Managed Care Manager - Contracts Job at Memorial Healthcare System (Hollywood)

Managed Care Senior Manager

Corporate level manager responsible for deploying and contributing to strategic ...

Location

United States , Fort Lauderdale

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Bachelors
Five (5) years contracting experience with three (3) years contracting for hospital, professional services, ancillary facilities or specialty networks

Job Responsibility

Execute, contribute and manage complex legal, financial and operational contract language negotiations in concert with the Director of Managed Care or independently as applicable to the negotiation
Execute contracting strategies for all service lines in Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services of the fully integrated healthcare delivery system and its joint owned or joint ventured entities for fee for service and value based arrangements
Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors
Plan and monitor activities of staff and team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions
Enhance, estimate and preserve net revenues
Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution
Execute strategies and guides operations to protect and build market share
Interface with managed care plans on claim reconciliations, trended issues and operational projects
Determine root cause and seek resolution
Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement

Fulltime

Global Fragrance and Oral Care Flavors Portfolio Assistance Procurement Manager Personal Care

This role is part of Procurement’s Sourcing team, which is responsible for leadi...

Location

India , Mumbai

Salary:

Not provided

Unilever

Expiration Date

Until further notice

Requirements

Procurement Sourcing Strategy (level 2 - Capable)
Supplier Analysis (level 3 - Intermediate)
Value Chain Understanding (level 3 - Intermediate)
Supplier Negotiation (level 3 - Intermediate)
Contract Negotiation (level 2 - Capable)
Sourcing Resilience (level 3 - Intermediate)
Stakeholder Management (level 3 - Intermediate)
Strategic Partnerships (level 3 - Intermediate)
Collaboration (level 3 - Intermediate)
Program Management (level 3 - Intermediate)

Job Responsibility

You are a strategy Champion: You lead the co-creation of the innovation agenda for your portfolio. You monitor and understand the dynamically changing consumer market, ensuring a future fit trend driven portfolio, delivering desirability at scale and affordable superiority. With a focus on emerging technologies, you lead the development of not only the current portfolio, but future capabilities.
You are external facing and an expert in the supplier landscape: You assess, identify, and select the appropriate supplier base that meet the needs of the business. You ensure and manage overall performance of suppliers and surpass stakeholder needs.
You take considered decisions under pressure: You handle complex and diverse customer, supplier, supply chain or operational issues within generally defined practices and policies in selecting methods and techniques for obtaining solutions.
You are a leader: You are a leader of procurement projects in your portfolio and for your materials. You take on a role leading portfolio wide activity such as accurate price forecasting and complexity reduction.
You are a storyteller: You use your strategic influencing skills to drive Procurement considerations and strategic recommendations with Stakeholders.
You create growth for Unilever: You work closely with Brand, R&D, Supply Chain, Strategy and Insights and Category Procurement teams to support the launch of innovations and new product development.
You achieve key financial targets: Delivering the business financial targets for Buying Performance, Product Superiority and Complexity reduction for the portfolio materials/services and suppliers. You prepare information on purchase prices and conditions to enable proper budgeting and cash forecasting.

Fulltime

Inpatient Hospital Biller (Managed Care & Medicare)

The Inpatient Hospital Biller is responsible for the accurate and timely billing...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2–4+ years of hands-on inpatient hospital billing experience
Direct experience billing Managed Care and Medicare inpatient claims
Strong understanding of inpatient hospital billing workflows, UB‑04 claim forms, DRGs and hospital charge structures and Medicare inpatient billing rules

Job Responsibility

Perform hands-on billing of inpatient hospital claims using the UB‑04 claim form
Generate, review, and submit inpatient claims to Managed Care and Medicare payers
Ensure claims are complete, accurate, and compliant with payer and regulatory requirements prior to submission
Review charges, DRGs, patient demographics, and insurance information for billing accuracy
Resolve billing edits and claim rejections prior to claim release
Ensure billing practices comply with Medicare regulations, Managed Care contracts, and hospital policies
Validate billing data in coordination with Coding, Case Management, and Revenue Integrity teams
Maintain accurate documentation and notes within the billing system
Work closely with internal Revenue Cycle and Finance teams to support clean claim submission
Assist with billing-related reporting or reconciliation as requested

What we offer

Medical
vision
dental
life and disability insurance
401(k) plan

Integrated Care Manager - Remote AZ

Location

United States of America , 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)
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

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

Consultant, Managed Care Policy

Baptist Health is hiring a Managed Care Policy Consultant for our Managed Care t...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

7+ years experience in Legal, Revenue Cycle and Managed Care required.
Bachelor's Degree
Juris Doctor Preferred

Job Responsibility

Proactively identifies, analyzes and resolves payer contract, underpayments and policy discrepancies and initiates timely contract disputes to recover lost revenue.
Investigate identified trends and payer issues to identify root causes and will develop solutions and communicate with internal and external contacts to resolve payer issues.
Collaborate with internal departments, including Revenue Integrity, Billing, Patient Access, Operations and Finance to develop thorough responses to plans.
Draft Notices and Formal Disputes to send to plans or government entities.
Have a deep understanding of healthcare operations, contract law, and regulatory frameworks, and is detail-oriented, self-directed, and capable of managing multiple complex projects simultaneously.

Fulltime

External Contracts Manager

We're looking for a External Contracts Managers to join our Property Care team w...

Location

United Kingdom , Eastleigh

Salary:

48383.00 GBP / Year

Abri

Expiration Date

Until further notice

Requirements

Experience of the Housing Association environment
Strong technical knowledge
Ability to forge strong relationships with partner providers
Confidence to challenge and push change
Flexibility to travel across Abri's geography
Ability to commute to one of primary offices in Eastleigh, Bracknell or Yeovil
Live within Abri's geography

Job Responsibility

Taking ownership of a roofing programme to deliver replacement roof coverings
Support a variety of externally sourced contracts which could include windows, doors, roofing, external works, and projects in support of objective of providing excellent service to customers
Ensuring works are delivered in line with financial, contractual, and quality expectations
Forge strong relationships with partner providers and challenge and push change
Drive improvement in the delivery of services
Taking on a variety of maintenance projects requiring more complex or specialist intervention
Travel across Abri's geography to sites and contractor meetings, with regular office days to collaborate with colleagues

What we offer

Competitive salaries
Comprehensive benefits
Excellent working environment

Fulltime

External Contracts Manager

We're looking for an External Contracts Manager to join our Property Care - Cust...

Location

United Kingdom , Yeovil

Salary:

43544.00 GBP / Year

Abri

Expiration Date

Until further notice

Requirements

Experience of the Housing Association environment
contract management experience
ability to travel across Abri's geography
ability to commute to one of the primary offices

Job Responsibility

Managing external contracts and contractors such as active fire safety equipment in communal blocks
ensuring inspection, servicing and maintenance programmes are delivered in line with financial, contractual, and quality expectations
specifying, scheduling, and delivering inspection and servicing programmes
procuring work in accordance with tendering, budgetary, and contractual regulations
identifying and managing maintenance work to ensure it aligns with regulatory and statutory requirements
ensuring compliance with all Health & Safety and CDM requirements
maintaining relevant customer engagement at all stages of projects, including Section 20 consultation

What we offer

Competitive salaries
comprehensive benefits
excellent working environment

Fulltime

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)
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

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

Select Country

Managed Care Manager - Contracts

Job Description

Job Responsibility

Requirements

Looking for more opportunities?