- AmeriHealth Caritas (Columbia, SC)
- … care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral ... Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care ,… more
- Molina Healthcare (Tacoma, WA)
- …of CPT, ICD-9, HCPCS and DRG requirements. + Two years of managed care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is...the medical necessity, level of services, and/or appropriateness of care in cases. The SIU Investigator is… more
- Molina Healthcare (AZ)
- …of CPT, ICD-9, HCPCS and DRG requirements. + Two years of managed care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted ... **JOB DESCRIPTION** **Job Summary** The Special Investigation Unit (SIU) Investigator is...the medical necessity, level of services, and/or appropriateness of care in cases. The SIU Investigator is… more
- Centene Corporation (Austin, TX)
- …and abuse experience required; experience in provider education and managed care organization preferred; coding certification preferred. ... health care , laboratory, etc. Provides investigative support to the Special Investigations Unit (SIU) related to coding and billing issues and identifies… more
- Novo Nordisk (Bloomington, IN)
- …a difference. For more than 100 years, we have led the way in diabetes care . Being part of Novo Nordisk allows our employees to embark on life-changing careers, and ... and regulatory agencies, as required, are properly made and managed + Conduct interviews in a logical and information...are interested in applying to Novo Nordisk and need special assistance or an accommodation to apply, please call… more
- MyFlorida (Tallahassee, FL)
- …does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive ... the Bureau's responsibility: Fraud and Abuse Detection, Prevention, Overpayment Recovery, and Managed Care Oversight. MPI operates with dynamic and fast-paced… more
- Mount Sinai Health System (New York, NY)
- …Central Billing Office (CBO) and Change Departments with key aspects of Managed Care contracting support including communication, fee schedule access, ... Oversee and supports the national payer contracts, acting as managed care liaison for internal and external...agreements. 20. Assist MS FPA, MSHP and MSHS on special projects eg network recruitment, roster reconciliation as assigned.… more
- MyFlorida (Miami, FL)
- …Certified Public Accountants (AICPA). Auditing and analyzing complex financials of the managed care provider including their provider network. Analyze and ... guidance as required by the Assistant Attorney General, Lead Investigator and Medical Investigator . Serve as lead...interpret managed care encounter data. Communicating the results… more
- Mount Sinai Health System (New York, NY)
- …each payor within the patient population * Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely ... fashion. * Provides clinical information requested by the managed care companies in accordance with contractual agreements. * Works collaboratively with… more
- Mount Sinai Health System (New York, NY)
- …+ Opportunity to work at the forefront of innovation in healthcare The Managed Care Contracting Team within MSHP is responsible for the negotiation, ... Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as...new opportunities and risks. * Assist with or leads special projects and provides analytical support. **About Us** **Strength… more