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A partner of the Optum Care network, WellMed Medical Group, is seeking a nurse practitioner or physician assistant to join our WellMed at Courtyard Plaza – New Braunfels. Bilingual (English/Spanish) fluencyA working understanding and support of a managed care environment.
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Access : Ensure Humana members with behavioral health needs have access to appropriate and high-quality behavioral health care by optimizing network design, benefit design, care management, and referral pathways.
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Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
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2+ years of experience with provider service/provider relations operations/managed care, or relevant experience preferred. Knowledge of health care, managed care, Medicare and Medicaid.
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Four (4) recent years of clinical experience preferred, which may include service coordination, case management, quality management, or managed care experience. The RN-SC conducts a holistic assessment of the Member's dynamics, needs, and preferences while providing education and health-related information to the Member, the Member’s Legal Authorized Representative (LAR), and the Member’s Support Network.
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Managed care orientation. Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers compensation claims.
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Required Qualifications: Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S Board certification in Neurology Active, unrestricted medical license in Texas Preferred Qualifications: Bilingual (English/Spanish) fluency A working understanding and support of a managed care environment The OptumCare Story: At OptumCare, we've found that putting clinicians at the center of care is the best way to improve lives.
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Consults with the Data Management Coordinator, Configuration Manager and Network Management staff regarding plans to achieve the designated objectives of network development and managed care contracts.
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EDUCATION/EXPERIENCEA minimum of five years of experience in customer service delivery, managed health care delivery or managed care operations environment is required (formal education may be substituted in lieu of experience.
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Management Applications, Inc., a leading provider of Managed IT Services and Network Management, Design and Implementation is seeking San Antonio IT Professionals to provide Information Management and Information Technology Support Services in support of health care delivery and administration to a military entity.
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Managed Vision Care - Lead, Network Management. Manage claim issues generated by credentialing challenges, partner with Network Management Associates and Third Party Billing to produce resolutions.
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Oversee multiple clinics in a managed care setting and enjoy excellent support from this large organization that has all the resources needed for success. Seeking Experienced Medical Director with Managed Care Knowledge.
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Manage Network Management related research projects as needed. Support Network Management Team as needed with special projects. All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures.
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2+ years LVN experience in a managed care environment. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
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