***This is a hybrid role Managed Care Contract Manager Position Highlights: The Managed Care Contract Manager... Guidelines. The Managed Care Contract Manager is responsible for managing payer relationships, negotiation of reimbursement...
the understanding of managed care policies and procedures. Identifies network access and deficiencies and develops... as needed. Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions...
and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers... clinical experience or case management, utilization management or managed care experience; or any combination of education...
policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate..., facilitation skills, and analytical skills preferred. Understanding of managed care or Medicaid/Medicare strongly preferred. In...
and apply member contracts, member benefits, and managed care products preferred. Certification as a Case Manager is preferred... by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products...
use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient... of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed...
policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate..., facilitation skills, and analytical skills preferred. Understanding of managed care or Medicaid/Medicare strongly preferred. In...
. You will report to the Team Leader onsite, who will support your skill and career development. You will act as a project manager... and fund accounts Subject matter expert as it relates to international institutional funds and separately managed accounts...
benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works...-effective setting according to contract. Serves as lead for Complex Care Conferences, consulting with clinical reviewers...