2,209 Managed Care jobs in the United States

• Location: Remote, based in Oklahoma, with health system and provider relationships in the state.

• Hours: Full-Time Consulting

• Start Date: 45-60 days from selection

• Duration: 12+ months

• Develop and execute regional managed care strategies across multiple markets.

• Lead complex contract negotiations for provider agreements, ensuring optimal terms and value-based alignment.

• Provide functional oversight for pricing analytics, revenue cycle management, and national value-based payment models.

• Drive the transition from fee-for-service to value-based care, ensuring network sustainability and performance.

• Oversee the development and implementation of network expansion strategies that align with organizational goals.

• Collaborate with executive leadership to assess market conditions and identify strategic partnership opportunities.

• Act as a trusted advisor, offering guidance on managed care initiatives, payer relations, and reimbursement structures.

• 10+ years of managed care experience, with a strong background in contract negotiations and payer strategy.

• 5+ years in a senior leadership or management role preferred.

• Bachelor's degree required; Master's degree preferred (business, healthcare administration, or related field).

• Proven ability to develop and implement value-based care models.

• Strong understanding of healthcare reimbursement, network development, and regulatory compliance.

• Excellent communication, negotiation, and stakeholder management skills.

• Prescreening via email.

• 1-2 interviews with EWINGS.

• 1-2 interviews with the client team.

Managed Care Coordinator Overview The Managed Care Coordinator assists and supports the LPN/ RN MDS Coordinator with case management responsibilities. The candidate is the primary liaison between the SNF and the HMO Managed Care Insurance Companies. Care Coordinator, Coordinator, Case Manager, Healthcare, Supervisor

Salary:
Range from: $20 - $22 / HR

Overview:

Managed Care Coordinator Overview

The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management responsibilities. The candidate is the primary liaison between the SNF and the HMO Managed Care Insurance Companies. This includes all types of communication (eFax, email, scan documents, phone calls) with case managers to provide concurrent updates as requested by Insurance Companies, handles Third Party appeals, peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator. Attends team meetings at the discretion of the MDS Coordinator.

Managed Care Coordinator Essential Job Fuctions

• Able to successfully interact with HMO Case Managers in a professional manner.
• Duties include scanning the documents from the EMR after the MDS Coordinator reviews.
• Participate in interdisciplinary team meetings as needed by the MDS Coordinator.
• Understands the organization's quality management program and the care coordinators role within that program, with compliance of all policies and procedures.
• Maintains privacy, as per policies and procedures within a secure environment of documentation and communication.
• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change.
• Utilizes electronic timekeeping system as directed.
• Arrives to work on time, regularly, and works as scheduled.
• Recognizes and follows the dress code of the facility including wearing name tag at all times.
• Follows policy and procedure regarding all electronic devices, computers, tablets, etc.
• Supports and abides by Elderwoods Mission, Vision, and Values.
• Abides by Elderwoods businesses code of conduct, compliance and HIPAA policies.
• Performs other duties as assigned by supervisor, management staff or Administrator.

Managed Care Coordinator Educational Requirements and Qualifications

• Minimum of High School Diploma
• 1 2 years of experience within the HMO Managed Care Insurance Companies
• Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review.

Managed Care Coordinator Skills and Competencies

• Demonstrated proficiency with Microsoft Office
• Bilingual English/Spanish speaking preferred
• This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.

Job Type

Full-time

Description

Summary

Responsible for all aspects of payer relations. Overall goal of, managing payor relationships and contract negotiations to meet the organization's strategies and financial success. Cultivates relationships to assist with problem resolution while positively advocating and removing barriers to access to ensure coverage and reimbursement.

Essential Duties

• Contract negotiations: Lead contract negotiations with payers to secure favorable reimbursement rates and terms for all segments of IBJI. This includes physicians services in office and surgical setting, imaging, rehabilitation and ASC's. Analyze the potential impact of contract renegotiations by modeling the financial impact.
• Market access strategy development: Contributing to the development and execution of strategies to gain access to payer networks and maximize patient access to services.
• Payer policy analysis: Monitor and analyze payer policies, coverage guidelines and reimbursement methodologies to identify potential challenges and opportunities. Educate leadership, revenue cycle and operations of these challenges and opportunities.
• Quality management: Key knowledge of payor quality measurement tools. Collaborate with internal teams to coordinate strategy and understanding of financial and clinical implications.

• Bachelor's degree is required, advanced degree is preferred.
• Experience in contract negotiations
• Deep knowledge of healthcare, managed care strategy, pricing and medical reimbursement environment required.
• Proven ability of successfully managing complexity, solving problems and building strong relationships.
• Ability to work well independently as well as collaboratively; self motivated and disciplined to meet deadlines in the context of competing priorities and projects; lead and work effectively with cross-functional teams
• Computer literacy, including high level of competency in Excel

Salary:
$18.50 - $23.07/Hour

Overview:

Managed Care Coordinator Overview

The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management responsibilities. The candidate is the primary liaison between the SNF and the HMO Managed Care Insurance Companies. This includes all types of communication (eFax, email, scan documents, phone calls) with case managers to provide concurrent updates as requested by Insurance Companies, handles Third Party appeals, peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator. Attends team meetings at the discretion of the MDS Coordinator.

Managed Care Coordinator Essential Job Fuctions

• Able to successfully interact with HMO Case Managers in a professional manner.
• Duties include scanning the documents from the EMR after the MDS Coordinator reviews.
• Participate in interdisciplinary team meetings as needed by the MDS Coordinator.
• Understands the organization's quality management program and the care coordinators role within that program, with compliance of all policies and procedures.
• Maintains privacy, as per policies and procedures within a secure environment of documentation and communication.
• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change.
• Utilizes electronic timekeeping system as directed.
• Arrives to work on time, regularly, and works as scheduled.
• Recognizes and follows the dress code of the facility including wearing name tag at all times.
• Follows policy and procedure regarding all electronic devices, computers, tablets, etc.
• Supports and abides by Elderwoods Mission, Vision, and Values.
• Abides by Elderwoods businesses code of conduct, compliance and HIPAA policies.
• Performs other duties as assigned by supervisor, management staff or Administrator.

Managed Care Coordinator Educational Requirements and Qualifications

• Minimum of High School Diploma
• 1 2 years of experience within the HMO Managed Care Insurance Companies
• Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review.

Managed Care Coordinator Skills and Competencies

• Demonstrated proficiency with Microsoft Office
• Bilingual English/Spanish speaking preferred
• This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.

Join to apply for the Managed Care Manager role at Illinois Bone & Joint Institute 2 weeks ago Be among the first 25 applicants Join to apply for the Managed Care Manager role at Illinois Bone & Joint Institute Get AI-powered advice on this job and more exclusive features. Summary Responsible for all aspects of payer relations. Overall goal of, managing payor relationships and contract negotiations to meet the organization's strategies and financial success. Cultivates relationships to assist with problem resolution while positively advocating and removing barriers to access to ensure coverage and reimbursement. Contract negotiations: Lead contract negotiations with payers to secure favorable reimbursement rates and terms for all segments of IBJI. This includes physicians services in office and surgical setting, imaging, rehabilitation and ASC’s. Analyze the potential impact of contract renegotiations by modeling the financial impact. Market access strategy development: Contributing to the development and execution of strategies to gain access to payer networks and maximize patient access to services. Payer policy analysis: Monitor and analyze payer policies, coverage guidelines and reimbursement methodologies to identify potential challenges and opportunities. Educate leadership, revenue cycle and operations of these challenges and opportunities. Quality management: Key knowledge of payor quality measurement tools. Collaborate with internal teams to coordinate strategy and understanding of financial and clinical implications. Job Type Full-time Description Summary Responsible for all aspects of payer relations. Overall goal of, managing payor relationships and contract negotiations to meet the organization's strategies and financial success. Cultivates relationships to assist with problem resolution while positively advocating and removing barriers to access to ensure coverage and reimbursement. Essential Duties Contract negotiations: Lead contract negotiations with payers to secure favorable reimbursement rates and terms for all segments of IBJI. This includes physicians services in office and surgical setting, imaging, rehabilitation and ASC’s. Analyze the potential impact of contract renegotiations by modeling the financial impact. Market access strategy development: Contributing to the development and execution of strategies to gain access to payer networks and maximize patient access to services. Payer policy analysis: Monitor and analyze payer policies, coverage guidelines and reimbursement methodologies to identify potential challenges and opportunities. Educate leadership, revenue cycle and operations of these challenges and opportunities. Quality management: Key knowledge of payor quality measurement tools. Collaborate with internal teams to coordinate strategy and understanding of financial and clinical implications. Requirements Job Qualifications Bachelor's degree is required, advanced degree is preferred. Experience in contract negotiations Deep knowledge of healthcare, managed care strategy, pricing and medical reimbursement environment required. Proven ability of successfully managing complexity, solving problems and building strong relationships. Ability to work well independently as well as collaboratively; self motivated and disciplined to meet deadlines in the context of competing priorities and projects; lead and work effectively with cross-functional teams Computer literacy, including high level of competency in Excel Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week): medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off. Salary Description $71K-$5K annually based on experience level Seniority level Seniority level Entry level Employment type Employment type Full-time Job function Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Illinois Bone & Joint Institute by 2x Get notified about new Clinic Manager jobs in Greater Chicago Area . Chicago, IL 55,000.00- 55,000.00 10 months ago Medical Operations Manager/ Practice Manager Medical Operations Manager/ Practice Manager Practice Manager Serious Illness (Palliative Care) Manager Nursing/Patient Care - Behavioral Health Chicago, IL 61,800.00- 63,100.00 3 days ago Sr Practice Manager - General Internal Medicine Chicago, IL 130,000.00- 180,000.00 1 week ago Chicago, IL 80,000.00- 97,000.00 6 hours ago Elgin, IL 89,400.00- 101,920.00 3 weeks ago Gary, IN 74,000.00- 90,000.00 6 hours ago Chicago, IL 85,000.00- 115,000.00 4 weeks ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr

Job Title: Managed Care Analytics Consultant - Healthcare & Oncology Focus

Location: 100% remote

Duration/Type: Contract to Hire

Job Opportunity:

Are you passionate about transforming healthcare through data-driven insights? A leading oncology-focused organization is seeking a talented Managed Care Analytics Consultant to support strategic initiatives in payer contracting and performance optimization. This is a contract role offering a dynamic opportunity to work at the intersection of analytics, healthcare strategy, and oncology care delivery.

Role Overview:

As the Managed Care Analytics Consultant, you will collaborate with cross-functional teams to uncover trends in payer reimbursement and utilization. Your work will directly inform contract negotiations and strategic decisions, helping partner practices enhance care delivery and financial performance.

Key Responsibilities

• Analyze large datasets including EHR, billing, and clinical data to identify patterns in payer behavior and utilization.

• Support contract modeling and performance analysis to guide managed care negotiations.

• Build intuitive dashboards that visualize contract metrics and performance indicators.

• Develop compelling presentations and reports to communicate findings to leadership teams.

• Contribute to initiatives aimed at improving outcomes for individuals living with cancer.

Core Competencies

• Strong analytical thinking with a pragmatic approach to problem-solving.

• Advanced proficiency in Excel, PowerPoint, and SQL.

• Experience with PowerBI or similar data visualization tools is a plus.

• Familiarity with healthcare data, especially payer contracts and reimbursement models.

Qualifications

• Bachelor's degree required.

• 2-5 years of professional experience, ideally in consulting, health insurance, or healthcare provider settings.

• A genuine interest in oncology and healthcare innovation.

Why This Role Stands Out

This opportunity offers a front-row seat to the evolving landscape of oncology care and managed care strategy. It's ideal for professionals eager to apply their analytical skills in a mission-driven environment that values insight, impact, and continuous learning.

Pay Details: $40.00 to $45.00 per hour

Search managed by: Marisa Marques

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Anticipated End Date:2025-07-18Position Title:Managed Care CoordinatorJob Description:Managed Care CoordinatorLocation: Must reside in Southwestern VirginiaHours: Monday - Friday 8:00 am - 4:30 pm ESTThe Managed Care Coordinator is responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's program needs.How will you make an impact:Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.The process does not involve clinical judgment.Manages the needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians.Identifies members that would benefit from expanded services.Minimum Requirements: Requires BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience which would provide an equivalent background.Preferred Skills, Capabilities and Qualifications: Masters degree in healthcare or human services (psychology or social work) preferred. Specific education and years and type of experience may be required based upon state law and contract requirements.Travels to worksite and other locations as necessary.Must be current on Covid-19 and Flu vaccines per CDC GuidelinesJob Level:Non-Management Non-ExemptWorkshift:1st Shift (United States of America)Job Family:MED > Care Coord & Care Mgmt (Non-Licensed)Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

With a high level of medical/mental health expertise and under minimal supervision, the managed care nurse provides medical/mental health case management for complex offenders. Serves as a resource and provides guidance and information for medical/me