Jobs
>
Albuquerque

    Director of Managed Care - Albuquerque, United States - HME Specialists LLC

    HME Specialists LLC
    HME Specialists LLC Albuquerque, United States

    2 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.
  • 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 ...

  • Presbyterian Healthcare Services

    rn care manager

    1 week 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 ...

  • Home Medical Equipment Specialists, Llc

    Director of Managed Care

    1 week ago

    Home Medical Equipment Specialists, Llc Albuquerque, United States

    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 fo ...

  • HME Specialists LLC

    Director of Managed Care

    1 week ago

    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 ...

  • HME Specialists LLC

    Director of Managed Care

    2 weeks ago

    HME Specialists LLC Albuquerque, United States

    Job Description · Job 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 Mana ...

  • Magellan Health

    Care Manager, BH

    1 week 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 ...

  • University of New Mexico - Hospitals

    RN Care Manager

    1 week 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 ...

  • Morada Quintessence

    Caregiver/Care Manager

    1 week ago

    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, ...

  • Centene Corporation

    Care Manager- LVN LPN

    1 week 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. ...

  • Adobe Population Health

    Community Care Case Manager

    1 week ago

    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

    RN Care Management Supervisor

    5 days 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 ...

  • MEDSHINE

    Social Care and Community Manage

    2 days ago

    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

    Dialysis Clinical Manager Registered Nurse

    6 hours ago

    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

    Dialysis Charge Registered Nurse

    6 hours ago

    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 ...

  • Aspen Dental

    Dental Assistant

    4 days 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 ...

  • Actalent

    Research Associate

    4 days 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 ...

  • Palmilla Senior Living

    Memory Care Manager, LPN Required

    3 days ago

    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 ...

  • Molina Healthcare

    ITU Tribal Liaison, Managed Care

    1 week ago

    Molina Healthcare Albuquerque, United States

    Molina Healthcare is in search of an I.T.U. Tribal Liaison, specifically with in-depth knowledge of Managed Care. Candidates for this role must reside within the state of New Mexico and be open to state-wide travel. We are also seeking someone who has a great deal of experience w ...

  • Home Care Assistance of Albuquerque

    Senior Home Care Case Manager

    5 days ago

    Home Care Assistance of Albuquerque Albuquerque, United States

    Job description · Primary Function: · The Client Care Manager is accountable for coordinating quality checks and communication requirements for all clients assigned. The position is responsible for ensuring the company's goals for client satisfaction, client retention/attrition ...

  • Molina Healthcare

    ITU Tribal Liaison, Managed Care

    1 week ago

    Molina Healthcare Albuquerque, United States

    Molina Healthcare is in search of an I.T.U. Tribal Liaison, specifically with in-depth knowledge of Managed Care. Candidates for this role must reside within the state of New Mexico and be open to state-wide travel. We are also seeking someone who has a great deal of experience w ...