Jobs
>
Albuquerque

    Director of Managed Care - Albuquerque, United States - Home Medical Equipment Specialists, Llc

    Home Medical Equipment Specialists, Llc
    Home Medical Equipment Specialists, Llc Albuquerque, United States

    3 weeks ago

    Default job background
    Description
    About the job

    HME Specialists is a fast growing primary player in NM providing Durable Medical Equipment, Home Infusion and LTC/Hospice services


    The Director of Managed Care & Contracting will oversee strategy and development for all Managed Care Services and Contracting for the LTC and New Vista lines of business.

    The Corporate Director is responsible for full managed care contract life-cycle support, including new business and revenue development through continued clinical integration and market expansion.

    Job duties & responsibilities

    Develop, negotiate, and implement new and ongoing payor strategies, models, and partnerships that support HME revenue and margin growth

    Proactively identify and engage target payors who are candidates for innovative partnership that maximize HME Specialists ability to provide services to all patients regardless of insurance


    Deliver improved payor satisfaction through the execution of strategic programs and assisting in reporting on patient care to managed care partners.

    Lead and maintain credentialing, re-recredentialing, reimbursement, and contracted entities updates

    Assist with claims escalation processes with payer partners

    Leads and assists with RFP's.

    Support and educate Case Management


    Serves as a subject matter expert on contract and reimbursement-related issues impacting our industry and healthcare industries, particularly with a managed care and commercial reimbursement focus.

    Knowledge/Skills/Abilities


    The qualified candidate will have extensive knowledge and relevant work experience in the Managed Care/insurance sectors including network planning/development, contract negotiations, etc.

    Proficient knowledge of medical contracting methodologies and claims pricing/reimbursement strategies

    This position reports to the VP of Sales and Business Development.

    Experience

    Experience in Managed Care contracting for a multi-site Ancillary Healthcare Provider desired.

    2 years of healthcare contracting experience required.

    Bachelors degree preferred

    Experience with Medicare Licensure preferred.

    #J-18808-Ljbffr

  • RiverValley Behavioral Health

    Care Manager

    1 week ago


    RiverValley Behavioral Health Albuquerque, United States Full time

    Job Summary: · Case management involves working with the individual and others who are identified by the individual such as a family member or guardian in developing an individual support plan and services. Case management works closely with the individual to assure higher on-go ...


  • Home Care Assistance of Albuquerque Albuquerque, United States

    Job Description · Job DescriptionSeeking an opportunity to make a difference in people's lives truly? Look no further As a Client Care Manager at Home Care Assistance, you're not just taking a job; you're stepping into a role that feeds your passion for helping others and provide ...

  • Presbyterian Healthcare Services

    rn care manager

    3 weeks ago


    Presbyterian Healthcare Services Albuquerque, NM , USA, United States

    Overview · Type of Opportunity: Per Required NeedFTE: Exempt: NoWork Schedule: Days · We're all about well-being, starting with yours.Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coac ...

  • University of New Mexico - Hospitals

    RN Care Manager

    3 weeks ago


    University of New Mexico - Hospitals Albuquerque, NM, United States Full time

    UNM Hospitals participates in the Clinical Advancement Program (CAP) and depending on your Nursing Education and National Certifications, you'll work towards one of five CAP levels that offer increasing compensation. Sign-on Bonus and Relocation Reimbursement available · Departme ...

  • Magellan Health

    Care Manager, BH

    5 days ago


    Magellan Health Albuquerque, United States

    100% Remote, Must be a NM resident.Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyze ...

  • Magellan Health

    Care Manager, BH

    3 weeks ago


    Magellan Health Albuquerque, United States

    100% Remote, Must be a NM resident. · Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. Collects and ana ...


  • HME Specialists LLC Albuquerque, United States

    Job Description · Job DescriptionAbout the job · HME Specialists is a fast growing primary player in NM providing Durable Medical Equipment, Home Infusion and LTC/Hospice services · The Director of Managed Care & Contracting will oversee strategy and development for all Managed C ...


  • Morada Quintessence Albuquerque, United States

    Job Description · Job DescriptionAbout Morada Senior Living: · Morada Senior Living, proudly part of the Discovery Senior Living family of operating companies, manages care- and lifestyle-focused senior living communities in Texas, Oklahoma, New Mexico, and Colorado. Our company, ...


  • Shield HealthCare Valencia, United States

    Since 1957, Shield Healthcare has provided high-quality healthcare services while focusing on customer satisfaction and employee achievement. We are dedicated to fulfilling the medical supply needs of consumers and the caregiving community while maintaining a 99% overall customer ...

  • Centene Corporation

    Care Manager- LVN LPN

    3 weeks ago


    Centene Corporation Albuquerque, United States

    You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...


  • Magellan Health Albuquerque, United States

    Responsible for the management, direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care management staff, providing expertise in designated programs. · Assists clinical management in the development ...


  • Adobe Population Health Albuquerque, United States

    Job Description · Job DescriptionABOUT APH · Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 and committed to positively impacting the lives we touch. The company has a culture of inclusivity and human kindness, based in Phoenix, AZ, with s ...


  • University of New Mexico - Hospitals Albuquerque, NM, United States Full time

    UNM Hospitals participates in the Clinical Advancement Program (CAP) and depending on your Nursing Education and National Certifications, you'll work towards one of five CAP levels that offer increasing compensation. Sign-on Bonus and Relocation Reimbursement available · Departme ...


  • MEDSHINE New Mexico, United States Full time

    Are you a BE/BC Pain Management Physician looking for an exciting new opportunity in a dynamic medical community? Our cutting-edge healthcare organization is seeking a Pain Management Physician to join an established medical facility in Chaves County, NM. · As our Pain Managemen ...


  • Fresenius Medical Care Albuquerque, United States Full time

    POSITION FEATURES: · Float position · Albuquerque Area · About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, col ...


  • Fresenius Medical Care Albuquerque, United States Full time

    POSITION FEATURES: · This job requires frequent travel between facilities in Albuquerque, Rio Rancho, and Santa Fe, Clovis, and Los Lunas · PURPOSE AND SCOPE: · Works with the Facility Manager, facility staff and physician to coordinate the facility operations and patient proced ...

  • Actalent

    Research Associate

    1 week ago


    Actalent Albuquerque, United States Full time

    Description: · Research Associate will conduct experiments and contribute to the development of our TBI product using modern immunochemical techniques under the supervision of the Senior Scientist and/or Director of Assay Development.Responsibilities:- Plan and execute experiment ...

  • Aspen Dental

    Dental Assistant

    2 weeks ago


    Aspen Dental Albuquerque, United States Full time

    *** $1,000 Sign On Bonus*** At Aspen Dental, we put You First, offering the security and job stability that comes with working with a world-class dental service organization (DSO). Our best-in-class training program, competitive compensation, and flexible scheduling will help you ...


  • Palmilla Senior Living Albuquerque, United States

    Company Description · At Spectrum Retirement Communities we believe in living without limits, in aging fearlessly, and in sharing great stories. The Spectrum Story is full of compassion, hard work, and fun. If the chapters of your life story include caring for others and a dedica ...

  • Actalent

    Research Associate

    2 weeks ago


    Actalent Albuquerque, United States Full time

    Description: · Research Associate will conduct experiments and contribute to the development of our TBI product using modern immunochemical techniques under the supervision of the lead Scientist and/or Director of Assay Development. · Responsibilities: · Plan and execute experime ...