal candidate will have a solid understanding of the regulatory framework for publicly-funded health and human service programs (e.g., Medicare, Medicaid, and HHS-administered grant programs) and transactional experience related to contracts between providers and vendors in compliance with federal fraud and abuse laws as well as participation agreements with managed care organizations or provider networks in compliance with federal Medicare and Medicaid managed care regulations.
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Knowledge of terminally ill patients and their families along with understanding of hospice concept; knowledge of roles of all disciplines providing hospice services; excellent patient assessment skills; good oral and written communication; thorough knowledge of managed care principles, regulatory guidelines (i.e., Medicare, Medicaid, and human resource) management principles.
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managed care jobs in Bridgeville, PA
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