- Oversees the Single Case Agreements (SCA's) process on behalf of the Network, including updates on the various SCA trackers and provide recommendations to the process.
- Responsible to ensure all hospital and ancillary credentialing are completed timely for the Network.
- Oversees all Hospital settlements to ensure payment for additional revenue for the Network.
- Assists VP Managed Care with managed care in negotiations on behalf of the Network. This includes existing payers and first time payers.
- Responsible for review of managed care contracts, including redlining of contract language and rate sheets for the Network.
- Works closely with Patient Accounts, Revenue Cycle, Utilization Management and Medical Records to ensure the managed care payers are adhering to the terms of the agreement and rates.
- Responsible for Joint Operation Committee meetings with the managed care payers.
- Responsible for maintaining and providing the network with current payer rate grids including Hospital, Professional, Home Care and key language grids for the Network.
- Ability to efficiently and proactively manage others, with a strong ability to communicate well both verbally and in writing.
- Demonstrates strong project management skills.
- Ability to multi-task on a daily basis.
- Ability to assist with various reports.
- Other job duties as assigned.
- Five to seven years of managed care experience in an academic medical center.
- Five years management experience.
- Thorough knowledge of various reimbursement methodologies, such as MSDRG, APR DRG, CPT-4, HCPCS, UB04 and NYS, CMS regulations as they relate to Managed Care Organizations.
- Strong experience in managed care contracting.
- Demonstrated proficiency in Microsoft Excel. Preferred experience with Access, Cerner Millennium or other EMR/Billing systems.
- Displays critical thinking to proactively diagnose root cause of issues and develop solutions.
- Has the ability to independently obtain, vet, analyze, and accurately summarize managed care agreements and data using all tools available.
- Clearly and accurately, communicate data, report results, and other findings both in writing and verbally.
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Care Management
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EA Team Inc. White Plains, United StatesBSN or related Bachelor's degree required · - 5 years clinical ED, critical care or med/surg experience required · - Previous case management experience preferred · - Knowledge of healthcare financial, regulatory, and payer issues preferred · - Knowledge of state, local, and fede ...
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TRI-COUNTY CARE LLC Chappaqua, United States**Job Overview**: · This position requires applicants outside of New York City to have a valid driver's license and reliable transportation. Travel reimbursement is provided. · - This position requires a quiet distraction-free environment for working, or the ability to work from ...
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Acacia Network Bronx, United StatesAcacia Network, the leading Latino integrated care nonprofit in the nation, offers the community, from children to seniors, a pathway to behavioral and primary healthcare, housing, and empowerment. We are visionary leaders transforming the triple aim of high quality, great experi ...
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TRI-COUNTY CARE LLC Rockland, United States**Job Overview**: · This position requires applicants outside of New York City to have a valid driver's license and reliable transportation. Travel reimbursement is provided. · - This position requires a quiet distraction-free environment for working, or the ability to work from ...
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Anchor Health Home Care Brooklyn, United States_At Anchor Health Home Care, we deeply appreciate the privilege of being welcomed into the family circle to provide care for our neighbors' beloved family members._ Our dedicated corporate office team at Anchor Health Home Care serves as the central hub for communication among cl ...
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Care Collab D.B.A Direct Care Management New York, United States**Position Summary**: · - Care Collab_ provides care coordination services to high-utilization Medicaid members with chronic medical and behavioral health conditions. We're currently seeking a dynamic **Care Manager** to play a central role in the active engagement and coordinati ...
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Care Manager
1 week ago
VNS Health New York, United States Full timeOverview · Conducts assessments and develops client/member centered plans of care. Provides coordination of services between the varying providers for clients / members with complex psychiatric, substance use, and/or co-morbid medical conditions. Ensures access and linkage to the ...
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Care Manager
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NYU Langone Health New York, United States**NYU Langone Health** is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. It comprises more than 200 locations throughout the New York area, including five inpatient locations, a children's h ...
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VNS Health New York, United States Full timeOverview · Conducts assessments and develops client/member centered plans of care. Provides coordination of services between the varying providers for clients / members with complex psychiatric, substance use, and/or co-morbid medical conditions. Ensures access and linkage to the ...
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Care Manager
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FORESTDALE INC. Forest Hills, United States**JOB SUMMARY** · Care Management is a service model whereby all of an individual's caregivers communicate and interface so that the patient's needs are addressed in a comprehensive manner. This is done primarily through a "care manager" who oversees and provides access to all of ...
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The Family Center Brooklyn, United StatesThe **Family Center** envisions a future where all New Yorkers thrive in secure healthy communities. Our mission is to · provide holistic care and support to individuals and families affected by life-altering events to create a path to healing, · stability and a fulfilling future ...
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New Alternatives for Children, Inc. New York, United StatesNew Alternatives for Children, Inc. (NAC) is an award-winning not-for-profit agency in Midtown Manhattan, with a satellite Bronx office, dedicated to serving children and families with medical complexity, chronic health conditions, significant disabilities and behavioral challeng ...
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The Family Center Brooklyn, United StatesThe Family Center is seeking a **Full-Time Care Manager, **who will assist in the full implementation of the Healthy Branches program, with a special focus on resolving barriers to engagement in services, ensuring linkages to medical care and assisting with managing chronic healt ...
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Care Manager
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Sun River Health New York, United States_Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who seek it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, No ...
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Care Manager
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TRI-COUNTY CARE LLC Brooklyn, United States**Job Overview**: · This position requires applicants outside of New York City to have a valid driver's license and reliable transportation. Travel reimbursement is provided. · - This position requires a quiet distraction-free environment for working, or the ability to work from ...
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Care Manager
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TRI-COUNTY CARE LLC Brooklyn, United States**Job Overview**: · This position requires applicants outside of New York City to have a valid driver's license and reliable transportation. Travel reimbursement is provided. · - This position requires a quiet distraction-free environment for working, or the ability to work from ...
Manager, Managed Care - Valhalla, United States - Westchester Medical Group P.c.
3 weeks ago
Description
Job Summary: The Manager of Managed Care will report directly to the Vice President of Managed Care and will be responsible to lead the Managed Care Specialist and Ancillary Contractor in single case agreements (SCA's), credentialing, and assisting with managed care contracts, including Pay for Performance and Centers of Excellence.Responsibilities:
Experience:
Licenses / Certifications. N/A
Other:
Special Requirements:
