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Director Managed Care Jobs

Managed Care Analyst Jobs
By Valley Health System of Ridgewood, NJ At , Ridgewood

Area of Talent: Professional Administration

Managed Care Analyst- Remote
By Premier Health At , Dayton, 45459
Other experience requirements: 1-2 years advanced Financial Analysis
PREMIER SYSTEM SUPPORT REMOTE POSITION / FULL TIME / 8A-4:30P/ 80 HOURS PER PAY
Minimum Level of Education Required: Bachelor's degree
Type of degree: Accounting, Finance, Healthcare Administration or related field
Minimum Level of Experience Required: 1 - 3 years of job-related experience
Strong statistical and analytical skills – Proficient in Excel
Managed Care Authorization Specialist
By AgeSpan At Lawrence, MA, United States
Encouragement of your development through opportunities to get involved, use your voice, and gain new knowledge and skills.
Support Management with updates and maintenance of forms and document, both digital and paper.
Data entry as requested or as needed in A&D or SCO databases including adding new members and closing disenrolled members
Attend any team, Managed Care Department and All Staff meetings and complete agency required trainings.
A refreshing culture that is supportive, collaborative, and encouraging of diverse perspectives and backgrounds.
A focus on innovation with a team recognized for developing and implementing innovative programs and novel solutions.
Managed Care Information Analyst
By Dept of Med Assistance Svcs At , Richmond $84,000 - $84,962 a year

Title: Managed Care Information Analyst State Role Title: Information Technology Specialist II Hiring Range: $84,000 - $84,962 Pay Band: 5 Agency: Dept of Med Assistance ...

Home Care Managed Care Coordinator
By Vanderbilt University Medical Center At , Nashville, 37232
Authorization Evaluation (Intermediate): Possesses sufficient knowledge, training, and experience to role model and coach less experienced peers.
Confer with other MCC's, brainstorm on any new payer process changes, and update Payer Auth Requirement document
The responsibilities listed are a general overview of the position and additional duties may be assigned.
Obtain Start of Care (SOC) authorization.
Obtain Add-on prior authorization, obtain prior authorization for Resumption of Care (ROC), obtain concurrent authorization.
Review written off no authorization (wona) requests from billing team for possible.
Contract Specialist, Managed Care
By UF Health Shands Hospital At , Gainesville, 32608 $31.78 - $43.96 an hour
Minimum Education and Experience Requirements:
Advanced managed care experience may substitute for the degree on a year-by-year basis.
Three to five years of managed care experience preferred.
Master's degree may substitute for the required experience on a year-by-year basis.
Director-Managed Care Jobs
By Mercy At , Chesterfield, 63017
Required Education: Bachelor's Degree in health care or business administration
Preferred Education: Master's Degree in Business or Health Administration
We're bringing to life a healing ministry through compassionate care.
What Makes You a Good Match for Mercy?
Director - Managed Care
By NewYork-Presbyterian Hospital At , Manhattan, 10065 $154,000 - $208,000 a year
Oversee the loading of Managed Care contracts into hospital’s billing and cost accounting systems.
Execute and manage one-time deal agreements and processes with non-contracted payers.
Five to seven years of previous work-related experience.
Experience the Pride of a Mission-Driven Career
Submit and oversee the hospital’s applications for insurance carriers’ centers of excellence.
Act as subject matter expert for transplant and psychiatric contracting matters.
Director, Managed Solutions Jobs
By The Select Group At United States
Provide operational, financial, technical and managerial skills necessary to manage the process and deliver winning solutions.
Customer facing ITIL certifications or ITIL design process experience a plus.
Director, Managed Solutions – TSG Managed Solutions - Remote
Lead the Solution Design process by analyzing RFI/RFP requirements and client needs to articulate solution strategy to solution architects.
Maintain and evolve technical skills aligned to industry trends and the TSG portfolio of Services.
Bachelor’s degree, preferably with Technology Focus or equivalent work experience
Managed Care Resource Jobs
By Quorum Services At , Tempe, 85282, Az $80,000 - $120,000 a year

Purpose of Your Position: To establish, implement, and evaluate the strategic plan(s) and managed care contracting and partnership opportunities that will ensure each logical operation to build ...

Auditor, Medicaid Managed Care (Full-Time, Remote)
By Integrity Management Services, Inc. At Alexandria, VA, United States
Typically 2+ years of related experience in finance, accounting, or auditing
Medicaid managed care work experience
Used Unified Case Management (UCM) and One PI Business Objects
Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data
Bachelor’s degree in finance, accounting, or related field preferred
Intermediate understanding of Medicaid managed care
Regional Director Of Managed Care
By Universal Health Services, Inc. - Corporate Office At , Temecula, 92590, Ca $200,000 - $240,000 a year
Comprehensive working knowledge of managed care contracting and practices sufficient to maximize revenue generated from these sources.
Extensive knowledge of health care finance practices and methods.
Demonstrated managed care contract negotiation skills.
Serves as resource to hospital executive management regarding pertinent industry insights and developments.
Benefits (Proceed as Guest) https://uhsbenefits.ehr.com/default.ashx?classname=splash
Maintains strong working relationship with managed care analytical reporting to improve negotiation goal setting and maximize contract performance.
Managed Care Member/Provider Specialist
By State of Iowa Talent Gateway At , Des Moines, 50319, Ia $59,322 - $92,040 a year
Manage within a capitated rate.
Modified CMS service requirements, State regulations and administrative rules.
Prepare monthly, quarterly, and annual MCO member and provider reports to meet state and federal requirements.
Review and provide feedback to Iowa Medicaid policies impacting MCO contract requirements and performance.
modified CMS service requirements, State regulations and administrative rules.
Provide member and provider service.
Director Of Managed Care
By Randstad At Hendersonville, NC, United States
• Ensure that managed care programs meet regulatory requirements and are compliant with state and federal laws.
• Knowledge of healthcare regulations and managed care industry trends.
• Strong leadership skills and the ability to manage a team.
• Develop and implement managed care strategies that support the organization's goals and objectives.
• Collaborate with other departments to develop policies and procedures related to managed care programs.
• Develop and manage budgets for managed care programs and ensure that expenditures are within budgetary constraints.
Director Of Managed Care
By Jobot At Atlanta, GA, United States
Minimum of 5 years of experience in a senior role in managed care, preferably in the finance industry.
Proven experience in implementing managed care strategies.
Knowledge of local, state, and federal regulations related to managed care.
Flexible Schedule (Can be remote if needed)!
Develop and implement managed care strategies that align with the organization's financial goals.
Collaborate with cross-functional teams to ensure alignment of managed care strategies with overall business objectives.
Managed Care Analyst- Remote
By Premier Health Partners At Dayton, OH, United States

PREMIER SYSTEM SUPPORT REMOTE POSITION / FULL TIME / 8A-4:30P/ 80 HOURS PER PAY The Managed Care Contract Analyst is responsible for analyzing financial and operational data related to managed care ...

Managed Care Contract Coordinator (Remote) - R6427
By CareSource At United States
Knowledge of all regulatory requirements and internal processes to ensure that all maintenance and contractual documents are managed to expectations
Minimum of one (1) year of experience in a managed care or healthcare organization or contract development and review is required
Prior experience with provider documents and provider data entry is highly preferred
Perform any other job duties as requested
Intermediate computer skills including Microsoft Word, Excel and Outlook
Critical listening and thinking skills
Managed Care Coordinator Jobs
By Elevance Health At Richmond, VA, United States
Specific education and years and type of experience may be required based upon state law and contract requirements.
Uses appropriate screening criteria knowledge and clinical judgment to assess member needs.
For MMP, requires Community Health Worker certification to be obtained within one year of employment.
QMHP Certification of MA/MS in Social Work, Counseling, or a related behavioral health field preferred.
Conducts assessments to identify individual needs and develops care plan to address objectives and goals as identified during assessment.
Monitors and evaluates effectiveness of care plan and modifies plan as needed.
Managed Care Coordinator - Rn (Remote)
By SPECTRAFORCE At Columbia, SC, United States
Preferred Work Experience: 7 years-healthcare program management.
Job title: Managed CareCoordinator II (Remote)
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Note: 1st week of onsite training then remote.
Preferred Education: Bachelor's degree- Nursing.
5% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
Director, Managed Care Group
By USAJOBS At Baltimore, MD, United States
Oversees the development, coordination, and implementation of new and amended national Medicaid policy, as it relates to Medicaid Managed Care.
Leads and manages the review of new or proposed legislation related to Medicaid managed care and integrated health services.
Only experience obtained by the closing date of this announcement will be considered.
Business Acumen: The ability to manage human, financial, and information resources strategically.
Directs the review and approval of Medicaid related state plan amendments and waivers.
Leads and directs projects to analyze key Medicaid policy issues to support legislative, regulatory, policy and/or operational initiatives.

Are you looking for an exciting opportunity to lead a team in the managed care industry? We are looking for a Director of Managed Care to join our team and help us shape the future of healthcare. You will be responsible for developing and implementing strategies to improve the quality and cost-effectiveness of our managed care services. If you are a motivated leader with a passion for healthcare, this is the perfect job for you!

Overview:

The Director of Managed Care is responsible for developing and implementing strategies to maximize the organization’s reimbursement from managed care payers. This includes negotiating and managing contracts, developing and implementing strategies to increase market share, and monitoring and analyzing managed care trends.

Detailed Job Description:

The Director of Managed Care is responsible for developing and implementing strategies to maximize the organization’s reimbursement from managed care payers. This includes negotiating and managing contracts, developing and implementing strategies to increase market share, and monitoring and analyzing managed care trends. The Director of Managed Care will also be responsible for developing and maintaining relationships with managed care payers, monitoring payer performance, and ensuring compliance with payer requirements. The Director of Managed Care will also be responsible for developing and implementing strategies to improve the organization’s managed care performance, including developing and implementing strategies to improve the organization’s utilization management processes.

What is Director Managed Care Job Skills Required?

• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to negotiate and manage contracts
• Knowledge of managed care trends and regulations
• Ability to develop and implement strategies to improve managed care performance
• Knowledge of utilization management processes
• Ability to develop and maintain relationships with managed care payers

What is Director Managed Care Job Qualifications?

• Bachelor’s degree in business, healthcare administration, or related field
• 5+ years of experience in managed care
• Knowledge of managed care regulations
• Experience in contract negotiation and management
• Experience in developing and implementing strategies to improve managed care performance

What is Director Managed Care Job Knowledge?

• Knowledge of managed care regulations
• Knowledge of utilization management processes
• Knowledge of managed care trends and regulations

What is Director Managed Care Job Experience?

• 5+ years of experience in managed care
• Experience in contract negotiation and management
• Experience in developing and implementing strategies to improve managed care performance

What is Director Managed Care Job Responsibilities?

• Negotiate and manage contracts with managed care payers
• Develop and implement strategies to increase market share
• Monitor and analyze managed care trends
• Develop and maintain relationships with managed care payers
• Monitor payer performance
• Ensure compliance with payer requirements
• Develop and implement strategies to improve the organization’s managed care performance
• Develop and implement strategies to improve the organization’s utilization management processes