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Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. We offer care management programs for asthma, diabetes, and high-risk pregnancy.
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Founded in 2013, Innovista Health offers solutions for providers at every point along the continuum of value-based care, ranging from care management, provider/ACO enablement, and quality improvement to performance insights, reporting, and managed administrative/payment services.
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Work Experience (Years and Area): At least 3-5 years of experience in a managed care health plan as a service coordinator and at least 3-5 years of experience training/precepting/coaching in STAR+PLUS Service Coordination.
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Minimum of eight (8) years US pharmaceutical sales, marketing, healthcare, or managed care with a minimum of three (3) years in; Oncology, rare disease and/or account management experience calling on C and D Suite customers across Integrated Delivery Networks.
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Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management. Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
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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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Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
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Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Knowledge of Medicare, Medicaid and Managed Care requirements.
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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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The Regional Director, Medical Imaging will collaborate with key departments including Ambulatory Services, Information Systems, Finance, Purchasing, Human Resources, Managed Care, Marketing, Medical Records, Quality Improvement, Risk Management, Coding Compliance, and the Laboratory to meet organizational and departmental goals.
$136,122 - $168,137 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Participate in end user on-boarding meetings to help explain the Complete Care program and show clients how to interact with our Service Desk. Walk users through the Complete Care end user guide and ensure the client understands the process while emphasizing our commitment to excellent customer service.
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Attends applicable committee meetings, such as a Joint Operating Committee (JOC), as requested by Utilization Management or Managed Care: Works with the Care Management Director and staff to facilitate client profiles, clinical service utilization and support for revenue management activities.
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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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Must have extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, Workers Comp, Commercial plans, etc. Endoscopy Center of Bergen County located in Paramus, NJ. United Surgical Partners International is a privately held company that specializes in the development and operation of Ambulatory Surgical Facilities in the U.S. We provide first-class surgical services for local communities and recognize our employees as our number one assets.
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Preferred Qualifications: Bilingual (English/Spanish) fluency A working understanding and support of a managed care environment The OptumCare Story: Optum is the largest care delivery organization in the world.
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managed care jobs in Houston, TX
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