Associate Director Managed Care Contracting Job at Advocate Health Care (Charlotte)

Integrated Care Manager

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

Associate Director – Contingency Claims

To service the claims needs of customers, providing quality customer care, ensur...

Location

United Kingdom , London

Salary:

50000.00 - 65000.00 GBP / Year

Lawes Consulting Group

Expiration Date

Until further notice

Requirements

English, Maths and or working towards CII qualifications is desirable
Working with bespoke London market IT platforms (training provided) within Windows Virtual Desktop application
Compliant in using MS Office applications, i.e., MS Word, MS Excel, MS Teams
Prior experience in a client facing role of Contingency claims handling and the entertainment market, 10+ years desirable

Job Responsibility

To service the claims needs of customers, providing quality customer care, ensuring that all issues relating to the claims process are dealt with proactively
To support the London Claims Team including fellow Associate Claims Director, management and colleagues throughout the company in their endeavours to achieve and surpass targets and always provide a first-class service whilst adhering to all FCA principles and the specific requirements of:Treating Customers Fairly, Contract Certainty and Conflict of Interest
Undertaking those enquiries necessary to obtain sufficient information to establish policy liability and progress claims efficiently
Registering new claims accurately on relevant computer systems and updating the records during the life of the claim
Ensuring all claims and correspondence, on delegated authority cases, are correctly maintained and to provide a clear and concise history of events, actions, and quantum assessment
Obtaining and submitting completed Client claim documentation to Insurers or nominated service providers promptly
Answering telephone calls promptly and effectively dealing with all enquiries in a professional and efficient manner
Processing incoming post within agreed service standards
Dealing with Client enquiries within designated time frames or as otherwise agreed with Client
Communicating effectively with Insurers, nominated service providers, engineers and Loss Adjusters etc, using methods appropriate to the circumstances, (including telephone/e-mail/fax, dictation), to ensure the highest levels of customer service are maintained

Fulltime

Rare Condition Manager

To support high-quality, cost-effective care by coordinating services for member...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge
Practice interpersonal and active listening skills to achieve customer satisfaction
Interpret and translate policies, procedures, programs, and guidelines

Job Responsibility

Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan
Make and answer a diverse and high volume of condition management-related member calls on a daily basis
Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs
Analyze medical records, claims data, and other information sources
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, BCBSAZ programs, provider networks, etc
Present status reports on cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy

Fulltime

Senior Manager, Government Programs - Medicaid

The Senior Manager for Government Programs - Medicaid at Baxter will work to ens...

Location

United States , Saint Paul, Minnesota

Salary:

152000.00 - 209000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Bachelor’s degree required
6 plus years in health policy, reimbursement, Medicaid and public health payment programs is required
3 plus years of pharmaceutical/medical device proven experience is required
Proven understanding of Medicaid systems and differences in state operations required
Detailed understanding of state programs, processes, and experience preferred
Established track record of cultivating relationships with Medicaid Administrators, specifically directors, policy managers, and medical directors, through articulate written and verbal communication.

Job Responsibility

Develop relationships with Medicaid Administrators to assist in clarification of state policies and find opportunities for coverage development
Act as the primary contact for Respiratory Health to Government Programs in communications and meetings
Supervise Government Payer requirements & policies to identify potential changes that may impact Respiratory Health’s reimbursement process
Lead resolution of Medicaid payer issues brought up from Patient & Customer Service teams
Advance questions requiring Legal or Compliance guidance related to reimbursement processes to appropriate resource
Participate in industry Trade Associations or State HME / DME Associations
Collaborate with Government Affairs on state lobbying efforts
Analyze government program trends applying internal and external data
Maintain communication with senior management regarding major reimbursement issues
Assist the Coverage Manager on Coverage Expansion strategy development

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan
401(k) Retirement Savings Plan
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

Region Director Payer Analytics Economics-Mountain

As our Division Director, Payer Analytics & Economics, you will be accountable f...

Location

United States , Englewood

Salary:

66.26 - 98.56 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Bachelors Other Business Administration, Accounting, Finance, Healthcare or related field
Minimum of eight (8) years of experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations
Minimum of three (3) years of healthcare or financial leadership experience
Managed Care and Healthcare experience strongly preferred

Job Responsibility

Manage the labor and operations of the Division Payer Analytics & Economics team(s) including the hiring, orienting, developing and managing of staff
Oversee quality control and quality assurance of Payer Analytics & Economics analytics deliverables and financial models to support the negotiation and implementation of appropriate reimbursement rates associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives
Review and accurately interpret contract terms, including payer policies and procedures to appropriately contract performance and influence strategic pricing strategies
Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability
Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes
Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities

What we offer

medical, prescription drug, dental, vision plans, life insurance, paid time off, tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Fulltime

Supervisor Care Management Population Health

The Supervisor Care Management Population Health will support the Director of Ca...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Graduate of an accredited Registered Nursing program
Excellent computer skills needed
Experience with word processing/spreadsheets, including Excel
Excellent verbal and written skills
Minimum of five years clinical experience
Three years Case Management experience preferred
Active RN Licensure in state of employment
CCM preferred

Job Responsibility

Supports leadership with the selection, training, development, appraisal, work assignments, performance management, staffing, and productivity of Associates within Population Health Care Management
Understands and supports “Triple Aim” objectives of Population Health and promotes these objectives in concert with organizational Core Values when supervising and leading the teams
Provides formal, structured orientation/training process for new Associates with regular opportunity for feedback and assessment of competency upon completion
Collaborates with Primary Care Clinics to implement Care Coordination and/or Nurse Navigation for value-based contracts
has experience with ambulatory clinic workflow with ability to partner and troubleshoot with ambulatory clinical team to develop and refine operational workflows within the practice and specific EHR
familiar with order sets, appointment templates, scheduling of procedures, and pre-authorization
Capable of learning to navigate EHRs to thoroughly research the patient medical record to locate and identify documentation for completion of quality measures
has or can develop expertise regarding clinical knowledge of quality measures with ability to interpret definitions regarding inclusions and exclusions
Collaborates with Primary Care Clinical Team to develop and test operational workflows within specific EHR to communicate/document appropriate Home Health Case Conference information and recertification recommendations to the clinician
Ability to develop collaborative relationships with Home Health Agencies to coordinate 485 plan of care process and Case Conference scheduling

Fulltime

Associate Director of Acorn Center for Early Education and Care

The Associate Director of Acorn Center for Early Education and Care is a member ...

Location

United States , Boston

Salary:

60000.00 - 73000.00 USD / Year

Boston Chinatown Neighborhood Center

Expiration Date

Until further notice

Requirements

A bachelor’s degree is required in Early Child Care or the Child Development field with a minimum of 3 years of supervisory experience
Department of Early Education and Care (EEC) Certifications of Lead Teacher Preschool, Infant-Toddler Teacher, Director I, and Director II are required
Must meet Department of Early Education and Care (EEC) health and background check requirements
Must be certified in First Aid and CPR within 6 months of employment
Proficiency in Microsoft Office and other related applications
Excellent organizational skills and ability to manage multiple tasks in a fast-paced environment
Strong interpersonal, relationship-building, communication, and collaboration skills
Experience with mentoring and coaching
Respect for differences and the ability to work well in a multicultural environment

Job Responsibility

Partner with the Director of Acorn Center in running the daily operation of the center
Serve as the primary on-site contact for the center administration, teachers, children, and families during the Director of Acorn Center’s absences
Provide support and assist the Director of Acorn Center in the center’s regulatory visits preparation (Department of Early Education and Care (EEC), National Association for the Education of Young Children (NAEYC))
Manage and work with the Director of Acorn Center on interviewing, hiring, and training new staff, and supervising and conducting the evaluations of all staff
Collaborate with and support the Assistant Director in maintaining daily staffing coverage and developing staff schedules to meet Department of Early Education and Care (EEC) teacher and staff ratio guidelines
Partner with the Family Engagement Coordinator in the recordkeeping of children and families following agency and contract regulations
provide center tours and orient new families to the program
advocate for families and children with special needs
and carry out all Boston Pre-K responsibilities
Partner with the Education Coordinator in observing teachers, assistant teachers, volunteers, and interns in the classrooms, and provide them with feedback

What we offer

Hiring bonus of $6000 available
Competitive compensation package
Comprehensive health, life, and disability coverage
Retirement plan with employer matching
Supportive time-off policy
Professional development

Fulltime

Associate Director, Contracts

We are seeking an experienced biotech industry contract specialist to provide ge...

Location

United States

Salary:

165000.00 - 185000.00 USD / Year

Apogee Therapeutics

Expiration Date

Until further notice

Requirements

Bachelor’s degree, or an equivalent amount of relevant industry experience in a legal or related field, is required
6+ years of experience in the life sciences industry drafting and negotiating a variety of contracts
Public company experience required
Prior in-house experience as a member of a Legal Department or clinical affairs department in a biotechnology or pharmaceutical company drafting and negotiating clinical trial agreements strongly preferred
Experience with confidentiality agreements, master services agreements, consulting agreements, clinical trial agreements, GCP guidelines and regulatory requirements for global clinical trials
Exceptional contract drafting and negotiation skills
Strong verbal and written communication skills, including proven ability to interact and communicate effectively with individuals from multiple departments at all levels of the organization
Excellent professionalism and interpersonal skills
ability to handle confidential and proprietary information using sound judgement and discretion
Experience with contract management systems and electronic signature systems and high proficiency in Microsoft Office applications required

Job Responsibility

Partner with Legal Department members to assist with the drafting, negotiation and management of a high volume of contracts for clinical, research, quality, manufacturing, commercial and other internal business partners, including clinical trial agreements, master services agreements, consulting agreements, confidentiality agreements, research agreements and other business agreements
Act as a liaison between internal business partners, the Legal Department, external vendors and outside counsel as necessary to facilitate contract implementation, renewals, and terminations
Continue to improve the internal contracting process, including assisting with the administration of our integrated contracts management system, developing internal training materials related to the contracting process and identifying steps to increase efficiency
Help develop and implement new policies, procedures and contract templates and provide related education and training to internal clients
Work closely with members of finance and other departments to help ensure compliance with cross-functional policies and procedures
Develop reports, presentations, spreadsheets, memos and other documents for the Legal Department, internal clients and/or the senior management team
Review clinical study informed consent forms and related documents as needed
Assist with completion, review and validation of needs assessment forms in connection with HCP engagements, including to confirm alignment with fair market value and contractual terms
Identify legal, documentation gaps and contractual risks and escalate matters in accordance with protocols and guidance
Provide practical contracts support to internal clients during contract preparation and negotiation

What we offer

Market competitive compensation and benefits package, including base salary, performance bonus, equity grant opportunities, health, welfare & retirement benefits
We provide competitive time off, including three weeks PTO, two one-week company-wide shutdowns a year and dedicated paid sick leave
Commitment to growing you professionally and providing access to resources to further your development
Apogee offers regular all team, in-person meetings to build relationships and problem solve

Fulltime

Associate Director Managed Care Contracting

Advocate Health Care

Location:
United States , Charlotte

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 08, 2026

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